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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Mainz//2011; 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi); 20110926-20110929; Mainz; DOC11gmds360 /20110920/
    Publication Date: 2011-09-20
    Keywords: Allogene Stammzelltransplantation ; Körperliche Leistungsfähigkeit ; Quality of Life ; Fatigue ; ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    Keywords: TIME ; EXPERIENCE ; BONE-MARROW-TRANSPLANTATION ; HIGH-DOSE CHEMOTHERAPY ; PHYSICAL-ACTIVITY ; QUALITY-OF-LIFE ; RANDOMIZED CONTROLLED-TRIAL ; AEROBIC EXERCISE ; CANCER-RELATED FATIGUE ; SKELETAL-MUSCLE STRENGTH ; SOCIAL SUPPORT ; SYMPTOM DISTRESS
    Abstract: Before, during, and after allogeneic hematopoietic stem cell transplantation (allo-HSCT), patients experience considerable physical and psychologic distress. Besides graft-versus-host disease and infections, reduced physical performance and high levels of fatigue affect patients' quality of life. This multicenter randomized controlled trial examined the effects of a partly self-administered exercise intervention before, during, and after allo-HSCT on these side effects. After randomization to an exercise and a social contact control group 105 patients trained in a home-based setting before hospital admission, during inpatient treatment and a 6- to 8-week period after discharge. Fatigue, physical performance, quality of life, and physical/psychologic distress were measured by standardized instruments at baseline, admission to, and discharge from hospital and 6 to 8 weeks after discharge. The exercise group showed significantly improvement in fatigue scores (up to 15% improvement in exercise group vs up to 28% deterioration in control; P 〈 .01-.03), physical fitness/functioning (P = .02-.03) and global distress (P = .03). All effects were at least detectable at one assessment time point after hospitalization or repeatedly. Physical fitness correlated significantly with all reported symptoms/variables. In conclusion, this partly supervised exercise intervention is beneficial for patients undergoing allo-HSCT. Because of low personnel requirements, it might be valuable to integrate such a program into standard medical care.
    Type of Publication: Journal article published
    PubMed ID: 21190995
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  • 3
    Keywords: BONE-MARROW-TRANSPLANTATION ; STEM-CELL TRANSPLANTATION ; RANDOMIZED-TRIAL ; PHYSICAL-ACTIVITY ; QUALITY-OF-LIFE ; CANCER SURVIVORS ; MUSCLE STRENGTH ; HAND-HELD DYNAMOMETRY ; INITIAL FITNESS ; 6-MINUTE WALK
    Abstract: Patients undergoing allo-HCT often experience a substantial loss in physical performance. We have recently published the general effectiveness of an exercise intervention in 105 allo-HCT patients on physical performance and psychosocial well- being. However, predictor variables for differentiated treatment response remained unclear. To determine the impact of basic physical performance on treatment response, we assessed muscle strength and endurance performance at four assessment points before and after allo-HCT. The exercise group started training 2 weeks before admission and ended 6-8 weeks after discharge. Comparing initially fit with unfit classified patients, the fit patients lost 31% of the strength of the knee-extensors, whereas the unfit patients lost only 1% (P〈0.05). For endurance capacity, fit patients lost 4% of their walking capability, whereas unfit patients gained 13% (P〈0.05). The individual percent change was statistically different at the 0.05 level in all measures of physical performance. Individual training response in allo-HCT patients strongly depends on the initial physical performance level. Unfit patients can be trained safely and may benefit more from this exercise intervention than fit patients. This result is of major clinical relevance and should encourage hematologists to promote exercise even more in impaired/unfit allo-HCT patients.
    Type of Publication: Journal article published
    PubMed ID: 24317122
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  • 4
    Keywords: DIAGNOSIS ; RISK ; PERFORMANCE ; COLORECTAL-CANCER ; BONE-MARROW-TRANSPLANTATION ; VERSUS-HOST-DISEASE ; IMMUNE FUNCTION ; BENEFITS ; COMORBIDITY INDEX ; MULTIMODAL INTERVENTION
    Abstract: Observational studies have suggested that physical activity may be associated with improved survival after cancer treatment. However, data from controlled clinical trials are required. We analyzed survival data of 103 patients from a previously published randomized controlled trial in allogeneic stem cell transplant patients who were randomized to either an exercise intervention (EX) or to a social contact control group. EX patients trained prior to hospital admission, during inpatient treatment, and for 6-8 weeks after discharge. Survival analyses were used to compare both total mortality (TM) and non-relapse mortality (NRM) after discharge and transplantation during an observation period of 2 years after transplantation. Analyses were corroborated with Cox and Fine & Gray regression models adjusting for potential confounders. After discharge, EX patients had a significantly lower TM rate than controls (12.0 vs. 28.3%, p = 0.030) and a numerically lower NRM rate (4.0 vs. 13.5%, p = 0.086). When the inpatient period was included, absolute risk reductions were similar but not significantly different (TM: 34.0 vs. 50.9%, p = 0.112; NRM: 26.0 vs. 36.5%, p = 0.293). The number needed to treat (NNT) to prevent one death with EX was about 6. Furthermore, regression analyses revealed that baseline fitness was protective against mortality. The data suggest that exercise might improve survival in patients undergoing allo-HCT. However, the results should be interpreted with caution as the study was not designed to detect differences in survival rates, and as no stratification on relevant prognostic factors was carried out.
