Search

Food plays a significant role in the environmental impacts of human activities. However, many agro-industrial processes are multi-product systems and their impacts need to be distributed between the different co-products in order to properly address two major issues: (1) prevention of food spoilage and food losses and (2) the eco-design of food systems, from processing up to recommendations for changes in Western diets. As a culturally and nutritionally central component of most human diets, milk is critical because processing is a preservation issue and most dairy products follow from separations, thereby generating co-products. Life Cycle Assessment (LCA) is a reference and standard method that allows quantification of the potential environmental impacts of a manufactured product throughout its life cycle. Application of the method requires foreground information on the system considered, as well as input and output flows that feed and exit the system. This data paper provides data related to the fractionation of milk into cream, casein, lactose and two whey protein ingredients at industrial scale, using up-to-date technologies used in French dairy factories in years 2000-2010s. Cleaning is included. Transcription of these input and output flows into a selection of processes in the Agribalyse 3.0.1 and Ecoinvent 3.8 databases is also provided. Application of the LCA method in its attributional approach leaves methodological choices up to the practitioner, such as subdivision of the system, allocation of the environmental burden where subdivision is not applied or not possible, and aggregation of the impacts. Therefore, this data paper also provides the allocation factors that are necessary to apply mass, dry matter, protein or economic allocation at every separation operation throughout the processing itinerary. Using the characterization method EF 3.0, this data paper provides the potential environmental impacts of the 5 co-products obtained with an initial input of 600 tons of raw milk, i.e., 63 tons of cream, 183 tons of wet casein, 90 tons of lactose, 1.7 ton of dried β-lactoglobulin and 0.3 ton of dried α-lactalbumin. The respective shares of the 5 co-products are calculated for each allocation rule. Finally, this data paper provides the potential environmental impacts for the manufacture of 1 kg of α-lactalbumin enriched ingredient, as the co-product with the longest process itinerary, with details of all intermediate input contributions as well as two possible aggregation rules: by step or by input type. The dataset participates in providing often confidential industrial-scale LCI data to the public. It will be helpful for the eco-design of future itineraries. In particular, it contributes to taking the fate of the co-products into account when using LCA for such eco-design., (© 2024 The Author(s).)

