N Schmitz

Asklepios Klinik St. Georg, Hamburg, Hamburg, Germany

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Publications (313)2047.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The optimal timing of allogeneic hematopoietic transplantation (HCT) in AML is controversial. We report on 1179 patients with a median age of 48 years who were randomized upfront. In the control arm, sibling HCT was scheduled in the first complete remission for intermediate-risk or high-risk AML and matched unrelated HCT in complex karyotype AML. In the experimental arm, matched unrelated HCT in the first remission was offered also to patients with an FLT3-ITD allelic ratio >0.8, poor day +15 marrow blast clearance, and adverse karyotypes. Further, allogeneic HCT was recommended in high-risk AML to be performed in aplasia after induction chemotherapy.Leukemia accepted article preview online, 01 December 2014. doi:10.1038/leu.2014.335.
    Leukemia. 12/2014;
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    ABSTRACT: PURPOSE: To study pharmacokinetics, toxicity, and efficacy of prolonged rituximab exposure in elderly patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS: In the SMARTE-R-CHOP-14 trial, rituximab 375 mg/m2 was administered, together with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone on a 14-day schedule (6xR-CHOP-14), on days -4, 0, 10, 29, 57, 99, 155, and 239. Pharmacokinetics and outcome were to be compared with those of patients who had received 6xR-CHOP-14 in combination with eight 2-week applications of rituximab in the RICOVER-60 (Rituximab With CHOP Over Age 60 Years) trial. RESULTS: The complete response (CR)/unconfirmed CR rate was 85% in 189 evaluable patients, 90% for 90 good-prognosis patients (International Prognostic Index [IPI], 1 or 2), and 81% for 99 poor-prognosis patients (IPI, 3 to 5); 3-year event-free survival (EFS) was 71%, 75%, and 67%, respectively; and 3-year overall survival (OS) was 84%, 88%, and 80%, respectively, with no differences between men and women. The preplanned historical comparison with 306 RICOVER-60 patients (good prognosis, n = 183; poor prognosis, n = 123) revealed no outcome differences for all and good-prognosis patients; however, the longer exposure time in SMARTE-R-CHOP-14 compared with RICOVER-60 was associated with better 3-year EFS (67% v 54%) and OS (80% v 67%) in poor-prognosis patients. CONCLUSION: Extended rituximab exposure compared with eight 2-week applications in combination with 6xR-CHOP-14 significantly improved outcome of elderly poor-prognosis patients without increasing toxicity. To our knowledge, results obtained with the SMARTE-R-CHOP-14 rituximab schedule are the best reported for elderly patients with DLBCL to date. In the subgroup of poor-prognosis patients treated with extended rituximab exposure, the outcome seemed superior to that of a similar historical cohort of patients treated with 6xR-CHOP-14 plus 2-week rituximab, with similar toxicity. A randomized comparison of the two schedules is warranted.
    J Clin Oncol. 11/2014;
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    ABSTRACT: The objective of this registry study was to analyze the outcome of patients who underwent allogeneic or autologous hematopoietic stem cell transplantation (HSCT) for hepatosplenic T cell lymphoma (HSTL), a rare and extremely aggressive peripheral T cell lymphoma subtype. Patients were eligible if they had histologically verified HSTL and underwent HSCT between 2003 and 2011. 76 patients were identified in the EBMT database. Additional baseline and follow-up information could be obtained from the referring centres for 36 patients. Eleven of these were excluded following histopathology review, leaving 25 patients in the final study cohort (alloHSCT 18, autoHSCT 7). With a median follow-up of 36 months, 2 patients relapsed after alloHSCT, resulting in a 3-year progression-free survival of 48%. After autoHSCT, 5 patients relapsed and subsequently died. This study indicates that graft-versus-lymphoma activity conferred by alloHSCT can result in long-term survival for a substantial proportion of patients with HSTL.Leukemia accepted article preview online, 19 September 2014. doi:10.1038/leu.2014.280.
