Gustav Fischmeister - Academia.edu (original) (raw)
Papers by Gustav Fischmeister
The International Journal of Cell Cloning, 1992
Colony assays in methylcellulose (semisolid medium) of erythroid precursors and granulocyte-macro... more Colony assays in methylcellulose (semisolid medium) of erythroid precursors and granulocyte-macrophage precursors from the peripheral blood of 34 patients with P-thalassemia major and 31 age-matched normal controls were studied. In patients homozygous for 0thalassemia, a signifcant increase of circulating erythroid progenitor cells to 3-5 times of normal controls was observed. Furthermore, the number of circulating colony forming units-granulocyte-macrophage (CFU-GM) and colony forming units-mixed (CFU-Mixed) also increased significantly. In these subjects, there was a linear relationship between the number of burst forming unitserythroid (BFU-E) and CFU-GM. The serum level of erythropoietin (EPO) was also significantly higher than that of normal controls QJ < 0.05). The increased hematopoiesis, indicated by an increased number of circulating hematopoietic progenitor cells and an elevated serum level of EPO, suggests that the physiologic regulation of erythropoiesis still operated in patients with P-thalassemia major.
Cancers
Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric... more Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5–21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09–0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy...
Lessons learned from a double-blind randomised placebo-controlled study with a iota-carrageenan n... more Lessons learned from a double-blind randomised placebo-controlled study with a iota-carrageenan nasal spray as medical device in children with future studies. Fazekas et al. BMC Complementary and Alternative Medicine 2012, 12:147
memo - Magazine of European Medical Oncology, 2021
Until 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pedi... more Until 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pediatric rehabilitation with different indications have been established with the goal of improving the health of sick children and young adults. The pediatric rehabilitation center “Leuwaldhof”, which is located south of Salzburg, is the only pediatric oncologic rehabilitation center in Austria. It offers rehabilitation and recovery for pediatric patients who suffered from malignancies, as well as for their families and siblings, but also for acute or chronic disease in metabolism or digestion. Cancer and its treatment significantly decrease the quality of life (QoL) of pediatric patients and their families. Families often have to split up during the months of chemotherapy if there are siblings in the family and very often it is the mother who stays with the sick child in the hospital. To facilitate recovery for the families in these difficult times, interdisciplinary and family-oriented i...
The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating ... more The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating factor or granulocytemacrophage colony-stimulating factor stimulation instead of bone marrow in healthy donors has become increasingly popular. Donors, given the choice between bone marrow and PBPC donation, often prefer cytapheresis because of the easier access, no necessity for general anesthesia, and no multiple bone marrow punctures. In addition, accelerated engraftment and immunomodulation by granulocyte colonystimulating factor–mobilized PBPCs are advantageous for the recipient. However, because of donor inconvenience and poor mobilization, there is a need to develop improved procedures. Aspects such as durability of hematopoietic engraftment, characterization of the earliest stem cell, and composition of PBPCs are not yet well defined, and international donor registration and follow-up must be considered when evaluating long-term safety profiles in healthy donors. This review conc...
Monatsschrift Kinderheilkunde, 2001
Zusammenfassung Fallbericht. Es wird über einen 8-jährigen Knaben berichtet, der nach einem Kenia... more Zusammenfassung Fallbericht. Es wird über einen 8-jährigen Knaben berichtet, der nach einem Keniaurlaub in Begleitung seiner Eltern mit Fieber bis 39°C, Erbrechen, Durchfall, Niereninsuffizienz und einer progredienten Bewusstseinstrübung aufgenommen wurde.Auf eine medikamentöse Malariaprophylaxe war auf Anraten des Hausarztes verzichtet worden. Anamnese,Thrombozytopenie, Hepatomegalie, Gerinnungsstörung und eine Plasmodium-falciparum-Dichte von 30% im Blut führten zur Diagnose Malaria tropica.Wegen zunehmender Somnolenz und einer respiratorischen Verschlechterung wurde der Knabe intubiert und zusätzlich zur Chinintherapie ein Blutaustausch begonnen.Dadurch wurde die Parasitämie am 1.Tag auf 13% und am 2.Tag auf 1% reduziert.Am 3.Tag konnte die Hämodiafiltration beendet, am 4.Tag der Patient extubiert und nach 10 Tagen der Knabe beschwerdefrei entlassen werden. Diskussion. Infolge zunehmender Reiseaktivität ist eine Malaria tropica bei Tropenrückkehrern heute keine Seltenheit mehr.Dieser Bericht veranschaulicht die Komplexität von Diagnose und Therapie der beim Nichtimmunen oft letal verlaufenden Malaria tropica sowie die Wichtigkeit einer konsequenten medikamentösen Malariaprophylaxe bei Reisen in Risikoländer. Schlüsselwörter Tropenreisen • Malariaprophylaxe • Kinder • Malaria tropica • Blutaustausch Die Malaria ist pro Jahr für den Tod von 1-2 Mio. Kindern verantwortlich [9]. Es gibt über 100 Plasmodienspezies, aber nur 4 führen zur Erkrankung:
Bone marrow transplantation, 1996
Our previous data obtained by flow cytometry and by clonogenic assay had consistently shown a low... more Our previous data obtained by flow cytometry and by clonogenic assay had consistently shown a lower cloning efficiency of hematopoietic progenitor cells in bone marrow (BM) compared to those in blood (PB) or in cord blood (CB). Also, recent clinical reports have described more rapid reconstitution after PB than after BM transplantation. We have applied two- or three-color flow cytometric analysis using monoclonal antibodies directed against the stem- and progenitor cell antigen CD34, in combination with other cell surface markers. We report significant differences in the composition of progenitor cells contained in BM (238 specimens from 53 healthy donors and from patients in remission), PB (301 samples from 92 patients with or without cytokine support) and CB (n = 37). Leukapheresis products (Pher, n = 69) were included in the study as well as positively selected CD34+ cells obtained from BM (BMsel, n = 2), PB (PBsel, n = 28) and CB (CBsel, n = 5). We used monoclonal antibodies dir...