Urgent action is needed to ensure humanity's future under climate change. Agriculture faces major challenges as it is both influenced by and contributes to climate change. Conservation agriculture sequesters carbon (C) in the soil due to practices such as reduced tillage and planting of cover crops. This study assessed effects of an innovative conservation agriculture popcorn (Zea mays) and wheat (Triticum aestivum) crop rotation in south-western France on soil C sequestration, GHG emissions and several environmental impacts. Two complementary approaches were used: i) a comparison based on field data and expert judgement to assess short-term effects and ii) modelling of three scenarios to quantify long-term outcomes. In both approaches Life cycle assessment (LCA) was used to compare popcorn and wheat rotations. The conventional rotation used ploughing, and its soil was bare between wheat harvest and popcorn sowing. Conservation agriculture used reduced tillage, cover crops, and compost of green waste. Impacts of compost production were allocated mainly to its waste treatment function, based on waste treatment cost and compost price. Simulation modelling of soil C was used to estimate the amount of C sequestered by the conservation and conventional crop rotations. LCA was combined with soil C modelling over 100 years to assess the long-term climate change impact of three scenarios for the popcorn and wheat rotation. These scenarios were 1) Conventional agriculture, 2) Conservation agriculture with cover crops only, 3) Conservation agriculture with cover crops + compost. Mean annual C sequestration and net climate change impact were -0.24 t/ha and 3867 kg CO2-eq./ha, respectively, for the conventional rotation and 0.91 t/ha and 434 kg CO2-eq./ha, respectively, for the conservation rotation. The climate change impact of the conservation rotation depended strongly on the allocation of composting impacts between the waste treatment and compost production functions. Compared to the conventional rotation, the conservation rotation had a lower marine eutrophication impact (-7%) but higher impacts for terrestrial acidification (+9%), land competition (+3%), and cumulative energy demand (+2%). Modelling over 100 years revealed that, at near soil C equilibrium, a conventional scenario lost 9% of soil C, whereas conservation agriculture scenarios gained 14% (only cover crop) and 26% of soil C (cover crop + compost). Conservation agriculture resulted in soil C sequestration over several decades, until a new soil C equilibrium was reached., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Guidoboni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Considering and reducing the environmental impacts has become one of the main concerns of agri-food systems. More specifically, the agri-food sector is increasingly confronted to the necessity of quantifying environmental impacts, e.g., to eco-design their products or to inform the consumers. Literature shows a high variability in environmental impacts between existing systems, as for example between cheeses and the necessity of more case studies to validate statements. In this context, this data paper provides some data related to Feta production in Greece, based on 8 farms of a cooperative (7 sheep livestock and one goat livestock). Feta cheese is PDO (Protected Designation of Origin), composed solely of goat's milk and sheep's milk under specific percentages (at least 70% sheep). More specifically, the data paper displays all the data used to obtain environmental impacts (calculated by using life cycle assessment (LCA)) of the production of Feta, from cradle to consumer. It includes the - sheep and goat - milk productions, the transformation into cheese, the packaging and the transport to wholesalers, then stores and then consumers. The raw data have mostly been obtained through interviews and surveys with the cheese and milk producers and complemented by literature. Data were used to build a life cycle inventory (LCI). For the milk production, the LCI was modeled using MEANS InOut software. For the whole LCI, Agribalyse 3.0 and Ecoinvent 3.8 were used as background databases, with modifications to reflect Greek context. The dataset also compiles the life cycle impact assessment (LCIA). The characterization method used is method EF3.0. This dataset participates in filling two gaps: (1) providing data to represent the variability between Feta cheese production systems and (2) providing data linking impacts of farm, transformation, retail and transport in a value chain perspective. This is done by (1) enlarging the perimeter when most studies found in literature focus on one stage (e.g. the production of milk) and (2) applying LCA to data specific to a regional production (Stymfalia in Greece)., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Inc.)

Environmental data on organic products are needed to assess their environmental performance. The purpose of the ACV Bio project reported here was to generate environmental data as life cycle assessment (LCA) data for a sample of French organic production systems including cropping systems (annual crops, intercrops, forages), grassland, wine grapes, cow milk, calves, beef cattle, sheep, pigs, broilers and eggs. LCA was used to estimate environmental impacts of products from these systems. Recommended uses are to characterize part of the diversity of French organic farming systems and some of their environmental impacts, identify areas for improvement, perform eco-design and sensitivity analysis, and/or make system choices in a given context. However, these data do not represent average French organic products and should not be used as such. The MEANS-InOut web application was used to generate life cycle inventories (LCI). Impact assessment was performed using SimaPro v9 software. The Environmental Footprint 2.0 characterisation method was used to generate LCA data. These data were supplemented with three LCA indicators: cumulative energy demand, land competition (CML-IA non-baseline) and biodiversity loss. Three non-LCA indicators were also calculated for certain systems: diversity of crop families (for cropping systems), agro-ecological infrastructure (for sheep) and pesticide treatment frequency index (for grapes). In total, 173 products were modelled. LCA and non-LCA data are available in the Microsoft® Excel file at Data INRAE (https://doi.org/10.15454/TTR25S). LCI data are available in the AGRIBALYSE database and can be accessed using SimaPro and openLCA software. Farmer-practice data are available on demand., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships which have or could be perceived to have influenced the work reported in this article., (© 2021 The Authors.)

Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases ( n = 69; 49%), hematology ( n = 68; 48%), and others ( n = 41; 29%). BCT was performed in 57% ( n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5-15%) and non-BCT centers (7%; IQR 5-10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% ( n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.

