Contributions to Pen & Touch Human-Computer Interaction

[EN] Computers are now present everywhere, but their potential is not fully exploited due to some lack of acceptance. In this thesis, the pen computer paradigm is adopted, whose main idea is to replace all input devices by a pen and/or the fingers, given that the origin of the rejection comes from using unfriendly interaction devices that must be replaced by something easier for the user. This paradigm, that was was proposed several years ago, has been only recently fully implemented in products, such as the smartphones. But computers are actual illiterates that do not understand gestures or handwriting, thus a recognition step is required to "translate" the meaning of these interactions to computer-understandable language. And for this input modality to be actually usable, its recognition accuracy must be high enough. In order to realistically think about the broader deployment of pen computing, it is necessary to improve the accuracy of handwriting and gesture recognizers. This thesis is devoted to study different approaches to improve the recognition accuracy of those systems. First, we will investigate how to take advantage of interaction-derived information to improve the accuracy of the recognizer. In particular, we will focus on interactive transcription of text images. Here the system initially proposes an automatic transcript. If necessary, the user can make some corrections, implicitly validating a correct part of the transcript. Then the system must take into account this validated prefix to suggest a suitable new hypothesis. Given that in such application the user is constantly interacting with the system, it makes sense to adapt this interactive application to be used on a pen computer. User corrections will be provided by means of pen-strokes and therefore it is necessary to introduce a recognizer in charge of decoding this king of nondeterministic user feedback. However, this recognizer performance can be boosted by taking advantage of interaction-derived information, such as the user-validated prefix. Then, this thesis focuses on the study of human movements, in particular, hand movements, from a generation point of view by tapping into the kinematic theory of rapid human movements and the Sigma-Lognormal model. Understanding how the human body generates movements and, particularly understand the origin of the human movement variability, is important in the development of a recognition system. The contribution of this thesis to this topic is important, since a new technique (which improves the previous results) to extract the Sigma-lognormal model parameters is presented. Closely related to the previous work, this thesis study the benefits of using synthetic data as training. The easiest way to train a recognizer is to provide "infinite" data, representing all possible variations. In general, the more the training data, the smaller the error. But usually it is not possible to infinitely increase the size of a training set. Recruiting participants, data collection, labeling, etc., necessary for achieving this goal can be time-consuming and expensive. One way to overcome this problem is to create and use synthetically generated data that looks like the human. We study how to create these synthetic data and explore different approaches on how to use them, both for handwriting and gesture recognition. The different contributions of this thesis have obtained good results, producing several publications in international conferences and journals. Finally, three applications related to the work of this thesis are presented. First, we created Escritorie, a digital desk prototype based on the pen computer paradigm for transcribing handwritten text images. Second, we developed "Gestures à Go Go", a web application for bootstrapping gestures. Finally, we studied another interactive application under the pen computer paradigm. In this case, we study how translation reviewing can be done more ergonomically using a pen.[ES] Hoy en día, los ordenadores están presentes en todas partes pero su potencial no se aprovecha debido al "miedo" que se les tiene. En esta tesis se adopta el paradigma del pen computer, cuya idea fundamental es sustituir todos los dispositivos de entrada por un lápiz electrónico o, directamente, por los dedos. El origen del rechazo a los ordenadores proviene del uso de interfaces poco amigables para el humano. El origen de este paradigma data de hace más de 40 años, pero solo recientemente se ha comenzado a implementar en dispositivos móviles. La lenta y tardía implantación probablemente se deba a que es necesario incluir un reconocedor que "traduzca" los trazos del usuario (texto manuscrito o gestos) a algo entendible por el ordenador. Para pensar de forma realista en la implantación del pen computer, es necesario mejorar la precisión del reconocimiento de texto y gestos. El objetivo de esta tesis es el estudio de diferentes estrategias para mejorar esta precisión. En primer lugar, esta tesis investiga como aprovechar información derivada de la interacción para mejorar el reconocimiento, en concreto, en la transcripción interactiva de imágenes con texto manuscrito. En la transcripción interactiva, el sistema y el usuario trabajan "codo con codo" para generar la transcripción. El usuario valida la salida del sistema proporcionando ciertas correcciones, mediante texto manuscrito, que el sistema debe tener en cuenta para proporcionar una mejor transcripción. Este texto manuscrito debe ser reconocido para ser utilizado. En esta tesis se propone aprovechar información contextual, como por ejemplo, el prefijo validado por el usuario, para mejorar la calidad del reconocimiento de la interacción. Tras esto, la tesis se centra en el estudio del movimiento