    Leukemia. 09/2014;
  • Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 08/2014;
  • Leukemia. 07/2014;
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    ABSTRACT: To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma we analyzed 11 consecutive DSHNHL trials. ECFI occurred in 290/4155 (7.0%) patients (orbita: 31, paranasal sinuses: 93; main nasal cavity: 38, tongue: 27, remaining oral cavity: 99, salivary glands: 54). In a multivariable analysis adjusted for IPI rituximab improved EFS and OS both in patients with and without ECFI. Three-year event-free (79% vs 79%; p=0.842) and overall survival (86% vs. 88%; p=0.351) were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of CNS disease was increased in 205 ECFI patients compared to 2586 non-ECFI patients (4.2% vs. 2.8%; p=0.038), while this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; p=0.682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, 2-year rate of CNS disease was 4.2% compared to 2.3% in 191 patients who did not (p=0.981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in CR/CRu. These findings should be confirmed in a prospective study.
    Blood 06/2014; · 9.78 Impact Factor
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    ABSTRACT: To improve outcome of elderly patients with DLBCL dose-dense rituximab was evaluated in the prospective DENSE-R-CHOP-14 trial.
    Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. 06/2014;
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    ABSTRACT: Allogeneic stem-cell transplantation has had limited success for patients with refractory and relapsed aggressive B-cell or T-cell lymphoma. We investigated the effect of adding rituximab to standard prophylaxis for graft-versus-host disease after transplantation and estimated overall survival when using a lymphoma-directed myeloablative conditioning regimen. We did this randomised, open-label, phase 2 study at seven German transplantation centres. We enrolled patients with aggressive B-cell or T-cell lymphoma and primary refractory disease, early relapse (<12 months after first-line treatment), or relapse after autologous transplantation. Conditioning with fludarabine (125 mg/m(2)), busulfan (12 mg/kg oral or 9·6 mg/kg intravenous), and cyclophosphamide (120 mg/kg) was followed by allogeneic stem-cell transplantation. Patients were randomly assigned (1:1) to receive rituximab (375 mg/m(2) on days 21, 28, 35, 42, 175, 182, 189, and 196) or not. Allocation was done with a centralised computer-generated procedure; patients were stratified by histological subtype (B-cell vs T-cell lymphoma) and donor match (HLA-identical vs non-identical). Neither investigators nor patients were masked to allocation. The primary endpoints were the incidence of acute graft-versus-host disease grade 2-4 in each treatment group and overall survival at 1 year in both groups combined. All analyses were done for the intention-to-treat population. The study is registered with ClinicalTrials.gov, number NCT00785330. Between June 16, 2004, and March 24, 2009, we screened 86 patients and enrolled 84; 42 were randomly assigned to each group. The cumulative incidence of grade 2-4 acute graft-versus-host disease was 46% (95% CI 32-62) in the rituximab group and 42% (95% CI 29-59) in the no rituximab group (hazard ratio [HR] 0·91, 95% CI 0·52-1·60; p=0·74). Overall survival at 1 year for the whole study population was 52% (95% CI 41-62). Grade 4 haematological toxic effects and grade 3 alopecia occurred in all patients. The most common non-haematological grade 5 toxic effects were pneumonia (nine in the no rituximab group vs ten in the rituximab group) and other infections (seven vs four). The lymphoma-directed myeloablative conditioning regimen developed here is promising for patients with refractory and relapsed aggressive B-cell and T-cell lymphomas. However, the addition of rituximab did not affect the incidence of graft-versus-host disease or overall survival. Hoffmann-La Roche, Amgen, Astellas Pharma.
    The Lancet Oncology 05/2014; · 25.12 Impact Factor
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    ABSTRACT: The treatment of patients with classical Hodgkin's lymphoma relapsing after autologous stem cell transplantation represents a clear unmet need. Overall long-term outcome is not the same in these patients and therapeutic options in this setting are very heterogeneous and include salvage CT and/or RT followed or not by a second stem cell transplantation, palliative care, new drugs, or biological agents. Despite the absence of prospective, randomized, clinical trials, allogeneic stem cell transplantation either from a HLA identical sibling or a matched, unrelated donor represents an attractive option for those young patients with chemosensitive disease after being treated with a salvage protocol. The use of reduced intensity conditioning regimens has been able to drastically decrease nonrelapse mortality, although relapse rate remains a significant issue in this setting. More intense conditioning protocols could eventually decrease the relapse rate after the allogeneic procedure and, as indicated by a recent retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation, nonrelapse mortality does not represent a major problem nowadays for patients with multiply relapsed Hodgkin's lymphoma. Brentuximab vedotin is an antibody-drug conjugate that selectively delivers monomethyl auristatin E, an antimicrotubule agent, into CD30-expressing cells. Its use has been approved recently for patients with Hodgkin's lymphoma relapsing after autologous stem cell transplantation. As a single dose, brentuximab vedotin is able to achieve an objective response rate of 75 % with 34 % of the patients achieving a complete remission. Its widespread use will most certainly change the treatment paradigm of this subgroup of patients, either avoiding the allogeneic procedure in some patients or by increasing the group of potential candidates to an allogeneic transplant being used as a "bridge to allo." Additional information on long-term outcome of patients being treated with this drug or the development of prospective clinical trials in this setting will most probably give some light to this question we have nowadays.