Vaccine, 2011
To determine the proficiency of the Austrian childhood vaccination schedule to induce long lastin... more To determine the proficiency of the Austrian childhood vaccination schedule to induce long lasting seroprotection against vaccine preventable diseases a seroepidemiological study in 348 children between four and eight years of age was conducted. Antibodies against diphtheria, tetanus, pertussis, hepatitis B, measles, mumps and rubella antigens were assessed in children, who had been vaccinated with hexavalent DTaP-HBV-IPV/Hib vaccines at three, four, five months and in the second year of life and/or MMR vaccines in the second year of life at least once, but mostly twice. High seroprotection rates (SPRs) were detected for tetanus (96%) and measles (90%). SPRs regarding diphtheria and mumps were 81% and 72%, respectively. Rubella-SPRs were 68% in females and 58% in males. Hepatitis B-antibody levels ≥10 mIU/mL were present in 52%; antibodies against pertussis were detected in 27% of the children. SPRs for measles and rubella depended on the interval since last vaccination; mumps-antibodies were significantly lower after one MMR-vaccination only. Antibodies against diphtheria, tetanus and pertussis depended on the interval since last vaccination while HBs-antibodies did not. The low levels of antibodies 1-7 years after vaccination against pertussis, rubella and mumps after only one vaccination should be considered when recommending new vaccination schedules.
Pediatric Hematology and Oncology, 2000
Two children are described who presented with fever and generalized seizures, days 50 and 200, re... more Two children are described who presented with fever and generalized seizures, days 50 and 200, respectively, after matched unrelated donor-bone marrow transplantation. Upon antiepileptic treatment the seizures vanished but somnolence and fever remained. Magnetic resonance imaging (MRI) of the brain was performed and revealed transient asymmetric multifocal hyperintense lesions. Seizures were considered related to infection, and the cyclosporin A (CsA) treatment was not interrupted. Enterovirus was detected by reverse transcriptase-polymerase chain reaction in the spinal fluid of one patient and in the sputum of the other. Both children recovered completely within the next weeks without neurological sequel. This report shows that enteroviral meningoencephalitis can present with seizures during the post-transplant period. It highlights the importance of MRI for neuroimaging and of viral infections as differential diagnosis to CsA neurotoxicity.
Pediatric Hematology and Oncology, 2002
In a single-center, case-control study the authors evaluated the efficacy and safety of epoetin a... more In a single-center, case-control study the authors evaluated the efficacy and safety of epoetin alfa in pediatric cancer patients receiving platinum- or nonplatinum-based chemotherapy. Thirty-seven patients with solid tumors received epoetin alfa 3 times weekly at a dose of 150 IU/kg (hemoglobin [Hb] &amp;amp;amp;amp;amp;amp;amp;gt; or = 12 g/dL and &amp;amp;amp;amp;amp;amp;amp;lt; or = 16 g/dL) or 300 IU/kg (Hb) &amp;amp;amp;amp;amp;amp;amp;lt; 12 g/dL) for 28 weeks. Data from treated patients were compared to data from 37 untreated control patients. Significant between-group differences in favor of the epoetin alfa-treated Patients were observed in overall red blood cell transfusion requirements (p = .007) and overall platelet transfusion requirements (p = .010). Additionally, significant between-group differences favoring epoetin alfa were seen by Kaplan-Meier plots, estimating mean time to first red blood cell transfusion (p = .0004). Mean Hb (g/dL) was maintained at baseline levels in the epoetin alfa group for most of the course of the study. No drug-related adverse events were seen in epoetin alfa-treated patients.
Journal of Clinical Apheresis, 2001
There is increasing demand for mononuclear cell (MNC) harvests not only for PBPC but also for imm... more There is increasing demand for mononuclear cell (MNC) harvests not only for PBPC but also for immune therapies using dendritic cells and donor lymphocytes. We determined the collection efficiencies (CE) of various MNC subpopulations during CD34+ cell harvests using a Fenwal CS 3000 Plus Omnix system in small children and adolescents. The cell content of 140 leukapheresis products (LP) was prospectively evaluated in 45 pretreated patients with solid tumors and hematological malignancies. The median age was 12 years (range 0.8-22), and the median body weight (BW) 43 kg (range 9-92). Depending upon the BW of the patients, the media used for priming were saline (SP) in 86, human albumin (HA, HAP) in 10, and packed red blood cells (BP) in 44 apheresis procedures. The major nucleated cell (NC) fractions collected were monocytes (52% of NC) and CD3+ T cells (26%). The median cell yield for monocytes was 174 * 10(6)/kg (range 24-613) representing a CE of 55%. The median number of CD3(+) T cells was 84 * 10(6)/kg (range 5.6-380; CE = 74%). CD34+ cells represented a very small cell fraction of the LP (1.3% of NC), with a median yield of 4.2 * 10(6)/kg (range 0.2-87) and a CE of 63%. The cell yield of various MNCs was significantly correlated with the cell count in the peripheral blood (PB) and with the blood volume processed (ANOVA, P < 0.0001). No influence on the CE was observed for the priming procedure, the patients' age or sex, or the other adaptations used in the harvesting protocol. In conclusion, the Fenwal CS 3000 Plus OMNIX system with the CD34+ cell program and the described adaptations, is also predictably useful for harvest of monocytes or lymphocytes in pediatric patients. We present regression equations that predict the cell yield of various MNC subpopulations in apheresis products.