humano, en particular del movimiento de las manos, utilizando la Teoría Cinemática y su modelo Sigma-Lognormal. Entender como se mueven las manos al escribir, y en particular, entender el origen de la variabilidad de la escritura, es importante para el desarrollo de un sistema de reconocimiento, La contribución de esta tesis a este tópico es importante, dado que se presenta una nueva técnica (que mejora los resultados previos) para extraer el modelo Sigma-Lognormal de trazos manuscritos. De forma muy relacionada con el trabajo anterior, se estudia el beneficio de utilizar datos sintéticos como entrenamiento. La forma más fácil de entrenar un reconocedor es proporcionar un conjunto de datos "infinito" que representen todas las posibles variaciones. En general, cuanto más datos de entrenamiento, menor será el error del reconocedor. No obstante, muchas veces no es posible proporcionar más datos, o hacerlo es muy caro. Por ello, se ha estudiado como crear y usar datos sintéticos que se parezcan a los reales. Las diferentes contribuciones de esta tesis han obtenido buenos resultados, produciendo varias publicaciones en conferencias internacionales y revistas. Finalmente, también se han explorado tres aplicaciones relaciones con el trabajo de esta tesis. En primer lugar, se ha creado Escritorie, un prototipo de mesa digital basada en el paradigma del pen computer para realizar transcripción interactiva de documentos manuscritos. En segundo lugar, se ha desarrollado "Gestures à Go Go", una aplicación web para generar datos sintéticos y empaquetarlos con un reconocedor de forma rápida y sencilla. Por último, se presenta un sistema interactivo real bajo el paradigma del pen computer. En este caso, se estudia como la revisión de traducciones automáticas se puede realizar de forma más ergonómica.[CA] Avui en dia, els ordinadors són presents a tot arreu i es comunament acceptat que la seva utilització proporciona beneficis. No obstant això, moltes vegades el seu potencial no s'aprofita totalment. En aquesta tesi s'adopta el paradigma del pen computer, on la idea fonamental és substituir tots els dispositius d'entrada per un llapis electrònic, o, directament, pels dits. Aquest paradigma postula que l'origen del rebuig als ordinadors prové de l'ús d'interfícies poc amigables per a l'humà, que han de ser substituïdes per alguna cosa més coneguda. Per tant, la interacció amb l'ordinador sota aquest paradigma es realitza per mitjà de text manuscrit i/o gestos. L'origen d'aquest paradigma data de fa més de 40 anys, però només recentment s'ha començat a implementar en dispositius mòbils. La lenta i tardana implantació probablement es degui al fet que és necessari incloure un reconeixedor que "tradueixi" els traços de l'usuari (text manuscrit o gestos) a alguna cosa comprensible per l'ordinador, i el resultat d'aquest reconeixement, actualment, és lluny de ser òptim. Per pensar de forma realista en la implantació del pen computer, cal millorar la precisió del reconeixement de text i gestos. L'objectiu d'aquesta tesi és l'estudi de diferents estratègies per millorar aquesta precisió. En primer lloc, aquesta tesi investiga com aprofitar informació derivada de la interacció per millorar el reconeixement, en concret, en la transcripció interactiva d'imatges amb text manuscrit. En la transcripció interactiva, el sistema i l'usuari treballen "braç a braç" per generar la transcripció. L'usuari valida la sortida del sistema donant certes correccions, que el sistema ha d'usar per millorar la transcripció. En aquesta tesi es proposa utilitzar correccions manuscrites, que el sistema ha de reconèixer primer. La qualitat del reconeixement d'aquesta interacció és millorada, tenint en compte informació contextual, com per exemple, el prefix validat per l'usuari. Després d'això, la tesi se centra en l'estudi del moviment humà en particular del moviment de les mans, des del punt de vista generatiu, utilitzant la Teoria Cinemàtica i el model Sigma-Lognormal. Entendre com es mouen les mans en escriure és important per al desenvolupament d'un sistema de reconeixement, en particular, per entendre l'origen de la variabilitat de l'escriptura. La contribució d'aquesta tesi a aquest tòpic és important, atès que es presenta una nova tècnica (que millora els resultats previs) per extreure el model Sigma- Lognormal de traços manuscrits. De forma molt relacionada amb el treball anterior, s'estudia el benefici d'utilitzar dades sintètiques per a l'entrenament. La forma més fàcil d'entrenar un reconeixedor és proporcionar un conjunt de dades "infinit" que representin totes les possibles variacions. En general, com més dades d'entrenament, menor serà l'error del reconeixedor. No obstant això, moltes vegades no és possible proporcionar més dades, o fer-ho és molt car. Per això, s'ha estudiat com crear i utilitzar dades sintètiques que s'assemblin a les reals. Les diferents contribucions d'aquesta tesi han obtingut bons resultats, produint diverses publicacions en conferències internacionals i revistes. Finalment, també s'han explorat tres aplicacions relacionades amb el treball d'aquesta tesi. En primer lloc, s'ha creat Escritorie, un prototip de taula digital basada en el paradigma del pen computer per realitzar transcripció interactiva de documents manuscrits. En segon lloc, s'ha desenvolupat "Gestures à Go Go", una aplicació web per a generar dades sintètiques i empaquetar-les amb un reconeixedor de forma ràpida i senzilla. Finalment, es presenta un altre sistema inter- actiu sota el paradigma del pen computer. En aquest cas, s'estudia com la revisió de traduccions automàtiques es pot realitzar de forma més ergonòmica.Martín-Albo Simón, D. (2016). Contributions to Pen & Touch Human-Computer Interaction [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/68482TESI