Cytomegalovirus reactivation can be life threatening. However, little evidence on its incidence in solid cancers is available. Therefore our single center Cytomegalovirus polymerase chain reaction database with altogether 890 CMV positive blood serum samples of mainly hematological and oncological patients was retrospectively analyzed to examine the occurrence of Cytomegalovirus reactivation in patients with solid tumors, resulting in 107 patients tested positive for Cytomegalovirus reactivation. Seventeen patients with solid cancer and a positive CMV-PCR test were identified, of which eight patients had clinically relevant CMV disease and received prompt antiviral treatment. Five patients fully recovered, but despite prompt antiviral treatment three patients died. Among these three patients two had significant co-infections (in one case EBV and in the other case Aspergillus) indicating that that CMV reactivation was at least one factor contributing to sepsis. The patient with the EBV co-infection was treated in an adjuvant therapy setting for breast cancer and died due to Cytomegalovirus and Epstein-Barr virus associated pneumonia despite intensive therapy. The other two patients had progressive disease of an underlying pancreatic cancer at the time of CMV diagnosis. One patient died due to attendant uncontrollable Aspergillus pneumonia, the other patient most likely died independent from CMV disease because of massively progressive underlying disease. Cytomegalovirus reactivation and disease might be underestimated in routine clinical practice. In our retrospective analysis we show that approximately 50 % of our patients suffering from solid cancers with a positive Cytomegalovirus polymerase chain reaction also had clinically relevant Cytomegalovirus disease requiring antiviral therapy.

The anthracycline doxorubicin plays a major role in the treatment of lymphoproliferative disorders. However, its use is often limited due to cardiac toxicity, which seems to be much less in the liposomal non-pegylated formulation (Myocet®). The aim of this study was the evaluation of efficacy and toxicity of Myocet®-containing treatment regimens, with a focus on cardiotoxicity during treatment in lymphoma patients. A total of 326 consecutive patients, treated between March 2008 and December 2013 in 11 Austrian and 1 Italian cancer centers, were retrospectively assessed. Patients' baseline and treatment-related parameters were obtained by reviewing hospital records. Median age was 74 years (range 26-93). The most common histology was DLBCL (60 %), followed by FL (13 %) and MCL (8 %). At least one cardiovascular comorbidity was present in 72 % of patients. Most common grade 3/4 toxicities were hematologic, namely, leukopenia, neutropenia, thrombocytopenia, and febrile neutropenia in 44, 40, 17, and 16 %. Overall, 43 patients suffered a cardiac event (any grade) with most patients developing congestive heart failure. Parameters significantly associated with severe cardiac events (grades 3-5) were the presence of cardiovascular comorbidities, chronic obstructive pulmonary disease, and elevated baseline NT-proBNP. Treatment response after first line Myocet®-containing therapy was ≥58 % among all entities (range 58-86 %) and therefore comparable to those of conventional therapeutic regimens. Herein, we provide a detailed toxicity profile of Myocet®-containing chemotherapy regimens. Despite the high rate of patients with preexisting comorbidities, the number of adverse events was encouraging. However, these results need to be confirmed in a prospective randomized trial.