International Journal of Cancer, 1998
EWS/ets-oncogene fusion transcripts can be detected in at least 98% of Ewing tumors [(ET) Ewing s... more EWS/ets-oncogene fusion transcripts can be detected in at least 98% of Ewing tumors [(ET) Ewing sarcoma and peripheral primitive neuroectodermal tumor] by reverse transcriptase-polymerase chain reaction (RT-PCR), thus confirming the histopathologic diagnosis. To detect minimal amounts of tumor cells in the bone marrow (BM), we used an RT-PCR assay with a high sensitivity, revealing one tumor cell in a background of 10(6) normal cells. We examined BM samples from 35 newly diagnosed ET patients (23 with localized and 12 with metastatic disease). At diagnosis, tumor cells in the BM were detected in 7/23 patients with localized disease (30%). Fifty percent of patients with isolated lung metastasis were RT-PCR positive (3/6), whereas 6/6 patients with bone metastases showed positive signals (100%). All patients with initial PCR positivity in the BM became negative during treatment. After a median follow-up of 30 months, relapses were observed in both groups of patients with localized disease (3/7 RT-PCR positive and 2/16 RT-PCR negative). The only recurrence in the group with isolated lung metastases occurred as progressive lung disease in 1 of the 2 RT-PCR-negative patients, whereas among the 6 patients with bone metastases 2 remain in complete remission. So far, RT-PCR screening for BM involvement did not allow prediction of early relapse in ET. To assess better the significance of this test in the evaluation of long-term prognosis and in monitoring the effectiveness of systemic therapy, long observation periods are warranted before it becomes a tool for treatment stratification.
European Journal of Cancer, 1999
Post-operative radiotherapy was omitted for 2 patients on POG-9354 who had complete resection of ... more Post-operative radiotherapy was omitted for 2 patients on POG-9354 who had complete resection of the primaly tumors. No patients had metastatic disease at presentation. 13 patients had gross total resection of the primaly tumors prior to enrollment on chemotherapy. Surgical margins were negative (lo), microscopic (2), and indeterminate (1). The patient who had biopsy only received induction chemotherapy followed by definitive surgical resection and post-operative local radiotherapy. The median follow-up was 77 months (range 17-111 months). None of the patients developed local recurrence or distant metastasis. Five patients developed treatment-related sequelae. Cutaneous and subcutaneous ES are associated with an indolent course and a favorable prognosis with multimodality treatment. The hypothesis that complete wide excision resulting in adequate local control without the use of post-operative radiation is being tested in the POG-9354 protocol to eliminate the potential risk of radiation-induced toxicity. The next goal is to tailor treatment to minimize toxicity while maintaining a high cure rate. 398 ORAL Recommended age for total thyroidectomy in children with MEN-2a syndrome
Current Opinion in Hematology, 2000
The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating ... more The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor stimulation instead of bone marrow in healthy donors has become increasingly popular. Donors, given the choice between bone marrow and PBPC donation, often prefer cytapheresis because of the easier access, no necessity for general anesthesia, and no multiple bone marrow punctures. In addition, accelerated engraftment and immunomodulation by granulocyte colony-stimulating factor-mobilized PBPCs are advantageous for the recipient. However, because of donor inconvenience and poor mobilization, there is a need to develop improved procedures. Aspects such as durability of hematopoietic engraftment, characterization of the earliest stem cell, and composition of PBPCs are not yet well defined, and international donor registration and follow-up must be considered when evaluating long-term safety profiles in healthy donors. This review concentrates on the most significant developments on mobilization of PBPCs published during the past year.
British Journal of Haematology, 1996
Flow cytometric DNA analysis was performed in combination with three-colour immunological stainin... more Flow cytometric DNA analysis was performed in combination with three-colour immunological staining of cell surface antigens on density-separated mononuclear cells (MNC) obtained from peripheral blood (PB) before, during and after cytokine stimulation of healthy adults. The aim of the study was to determine the cell-cycling status of haemopoietic progenitor cells mobilized into the blood of healthy volunteers during a 5 d treatment period with 5/micrograms per kg body weight of either granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-simulating factor (GM-CSF). Despite considerably increasing numbers of CD34+ PB MNC, the latter were not found to be in S/G2M phase, whereas, among the CD34- MNC, the proportion of cells in S/G2M phase increased from < 0.1% to 0.75 +/- 0.4% (GM-CSF) and to 1.34 +/- 0.75% (G-CSF) and dropped again after discontinuation of the cytokine stimulation. These cells expressed CD33 but were negative for CD45RA, CD3, CD19 and CD14 and were thus considered granulopoietic cells. Analogous results were obtained from analyses of cord blood (CB). In contrast, CD34+ cells from bone marrow (BM) were partially (between 9% and 15%) found to be in S/G2M phase. The non-cycling status of PB and progenitor cells was confirmed by the analysis of CD34+ cells enriched from the two cells sources. However, in vitro stimulation of these progenitor cells using IL3, GM-CSF, erythropoietin and steel factor (SF) revealed that, after 48 h in suspension culture, up to 30% of the CD34+ cells were in S/G2m phase. The fact that cycling CD34+ cells are only detectable in BM but not in PB or CB may suggest different adhesive properties of migrating/mobilized 'stem cells' which may require the BM micro-environment for adequate proliferation in vivo.
Bone Marrow Transplantation, 1999
Reverse transcriptase polymerase chain reaction (RT-PCR) was applied to evaluate the frequency of... more Reverse transcriptase polymerase chain reaction (RT-PCR) was applied to evaluate the frequency of tumour cells in PBPC products from 15 high risk Ewing tumour (ET) patients who were treated according to EICESS 92 with high-dose chemotherapy (HDC) and stem cell rescue. Initial tumour cell contamination of the bone marrow (BM) detected by light microscopy was found in five and by RT-PCR in eight cases. RT-PCR was performed on each PBPC sample repeatedly at a sensitivity comparable to 20-100 highly EWS-Fli1 expressing tumour cells per 10 ml of fresh blood. Irrespective of the extent of BM involvement at diagnosis, all BM samples obtained before harvest were RT-PCR negative. Among 12 of 35 analysed apheresis products with single positive RT-PCR results only one sample tested reproducibly positive for tumour cell contamination in independent determinations. These preliminary data suggest that tumour cell contamination of PBPC is rarely found in patients with ET.
