Improved outcome of acute lymphoblastic leukaemia treated by delayed intensification in Hong Kong children: HKALL 97 study

Objective. To study the outcome of children with acute lymphoblastic leukaemia who were treated using a protocol including one or two delayed intensifications. Design. Prospective single-arm multicentre study. Setting. Five designated children cancer units of the Hospital Authority of Hong Kong. Patients. Children aged between 1 and 17.9 years with newly diagnosed acute lymphoblastic leukaemia seen from November 1997 to December 2002. Intervention. Chemotherapy was modified from a German Berlin-Frankfurt-Muenster 95 (BFM95) protocol that included a delayed intensification similar to the induction phase repeated 5 months after diagnosis. High-risk patients were given double delayed intensification. Main outcome measures. Overall survival and event-free survival of the whole group and the three risk groups (standard-, intermediate-, and high-risk groups), and comparison with historical controls. Results. A total of 171 patients were recruited with a median age at diagnosis of 5.57 years (range, 1.15-17.85 years). The induction remission rate was 95.3% and non-leukaemia mortality during remission was 2.3%. At 4 years, the relapse rate of this (HKALL97) study was significantly lower than that of the HKALL93 study (15.7 vs 37.3%; P<0.001). The 4-year overall survival of HKALL97 and HKALL93 studies were 86.5% and 81.8%, respectively (P=0.51). The 4-year event-free survival for HKALL 97 and HKALL93 studies were 79% and 65%, respectively (P=0.007). Nonetheless the difference of event-free survival was most remarkable in the intermediate-risk group: 75.6% and 53.1% for HKALL97 and HKALL93 studies, respectively (P=0.06). Conclusion. A more intensive delayed consolidation phase improved the outcome for children with acute lymphoblastic leukaemia by reducing relapses at 4 years. The early treatment complications were manageable and non-leukaemia mortality during remission remained low.published_or_final_versio

Nonlocal observables and lightcone-averaging in relativistic thermodynamics

The unification of relativity and thermodynamics has been a subject of considerable debate over the last 100 years. The reasons for this are twofold: (i) Thermodynamic variables are nonlocal quantities and, thus, single out a preferred class of hyperplanes in spacetime. (ii) There exist different, seemingly equally plausible ways of defining heat and work in relativistic systems. These ambiguities led, for example, to various proposals for the Lorentz transformation law of temperature. Traditional 'isochronous' formulations of relativistic thermodynamics are neither theoretically satisfactory nor experimentally feasible. Here, we demonstrate how these deficiencies can be resolved by defining thermodynamic quantities with respect to the backward-lightcone of an observation event. This approach yields novel, testable predictions and allows for a straightforward-extension of thermodynamics to General Relativity. Our theoretical considerations are illustrated through three-dimensional relativistic many-body simulations.Comment: typos in Eqs. (12) and (14) corrected, minor additions in the tex

Minimal residual disease-based risk stratification in Chinese childhood acute lymphoblastic leukemia by flow cytometry and plasma DNA quantitative polymerase chain reaction

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†Kenyaichthyidae fam. nov and †Kenyaichthys gen. nov - First Record of a Fossil Aplocheiloid Killifish (Teleostei, Cyprinodontiformes)

The extant Cyprinodontiformes (killifishes) with their two suborders Cyprinodontoidei and Aplocheiloidei represent a diverse and well-studied group of fishes. However, their fossil record is comparatively sparse and has so far yielded members of the Cyprinodontoidei only. Here we report on cyprinodontiform fossils from the upper Miocene Lukeino Formation in the Tugen Hills of the Central Rift Valley of Kenya, which represent the first fossil record of an aplocheiloid killifish. A total of 169 specimens - mostly extraordinarily well preserved and a sample of ten extant cyprinodontiform species were studied on the basis of morphometrics, meristics and osteology. A phylogenetic analysis using PAUP was also conducted for the fossils. Both the osteological data and the phylogenetic analysis provide strong evidence for the assignment of the fossils to the Aplocheiloidei, and justify the definition of the new family dagger Kenyaichthyidae, the new genus dagger Kenyaichthys and the new species dagger K. kipkechi sp. nov. The phylogenetic analysis unexpectedly places dagger Kenyaichthys gen. nov. in a sister relationship to the Rivulidae (a purely Neotropical group),a probable explanation might be lack of available synapomorphies for the Rivulidae, Nothobranchiidae and Aplocheilidae. The specimens of dagger K. kipkechi sp. nov. show several polymorphic characters and large overlap in meristic traits, which justifies their interpretation as a species flock in statu nascendi. Patterns of variation in neural and haemal spine dimensions in the caudal vertebrae of dagger Kenyaichthys gen. nov. and the extant species studied indicate that some previously suggested synapomorphies of the Cyprinodontoidei and Aplocheiloidei need to be revised

Provision of phenotype-matched blood units : no need for pre-transfusion antibody screening

202012 bcrcVersion of RecordPublishe

Acute myeloid leukemia following psoralen with ultraviolet A therapy: A fluorescence in situ hybridization study

A woman with mycosis fungoides treated by psoralen with ultraviolet A (PUVA) and electron beam therapy developed acute myeloid leukemia (AML) three years later. Karyotypic analysis of the leukemia cells revealed monosomy 7. Fluorescence in situ hybridization showed that the monosomy 7 clone had accounted for about a third of the marrow cells after PUVA treatment, but replaced the entire marrow at leukemic transformation. These findings were consistent with a secondary AML evolving from an underlying myelodysplasia, supporting that PUVA therapy might have a mutagenic effect on hematopoietic cells. This might be related to its effect on circulating hematopoietic stem cells.link_to_subscribed_fulltex

Sustained antitumor activity by co-targeting mTOR and the microtubule with temsirolimus/vinblastine combination in hepatocellular carcinoma

The mammalian target of rapamycin (mTOR) and the microtubules are prominent druggable targets for hepatocellular carcinoma (HCC). PI3K/Akt/mTOR activation is associated with resistance to microtubule inhibitors. Here, we hypothesized that co-targeting of mTOR (by mTOR inhibitor temsirolimus) and the microtubule (by microtubule-destabilizing agent vinblastine) would be more efficacious than single targeting in HCC models. In vitro studies showed that effective inhibition of mTOR signaling with temsirolimus alone was able to suppress HCC cell growth in a dose-dependent manner. Among five cell lines tested, Huh7 was the most temsirolimus-sensitive (IC 50 = 1.27 ± 0.06 μM), while Hep3B was the most temsirolimus-resistant (IC 50 = 52.95 ± 17.14 μM). We found that co-targeting of mTOR (by temsirolimus) and the microtubule (by vinblastine, at low nM) resulted in marked growth inhibition in Huh7 cells and synergistic growth inhibition in Hep3B cells (achieving maximal growth inhibition of 80-90%), demonstrating potent antitumor activity of this novel combination. In vivo studies showed that temsirolimus treatment alone for 1 week was able to inhibit the growth of Huh7 xenografts. Strikingly, the temsirolimus/vinblastine combination induced a significant and sustained antitumor activity (up to 27 days post-treatment), with effective reduction of tumor vessel density in both Huh7 and Hep3B xenograft models. Mechanistic investigation revealed that this marked antitumor effect was accompanied by specific and concerted down-regulation of several key anti-apoptotic/survival proteins (survivin, Bcl-2, and Mcl-1), which was not observed in single agent treatments. Our findings demonstrated that the potent anti-cancer activity of this co-targeting strategy was indeed mediated in parts by inhibition of these key survival/anti-apoptotic proteins. © 2012 Elsevier Inc.link_to_subscribed_fulltex