Mould-active antifungal prophylaxis is increasingly used in patients at risk for invasive fungal disease. Between June 2011 and June 2012, one hundred patients with various haematological malignancies at risk for invasive fungal disease received primary antifungal prophylaxis with intravenous micafungin at a daily dosage of 50 mg during neutropenia. The median number of days on micafungin prophylaxis was 14 (range, 6-48 d). The incidence of proven and probable breakthrough invasive fungal diseases (bIFDs) was 6% and 3%, respectively. There were two bloodstream infections caused by yeasts or yeast-like fungi (Candida krusei, Trichosporon asahii) in two patients during the neutropenic phase after allogeneic haematopoietic stem cell transplantation. Four proven bIFDs caused by non-Aspergillus moulds and three cases of probable pulmonary bIFDs were documented during the neutropenic phase after induction/consolidation chemotherapy for acute leukaemia. Colonisation with Candida spp. was documented in 51% of the patients with none of the isolates being in vitro micafungin resistant. Compared to a historical control, receiving primary prophylaxis with posaconazole micafungin is at least as effective in preventing IFD. In both cohorts, bIFDs were exclusively caused by emerging pathogens with a highly preserved in vitro sensitivity to amphotericin B., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: The aim of this study was to describe a large consecutive cohort of non-small cell lung cancer (NSCLC) patients treated in daily routine within the last 25 years. An extensive list of general baseline characteristics (comorbidities, laboratory values, symptoms, performance state), NSCLC related factors (stage, histology), treatment related parameters (approach, applied therapies) and outcome (PFS, RFS, OS, perspective of decades) were analyzed in detail., Patients and Methods: Medical files of 2293 consecutive NSCLC patients diagnosed between 1989 and 2009 at the Medical University of Innsbruck and affiliated hospitals were retrospectively analyzed. Patients were documented within our institution's comprehensive lung cancer project "Twenty-Year Retrospective of Lung Cancer (TYROL study)"., Results: Mean age at diagnosis was 64.1 years and 1611 patients (70.3%) were male. Most patients were diagnosed in stage IV (37.9%). The most frequent comorbidities present at diagnosis were cardiovascular disease (62.1%) and COPD (62.0%). The most common symptoms at diagnosis were coughing (54.7%) and dyspnea (45.3%). Of all 2293 patients 1981 (86.4%) received adequate antineoplastic treatment. In total 874 patients were radically operated, 119 received radiotherapy/radio-chemotherapy and the majority of patients (n=1278) were treated in palliative intent. A 2nd, 3rd, 4th and 5th-line palliative therapy was administered to 612, 278, 102, and 36 patients. Median OS, RFS and PFS were 16.4 months, 86.4 months and 5.1 months, respectively. A multitude of factors was associated with all three outcome variables. Of note, outcome has improved stepwise in the recent decade based on increased response rates leading to prolonged OS., Conclusion: This work incorporates most clinical aspects relevant in the treatment of NSCLC and beyond. Therefore, this comprehensive analysis provides a definite benchmark for prognostication and epidemiology of NSCLC in a Western European society., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Clinical and/or biological risk factors are needed to identify elderly patients with aggressive B-cell lymphoma able to receive full-dose R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) treatment. We present a retrospective analysis of 83 patients≥75 years of age (range: 75-97) who were diagnosed with aggressive B cell lymphoma between 2004 and 2011 in our clinic. R-CHOP-like therapy was administered in 82% of these patients resulting in a median overall survival of 54 months. A median cumulative dose of 226 mg/m2 doxorubicin and a median of six cycles were applied in these patients. Two genotypes of the CBR3 and MLH1 genes affecting the metabolism of cytostatics identified a subgroup with a favorable prognosis (median overall survival not reached vs. 30 months, p=0.01). A treatment strategy aiming at full-dose R-CHOP was feasible and resulted in an encouraging treatment outcome in patients≥75 years. Pharmacogenetic parameters, if independently validated, may be helpful in elderly patients.

5-Azacytidine (5-AZA) was the first drug to be approved for the treatment of high-risk myelodysplastic syndrome (MDS). The adverse event profile of this drug appears favorable compared with the conventional intensive chemotherapy that is used for MDS or acute myeloid leukemia. However, uncommon adverse events may have remained undetected in the limited number of patients that have been treated to date. The present study describes three cases/66.8 person-years (4,491 cases/100,000 person-years) of severe ischemic colitis in a single center cohort of 95 patients who were consecutively treated using subcutaneous 5-AZA. The results demonstrated a much higher incidence of colitis compared with the rates in the general population or in patients of greater ages and co-morbidities. The present study investigated whether the combination of anemia and constipation due to the co-medication of 5-HT 3 receptor antagonists may explain the three cases of ischemic colitis.