Bone Marrow Transplantation, 1999
Children with high risk malignancies are usually given permanent (Hickman-type) tunneled silicone... more Children with high risk malignancies are usually given permanent (Hickman-type) tunneled silicone rubber central venous catheters (silicone CVCs) for the administration of chemotherapy. In the past, these children received an additional short-term polyurethane dialysis CVC for stem cell apheresis. To avoid placement of an additional short-term CVC, we started in 1995 to use pre-existing silicone CVCs for PBPC harvests. From May 1996 to February 1999 we evaluated 165 harvests in 37 children and 14 young adults (16-28 years) treated with high-dose chemotherapy and stem cell support, comparing CD34 + cell harvest efficiency, catheter tolerability, and complications in three different approaches to vascular access. Pre-existing silicone CVCs (64%) or peripheral venous cannulae (15%) were the first choice for venous access. Only when these failed were polyurethane CVCs (21%) used. No significant difference was seen between these three groups, even after dividing the silicone CVC group (105 harvests in 32 patients) into three subgroups according to weight and age. The most frequent problems were citrate toxicity (n = 33), mechanical obstruction inside (n = 9) and outside the cell separator (n = 2), decreased draw line flow in silicone CVCs (n = 7), decreased draw line flow in peripheral venous cannulae (n = 6), and one occlusion in a polyurethane CVC. Pre-existing CVCs and peripheral venous cannulae functioned efficiently when used as a draw line in 79% of the apheresis procedures without significantly reducing single harvest efficiency or catheter tolerability. Consequently, the risks and costs associated with the placement of a dialysis CVC could be avoided in the majority of cases.
BMC Complementary and Alternative Medicine, 2012
Background Common cold is caused by a variety of respiratory viruses. The prevalence in children ... more Background Common cold is caused by a variety of respiratory viruses. The prevalence in children is high, and it potentially contributes to significant morbidity. Iota-carragenan, a polymer derived from red seaweed, has reduced viral load in nasal secretions and alleviated symptoms in adults with common cold. Methods We have assessed the antiviral and therapeutic activity of a nasal spray containing iota-carrageenan in children with acute symptoms of common cold. A cohort of 153 children between 1–18 years (mean age 5 years), displaying acute symptoms of common cold were randomly assigned to treatment with a nasal spray containing iota-carrageenan (0.12%) as verum or 0.9% sodium chloride solution as placebo for seven days. Symptoms of common cold were recorded and the viral load of respiratory viruses in nasal secretions was determined at two consecutive visits. Results The results of the present study showed no significant difference between the iota carrageenan and the placebo gro...
Annals of Hematology, 1999
This study compared two recombinant human (rh) hematopoietic growth factors in healthy volunteers... more This study compared two recombinant human (rh) hematopoietic growth factors in healthy volunteers for stem cell stimulation. Granulocyte colony-stimulating factor (G-CSF, n=9) or granulocyte-macrophage colony-stimulating factor (GM-CSF, n=8) was given subcutaneously for 5 days (5 microg/kg/day). Controls (n=5) received no growth factor. Laboratory parameters and side effects were monitored for 8 days. Within 24 h, both cytokines led to a rapid increase of leukocytes, the majority of which were granulocytes. Compared with the controls (n=5), the increase on day 5 in the G-CSF/GM-CSF groups was 37-/10-fold (CD34+ cells), 5.2-/2.4-fold (leukocytes), 7.2-/3.0-fold (granulocytes), 7.4-/4.4-fold (monocytes), 1.7-/1.1-fold (lymphocytes), 9.8-/2.7-fold (basophils), 2.3-/9.6-fold (eosinophils), and 1.9-/1.6-fold (reticulocytes). The mobilization of myeloblasts, promyelocytes, myelocytes, and metamyelocytes coincided with the pronounced increase of CD34 + PBPC observed on day 4. Serum levels of uric acid (UA) and lactic dehydrogenase (LDH) increased under G-CSF, and platelets decreased after G-CSF discontinuation. Rash at the injection site occurred in 50% of the GM-CSF-treated volunteers. Seven volunteers in the GM-CSF group and six in the G-CSF cohort complained of flu-like symptoms, including musculoskeletal pain. We conclude that, in terms of tolerance and mobilization of CD34+ cells and leukocytes, G-CSF is superior to GM-CSF, but higher levels of UA and LDH and late decrease in platelets make monitoring of these parameters necessary.
Bone Marrow Transplantation, 2001
A girl with myelodysplastic syndrome (RAEB-T) received HLA-identical bone marrow from her younger... more A girl with myelodysplastic syndrome (RAEB-T) received HLA-identical bone marrow from her younger brother after myeloablative treatment with busulfan and cyclophosphamide. After bone marrow transplantation, fever, exanthema, pruritis, and a pulmonary infiltrate were treated symptomatically. Bacterial cultures remained negative. Leukocyte engraftment began on day 10, and all blood cell populations proved to be of donor origin on FISH analysis. Increasing IgE levels (21 000 U/ml) on day 14 after BMT, positive RAST, specific IgG-antibodies, and missing Toxocara (T.) canis antigens in the recipient indicated donor-derived seroconversion. Before BMT, the recipient had been negative for T. canis in routine parasitological screening, and the donor proved to be positive for T. canis antibody by ELISA. This report suggests that the transfer of IgE immunity in the absence of detectable antigens may be responsible for IgE-mediated symptoms consistent with toxocara infection and confirms the need for parasite screening in donor medical examinations.
