The program includes:
- Initial presentation in the clinic
- Clinical history taking
- Physical examination
- Review of medical records
- Laboratory tests:
- Complete blood count
- General urine analysis
- Biochemical blood test (kidney and liver function tests)
- Indicators of inflammation (CRP, ESR)
- Indicators of blood coagulation
- Immunohistochemical and genetic analysis of tumor cells (if indicated)
- Leukapheresis, processing of T-cells and cultivation of CAR T-cells
- Adjuvant chemotherapy
- Infusion of modified CAR T-cells to a patient
- Control examinations
- Cost of essential medicines and materials
- Nursing services
- Full hospital accommodation
- Explanation of future recommendations
Indications
- Acute myeloid leukemia (AML) that is resistant to the conventional therapy
How program is carried out
Days 1-2. Initial presentation at the clinic. The doctor collects the patient's medical history, looks at his medical records and previous examinations. Special attention is paid to previous cancer treatments and their results, since CAR T-cell therapy is indicated only if the conventional treatment protocols are ineffective. Based on the results of the consultation, the doctor administers the examination, which includes a complete blood count with white blood cell count, assessment of liver and kidney function, immunohistochemical and genetic analysis of tumor cells (if indicated) and other studies.
Day 3. Collecting patient’s blood. During the leukapheresis procedure, doctors harvest at least 100 million T-cells, which will subsequently undergo gene modification. If there are certain clinical reasons, and the patient needs to postpone the subsequent stages of CAR T-cell therapy, the harvested T-cells undergo the procedure of cryoconservation. If the patient is able to continue treatment immediately, then the harvested T-cells are transferred to the laboratory.
Days 4-12. Processing and gene modification of the T-cells pool lasts 7-10 days. During this time, the patient is receiving immunosuppressive chemotherapy drugs. The chemotherapy is aimed at suppressing the patient's own immune system, which will allow CAR T-cells to fight the tumor more effectively.
Day 13. Manufactured CAR T-cells are tested for the microbiological safety and functional activity. After the successful testing completion, the solution with CAR T-cells is administered to the patient intravenously.
Day 14 and other days. Control examination and further medical supervision in the hospital are carried out. If there are no side effects of CAR T-cell therapy, a stable tendency towards normalization of blood count is observed and the patient has stable general health condition, the patient is discharged from the hospital. Before the discharge, the patient receives the detailed recommendations for further follow-up during the disease remission.
Required documents
- Complete blood count with white blood cell count
- Biochemical blood test (renal and liver function tests), if available
- Bone marrow biopsy results
- CT scan, if available
Service
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About the department
The Department of Pediatric Hematology and Oncology at the University Hospital Hamburg-Eppendorf offers all the options of modern diagnostics and therapy for children and adolescents with malignant diseases (leukemia and solid tumors), blood diseases and bleeding disorders. It is one of the largest medical facilities of this kind in Germany in this field and the only one of this kind in Hamburg. The treatment is provided in accordance with the recommendations of the Society for Pediatric Oncology and Haematology with the engagement of the necessary specialists from all related medical fields. The department is headed by Prof. Dr. med. Stefan Rutkowski.
The department's doctors have enormous and successful experience in the treatment of leukemia, brain and bone tumors, as well as other solid tumors. In addition, the doctors have excellent qualifications in the field of blood stem cell and bone marrow transplantation in leukemia, solid tumors, blood diseases, immunodeficiencies and metabolic disorders. Another focus of the department’s work is the treatment of congenital immunodeficiencies and blood clotting disorder, such as hemophilia and von Willebrand disease in children and adolescents.
The department annually treats more than 10,000 small patients on an outpatient basis. Also, the department's doctors annually perform 40 bone marrow and stem cell transplantations. An important component of the oncopathology treatment is the psychological care.
The main clinical focuses of the department include:
- Diagnostics and treatment of solid tumors, malignant blood diseases
- Chemotherapy
- Radiation therapy
- Maintenance therapy (for example, blood transfusions, antibiotic therapy)
- Diagnostic examinations (bone marrow biopsy, lumbar puncture)
- Functional diagnostics
- Diagnostics and treatment of congenital and acquired hematopoietic defects
- Diagnostics and treatment of congenital and acquired blood clotting disorders
- Diagnostics and treatment of immunodeficiencies
- Diagnostics and treatment of malignant systemic diseases
- Bone marrow and stem cell transplantation
- Palliative care
- Psychosocial care
- Other medical services
Curriculum vitae
- 10.1988 - 04.1995 Study of Human Medicine, University of Bonn.
- 12.06.1995 Medical Examination.
- 06.1996 Doctoral thesis, University of Frankfurt. Subject: "Cytokines in umbilical cord blood of mature newborns and premature babies during normal pregnancy and under the influence of perinatal stress and infections".
- 07.1995 - 08.2002 Intern and Research Fellow, University Hospital Würzburg.
- 09.2002 - 03.2005 Acting Head of the Department, Department of Oncology with the focus on Neuro-Oncology, University Hospital Würzburg.
- 12.2003 Board certification in Pediatric and Adolescent Medicine.
- 04.2005 - 02.2009 Senior Physician, Department of Oncology and Hematology, University Hospital Würzburg.
- 06.2005 Philip Kind Prize for the Best Scientific Work in Pediatric Oncology in German-speaking countries (in collaboration with Prof. J. Kühl).
- 01.2007 Habilitation and Venia legendi, Faculty of Medicine, University of Würzburg.
- 04.2007 Venia legendi in Pediatrics, University of Würzburg.
