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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Das Monitoring Minimaler Resterkrankung bei Patienten mit akuter myeloischer Leukämie und Myelodysplastischem Syndrom nach allogener Blutstammzelltransplantation mit reduzierter Konditionierung

Hubmann, Max 31 May 2012 (has links)
Im Rahmen dieser Dissertation wurde retrospektiv die Minimale Resterkrankung von Patienten mit akuter myeloischer Leukämie und Myelodysplastischen Syndrom nach allogener Stammzelltransplantation mit minimaler Konditionierung untersucht. Hierfür wurden vier unterschiedliche Methoden zur Detektion der Minimalen Resterkrankung analysiert. Nach Etablierung einer quantitativen Real-Time PCR für das Wilms Tumor Gen 1 (WT1) im peripheren Blut wurden diese Ergebnisse mit bereits routinemäßig erhobenen Daten des Chimärismus im Gesamtknochenmark und in CD34+ Zellen sowie der Fluoreszenz-in-situ-Hybridisierung (FISH) krankheitsspezifischer chromosomaler Aberrationen von insgesamt 88 Patienten verglichen und statistisch ausgewertet. Es konnte gezeigt werden, dass die Genexpressionanalysen des WT1 sowie die Chimärismusanalysen ein Rezidiv im Gegensatz zu den FISH Analysen vier Wochen im Voraus detektieren können. In Reiceiver Operating Curve Analysen wurden eine WT1 Expression von > 24 WT1/10.000 ABL1 Kopien und der Abfall des CD34+ Spenderchimärismus von ≥ 5% als diagnostisch stärkste Methoden identifiziert. In uni- und multivariaten Analysen von insgesamt 20 Parametern wurden die beiden Methoden als unabhängige Variablen für ein frühes Rezidiv, progressionsfreies Überleben und Gesamtüberleben bestätigt. Kombiniert man beide Methoden, so kann bei jeweiligem negativen Testergebnis ein Rezidiv innerhalb der nächsten vier Wochen nahezu ausgeschlossen werden.
32

Deep learning identifies Acute Promyelocytic Leukemia in bone marrow smears

Eckardt, Jan‑Niklas, Schmittmann, Tim, Riechert, Sebastian, Kramer, Michael, Shekh Sulaiman, Anas, Sockel, Katja, Kroschinsky, Frank, Schetelig, Johannes, Wagenführ, Lisa, Schuler, Ulrich, Platzbecker, Uwe, Thiede, Christian, Stölzel, Friedrich, Röllig, Christoph, Bornhäuser, Martin, Wendt, Karsten, Middeke, Jan Moritz 20 March 2024 (has links)
Background: Acute promyelocytic leukemia (APL) is considered a hematologic emergency due to high risk of bleeding and fatal hemorrhages being a major cause of death. Despite lower death rates reported from clinical trials, patient registry data suggest an early death rate of 20%, especially for elderly and frail patients. Therefore, reliable diagnosis is required as treatment with differentiation-inducing agents leads to cure in the majority of patients. However, diagnosis commonly relies on cytomorphology and genetic confirmation of the pathognomonic t(15;17). Yet, the latter is more time consuming and in some regions unavailable. - Methods: In recent years, deep learning (DL) has been evaluated for medical image recognition showing outstanding capabilities in analyzing large amounts of image data and provides reliable classification results. We developed a multi-stage DL platform that automatically reads images of bone marrow smears, accurately segments cells, and subsequently predicts APL using image data only. We retrospectively identified 51 APL patients from previous multicenter trials and compared them to 1048 non-APL acute myeloid leukemia (AML) patients and 236 healthy bone marrow donor samples, respectively. - Results: Our DL platform segments bone marrow cells with a mean average precision and a mean average recall of both 0.97. Further, it achieves high accuracy in detecting APL by distinguishing between APL and non-APL AML as well as APL and healthy donors with an area under the receiver operating characteristic of 0.8575 and 0.9585, respectively, using visual image data only. - Conclusions: Our study underlines not only the feasibility of DL to detect distinct morphologies that accompany a cytogenetic aberration like t(15;17) in APL, but also shows the capability of DL to abstract information from a small medical data set, i. e. 51 APL patients, and infer correct predictions. This demonstrates the suitability of DL to assist in the diagnosis of rare cancer entities. As our DL platform predicts APL from bone marrow smear images alone, this may be used to diagnose APL in regions were molecular or cytogenetic subtyping is not routinely available and raise attention to suspected cases of APL for expert evaluation.
33