The International Journal of Cell Cloning, 1992
Colony assays in methylcellulose (semisolid medium) of erythroid precursors and granulocyte-macro... more Colony assays in methylcellulose (semisolid medium) of erythroid precursors and granulocyte-macrophage precursors from the peripheral blood of 34 patients with P-thalassemia major and 31 age-matched normal controls were studied. In patients homozygous for 0thalassemia, a signifcant increase of circulating erythroid progenitor cells to 3-5 times of normal controls was observed. Furthermore, the number of circulating colony forming units-granulocyte-macrophage (CFU-GM) and colony forming units-mixed (CFU-Mixed) also increased significantly. In these subjects, there was a linear relationship between the number of burst forming unitserythroid (BFU-E) and CFU-GM. The serum level of erythropoietin (EPO) was also significantly higher than that of normal controls QJ < 0.05). The increased hematopoiesis, indicated by an increased number of circulating hematopoietic progenitor cells and an elevated serum level of EPO, suggests that the physiologic regulation of erythropoiesis still operated in patients with P-thalassemia major.
Cancers
Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric... more Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5–21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09–0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy...
Lessons learned from a double-blind randomised placebo-controlled study with a iota-carrageenan n... more Lessons learned from a double-blind randomised placebo-controlled study with a iota-carrageenan nasal spray as medical device in children with future studies. Fazekas et al. BMC Complementary and Alternative Medicine 2012, 12:147
memo - Magazine of European Medical Oncology, 2021
Until 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pedi... more Until 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pediatric rehabilitation with different indications have been established with the goal of improving the health of sick children and young adults. The pediatric rehabilitation center “Leuwaldhof”, which is located south of Salzburg, is the only pediatric oncologic rehabilitation center in Austria. It offers rehabilitation and recovery for pediatric patients who suffered from malignancies, as well as for their families and siblings, but also for acute or chronic disease in metabolism or digestion. Cancer and its treatment significantly decrease the quality of life (QoL) of pediatric patients and their families. Families often have to split up during the months of chemotherapy if there are siblings in the family and very often it is the mother who stays with the sick child in the hospital. To facilitate recovery for the families in these difficult times, interdisciplinary and family-oriented i...
The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating ... more The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating factor or granulocytemacrophage colony-stimulating factor stimulation instead of bone marrow in healthy donors has become increasingly popular. Donors, given the choice between bone marrow and PBPC donation, often prefer cytapheresis because of the easier access, no necessity for general anesthesia, and no multiple bone marrow punctures. In addition, accelerated engraftment and immunomodulation by granulocyte colonystimulating factor–mobilized PBPCs are advantageous for the recipient. However, because of donor inconvenience and poor mobilization, there is a need to develop improved procedures. Aspects such as durability of hematopoietic engraftment, characterization of the earliest stem cell, and composition of PBPCs are not yet well defined, and international donor registration and follow-up must be considered when evaluating long-term safety profiles in healthy donors. This review conc...
Monatsschrift Kinderheilkunde, 2001
Zusammenfassung Fallbericht. Es wird über einen 8-jährigen Knaben berichtet, der nach einem Kenia... more Zusammenfassung Fallbericht. Es wird über einen 8-jährigen Knaben berichtet, der nach einem Keniaurlaub in Begleitung seiner Eltern mit Fieber bis 39°C, Erbrechen, Durchfall, Niereninsuffizienz und einer progredienten Bewusstseinstrübung aufgenommen wurde.Auf eine medikamentöse Malariaprophylaxe war auf Anraten des Hausarztes verzichtet worden. Anamnese,Thrombozytopenie, Hepatomegalie, Gerinnungsstörung und eine Plasmodium-falciparum-Dichte von 30% im Blut führten zur Diagnose Malaria tropica.Wegen zunehmender Somnolenz und einer respiratorischen Verschlechterung wurde der Knabe intubiert und zusätzlich zur Chinintherapie ein Blutaustausch begonnen.Dadurch wurde die Parasitämie am 1.Tag auf 13% und am 2.Tag auf 1% reduziert.Am 3.Tag konnte die Hämodiafiltration beendet, am 4.Tag der Patient extubiert und nach 10 Tagen der Knabe beschwerdefrei entlassen werden. Diskussion. Infolge zunehmender Reiseaktivität ist eine Malaria tropica bei Tropenrückkehrern heute keine Seltenheit mehr.Dieser Bericht veranschaulicht die Komplexität von Diagnose und Therapie der beim Nichtimmunen oft letal verlaufenden Malaria tropica sowie die Wichtigkeit einer konsequenten medikamentösen Malariaprophylaxe bei Reisen in Risikoländer. Schlüsselwörter Tropenreisen • Malariaprophylaxe • Kinder • Malaria tropica • Blutaustausch Die Malaria ist pro Jahr für den Tod von 1-2 Mio. Kindern verantwortlich [9]. Es gibt über 100 Plasmodienspezies, aber nur 4 führen zur Erkrankung:
Bone marrow transplantation, 1996
Our previous data obtained by flow cytometry and by clonogenic assay had consistently shown a low... more Our previous data obtained by flow cytometry and by clonogenic assay had consistently shown a lower cloning efficiency of hematopoietic progenitor cells in bone marrow (BM) compared to those in blood (PB) or in cord blood (CB). Also, recent clinical reports have described more rapid reconstitution after PB than after BM transplantation. We have applied two- or three-color flow cytometric analysis using monoclonal antibodies directed against the stem- and progenitor cell antigen CD34, in combination with other cell surface markers. We report significant differences in the composition of progenitor cells contained in BM (238 specimens from 53 healthy donors and from patients in remission), PB (301 samples from 92 patients with or without cytokine support) and CB (n = 37). Leukapheresis products (Pher, n = 69) were included in the study as well as positively selected CD34+ cells obtained from BM (BMsel, n = 2), PB (PBsel, n = 28) and CB (CBsel, n = 5). We used monoclonal antibodies dir...