    Type of Publication: Journal article published
    PubMed ID: 26061092
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  • 5
    Abstract: PURPOSE: Evidence from randomized controlled trials (RCT) is growing that exercise interventions have beneficial effects in patients undergoing allogeneic stem cell transplantation (allo-HSCT). However, intensive chemotherapy conditioning as well as glucocorticoid (GC) treatment is always part of an allo-HSCT and possibly impact exercise adherence and training response. Therefore, we aimed to examine whether various conditioning protocols or different doses of GC treatment affect exercise adherence and/or training response during the inpatient period. METHODS: We analyzed inpatient data from intervention groups of two large RCTs in allo-HSCT patients (n=113). The intervention incorporated partly supervised endurance and resistance exercise 3-5x/week. According to the potentially interfering factors patients were divided into groups depending on intensity of conditioning (myeloablative conditioning (MAC), reduced-intensity conditioning (RIC) and nonmyeloablative conditioning (NMC)) and cumulative dose of GC treatment (GC LOW 〈/= 9 mg/kg prednisone or GC HIGH 〉 9 mg/kg prednisone) and were compared. RESULTS: Median exercise adherence (target value 5 sessions weekly) during the inpatient period was 64% in MAC, 54% in RIC and 63% in NMC. The proportion of prematurely terminated training sessions ranged from 11% to 15%. Tiredness was the most frequent cause of exercise termination in all groups. Exercise adherence, duration (minutes/week) and type of training was significantly associated with GC dose. With regard to training response, results suggest GC LOW patients tend to respond better in knee extensor muscle strength. CONCLUSIONS: Exercise adherence during inpatient period is significantly impacted by dose of GC treatment but not by condition regimen. However, given the reasonable adherence rates also in the GC HIGH group data supports the feasibility and importance of exercising for all allo-HSCT patients during the inpatient period.
    Type of Publication: Journal article published
    PubMed ID: 28657933
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  • 6
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    German Medical Science; Düsseldorf, Köln
    In:  27. Deutscher Krebskongress; 20060322-20060326; Berlin; DOCPO385 /20060320/
    Publication Date: 2006-04-21
    Keywords: ddc: 610
    Language: English
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  • 7
    ISSN: 1432-0584
    Keywords: Factor VIII inhibitor ; Freundlich's adsorption isotherme ; Inhibitor units
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We examined the physico-chemical properties of factor VIII inhibitors in two patients. There is no stoichiometric mixture of factor VIII and factor VIII inhibitor since one polyvalent factor VIII particle can be bound by various numbers of factor VIII inhibitor particles. The balance between free factor VIII and inhibitor and their antigen-antibody complexes cannot be explained by the homogeneous natural law of mass action. A patient with classical hemophilia A exhibited an inhibitor which shows conformity with the Poisson distribution as far as the portion of free factor VIII activity is concerned. The spontaneously occuring inhibitor showed a different binding characteristic to factor VIII. We demonstrated here that the Freundlich's adsorption isotherme is effective for a spontaneous factor VIII inhibitor. During follow up qualitative and quantitative changes of both inhibitor types were observed. We assume that the change of property of inhibitor in hemophiliacs is due to a stronger binding to factor VIII and of the spontaneous inhibitor to a poorer fit of antigen and antibody.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-0584
    Keywords: Key words CMV ; Prophylaxis ; Foscarnet ; Allogeneic stem cell transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Cytomegalovirus (CMV) disease is a serious complication after allogeneic hematopoietic stem cell transplantation (HSCT) and is associated with high morbidity and mortality. Early detection of the disease by antigenemia testing and polymerase chain reaction (PCR) along with pre-emptive antiviral therapy has been shown to be very effective in decreasing the incidence of CMV. We performed an uncontrolled observational study in 21 patients after HSCT (14 related, 7 unrelated donors) to evaluate the efficacy and toxicity of foscarnet administered as prophylaxis for CMV reactivation. Ten patients received bone marrow, and eleven patients received peripheral blood stem cells. All patients received foscarnet prophylaxis to study side effects, incidence of CMV reactivation, CMV disease, and transplant-related mortality. Foscarnet (90 mg/kg) was given every 12 h, day +11 to day +16. Thereafter, foscarnet (90 mg/kg) was given once per day, three times per week until day +60. The incidence of CMV reactivation detected by antigenemia (pp65 antigen) or PCR was 23.8% (5 of 21 patients). Two patients developed CMV disease and one patient died of CMV-pneumonia. Seventeen patients (81%) reported severe side effects, such as gastrointestinal disturbance, headache, and urethritis. In eight patients (38%), the dose of foscarnet had to be reduced and, in six patients (28.5%), foscarnet application was discontinued because of side effects. Compared with other groups, we believe that the potential benefit of foscarnet administration in this early setting is outweighed by the risks of severe toxicity.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-0584
    Keywords: Diffuse alveolar hemorrhage ; Bone marrow transplantation ; Interstitial pneumonitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Diffuse pulmonary alveolar hemorrhage (DAH) is a life-threatening complication following bone marrow transplantation (BMT). So far it has been seen preferentially after autologous BMT. Here, we describe a patient who presented with the picture of DAH after allogeneic BMT. We draw attention to the fact that the syndrome may occur after allogeneic BMT, too.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-0711
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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