The aim of this study was to investigate the relationship between fungal exposure prior to hospitalisation and ensuing onset of invasive mould infections (IMI) in patients at risk. Patients admitted to the Department of Haematology, Oncology and Transplant Surgery of the Medical University Innsbruck received a questionnaire regarding fungal exposure prior to hospital stay. Questions inquired heavy fungal exposures up to 5 days before hospitalisation. A total of 234 patients were enrolled in this study. Multiple fungus exposures were associated with the onset of community-acquired IMI in patients with haematological malignancies. In univariate analysis, haematological malignancies (P = 0.013) and allergy to dust, pollen or moulds (P = 0.015) were significantly associated with fungal infections. In multivariate analysis, logistic regression showed that haematological patients (P = 0.015) and patients with allergy (P = 0.015) were significantly more frequently infected with fungi. Hospital-independent fungal sources highlight risk-factors for IMI in severe immunocompromised patients and the rate of community-acquired IMI does increase., (© 2011 Blackwell Verlag GmbH.)

Objectives: Granulocyte colony-stimulating factor-mobilized peripheral blood hematopoietic stem cell transplantation (HSCT) provides a valuable and increasingly used alternative to bone marrow transplantation (BMT). This retrospective study aimed at determining whether the stem cell source is predictive for outcome, relapse incidence, non-relapse mortality, and severity and incidence of both, acute and chronic graft-versus-host disease (GVHD) in patients undergoing allogeneic HSCT., Patients and Methods: Between 1983 and 2007, 329 adult patients (median age 40, range 18-76) received a first allogeneic HSCT from either sibling (n = 203) or volunteer unrelated donors (n = 126) at our institution. The source of stem cells was bone marrow in 177 (54%) and peripheral blood in the remaining 152 (46%) patients., Results: Overall survival was 37% (31-43%, 95% confidence interval, CI), the relapse incidence was 30% (25-36%, 95% CI), and the non-relapse mortality was 43% (38-49%, 95% CI) for the entire cohort with no significant differences between peripheral blood stem cell or BMT. In patients receiving myeloablative conditioning, peripheral blood stem cell transplantation (PBSCT) was associated with a significantly lower non-relapse mortality (32% vs. 46%, P = 0.05), which, however, was restricted to standard-risk disease (23% vs. 42%, P = 0.02). The overall cumulative incidences of acute GVHD II-IV were 51% and 54% following bone marrow and PBSCT, respectively. Severe acute GVHD III-IV was significantly more frequent after BMT (24% vs. 14%, P = 0.04), whereas chronic GVHD was significantly more frequent following PBSCT (48% vs. 24%, P = 0.0001). By multivariate analysis, PBSCT was only predictive for chronic GVHD (RR 2.29, P = 0.02)., Conclusion: Although we failed to demonstrate any advantage of PBSCT over conventional BMT with regard to overall survival, relapse incidence and non-relapse mortality PBSCT were associated with a significantly higher incidence of chronic graft-versus-host disease. Therefore, and by virtue of observations, that some patient groups might benefit from either stem cell source, there is still need for prospective randomized trials with special emphasize on quality of life in long-term survivors., (© 2011 John Wiley & Sons A/S.)