Vaccine, 2011
To determine the proficiency of the Austrian childhood vaccination schedule to induce long lastin... more To determine the proficiency of the Austrian childhood vaccination schedule to induce long lasting seroprotection against vaccine preventable diseases a seroepidemiological study in 348 children between four and eight years of age was conducted. Antibodies against diphtheria, tetanus, pertussis, hepatitis B, measles, mumps and rubella antigens were assessed in children, who had been vaccinated with hexavalent DTaP-HBV-IPV/Hib vaccines at three, four, five months and in the second year of life and/or MMR vaccines in the second year of life at least once, but mostly twice. High seroprotection rates (SPRs) were detected for tetanus (96%) and measles (90%). SPRs regarding diphtheria and mumps were 81% and 72%, respectively. Rubella-SPRs were 68% in females and 58% in males. Hepatitis B-antibody levels ≥10 mIU/mL were present in 52%; antibodies against pertussis were detected in 27% of the children. SPRs for measles and rubella depended on the interval since last vaccination; mumps-antibodies were significantly lower after one MMR-vaccination only. Antibodies against diphtheria, tetanus and pertussis depended on the interval since last vaccination while HBs-antibodies did not. The low levels of antibodies 1-7 years after vaccination against pertussis, rubella and mumps after only one vaccination should be considered when recommending new vaccination schedules.
Pediatric Hematology and Oncology, 2000
Two children are described who presented with fever and generalized seizures, days 50 and 200, re... more Two children are described who presented with fever and generalized seizures, days 50 and 200, respectively, after matched unrelated donor-bone marrow transplantation. Upon antiepileptic treatment the seizures vanished but somnolence and fever remained. Magnetic resonance imaging (MRI) of the brain was performed and revealed transient asymmetric multifocal hyperintense lesions. Seizures were considered related to infection, and the cyclosporin A (CsA) treatment was not interrupted. Enterovirus was detected by reverse transcriptase-polymerase chain reaction in the spinal fluid of one patient and in the sputum of the other. Both children recovered completely within the next weeks without neurological sequel. This report shows that enteroviral meningoencephalitis can present with seizures during the post-transplant period. It highlights the importance of MRI for neuroimaging and of viral infections as differential diagnosis to CsA neurotoxicity.
Pediatric Hematology and Oncology, 2002
In a single-center, case-control study the authors evaluated the efficacy and safety of epoetin a... more In a single-center, case-control study the authors evaluated the efficacy and safety of epoetin alfa in pediatric cancer patients receiving platinum- or nonplatinum-based chemotherapy. Thirty-seven patients with solid tumors received epoetin alfa 3 times weekly at a dose of 150 IU/kg (hemoglobin [Hb] &amp;amp;amp;amp;amp;amp;amp;gt; or = 12 g/dL and &amp;amp;amp;amp;amp;amp;amp;lt; or = 16 g/dL) or 300 IU/kg (Hb) &amp;amp;amp;amp;amp;amp;amp;lt; 12 g/dL) for 28 weeks. Data from treated patients were compared to data from 37 untreated control patients. Significant between-group differences in favor of the epoetin alfa-treated Patients were observed in overall red blood cell transfusion requirements (p = .007) and overall platelet transfusion requirements (p = .010). Additionally, significant between-group differences favoring epoetin alfa were seen by Kaplan-Meier plots, estimating mean time to first red blood cell transfusion (p = .0004). Mean Hb (g/dL) was maintained at baseline levels in the epoetin alfa group for most of the course of the study. No drug-related adverse events were seen in epoetin alfa-treated patients.
Journal of Clinical Apheresis, 2001
There is increasing demand for mononuclear cell (MNC) harvests not only for PBPC but also for imm... more There is increasing demand for mononuclear cell (MNC) harvests not only for PBPC but also for immune therapies using dendritic cells and donor lymphocytes. We determined the collection efficiencies (CE) of various MNC subpopulations during CD34+ cell harvests using a Fenwal CS 3000 Plus Omnix system in small children and adolescents. The cell content of 140 leukapheresis products (LP) was prospectively evaluated in 45 pretreated patients with solid tumors and hematological malignancies. The median age was 12 years (range 0.8-22), and the median body weight (BW) 43 kg (range 9-92). Depending upon the BW of the patients, the media used for priming were saline (SP) in 86, human albumin (HA, HAP) in 10, and packed red blood cells (BP) in 44 apheresis procedures. The major nucleated cell (NC) fractions collected were monocytes (52% of NC) and CD3+ T cells (26%). The median cell yield for monocytes was 174 * 10(6)/kg (range 24-613) representing a CE of 55%. The median number of CD3(+) T cells was 84 * 10(6)/kg (range 5.6-380; CE = 74%). CD34+ cells represented a very small cell fraction of the LP (1.3% of NC), with a median yield of 4.2 * 10(6)/kg (range 0.2-87) and a CE of 63%. The cell yield of various MNCs was significantly correlated with the cell count in the peripheral blood (PB) and with the blood volume processed (ANOVA, P < 0.0001). No influence on the CE was observed for the priming procedure, the patients' age or sex, or the other adaptations used in the harvesting protocol. In conclusion, the Fenwal CS 3000 Plus OMNIX system with the CD34+ cell program and the described adaptations, is also predictably useful for harvest of monocytes or lymphocytes in pediatric patients. We present regression equations that predict the cell yield of various MNC subpopulations in apheresis products.
