Durable remissions of myelodysplastic syndrome and acute myeloid leukemia after reduced-intensity allografting

Purpose: To evaluate the use of reduced-intensity (RI) conditioning with allogeneic hematopoietic stem cell transplantation (HSCT) from HLA-identical family donors in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).Patients and Methods: Sixteen patients (median age, 54 years; range, 37 to 66 years) underwent RI-HSCT using a conditioning regimen of fludarabine 25 mg/m2 daily for 5 days and either cyclophosphamide 1 g/m2 daily for 2 days (14 patients) or melphalan 140 mg/m2 for 1 day (two patients). The median number of CD34+ cells and CD3+ cells infused per kilogram of recipient weight was 4.5 x 106 (range, 1.8 to 7.3 x 106 cells) and 2.9 x 108 (range, 0.1 to 9.6 x 108 cells), respectively.Results: There was no transplant-related mortality (TRM) within 100 days of HSCT. Grade 1 to 2 acute graft-versus-host disease (GVHD) occurred in three patients, but neither grade 3 nor grade 4 disease was observed. Chronic GVHD occurred in 10 patients. One patient had cytomegalovirus (CMV) reactivation but did not develop CMV disease. With a median follow-up of 26 months (range, 15 to 45 months), 11 patients are alive (nine in continuous complete remission and one in complete remission after a second transplantation), and five have died (four from disease progression and one from bone-marrow aplasia induced by cyclosporine withdrawal). The 2-year actuarial overall and event-free survival rates were 69% (95% confidence interval [CI], 40% to 86%) and 56% (95% CI, 30% to 68%), respectively.Conclusion: This strategy of RI-HSCT resulted in reliable engraftment with low incidence of acute GVHD and TRM. Durable remissions were observed in patients with MDS and AML consistent with a graft-versus-leukemia effect

13C surface characterization of midplane and crown collector probes on DIII-D

A dual collector probe system has been implemented on DIII-D for scrape-off-layer (SOL) impurity transport studies. These experiments injected isotopically enriched methane (13CD4) and sampled the impurities from this extrinsic, primary source with graphite collector probes at the outboard midplane and crown of upper single null L-mode plasmas. Using a stable isotopic mixing model, results suggest that 13C from methane injections prior to these experiments has built up on the walls of DIII-D to act as a secondary, intrinsic source of enriched 13C to the collector probes. This secondary source accounts for nearly 60 % of the deposits on the midplane collector probes and nearly 90 % of the deposition on the collector probes in the crown. These results lay the foundation for future impurity transport models and suggest that further simulation of impurity transport during the methane injection experiments will require two sources of enriched impurities in order to accurately model the SOL impurity profiles of 13C