CHARACTER-LEVEL INTERACTIONS IN MULTIMODAL COMPUTER-ASSISTED TRANSCRIPTION OF TEXT IMAGES

HTR systems don't achieve acceptable results in unconstrained applications. Therefore, it is convenient to use a system that allows the user to cooperate in the most confortable way with the system to generate a correct transcription. In this paper, multimodal interaction at character-level is studied.Martín-Albo Simón, D. (2011). CHARACTER-LEVEL INTERACTIONS IN MULTIMODAL COMPUTER-ASSISTED TRANSCRIPTION OF TEXT IMAGES. http://hdl.handle.net/10251/11313Archivo delegad

Training of On-line Handwriting Text Recognizers with Synthetic Text Generated Using the Kinematic Theory of Rapid Human Movements

©2014 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.A method for automatic generation of synthetic handwritten words is presented which is based in the Kinematic Theory and its Sigma-lognormal model. To generate a new synthetic sample, first a real word is modelled using the Sigmalognormal model. Then the Sigma-lognormal parameters are randomly perturbed within a range, introducing human-like variations in the sample. Finally, the velocity function is recalculated taking into account the new parameters. The synthetic words are then used as training data for a Hidden Markov Model based on-line handwritten recognizer. The experimental results confirm the great potential of the Kinematic Theory of rapid human movements applied to writer adaptation.This work was partially supported by the Universitat Politècnica de València under the PMIA-2013 scholarship, the Spanish MEC under FPU scholarship AP2010-0575, the EU’s 7th Framework Programme (FP7/2007-2013) under grant agreement n. 600707 (tranScriptorium) and n. 287576 (CasMaCat) and the Natural Sciences and Engineering Research Council of Canada (NSERC) under grant RGPIN-915.Martín-Albo Simón, D.; Plamondon, R.; Vidal Ruiz, E. (2014). Training of On-line Handwriting Text Recognizers with Synthetic Text Generated Using the Kinematic Theory of Rapid Human Movements. IEEE. https://doi.org/10.1109/ICFHR.2014.97

Escritoire: A Multi-touch Desk with e-Pen Input for Capture, Management and Multimodal Interactive Transcription of Handwritten Documents