International Journal of Cancer, 1998
EWS/ets-oncogene fusion transcripts can be detected in at least 98% of Ewing tumors [(ET) Ewing s... more EWS/ets-oncogene fusion transcripts can be detected in at least 98% of Ewing tumors [(ET) Ewing sarcoma and peripheral primitive neuroectodermal tumor] by reverse transcriptase-polymerase chain reaction (RT-PCR), thus confirming the histopathologic diagnosis. To detect minimal amounts of tumor cells in the bone marrow (BM), we used an RT-PCR assay with a high sensitivity, revealing one tumor cell in a background of 10(6) normal cells. We examined BM samples from 35 newly diagnosed ET patients (23 with localized and 12 with metastatic disease). At diagnosis, tumor cells in the BM were detected in 7/23 patients with localized disease (30%). Fifty percent of patients with isolated lung metastasis were RT-PCR positive (3/6), whereas 6/6 patients with bone metastases showed positive signals (100%). All patients with initial PCR positivity in the BM became negative during treatment. After a median follow-up of 30 months, relapses were observed in both groups of patients with localized disease (3/7 RT-PCR positive and 2/16 RT-PCR negative). The only recurrence in the group with isolated lung metastases occurred as progressive lung disease in 1 of the 2 RT-PCR-negative patients, whereas among the 6 patients with bone metastases 2 remain in complete remission. So far, RT-PCR screening for BM involvement did not allow prediction of early relapse in ET. To assess better the significance of this test in the evaluation of long-term prognosis and in monitoring the effectiveness of systemic therapy, long observation periods are warranted before it becomes a tool for treatment stratification.
European Journal of Cancer, 1999
Post-operative radiotherapy was omitted for 2 patients on POG-9354 who had complete resection of ... more Post-operative radiotherapy was omitted for 2 patients on POG-9354 who had complete resection of the primaly tumors. No patients had metastatic disease at presentation. 13 patients had gross total resection of the primaly tumors prior to enrollment on chemotherapy. Surgical margins were negative (lo), microscopic (2), and indeterminate (1). The patient who had biopsy only received induction chemotherapy followed by definitive surgical resection and post-operative local radiotherapy. The median follow-up was 77 months (range 17-111 months). None of the patients developed local recurrence or distant metastasis. Five patients developed treatment-related sequelae. Cutaneous and subcutaneous ES are associated with an indolent course and a favorable prognosis with multimodality treatment. The hypothesis that complete wide excision resulting in adequate local control without the use of post-operative radiation is being tested in the POG-9354 protocol to eliminate the potential risk of radiation-induced toxicity. The next goal is to tailor treatment to minimize toxicity while maintaining a high cure rate. 398 ORAL Recommended age for total thyroidectomy in children with MEN-2a syndrome
Current Opinion in Hematology, 2000
The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating ... more The harvesting of peripheral blood progenitor cells (PBPCs) after granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor stimulation instead of bone marrow in healthy donors has become increasingly popular. Donors, given the choice between bone marrow and PBPC donation, often prefer cytapheresis because of the easier access, no necessity for general anesthesia, and no multiple bone marrow punctures. In addition, accelerated engraftment and immunomodulation by granulocyte colony-stimulating factor-mobilized PBPCs are advantageous for the recipient. However, because of donor inconvenience and poor mobilization, there is a need to develop improved procedures. Aspects such as durability of hematopoietic engraftment, characterization of the earliest stem cell, and composition of PBPCs are not yet well defined, and international donor registration and follow-up must be considered when evaluating long-term safety profiles in healthy donors. This review concentrates on the most significant developments on mobilization of PBPCs published during the past year.
British Journal of Haematology, 1996
Flow cytometric DNA analysis was performed in combination with three-colour immunological stainin... more Flow cytometric DNA analysis was performed in combination with three-colour immunological staining of cell surface antigens on density-separated mononuclear cells (MNC) obtained from peripheral blood (PB) before, during and after cytokine stimulation of healthy adults. The aim of the study was to determine the cell-cycling status of haemopoietic progenitor cells mobilized into the blood of healthy volunteers during a 5 d treatment period with 5/micrograms per kg body weight of either granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-simulating factor (GM-CSF). Despite considerably increasing numbers of CD34+ PB MNC, the latter were not found to be in S/G2M phase, whereas, among the CD34- MNC, the proportion of cells in S/G2M phase increased from < 0.1% to 0.75 +/- 0.4% (GM-CSF) and to 1.34 +/- 0.75% (G-CSF) and dropped again after discontinuation of the cytokine stimulation. These cells expressed CD33 but were negative for CD45RA, CD3, CD19 and CD14 and were thus considered granulopoietic cells. Analogous results were obtained from analyses of cord blood (CB). In contrast, CD34+ cells from bone marrow (BM) were partially (between 9% and 15%) found to be in S/G2M phase. The non-cycling status of PB and progenitor cells was confirmed by the analysis of CD34+ cells enriched from the two cells sources. However, in vitro stimulation of these progenitor cells using IL3, GM-CSF, erythropoietin and steel factor (SF) revealed that, after 48 h in suspension culture, up to 30% of the CD34+ cells were in S/G2m phase. The fact that cycling CD34+ cells are only detectable in BM but not in PB or CB may suggest different adhesive properties of migrating/mobilized 'stem cells' which may require the BM micro-environment for adequate proliferation in vivo.
Bone Marrow Transplantation, 1999
Reverse transcriptase polymerase chain reaction (RT-PCR) was applied to evaluate the frequency of... more Reverse transcriptase polymerase chain reaction (RT-PCR) was applied to evaluate the frequency of tumour cells in PBPC products from 15 high risk Ewing tumour (ET) patients who were treated according to EICESS 92 with high-dose chemotherapy (HDC) and stem cell rescue. Initial tumour cell contamination of the bone marrow (BM) detected by light microscopy was found in five and by RT-PCR in eight cases. RT-PCR was performed on each PBPC sample repeatedly at a sensitivity comparable to 20-100 highly EWS-Fli1 expressing tumour cells per 10 ml of fresh blood. Irrespective of the extent of BM involvement at diagnosis, all BM samples obtained before harvest were RT-PCR negative. Among 12 of 35 analysed apheresis products with single positive RT-PCR results only one sample tested reproducibly positive for tumour cell contamination in independent determinations. These preliminary data suggest that tumour cell contamination of PBPC is rarely found in patients with ET.