Introduction: A large group of interacting molecular factors, involved in epithelial-mesenchymal transition, epidermal growth factor receptor (EGFR) signaling, and G1 mitotic phase, are shown to play an important role in cancerogenesis and progression of non-small cell lung cancer (NSCLC). Since success concerning potential correlations, structural and numeric gene aberrations, and biological risk assessment of these molecular factors are still lacking, combined analysis of a multitude of intertwined factors is currently a promising approach., Methods: Cyclins (D1, D2, D3, and E), p21, p27, EGFR, Snail, E-cadherin, beta-catenin, phosphatidylinositol-3' kinase, phosphatase and tensin homologue, phosphorylated Akt, and phosphorylated signal transducer, and activator of transcription-3 were analyzed by immunohistochemistry in 405 surgically resected NSCLC, using a standardized tissue microarray platform. In addition, the gene status of EGFR and cyclin D1 was examined by fluorescence in situ hybridization. Extensive clinical data were acquired, enabling detailed clinicopathologic correlation during a postoperative follow-up period of up to 14 years., Results: The protein overexpressions of nuclear p27, cyclin D1, cyclin D3, E-cadherin, and EGFR as assessed by immunohistochemistry were all associated with a significant reduction in overall survival time. In addition, cyclin D1 proved especially important, being the only independent molecular tumor-related factor with prognostic significance by multivariable analysis. In analogy to EGFR, recurrent numeric gene aberrations, particularly high-level amplifications, of cyclin D1 were obvious., Conclusions: The results emphasize that deregulation of controlling factors of the early G1 phase is of significant oncogenic relevance and may represent a potential treatment target in NSCLC.

The contribution of natural killer (NK) cells to graft-versus-malignancy (GVM) effects following hematopoietic stem cell transplantation (HSCT) remains uncertain, particularly in the HLA-identical setting. A model considering missing HLA ligands to the donor's inhibitory killer cell immunoglobulin-like receptor (KIR), termed the missing KIR ligand model, has been established in T cell depleted bone marrow transplantation (BMT), but lacks validity in other cohorts with different treatment characteristics. We hypothesized that the impact of missing KIR ligands on relapse-free survival (RFS) and overall survival (OS) in T cell replete peripheral blood SCT (PBSCT) differs from that in the T cell depleted BMT setting, and retrospectively evaluated 100 consecutive, HLA-identical sibling transplantations for hematologic malignancies. In addition to KIR ligand status, we considered the donors' activating KIRs and grafted NK, T, and CD34(+) cell doses. Our findings demonstrate noninferiority for OS (P = .005) and RFS (P = .002) for the heterozygous HLA-C group KIR ligand status (C1/2; n = 47) compared with patients missing either C1 or C2 (n = 53). Similarly, OS (P = .031) and RFS (P = .034) of Bw4-positive patients was noninferior to that of patients missing a Bw4 ligand to KIR3DL1. By multivariate analysis, C1/2 heterozygous patients had a favorable risk ratio (RR) for relapse (RR = 0.28; P = .003), RFS (RR = 0.56; P = .046), and acute graft-versus-host disease grade II-IV (RR = 0.36; P = .05). Following reduced-intensity conditioning (RIC), but not standard-intensity conditioning, myeloablative (MA) transplantation, a grafted NK cell dose above the median (3.4 x 10(7)/kg) was associated with a lower risk of relapse (RR = 0.57; P = .003) and improved survival (RR = 0.78; P = .03). Overall, our findings support a role for NK alloreactivity in HLA-identical HSCT, but argue against a favorable impact of missing KIR ligands in the given setting. We conclude that the mechanism favoring the missing KIR ligand constellation in T cell depleted BMT may not operate in T cell replete PBSCT. The reasons for this differential effect remain unresolved., (Copyright 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

Neuroendocrine differentiation in non-small cell lung cancer is a common feature, which has caused contradictory conclusions concerning survival estimates and responsiveness to therapy. Aiming to clarify this conflict, we analyzed neuroendocrine differentiation by immunohistochemistry in 405 surgically resected non-small cell lung carcinomas using standardized tissue microarray platform and the currently recommended antibody panel consisting of chromogranin-A, synaptophysin, and neural-cell adhesion molecule. Diagnostic criteria provided by the World Health Organization were applied. Histological subtypes were primarily reclassified according to current guidelines, assisted by auxiliary immunohistochemistry. Extensive clinical data was acquired, enabling detailed clinicopathological correlation. Importantly, neuroendocrine differentiation assessed by immunohistochemistry showed no significant relation to overall survival estimates, which remained unaffected by histological subtype, neuroendocrine marker type, adjuvant therapy, and recurring disease. The only exception was a small group consisting of three large cell carcinomas, each expressing all three neuroendocrine markers and demonstrating decreased survival. In conclusion, additional immunohistochemical detection of neuroendocrine differentiation in non-small cell lung cancer is presently not of prognostic importance and does not justify a distinct consideration.