The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-319-19390-8_53A large quantity of documents used every day are still handwritten. However, it is interesting to transform each of these documents into its digital version for managing, archiving and sharing. Here we present Escritoire, a multi-touch desk that allows the user to capture, transcribe and work with handwritten documents. The desktop is continuously monitored using two cameras. Whenever the user makes a specific hand gesture over a paper, Escritoire proceeds to take an image. Then, the capture is automatically preprocesses, obtaining as a result an improved representation. Finally, the text image is transcribed using automatic techniques and finally the transcription is displayed on Escritoire.This work was partially supported by the Spanish MEC under FPU scholarship (AP2010-0575), STraDA research project (TIN2012-37475-C02-01) and MITTRAL research project (TIN2009-14633-C03-01); the EU’s 7th Framework Programme under tranScriptorium grant agreement (FP7/2007-2013/600707).Martín-Albo Simón, D.; Romero Gómez, V.; Vidal Ruiz, E. (2015). Escritoire: A Multi-touch Desk with e-Pen Input for Capture, Management and Multimodal Interactive Transcription of Handwritten Documents. En Pattern Recognition and Image Analysis. Springer. 471-478. https://doi.org/10.1007/978-3-319-19390-8_53S471478Andrew, A.: Another efficient algorithm for convex hulls in two dimensions. Inf. Process. Lett. 9(5), 216–219 (1979)Bosch, V., Toselli, A.H., Vidal, E.: Statistical text line analysis in handwritten documents. In: Proceedings of ICFHR (2012)Eisenstein, J., Puerta, A.: Adaptation in automated user-interface design. In: Proceedings of International Conference on Intelligent User Interfaces (2000)Jelinek, F.: Statistical Methods for Speech Recognition. MIT Press, Cambridge (1998)Kalman, R.E.: A new approach to linear filtering and prediction problems. Trans. ASME-J. Basic Eng. 82(Series D), 35–45 (1960)Keysers, D., Shafait, F., Breuel, T.M.: Document image zone classification - a simple high-performance approach. In: Proceedings of International Conference on Computer Vision Theory (2007)Kozielski, M., Forster, J., Ney, H.: Moment-based image normalization for handwritten text recognition. In: Proceedings of ICFHR (2012)Lampert, C.H., Braun, T., Ulges, A., Keysers, D., Breuel, T.M.: Oblivious document capture and real-time retrieval. In: International Workshop on Camera Based Document Analysis and Recognition (2005)Liang, J., Doermann, D., Li, H.: Camera based analysis of text and documents a survey. Int. J. Doc. Anal. Recogn. 7(2–3), 84–104 (2005)Liwicki, M., Rostanin, O., El-Neklawy, S.M., Dengel, A.: Touch & write: a multi-touch table with pen-input. In: Proceedings of International Workshop on Document Analysis Systems (2010)Marti, U.V., Bunke, H.: Text line segmentation and word recognition in a system for general writer independent handwriting recognition. In: Proceedings of ICDAR (2001)Martín-Albo, D., Romero, V., Toselli, A.H., Vidal, E.: Multimodal computer-assisted transcription of text images at character-level interaction. Int. J. Pattern Recogn. Artif. Intell. 26(5), 19 (2012)Martín-Albo, D., Romero, V., Vidal, E.: Interactive off-line handwritten text transcription using on-line handwritten text as feedback. In: Proceedings of ICDAR (2013)Mitra, S., Acharya, T.: Gesture recognition: a survey. IEEE Trans. Syst. Man Cybern. B Cybern. 37(3), 311–324 (2007)Terry, M., Mynatt, E.D.: Recognizing creative needs in user interface design. In: Proceedings of C&C (2002)Toselli, A.H., Juan, A., Keysers, D., González, J., Salvador, I., Ney, H., Vidal, E., Casacuberta, F.: Integrated handwriting recognition and interpretation using finite-state models. Int. J. Pattern Recognit. Artif. Intell. 18(4), 519–539 (2004)Toselli, A.H., Romero, V., Pastor, M., Vidal, E.: Multimodal interactive transcription of text images. Pattern Recognit. 43(5), 1814–1825 (2010)Toselli, A.H., Romero, V., Vidal, E.: Computer assisted transcription of text images and multimodal interaction. In: Popescu-Belis, A., Stiefelhagen, R. (eds.) MLMI 2008. LNCS, vol. 5237, pp. 296–308. Springer, Heidelberg (2008)Wachs, J.P., Kolsch, M., Stern, H., Edan, Y.: Vision-based hand-gesture applications. Commun. ACM. 54(2), 60–71 (2011)Wobbrock, J.O., Morris, M.R., Wilson, A.D.: User-defined gestures for surface computing. In: Proceedings of CHI (2009

