Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Potential effects of abiotic factors on the abundance and distribution of the plankton in the Western Harbour, south-eastern Mediterranean Sea, Egypt

Samples were collected seasonally from Western Harbour during winter 2012–winter 2013 to examine spatial and temporal variability in phytoplankton and zooplankton abundance in relation to physicochemical parameters. Water was alkaline and well oxygenated. Nutrient concentrations were generally high and related to inflow of discharged waters. A total of 157 and 106 of phytoplankton and zooplankton species were recorded, respectively. The average plankton population was 4 × 106 cells l−1 in terms of phytoplankton and 24 × 103 ind. m−3 in terms of zooplankton. Seasonal differences in the quantitative and qualitative composition of both communities in the different stations were marked. Eutreptiella belonging to class Euglenophyceae overwhelming during spring, reaching an average of 17 × 106 cells l−1. The genus previously was recorded as rare form in the Egyptian waters and may have been introduced via ballast water. Except in spring, copepods were the most abundant group and tintinnid abundances generally increased in spring. The ranges of Shannon diversity indices indicate disturbance level and sometimes high productivity. Salinity, dissolved oxygen and pH may be responsible for the variations in phytoplankton and zooplankton community structure. The results indicate that not only the discharged water make the harbour at risk, but also the ballast water is not less dangerous, and so, we emphasize the need for activation of the ballast water management IMO Ballast Water Management Conventions to reduce the risk of future species invasions