Invasive fungal infections (IFI) remain a leading cause of morbidity and mortality in immunocompromised patients. This retrospective single-center study analyzed incidence, treatment and outcome of invasive fungal infections in 1,095 patients with hematological malignancies receiving either cytoreductive chemotherapy or autologous or allogeneic hematopoietic stem cell transplantation at our institution between 1995 and 2004. IFI occurred in 167/1,095 (15%) patients with a significant increase over time (12.7% between 1995 and 2000 vs. 18.1% in the later IFI cohort, P = 0.0134). Fifty-four (32%) patients had proven, 70 (42%) patients had probable, and 43 (26%) patients suffered from possible IFI according to EORTC/MSG criteria. In 108/124 (87%) cases with proven or probable IFI, moulds were the causative pathogens. Both, Aspergillus fumigatus (n = 46) and Aspergillus terreus (n = 41) were predominant. Yeast infections (Candida spp.) were documented in 16/124 (10%) cases with proven or probable IFI. Median overall survival of the entire IFI cohort was 7 (3-17) months. Overall survival was significantly better in patients with probable or possible IFI (37 and 38%, respectively) compared with patients with proven IFI (28%, P = 0.019). In 35% of patients, IFI was the principal cause of death with a significant decrease over time (44% in time cohort 1995-2000 vs. 28% in the later IFI cohort, P = 0.018) accompanied by an increased use of novel antifungals. By multivariate analysis, only proven IFI was significantly predictive for death (HR 1.7, P = 0.018). A significant decrease in fungus-related deaths was observed despite a significant increase of IFI over time, probably due to improved diagnostic and therapeutic approaches.

Aspergillus niveus is a species uncommon in clinical samples, and to date, invasive fungal infections caused by this fungal pathogen have not been described. This is the 1st report on a pulmonary breakthrough aspergillosis caused by A. niveus in a 21-year-old woman after allogeneic hematopoietic stem cell transplantation for Fanconi anemia.

Disease recurrence has been and remains the leading cause of treatment failure in patients with high-risk leukemia. We retrospectively analyzed outcome in 61 patients with high-risk leukemia receiving a combination of fludarabine and intermediate-dose cytarabine as induction (n = 11) or salvage therapy (n = 35). Thirty-six patients having a suitable stem cell donor proceeded to allogeneic hematopoietic stem cell transplantation (HSCT). Ten patients received fludarabine-based salvage therapy without consecutive allogeneic transplantation and 15 patients received fludarabine/intermediate-dose cytarabine because of disease relapse following allogeneic stem cell transplantation. In patients without prior allogeneic HSCT (n = 46) the complete remission rate (CR) was 41% with a CR rate of 46 and 14% in patients with acute myeloid leukemia (AML) and with acute lymphoblastic leukemia (ALL), respectively. Overall survival for patients achieving a CR was 41 versus 0% for patients not achieving CR (P < 0.0001). The best outcome was observed in patients receiving an allogeneic HSCT in CR following fludarabine/ intermediate-dose cytarabine (47 vs. 0% for patients not in CR at the time of allografting, P = 0.01). All 10 patients receiving fludarabine/intermediate-dose cytarabine without subsequent allogeneic HSCT died within 3 years either of disease relapse/progression or infection. Only 1/15 (7%) patients receiving fludarabine/intermediate-dose cytarabine because of relapse following allogeneic HSCT became a long-term survivor. By multivariate analysis achieving CR, receiving an allogeneic HSCT, and being in first relapse or untreated were the only parameters that significantly determine the outcome. Although preliminary only high-risk AML patients having a stem cell donor are candidates for fludarabine/intermediate-dose cytarabine and only those achieving a CR should be referred to subsequent allogeneic HSCT. All other patients with high-risk leukemia are candidates for experimental therapies within controlled trials.