Post-translational Modifications Of C/EBP Alpha p30 Regulate Its Functions In Leukemogenesis and Differentiation

Nguyễn, Thùy Linh 24 November 2022 (has links)
Die myeloische Entwicklung wird durch die Familie der Transkriptionsfaktoren CCAAT/Enhancer-Binding-Protein (C/EBP) reguliert. Eine aberrante Expression oder Funktion von C/EBPs stört die normale myeloische Differenzierung und wird bei vielen Arten hämatopoetischer Malignome beobachtet. Mutationen von CEBPA führen zu einem veränderten Expressionsanteil der verkürzten Isoform C/EBPa p30 und werden bei etwa 15% der AML-Patienten (akute myeloische Leukämie) nachgewiesen. Obwohl die verkürzte Isoform C/EBPα p30 als Onkogen identifiziert wurde da sie die Proliferation myeloischer Vorläufer fördert, behält sie dennoch eine Differenzierungsfunktion. Unser Interesse gilt der Frage, wie diese beiden Funktionen von C/EBPα p30 reguliert werden. Die C/EBP-Familie gehört der Gruppe intrinsisch ungeordneter Proteine an, die zudem viele posttranslationale Modifikationen (PTMs) aufweisen. PTMs auf C/EBPα verändern seine biologische Funktionsweise stark. Frühere Forschungsarbeiten haben drei Argininreste am N-Terminus von C/EBPα p30 identifiziert, die aufgrund des Methylierungsstatus differentiell mit anderen Proteinen interagieren. In dieser Arbeit untersuchen wir den Einfluss der C/EBPα p30 Arginin-Methylierung auf seine pro-leukämische Aktivität sowie dessen Fähigkeit zur Neuausrichtung der hämatopoietischen Differenzierungslinie. Mit Hilfe von Aminosäuresubstitutionen fanden wir heraus, dass C/EBPα p30 Mutanten der Methylierungsmimesis oder Ladungsabschaffung die myeloische Differenzierung verstärkt, während Ladungserhalt-Mutanten die Erneuerung und Proliferation hämatopoetischer Stamm-/Vorläuferzellen unterstützt. Transkriptionelles Profiling von Zellen, die mutierte C/EBPα -p30-Varianten exprimieren, deutet auf potenzielle Ziele der methyliertem bzw. unmethyliertem C/EBPα p30 hin. Die Ergebnisse legen nahe, dass der Arginin-Methylierungsstatus das Leukämie- und Differenzierungs-Potenzial von C/EBPα p30 verändert und somit ein neues Ziel der Leukämietherapie darstellen könnten. / Myeloid development is regulated by the family of transcription factors CCAAT/enhancer-binding-protein (C/EBP). Aberrant expression or functioning of C/EBPs disturbs normal myeloid differentiation and is found in many types of hematopoietic malignancies. Mutations of CEBPA lead to imbalanced expression of the truncated isoform C/EBPα p30 and are found in approximately 15% of AML (acute myeloid leukemia) patients. Yet, how C/EBPα participates in leukemic progression remains to be discovered. More specifically, the truncated isoform C/EBPα p30, although being identified as an oncogenic isoform that promotes proliferation of myeloid progenitors, still retains differentiation function. The question of how both functions of C/EBPα p30 are regulated, is of our interest. C/EBP family also represents a group of intrinsically disordered proteins, which contain many post-translational modifications (PTMs). PTMs on C/EBPα greatly alter its functioning. Previous works have identified three arginine residues at the N-terminus of C/EBPα p30 that interact differently with others protein dependent on their methylation status. We hypothesize, that methylation of these arginine residues plays important roles in the biology of C/EBPα p30. In this study, we used a lymphoid-to-myeloid transdifferentiation (LMT) system to investigate the influence of arginine-methylation on C/EBPα-induced lineage switch and its pro-leukemic activity. Using amino acid substitution, we found that C/EBPα p30 mutants that resemble arginine-methylated p30 enhanced myeloid differentiation, while the charge-retention mutant, resembling arginine-unmethylated p30, supported renewability and proliferation of hematopoietic progenitors. Transcriptional profiling of cells expressing C/EBPα p30 variants suggested potential targets of either methylated or unmethylated p30. The results implied that arginine methylations alter C/EBPα p30’s leukemic potential and might comprise novel targets of leukemia therapy.
34