    Current Treatment Options in Oncology 04/2014; · 2.42 Impact Factor
  • Norbert Schmitz, Marita Ziepert, Umberto Vitolo
    New England Journal of Medicine 02/2014; 370(6):574-5. · 54.42 Impact Factor
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    ABSTRACT: R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) is standard care for aggressive B-cell lymphoma. A prospective trial was conducted to investigate the role of additive radiotherapy (RT) to bulky and extralymphatic disease. The best arm of the RICOVER-60 trial (6×R-CHOP-14+2R [R-CHOP administered once every 2 weeks plus two additional applications of rituximab] plus involved-field RT [36 Gy] to sites of initial bulky [≥ 7.5 cm] disease and extralymphatic involvement) was compared with a cohort receiving the same immunochemotherapy but without RT in an amendment to the RICOVER-60 trial (RICOVER-noRTh) in a prospective fashion. After a median observation time of 39 months, 164 of 166 RICOVER-noRTh patients were evaluable. In a multivariable analysis of the intention-to-treat population adjusting for International Prognostic Index risk factors and age (> 70 years), event-free survival (EFS) of patients with bulky disease was inferior without additive RT (hazard ratio [HR], 2.1; 95% CI, 1.3 to 3.5; P = .005), with trends for inferior progression-free (PFS; HR, 1.8; 95% CI, 1.0 to 3.3; P = .058) and overall survival (OS; HR, 1.6; 95% CI, 0.9 to 3.1; P = .127). In a per-protocol analysis with 11 patients in RICOVER-noRTh excluded for receiving unplanned RT, multivariable analysis revealed HRs of 2.7 (95% CI, 1.3 to 5.9; P = .011) for EFS, 4.4 (95% CI, 1.8 to 10.6; P = .001) for PFS, and 4.3 (95% CI, 1.7 to 11.1; P = .002) for OS for patients not receiving RT to bulky disease. Additive RT to bulky sites abrogates bulky disease as a risk factor and improves outcome of elderly patients with aggressive B-cell lymphoma. Whether RT can be spared in patients with (metabolic) complete remission after immunochemotherapy must be addressed in appropriately designed prospective trials.
    Journal of Clinical Oncology 02/2014; · 18.04 Impact Factor
  • Norbert Schmitz, Huei-Shan Wu, Bertram Glass
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    ABSTRACT: Except for ALK-positive anaplastic large cell lymphoma (ALCL) and patients with limited disease, mature T- and natural killer (NK) cell lymphomas are disorders with a poor prognosis. Patients with relapsed or refractory ALK-negative ALCL, angioimmunoblastic T-cell lymphoma (AITL), or peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) after allogeneic transplantation of hematopoietic stem cells (alloSCT) achieve long-term survival in 35%-50% of cases. Survival in patients with less frequent subtypes (NK/T-cell lymphoma, cutaneous T-cell lymphomas, acute T-cell leukemia/lymphoma, or hepatosplenic T-cell lymphoma) also seems promising. These results are significantly better than those of any other treatment modality, including the new drugs. Therefore, alloSCT should be considered in patients with relapsed/ refractory T-cell lymphoma. Because of low patient numbers and lack of comparative studies, the optimum conditioning regimen prior to transplantation as well as other details of the transplant procedure remain unknown and await further study. Studies investigating the role of alloSCT as part of first-line therapy in poor-risk T-cell lymphomas are ongoing. At present, data are not sufficient to recommend alloSCT outside of clinical trials.