Polyethylene glycol pulsed electrodeposition for the development of antifouling coatings on titanium

Titanium dental implants are widely used for the replacement of damaged teeth. However, bacterial infections at the interface between soft tissues and the implant can impair the functionality of the device and lead to failure. In this work, the preparation of an antifouling coating of polyethylene glycol (PEG) on titanium by pulsed electrodeposition was investigated in order to reduce Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) adhesion while maintaining human fibroblast adhesion. Different pulsed conditions were prepared and characterized by contact angle, Focused Ion Beam (FIB), Fourier Transformed Infrared Spectroscopy in the Attenuated Total Reflectance mode (ATR-FTIR), and X-ray photoelectron spectroscopy (XPS). XPS tested fibronectin adsorption. S. aureus, E. coli and human fibroblast adhesion was tested in vitro in both mono and co-culture settings. Physicochemical characterization proved useful for confirming the presence of PEG and evaluating the efficiency of the coating methods. Fibronectin adsorption decreased for all of the conditions, but an adsorption of 20% when compared to titanium was maintained, which supported fibroblast adhesion on the surfaces. In contrast, S. aureus and E. coli attachment on coated surfaces decreased up to 90% vs. control titanium. Co-culture studies with the two bacterial strains and human fibroblasts showed the efficacy of the coatings to allow for eukaryotic cell adhesion, even in the presence of pre-adhered bacteria.Peer ReviewedPostprint (published version

Development of an immunodiffusion technique for the detection of Sacbrood bee virus

La apicultura es una de las actividades agrícolas más importantes de la República Argentina. En los últimos años se ha observado, a nivel mundial, una marcada disminución en el número de abejas. La mortalidad de las abejas, puede atribuirse a la interacción de factores ambientales, al manejo de las colonias o a la acción de diversos microorganismos, entre ellos los virus. Teniendo en cuenta que en la Argentina en este momento solamente se cuenta con técnicas de diagnostico moleculares para la detección de virus, el objetivo de este trabajo fue desarrollar un test de inmunodifusión que permita la detección del Virus de la Cría Ensacada de forma más sencilla y económica. Para ello una cepa autóctona del virus Virus de la Cría Ensacada fue utilizada para inocular un conejo a partir del cual se obtuvieron anticuerpos específicos contra este virus, que posteriormente fueron utilizados para estandarizar la técnica de inmuodifusión. Esta técnica podría ser de gran utilidad en el futuro para realizar un relevamiento rápido de las condiciones sanitarias para SBV en colmenas de la República Argentina ya que debido a su baja complejidad podría ser llevada a cabo en laboratorios de baja complejidad de todo el país.Beekeeping is one of the most important agricultural activities in Argentine.In recent years, there has been a decrease in the number of bees worldwide. The mortality of bees can be attributed to several factors, such as the interaction of environmental factors, wrong management of colonies or the action of various patognes, including viruses. Considering that in Argentina, only molecular diagnostic techniques are available for the detection of viruses, the objective of this work was to develop an immunodiffusion test that allows the detection of the sacbrood bee virus as a simpler and Economical alternative. To developed the immunodiffusion test we use an indigenous virus strain of sacbrood was used to inoculate a rabbit from which specific antibodies were obtained against this virus. Later were used to standardize the immuodiffusion technique. This technique could be very useful in the future to carry out a rapid survey of the sanitary conditions for SBV in hives of Argentine, because due to its low complexity it could be carried out in laboratories of low complexity throughout the country.Laboratorio de VirologíaFacultad de Ciencias Agrarias y Forestale

The mite Varroa jacobsoni does not transmit American foulbrood from infected to healthy colonies