Allogeneic hematopoietic stem cell transplantation is frequently complicated by syndromes characterized by a disruption of the endothelial integrity such as graft-versus-host disease or liver toxicity. Vascular endothelial growth factor and activin-A, a member of the transforming growth factor beta (TGF-beta) superfamily, are important for endothelial integrity and tissue repair. We retrospectively measured endogenous vascular endothelial growth factor and activin-A serum levels in 70 patients following allogeneic stem cell transplantation. Vascular endothelial growth factor serum levels were significantly decreased within the first 2 weeks after the transplant and returned to pre transplant levels by day +15. Activin-A serum levels were significantly elevated from day +7 with peak levels reached on day +10. By using the median value as cutoff high vascular endothelial growth factor levels on day +15 were associated with significantly better overall survival, less liver toxicity, faster neutrophil recovery, and a trend towards less severe acute graft-versus-host disease. No correlation was found between activin-A serum levels and survival, liver toxicity, neutrophil recovery, or graft-versus-host disease. Monitoring of vascular endothelial growth factor levels following allogeneic hematopoietic stem cell transplantation might help to identify patients with a very high risk for early transplant-related complications.

Targeted therapies focus on signaling pathways in cancer cells and other molecular processes involved in oncogenesis. Recent approaches affect the following major groups: the epidermal growth factor receptor (EGFR)-family, angiogenesis, the eicosanoid pathway, the PKC/ Ras/ MAPK pathway, the proteasome and inducers of apoptosis. Numerous phase I and II trials have provided promising results and recently, anti-EGFR and anti-VEGF treatments have proven their efficacy in phase III trials. However, others failed in phase III settings (e.g. PKC- and matrix metalloproteinase inhibitors) and it is a moot point, whether patients have been selected properly. The huge amount of new medications raises questions like when to use which strategy in which sequence. The successful implementation of targeted agents into clinical routine will depend on the verification of sufficient predictive markers, allowing their economically reasonable usage. In the current review the up-to-date knowledge concerning targeted therapies in NSCLC is summarized and their therapeutical potential is discussed.

Detection of molecular abnormalities could provide an essential tool for the diagnosis of non-small cell lung cancer (NSCLC) and defining patients at risk for early relapse. Fluorescence in situ hybridisation (FISH) targeting 17 gene loci was applied to determine the frequency of molecular alteration in NSCLC probes and adjacent tumour-free bronchial epithelium. FISH was performed on fresh frozen specimens from 76 patients with histologically confirmed NSCLC and 54 specimens of adjacent tumour-free tissue. Routine autopsy lung tissue probes from 7 cancer-free patients served as a control group. Locus-specific (3p14.2, 3p21.2, 3p21.3, 3p25.3, 5p15.2, 7p12, 8q24.12, 9p21, 13q14, and 17p13.1) as well as centromere probes (4, 6, 7, 9, 11 and 16) were used. Molecular alterations using FISH on interphase nuclei were detected in 100% of NSCLC tumour specimens and 89% of microscopically tumour-free tissues of NSCLC patients. In histologically 'normal' epithelium, the most frequent alterations were seen with locus-specific probes for 3p14.2, 3p.21, 3p21.3, 3p25.3 and 7p12 and centromere-specific probes 11 and 16 (12-93%). As expected, the majority of genetic alterations seen in 'premalignant' specimens were found in the correlating tumour probes. None of the tested parameters revealed prognostic significance in univariate Cox analysis. FISH analysis, performing multicolour strategies, demonstrated its power in detecting genetic abnormalities in NSCLC specimens and even in tumour-free sections of tumour patients.