    Seminars in Hematology 01/2014; 51(1):67-72. · 3.36 Impact Factor
  • Ash 2013; 12/2013
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    ABSTRACT: To determine the effect of sex on outcome, the male hazard ratio for PFS (HRPFS-male) was determined in patients with DLBCL. In young patients (MInT study), HRPFS-male was 1.3 (p=0.092) without and 1.1 (p=0.660) with rituximab. In elderly patients (RICOVER-60 study), HRPFS-male was 1.1 (p=0.348) with CHOP, but increased to 1.6 (p=0.004) with R-CHOP. The similar improvements of outcome in young patients were associated with similar rituximab clearances in young males and females (9.89 vs. 10.38 ml/h; p=0.238), while the greater benefit for elderly females was associated with a slower rituximab clearance (8.47 vs. 10.59 ml/h; p=0.005) and hence higher serum levels and longer exposure times, due to an age-dependent (p=0.004) decrease of rituximab clearance in females, but not males. Compared to elderly females all other subgroups had significantly faster rituximab clearances and hence appear to be suboptimally dosed when rituximab is given at 375 mg/m(2). While early results of pharmacokinetic-based prospective trials designed to exploit the full therapeutic potential of rituximab suggest that increased doses and/or prolonged exposure times can improve the outcome of elderly males with DLBCL, further studies are warranted that address the optimization of rituximab dose and schedule in all subgroups of DLBCL patients.
    Blood 12/2013; · 9.78 Impact Factor
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    ABSTRACT: Background All-trans retinoic acid (ATRA) with chemotherapy is the standard of care for acute promyelocytic leukemia (APL), resulting in cure rates exceeding 80%. Pilot studies of treatment with arsenic trioxide with or without ATRA have shown high efficacy and reduced hematologic toxicity. Methods We conducted a phase 3, multicenter trial comparing ATRA plus chemotherapy with ATRA plus arsenic trioxide in patients with APL classified as low-to-intermediate risk (white-cell count, ≤10×10(9) per liter). Patients were randomly assigned to receive either ATRA plus arsenic trioxide for induction and consolidation therapy or standard ATRA-idarubicin induction therapy followed by three cycles of consolidation therapy with ATRA plus chemotherapy and maintenance therapy with low-dose chemotherapy and ATRA. The study was designed as a noninferiority trial to show that the difference between the rates of event-free survival at 2 years in the two groups was not greater than 5%. Results Complete remission was achieved in all 77 patients in the ATRA-arsenic trioxide group who could be evaluated (100%) and in 75 of 79 patients in the ATRA-chemotherapy group (95%) (P=0.12). The median follow-up was 34.4 months. Two-year event-free survival rates were 97% in the ATRA-arsenic trioxide group and 86% in the ATRA-chemotherapy group (95% confidence interval for the difference, 2 to 22 percentage points; P<0.001 for noninferiority and P=0.02 for superiority of ATRA-arsenic trioxide). Overall survival was also better with ATRA-arsenic trioxide (P=0.02). As compared with ATRA-chemotherapy, ATRA-arsenic trioxide was associated with less hematologic toxicity and fewer infections but with more hepatic toxicity. Conclusions ATRA plus arsenic trioxide is at least not inferior and may be superior to ATRA plus chemotherapy in the treatment of patients with low-to-intermediate-risk APL. (Funded by Associazione Italiana contro le Leucemie and others; ClinicalTrials.gov number, NCT00482833 .).
    New England Journal of Medicine 11/2013; 369(2):112-21. · 54.42 Impact Factor
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    ABSTRACT: Severe adverse events (SAE) and late hematological malignancies have been reported after PBSC donation. No prospective data on incidence and risk factors have been available for family donors so far. The Japan Society for Hematopoietic Cell Transplantation (JSHCT) introduced therefore in 2000 a mandatory registration system. It defined standards for donor eligibility and asked harvest centers to report any SAE immediately. All donors were examined at day 30 and were to be contacted once each year for a period of 5 years. Acute SAEs within day 30 were reported from 47/3264 donations (1.44%) with 14 events considered as unexpected and severe (0.58%). No donor died within 30 days. Late SAEs were reported from 39/1708 donors (2.3%). The incidence of acute SAEs was significantly higher among donors not matching the JSHCT standards (P=0.0023). Late hematological malignancies in PBSC donors were not different compared with a retrospective cohort of BM donors (N:1/1708 vs N:2/5921; P=0.53). In conclusion, acute and late SAEs do occur in PBSC donors at relatively low frequency but risk factors can be defined.Bone Marrow Transplantation advance online publication, 30 September 2013; doi:10.1038/bmt.2013.147.