Expression von Peptidyl-prolyl cis/trans isomerase NIMA-interacting 1 (PIN1) in Blasten von Patienten mit akuter myeloischer Leukämie / Expression of peptidyl-prolyl cis/trans isomerase NIMA-interacting 1 (PIN1) in blasts of patients with acute myeloid leukemia

Hangen, Hanne 05 July 2011 (has links)
No description available.
35

Allogeneic Stem Cell Transplantation with Sequential Melphalan-Based Conditioning in AML: Residual Morphological Blast Count Determines the Risk of Relapse

Sockel, Katja, Stölzel, Friedrich, Hönl, Franziska, Baldauf, Henning, Röllig, Christoph, Wermke, Martin, Bonin, Malte von, Teipel, Raphael, Link-Rachner, Cornelia, Brandt, Kalina, Kroschinsky, Frank, Hänel, Mathias, Morgner, Anke, Klesse, Christian, Ehninger, Gerhard, Platzbecker, Uwe, Bornhäuser, Martin, Schetelig, Johannes, Moritz Middeke, Jan 11 June 2024 (has links)
Introduction: Allogeneic hematopoietic cell transplantation (HCT) during chemotherapy-induced aplasia may offer long-term survival in acute myeloid leukemia (AML) with otherwise poor prognosis including ELN adverse risk, relapsed or refractory disease. However, the value of residual morphologic disease prior HCT in this context has not been conclusively settled until yet. Therefore, we aimed to investigate variables predicting outcome in this unique setting of sequential conditioning therapy, with a focus on pretreatment morphologic blast count. In contrast to the most popular FLAMSA-RIC protocol, we used a melphalan-based conditioning regimen during aplasia. Methods: We retrospectively analyzed data from 173 AML patients who underwent a sequential melphalan-based conditioning therapy between 2003 and 2015 at our centre. All patients participated either in the prospective Phase 2 BRIDGE trial (NCT01295307), the Phase 3 AML2003 study (NCT00180102) or were treated according to this protocol and underwent allogeneic HCT after melphalan-based conditioning in treatment-induced aplasia. Results: Median bone marrow blast count prior to conditioning was 10% (range, 0–96%). Four year probabilities of EFS and OS were 34% (95% CI, 28–43%) and 43% (95% CI, 36–52%), respectively. In multivariate analysis, blast count >20% was associated with worse EFS (HR = 1.93; p = 0.009) and OS (HR = 1.80; p = 0.026). This effect was not significant anymore for HCT during 1st line therapy. Conclusion: Allogeneic HCT in aplasia with a melphalan-based conditioning regimen has the potential to cure a subset of adverse risk AML patients, even with persistent morphological disease prior HCT. However, a high pre-transplant blast count still indicates patients with a dismal prognosis, especially in the relapsed patient group, for whom post-transplant strategies should be considered to further optimize post HCT outcome.

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