Bone Marrow Transplantation, 1999
Children with high risk malignancies are usually given permanent (Hickman-type) tunneled silicone... more Children with high risk malignancies are usually given permanent (Hickman-type) tunneled silicone rubber central venous catheters (silicone CVCs) for the administration of chemotherapy. In the past, these children received an additional short-term polyurethane dialysis CVC for stem cell apheresis. To avoid placement of an additional short-term CVC, we started in 1995 to use pre-existing silicone CVCs for PBPC harvests. From May 1996 to February 1999 we evaluated 165 harvests in 37 children and 14 young adults (16-28 years) treated with high-dose chemotherapy and stem cell support, comparing CD34 + cell harvest efficiency, catheter tolerability, and complications in three different approaches to vascular access. Pre-existing silicone CVCs (64%) or peripheral venous cannulae (15%) were the first choice for venous access. Only when these failed were polyurethane CVCs (21%) used. No significant difference was seen between these three groups, even after dividing the silicone CVC group (105 harvests in 32 patients) into three subgroups according to weight and age. The most frequent problems were citrate toxicity (n = 33), mechanical obstruction inside (n = 9) and outside the cell separator (n = 2), decreased draw line flow in silicone CVCs (n = 7), decreased draw line flow in peripheral venous cannulae (n = 6), and one occlusion in a polyurethane CVC. Pre-existing CVCs and peripheral venous cannulae functioned efficiently when used as a draw line in 79% of the apheresis procedures without significantly reducing single harvest efficiency or catheter tolerability. Consequently, the risks and costs associated with the placement of a dialysis CVC could be avoided in the majority of cases.
BMC Complementary and Alternative Medicine, 2012
Background Common cold is caused by a variety of respiratory viruses. The prevalence in children ... more Background Common cold is caused by a variety of respiratory viruses. The prevalence in children is high, and it potentially contributes to significant morbidity. Iota-carragenan, a polymer derived from red seaweed, has reduced viral load in nasal secretions and alleviated symptoms in adults with common cold. Methods We have assessed the antiviral and therapeutic activity of a nasal spray containing iota-carrageenan in children with acute symptoms of common cold. A cohort of 153 children between 1–18 years (mean age 5 years), displaying acute symptoms of common cold were randomly assigned to treatment with a nasal spray containing iota-carrageenan (0.12%) as verum or 0.9% sodium chloride solution as placebo for seven days. Symptoms of common cold were recorded and the viral load of respiratory viruses in nasal secretions was determined at two consecutive visits. Results The results of the present study showed no significant difference between the iota carrageenan and the placebo gro...
Annals of Hematology, 1999
This study compared two recombinant human (rh) hematopoietic growth factors in healthy volunteers... more This study compared two recombinant human (rh) hematopoietic growth factors in healthy volunteers for stem cell stimulation. Granulocyte colony-stimulating factor (G-CSF, n=9) or granulocyte-macrophage colony-stimulating factor (GM-CSF, n=8) was given subcutaneously for 5 days (5 microg/kg/day). Controls (n=5) received no growth factor. Laboratory parameters and side effects were monitored for 8 days. Within 24 h, both cytokines led to a rapid increase of leukocytes, the majority of which were granulocytes. Compared with the controls (n=5), the increase on day 5 in the G-CSF/GM-CSF groups was 37-/10-fold (CD34+ cells), 5.2-/2.4-fold (leukocytes), 7.2-/3.0-fold (granulocytes), 7.4-/4.4-fold (monocytes), 1.7-/1.1-fold (lymphocytes), 9.8-/2.7-fold (basophils), 2.3-/9.6-fold (eosinophils), and 1.9-/1.6-fold (reticulocytes). The mobilization of myeloblasts, promyelocytes, myelocytes, and metamyelocytes coincided with the pronounced increase of CD34 + PBPC observed on day 4. Serum levels of uric acid (UA) and lactic dehydrogenase (LDH) increased under G-CSF, and platelets decreased after G-CSF discontinuation. Rash at the injection site occurred in 50% of the GM-CSF-treated volunteers. Seven volunteers in the GM-CSF group and six in the G-CSF cohort complained of flu-like symptoms, including musculoskeletal pain. We conclude that, in terms of tolerance and mobilization of CD34+ cells and leukocytes, G-CSF is superior to GM-CSF, but higher levels of UA and LDH and late decrease in platelets make monitoring of these parameters necessary.
Bone Marrow Transplantation, 2001
A girl with myelodysplastic syndrome (RAEB-T) received HLA-identical bone marrow from her younger... more A girl with myelodysplastic syndrome (RAEB-T) received HLA-identical bone marrow from her younger brother after myeloablative treatment with busulfan and cyclophosphamide. After bone marrow transplantation, fever, exanthema, pruritis, and a pulmonary infiltrate were treated symptomatically. Bacterial cultures remained negative. Leukocyte engraftment began on day 10, and all blood cell populations proved to be of donor origin on FISH analysis. Increasing IgE levels (21 000 U/ml) on day 14 after BMT, positive RAST, specific IgG-antibodies, and missing Toxocara (T.) canis antigens in the recipient indicated donor-derived seroconversion. Before BMT, the recipient had been negative for T. canis in routine parasitological screening, and the donor proved to be positive for T. canis antibody by ELISA. This report suggests that the transfer of IgE immunity in the absence of detectable antigens may be responsible for IgE-mediated symptoms consistent with toxocara infection and confirms the need for parasite screening in donor medical examinations.