Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia

Background: chronic lymphocytic leukemia (CLL) primarily affects older persons who often have coexisting conditions in addition to disease-related immunosuppression and myelosuppression. We conducted an international, open-label, randomized phase 3 trial to compare two oral agents, ibrutinib and chlorambucil, in previously untreated older patients with CLL or small lymphocytic lymphoma. Methods: we randomly assigned 269 previously untreated patients who were 65 years of age or older and had CLL or small lymphocytic lymphoma to receive ibrutinib or chlorambucil. The primary end point was progression-free survival as assessed by an independent review committee. Results: the median age of the patients was 73 years. During a median follow-up period of 18.4 months, ibrutinib resulted in significantly longer progression-free survival than did chlorambucil (median, not reached vs. 18.9 months), with a risk of progression or death that was 84% lower with ibrutinib than that with chlorambucil (hazard ratio, 0.16; P<0.001). Ibrutinib significantly prolonged overall survival; the estimated survival rate at 24 months was 98% with ibrutinib versus 85% with chlorambucil, with a relative risk of death that was 84% lower in the ibrutinib group than in the chlorambucil group (hazard ratio, 0.16; P=0.001). The overall response rate was higher with ibrutinib than with chlorambucil (86% vs. 35%, P<0.001). The rates of sustained increases from baseline values in the hemoglobin and platelet levels were higher with ibrutinib. Adverse events of any grade that occurred in at least 20% of the patients receiving ibrutinib included diarrhea, fatigue, cough, and nausea; adverse events occurring in at least 20% of those receiving chlorambucil included nausea, fatigue, neutropenia, anemia, and vomiting. In the ibrutinib group, four patients had a grade 3 hemorrhage and one had a grade 4 hemorrhage. A total of 87% of the patients in the ibrutinib group are continuing to take ibrutinib. Conclusions: ibrutinib was superior to chlorambucil in previously untreated patients with CLL or small lymphocytic lymphoma, as assessed by progression-free survival, overall survival, response rate, and improvement in hematologic variables. (Funded by Pharmacyclics and others; RESONATE-2 ClinicalTrials.gov number, NCT01722487.)

Health related quality of life in Parkinson's disease: a prospective longitudinal study

OBJECTIVES—To examine the change over time in health related quality of life (HRQL) in a community based cohort of patients with Parkinson's disease.
METHODS—One hundred and eleven patients were evaluated for HRQL in 1993 and then again in a follow up study 4 years later. The patients included in the study in 1993 were derived from a prevalence study of patients with Parkinson's disease in the county of Rogaland, Norway. The HRQL was measured by the Nottingham health profile (NHP). At both evaluations clinical and demographic variables were determined during semistructured interviews and by clinical examinations by a neurologist.
RESULTS—During the 4 year follow up period there was a significant increase in NHP scores, reflecting a decreased HRQL, in the dimensions of physical mobility, emotional reactions, pain, and social isolation. In the same time period mean total NHP score increased from 120.0(SD 102.6) to 176.0 (SD 119.4) (p<0.01). There were no clinical or demographic factors found in 1993 that identified patients at higher risk for developing decreased HRQL. Increased UPDRS score (unified Parkinson's disease rating scale) and Hoehn and Yahr stage during the 4 year study period correlated with increased NHP scores. Even though there was no increase in depressive symptoms or self reported insomnia, these symptoms, together with lower Schwab and England score, were the most important factors for a poor HRQL in 1997.
CONCLUSIONS—Parkinson's disease has a substantial impact on HRQL. Despite modern care, we found a significantly increased distress during the 4 year follow up period. Increased parkinsonism, measured by UPDRS and Hoehn and Yahr stage, correlated with increased stress, not only in the dimension of physical mobility, but also in the areas of pain, social isolation, and emotional reactions. In addition to the clinical examination, HRQL scoring provides valuable information on the total health burden of Parkinson's disease in both cross sectional and longitudinal evaluations, and contributes to a more comprehensive picture of the total disease impact.


Sequential study on reactive blue 29 dye removal from aqueous solution by peroxy acid and single wall carbon nanotubes: experiment and theory

<p>Abstract</p> <p>The majority of anthraquinone dye released to the environment come from antrapogenic sources. Several techniques are available for dyes' removal. In this study removal of reactive blue 29 (RB29) by an advanced oxidation process sequenced with single wall carbon nanotubes was investigated. Advanced oxidation process was optimized over a period of 60 minutes by changing the ratio of acetic acid to hydrogen peroxide, the compounds which form peroxy acid. Reduction of 20.2% -56.4% of reactive blue 29 was observed when the ratio of hydrogen peroxide/acetic acid/dye changed from 344/344/1 to 344/344/0.08 at different times (60, 120 and 180 min). The optimum ratio of acetic acid/hydrogen peroxide/dye was found to be 344/344/0.16 over 60 min. The resultant then was introduced for further removal by single wall carbon nanotubes(SWCNTs) as adsorbent. The adsorption of reactive blue 29 onto SWCNTs was also investigated. Langmuir, Freundlich and BET isotherms were determined and the results revealed that the adsorption of RB29 onto SWCNTs was well explained by BET model and changed to Freundlich isotherm when SWCNTs was used after the application of peroxy acid. Kinetic study showed that the equilibrium time for adsorption of RB 29 on to SWCNT is 4 h. Experiments were carried out to investigate adsorption kinetics, adsorbent capacity and the effect of solution pH on the removal of reactive blue29. The pseudo-second order kinetic equation could best describe the sorption kinetics. The most efficient pH for color removal (amongst pH=3, 5 and 8) was pH= 5. Further studies are needed to identify the peroxy acid degradation intermediates and to investigate their effects on SWCNTs.</p