The present study was conducted to determine whether Varroa jacobsoni can transmit American foulbrood (AFB), caused by the bacterium Paenibacillus larvae to healthy colonies by the surface transport of spores. Five two-storey Langstroth colonies of Apis mellifera ligustica were infested by placing a sealed brood comb, with 10% Varroa prevalence, between the central brood combs of each colony. Two months later the colonies were inoculated with P. larvae by adding brood comb pieces with clinical signs of AFB (45±5 scales per colony). After 60 days the brood area was completely uncapped by means of dissecting needles and tweezers, separating the Varroa mites from the larvae and the collected mites were introduced at a rate of 51 per colony into four recipient hives placed in an isolated apiary. Twenty female Varroa specimens were separated at random and observed by SEM. Paenibacillus larvae spores were found on the dorsal shield surface and on idiosomal setae. All colonies died after 4–5 months due to a high incidence of varroosis. No clinical AFB symptoms or P. larvae spores were observed in microscopic preparations. It is concluded that Varroa jacobsoni does not transmit AFB from infected to healthy colonies; it does, however transport P. larvae spores on its surface.Facultad de Ciencias Agrarias y Forestale

Development of an immunodiffusion technique for the detection of Sacbrood bee virus

La apicultura es una de las actividades agrícolas más importantes de la República Argentina.En los últimos años se ha observado, a nivel mundial, una marcada disminución en el númerode abejas. La mortalidad de las abejas, puede atribuirse a la interacción de factores ambientales,al manejo de las colonias o a la acción de diversos microorganismos, entre ellos los virus.Teniendo en cuenta que en la Argentina en este momento solamente se cuenta con técnicas dediagnostico moleculares para la detección de virus, el objetivo de este trabajo fue desarrollarun test de inmunodifusión que permita la detección del Virus de la Cría Ensacada de formamás sencilla y económica.Para ello una cepa autóctona del virus Virus de la Cría Ensacada fue utilizada para inocular unconejo a partir del cual se obtuvieron anticuerpos específicos contra este virus, que posteriormentefueron utilizados para estandarizar la técnica de inmuodifusión. Esta técnica podría ser de granutilidad en el futuro para realizar un relevamiento rápido de las condiciones sanitarias para SBVen colmenas de la República Argentina ya que debido a su baja complejidad podría ser llevadaa cabo en laboratorios de baja complejidad de todo el país.Beekeeping is one of the most important agricultural activities in Argentine.In recent years, there has been a decrease in the number of bees worldwide. The mortality of bees can be attributed to several factors, such as the interaction of environmental factors, wrong management of colonies or the action of various patognes, including viruses. Considering that in Argentina, only molecular diagnostic techniques are available for the detection of viruses, the objective of this work was to develop an immunodiffusion test that allows the detection of the sacbrood bee virus as a simpler and Economical alternative. To developed the immunodiffusion test we use an indigenous virus strain of sacbrood was used to inoculate a rabbit from which specific antibodies were obtained against this virus. Later were used to standardize the immuodiffusion technique. This technique could be very useful in the future to carry out a rapid survey of the sanitary conditions for SBV in hives of Argentine, because due to its low complexity it could be carried out in laboratories of low complexity throughout the country.Fil: Albo, Graciela Noemí. Universidad Nacional de La Plata. Facultad de Ciencias Agrarias y Forestales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Kuzmanich, R.. Universidad Nacional de La Plata. Facultad de Ciencias Agrarias y Forestales; ArgentinaFil: Reynaldi, Francisco José. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Microbiología. Cátedra de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Picotto, Leandro Daniel. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Microbiología. Cátedra de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Sguazza, Guillermo Hernán. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias. Departamento de Microbiología. Cátedra de Virología; Argentin

Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study

PETHEMA (Programa Español de Tratamientos en Hematología) and GETH (Grupo Espa~nol de Trasplante Hematopoyético y Terapia Celular) Cooperative GroupsAcute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.Supported by a Río Hortega academic clinical fellowship (CM19/00194) from the Instituto de Salud Carlos III, Spain (E.R.A.). Additional funding has been provided by CIBERONC grants to J.P.S. (CB16/12/00480), M.M.S. (CB16/12/00369) and B.V. (CB16/12/00233)