    Bone marrow transplantation 09/2013; · 3.00 Impact Factor
  • Journal of Clinical Oncology 09/2013; · 18.04 Impact Factor
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    ABSTRACT: To study clinical presentation, outcome, and the role of radiotherapy in patients with aggressive B-cell lymphoma and skeletal involvement treated with and without rituximab. Outcome of patients with skeletal involvement was analyzed in a retrospective study of nine consecutive prospective trials of the German High-Grade Non-Hodgkin lymphoma Study Group. Of 3,840 patients, 292 (7.6%) had skeletal involvement. In the MabThera International Trial (MInT) for young good-prognosis patients and the Rituximab With CHOP Over 60 Years (RICOVER-60) study for elderly patients, the randomized addition of rituximab improved event-free survival (EFS; hazard ratio for MInT [HRMInT] = 0.4, P > 001; hazard ratio for RICOVER-60 [HRRICOVER-60] = 0.6, P > .001) and overall survival (OS; HRMInT = 0.4, P < .001; HRRICOVER-60 = 0.7, P = .002) in patients without skeletal involvement, but failed to improve the outcome of patients with skeletal involvement (EFS: HRMInT = 1.4, P = .444; HRRICOVER-60 = 0.8, P = .449; OS: HRMInT = 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935). Skeletal involvement was associated with a worse outcome after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab (HREFS = 1.5, P = .048; HROS = 1.1; P = .828), but not after CHOP without rituximab (HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In contrast to rituximab, additive radiotherapy to sites of skeletal involvement was associated with a decreased risk (HREFS = 0.3, P = .001; HROS = 0.5; P = .111). Rituximab failed to improve the outcome of patients with diffuse large B-cell lymphoma with skeletal involvement, although our data suggest a beneficial effect of radiotherapy to sites of skeletal involvement. Whether radiotherapy to sites of skeletal involvement can be spared in cases with a negative positron emission tomography after immunochemotherapy should be addressed in appropriately designed prospective trials.
    Journal of Clinical Oncology 09/2013; · 18.04 Impact Factor
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    ABSTRACT: The rate of long-term remissions after treatment of peripheral T cell lymphomas (PTCL) with standard CHOP-like protocols is unsatisfactory. A prospective multicenter phase II trial was initiated in untreated patients with PTCL of all International Prognostic Index-risk groups, evaluating alemtuzumab consolidation in patients with complete or good partial remission after CHO(E)P-14 induction. Twenty-nine (70.7 %) of the 41 enrolled patients received alemtuzumab consolidation (133 mg in total). The main grades 3-4 toxicities during alemtuzumab therapy were infections and neutropenia with one potentially treatment-related death. Complete responses were seen in 58.5 %, partial responses in 2.4 % and 29.3 % had progressive disease. After a median observation time of 46 months, 19 patients have died, 16 of them due to lymphoma and/or salvage therapy complications. Event-free and overall survival at 3 years in the whole intent to treat population are 32.3 and 62.5 %, respectively, and 42.4 and 75.1 % in the patients who received alemtuzumab. In conclusion, application of a short course of alemtuzumab after CHO(E)P-14 induction is feasible although complicated by severe infections. A current phase III trial, applying alemtuzumab as part of the initial chemotherapy protocol to avoid early progression, will further clarify its significance for the therapeutic outcome.