- 02.2008 Specialization in Pediatric Oncology and Hematology.
- 03.2009 - 09.2015 W2 Professor in Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, as well as Deputy Head of the Department.
- Since 10.2015, Head of the Department of Pediatric Hematology and Oncology at the University Hospital Hamburg-Eppendorf.
Other Activities
- Since 11.2002 Elected Head of the HIT-MED Research Group of the Society for Pediatric Oncology and Hematology.
- Since 03.2006 Representative of the HIT Medical Network (Working Group on Pediatric Neuro-Oncology and All Researches of Brain Tumors of the Society for Pediatric Oncology and Hematology).
- 01.2007 - 06.2012 Chairman of the European PNET Working Group of the European Society of Pediatric Oncology, the Researches of Medulloblastoma and Primitive Neuroectodermal Tumors.
- 11.2009 - 12.2015 Board Member of the Society for Pediatric Oncology and Hematology.
- 09.2011 Adam Balinski Academy Award, Hospital for Sick Children, Toronto, Canada.
- 03.2012 Scientific Director at the Сonference of HIT Medical Network within the Comprehensive Cancer Centre Hamburg.
- 09.2012 -12.2015 First Deputy Chairman of the Society for Pediatric Oncology and Hematology.
- Since 04.2014. Member of the Ethics Committee of the Medical Association Hamburg.
- Since 06.2014 Research Director, Multicenter Research SIOP PNET5-MB (sponsored by the University Hospital Hamburg-Eppendorf).
- Since 06.2014 Chairman of the Pediatric Brain Tumor Committee, European Section of the International Society of Pediatric Oncology.
Memberships in Professional Societies
- Society for Pediatric Oncology and Hematology.
- German Cancer Society.
- International Society of Pediatric Oncology.
Photo of the doctor: (c) Universitätsklinikum Hamburg-Eppendorf (UKE)
About hospital
According to the Focus magazine, the University Hospital Hamburg-Eppendorf ranks among the top ten hospitals in Germany!
Since its foundation in 1889, the hospital has taken a leading position in the European medical arena and still occupies it until today. A highly competent medical team of more than 11,000 employees takes care of the health of patients. About 2,900 of them are doctors and researchers, while more than 3,400 of them work as nurses and therapists. The hospital has 1,738 beds for inpatient treatment. The key principles of each employee’s work is care for the health and well-being of the patient.
It is worth noting that the medical facility became the first university hospital in Europe, which introduced an electronic system for storing medical histories. Thus, all the processes of diagnostics and treatment are stored electronically. In 2011, the hospital was certified as the first fully digital hospital in Europe.
The hospital presents all fields of modern medicine. The doctors of the medical facility have the necessary theoretical knowledge and enormous clinical experience, which allows them to easily cope with the treatment of common and extremely rare, complex clinical cases.
An important component of the university hospital work is research activities aimed at the development of innovative diagnostic and treatment methods. The main scientific focuses of the hospital include neurobiology, oncology, examination of the cardiovascular system, infectious and inflammatory diseases. Today, the key attention is also paid to researches in the field of molecular imaging and skeletal biology.
The hospital is distinguished not only by the first-class medical care, advanced technical equipment, but also by the modern infrastructure, courteousness, friendly and respectful attitude towards the patient by the entire medical staff.
Photo: (c) depositphotos
Accommodation in hospital
Patients rooms
The patients of the University Hospital Hamburg-Eppendorf live in comfortable single and double rooms designed in bright colors. Each room is equipped with an ensuite bathroom with a toilet and a shower. The standard room includes an automatically adjustable bed, a bedside table, a wardrobe, a table and chairs for receiving visitors, a telephone, a radio and a TV. Also, there is Wi-Fi access.
Meals and Menus
The patient and his accompanying person have a daily choice of three menus. If for any reason you do not eat all the food, you will be offered an individual menu. Please inform the medical staff about your dietary preferences prior to the treatment.
Further details
Standard rooms include:
Religion
Religious services are available upon request.
Accompanying person
During the inpatient program, an accompanying person may stay with you in a patient room or hotel of your choice.
Hospital accommodation
During the outpatient program, you may stay in a hotel at the hospital.
Hotel
During the outpatient program, you may stay in a hotel of your choice. Managers will help you choose the most suitable options.
The hospital offers a full range of laboratory tests (general, hormonal, tests for infections, antibodies, tumor markers, etc.), genetic tests, various modifications of ultrasound scans, CT scans, MRI and PET / CT, angiography, myelography, biopsy and other examinations. Treatment with medications, endoscopic and robotic operations, stereotaxic interventions is carried out here, modern types of radiation therapy are also used. The hospital offers patients all the necessary therapeutic techniques.
- Coiling and clipping of aneurysms of different localizations
- Transjugular intrahepatic portosystemic shunting in patients with portal hypertension
- Minimally invasive surgeries (da Vinci)
- Removal and reconstruction of mammary glands
- Hyperthermic intraperitoneal chemotherapy (HIPEC)
These are arteriovenous malformations and angiomas, vascular aneurysms, pathologies of the mammary glands, pelvic organ prolapse, urinary incontinence, malignant tumors of various localizations (area of special attention is treatment of intestinal cancer), pathologies of liver and pancreas, cataracts and rare ophthalmic pathologies (aphakia, aniridia ), infertility and other diseases.
- Interventional neuroradiology
- Mammology
- Oncology
- Gastroenterology
- Surgery
Over 2,900 highly qualified physicians and researchers work at the hospital.