    Annals of Hematology 08/2013; · 2.87 Impact Factor
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    ABSTRACT: Lymphomatoid granulomatosis (LG) is a very rare, EBV-associated lymphoproliferative disorder of B-cells. Prognosis is poor particularly after relapse and no curative treatment exists. We report the results of high-dose therapy and autologous (ASCT) or reduced-intensity and allogeneic stem cell transplantation (alloSCT) in patients with multiply relapsed LG. An EBMT survey identified ten patients who had received nine ASCT and four alloSCT. All patients had active disease at the time of transplantation. With a median follow up of 5.1 (range 1.4-6.3) years six patients are alive and disease-free. Two ASCT patients died of septicemia early after transplantation, one committed suicide being in continuous complete remission 19 months post ASCT. Another patient allografted four years after ASCT remained disease-free but died of severe GvHD three months after alloSCT. HDT / ASCT and alloSCT are effective therapeutic options and should be considered in all patients with refractory and multiply relapsed LG.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 08/2013; · 3.15 Impact Factor

Publication Stats

10k Citations
2,047.82 Total Impact Points

Institutions

  • 2006–2014
    • Asklepios Klinik St. Georg
      Hamburg, Hamburg, Germany
    • Westpfalz-Klinikum GmbH
      Kaiserlautern, Rheinland-Pfalz, Germany
  • 2013
    • Aichi Medical University
      • Department of Promotion for Blood and Marrow Transplantation
      Okazaki, Aichi, Japan
  • 2009–2013
    • Universität Heidelberg
      • • V. Medicine Clinic
      • • University Hospital of Internal Medicine
      • • Department of Hematology / Oncology
      Heidelberg, Baden-Wuerttemberg, Germany
    • Hospital General Universitario Gregorio Marañón
      • Department of Hematology
      Madrid, Madrid, Spain
    • North West London Hospitals NHS Trust
      Harrow, England, United Kingdom
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
  • 2002–2012
    • Hospital de la Santa Creu i Sant Pau
      • Hematology Clinic Services
      Barcino, Catalonia, Spain
  • 2010
    • Hôpital Saint-Louis (Hôpitaux Universitaires Saint-Louis, Laboisière, Fernand-Widal)
      Lutetia Parisorum, Île-de-France, France
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 2008–2010
    • Catalan Institute of Oncology
      Badalona, Catalonia, Spain
    • Universität des Saarlandes
      Saarbrücken, Saarland, Germany
    • Carl Gustav Carus-Institut
      Pforzheim, Baden-Württemberg, Germany
    • Nottingham University Hospitals NHS Trust
      • Division of Haematology
      Nottigham, England, United Kingdom
  • 2003–2010
    • University of Leipzig
      • Institute of Medical Informatics, Statistics and Epidemiology
      Leipzig, Saxony, Germany
    • Oxford University Hospitals NHS Trust
      • Nuffield Department of Clinical Laboratory Sciences
      Oxford, England, United Kingdom
    • British Society of Blood and Marrow Transplantation
      Londinium, England, United Kingdom
    • Klinik St. Georg
      Albling, Bavaria, Germany
    • St. James's Hospital
      Dublin, Leinster, Ireland
  • 2008–2009
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2004–2009
    • Universitätsmedizin Göttingen
      • Department of Hematology and Oncology
      Göttingen, Lower Saxony, Germany
  • 1999–2009
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2001–2008
    • University College London
      • Department of Haematology
      Londinium, England, United Kingdom
  • 2007
    • Cancer Research UK
      • Institute of Cancer Sciences
      Londinium, England, United Kingdom
    • Asklepios Klinik Barmbek
      Hamburg, Hamburg, Germany
  • 2004–2007
    • Klinikum St. Georg Leipzig
      Leipzig, Saxony, Germany
  • 1982–2004
    • Christian-Albrechts-Universität zu Kiel
      • UKSH II. Medizinische Klinik und Poliklinik
      Kiel, Schleswig-Holstein, Germany
  • 1999–2001
    • University of Southampton
      Southampton, England, United Kingdom
  • 2000
    • Medical College of Wisconsin
      Milwaukee, Wisconsin, United States
  • 1998
    • Imperial College London
      Londinium, England, United Kingdom
  • 1995–1997
    • University of Cologne
      • • Department of Internal Medicine
      • • Division of Haematology, Immunology, Infectiology, Intensive Care and Oncology
      Köln, North Rhine-Westphalia, Germany
  • 1993
    • HELIOS Klinik Kiel
      Kiel, Schleswig-Holstein, Germany
  • 1990
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 1981
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany