Response-adapted treatment with rituximab, bendamustine, mitoxantrone, and dexamethasone followed by rituximab maintenance in patients with relapsed or refractory follicular lymphoma after first-line immunochemotherapy: Results of the RBMDGELTAMO08 phase II trial

Background Consensus is lacking regarding the optimal salvage therapy for patients with follicular lymphoma who relapse after or are refractory to immunochemotherapy. Methods This phase II trial evaluated the efficacy and safety of response-adapted therapy with rituximab, bendamustine, mitoxantrone, and dexamethasone (RBMD) in follicular lymphoma patients who relapsed after or were refractory to first-line immunochemotherapy. Sixty patients received three treatment cycles, and depending on their response received an additional one (complete/unconfirmed complete response) or three (partial response) cycles. Patients who responded to induction received rituximab maintenance therapy for 2 years. Results Thirty-three (55%) and 42 (70%) patients achieved complete/unconfirmed complete response after three cycles and on completing induction therapy (4-6 cycles), respectively (final overall response rate, 88.3%). Median progression-free survival was 56.4 months (median follow-up, 28.3 months; 95% CI, 15.6-51.2). Overall survival was not reached. Progression-free survival did not differ between patients who received four vs six cycles (P = .6665), nor between patients who did/did not receive rituximab maintenance after first-line therapy (P = .5790). Median progression-free survival in the 10 refractory patients was 25.5 months (95% CI, 0.6-N/A) and was longer in patients who had shown progression of disease after 24 months of first-line therapy (median, 56.4 months; 95% CI, 19.8-56.4) than in those who showed early progression (median, 42.31 months; 95% CI, 24.41-NA) (P = .4258). Thirty-six (60%) patients had grade 3/4 neutropenia. Grade 3/4 febrile neutropenia and infection were recorded during induction (4/60 [6.7%] and 5/60 [8.3%] patients, respectively) and maintenance (2/43 [4.5%] and 4/43 [9.1%] patients, respectively). Conclusions This response-adapted treatment with RBMD followed by rituximab maintenance is an effective and well-tolerated salvage treatment for relapsed/refractory follicular lymphoma following first-line immunochemotherapy

Bortezomib plus melphalan and prednisone in elderly untreated patients with multiple myeloma: updated time-to-events results and prognostic factors for time to progression

New treatment options offering enhanced activity in elderly, newly diagnosed patients with multiple myeloma are required. One strategy is to combine melphalan and prednisone with novel agents. We previously reported an 89% response rate, including 32% complete responses and 11% near complete responses, in our phase 1/2 study of bortezomib plus melphalan and prednisone (VMP) in 60 newly diagnosed multiple myeloma patients with a median age of 75 years. Here, we report updated time-to-events data and the impact of poor prognosis factors on outcome

Analysis of BAC-end sequences in rainbow trout: Content characterization and assessment of synteny between trout and other fish genomes

<p>Abstract</p> <p>Background</p> <p>Rainbow trout (<it>Oncorhynchus mykiss</it>) are cultivated worldwide for aquaculture production and are widely used as a model species to gain knowledge of many aspects of fish biology. The common ancestor of the salmonids experienced a whole genome duplication event, making extant salmonids such as the rainbow trout an excellent model for studying the evolution of tetraploidization and re-diploidization in vertebrates. However, the lack of a reference genome sequence hampers research progress for both academic and applied purposes. In order to enrich the genomic tools already available in this species and provide further insight on the complexity of its genome, we sequenced a large number of rainbow trout BAC-end sequences (BES) and characterized their contents.</p> <p>Results</p> <p>A total of 176,485 high quality BES, were generated, representing approximately 4% of the trout genome. BES analyses identified 6,848 simple sequence repeats (SSRs), of which 3,854 had high quality flanking sequences for PCR primers design. The first rainbow trout repeat elements database (INRA RT rep1.0) containing 735 putative repeat elements was developed, and identified almost 59.5% of the BES database in base-pairs as repetitive sequence. Approximately 55% of the BES reads (97,846) had more than 100 base pairs of contiguous non-repetitive sequences. The fractions of the 97,846 non-repetitive trout BES reads that had significant BLASTN hits against the zebrafish, medaka and stickleback genome databases were 15%, 16.2% and 17.9%, respectively, while the fractions of the non-repetitive BES reads that had significant BLASTX hits against the zebrafish, medaka, and stickleback protein databases were 10.7%, 9.5% and 9.5%, respectively. Comparative genomics using paired BAC-ends revealed several regions of conserved synteny across all the fish species analyzed in this study.</p> <p>Conclusions</p> <p>The characterization of BES provided insights on the rainbow trout genome. The discovery of specific repeat elements will facilitate analyses of sequence content (e.g. for SNPs discovery and for transcriptome characterization) and future genome sequence assemblies. The numerous microsatellites will facilitate integration of the linkage and physical maps and serve as valuable resource for fine mapping QTL and positional cloning of genes affecting aquaculture production traits. Furthermore, comparative genomics through BES can be used for identifying positional candidate genes from QTL mapping studies, aid in future assembly of a reference genome sequence and elucidating sequence content and complexity in the rainbow trout genome.</p

Roflumilast in moderate-to-severe chronic obstructive pulmonary disease treated with longacting bronchodilators: two randomised clinical trials

Background Patients with chronic obstructive pulmonary disease (COPD) have few options for treatment. The efficacy and safety of the phosphodiesterase-4 inhibitor roflumilast have been investigated in studies of patients with moderate-to-severe COPD, but not in those concomitantly treated with longacting inhaled bronchodilators. The effect of roflumilast on lung function in patients with COPD that is moderate to severe who are already being treated with salmeterol or tiotropium was investigated. Methods In two double-blind, multicentre studies done in an outpatient setting, after a 4-week run-in, patients older than 40 years with moderate-to-severe COPD were randomly assigned to oral roflumilast 500 mu g or placebo once a day for 24 weeks, in addition to salmeterol (M2-127 study) or tiotropium (M2-128 study). The primary endpoint was change in prebronchodilator forced expiratory volume in 1s (FEV(1)). Analysis was by intention to treat. The studies are registered with ClinicalTrials.gov, number NCT00313209 for M2-127, and NCT00424268 for M2-128. Findings In the salmeterol plus roflumilast trial, 466 patients were assigned to and treated with roflumilast and 467 with placebo; in the tiotropium plus roflumilast trial, 371 patients were assigned to and treated with roflumilast and 372 with placebo. Compared with placebo, roflumilast consistently improved mean prebronchodilator FEV(1) by 49 mL (p<0.0001) in patients treated with salmeterol, and 80 mL (p<0.0001) in those treated with tiotropium. Similar improvement in postbronchodilator FEV(1) was noted in both groups. Furthermore, roflumilast had beneficial effects on other lung function measurements and on selected patient-reported outcomes in both groups. Nausea, diarrhoea, weight loss, and, to a lesser extent, headache were more frequent in patients in the roflumilast groups. These adverse events were associated with increased patient withdrawal. Interpretation Roflumilast improves lung function in patients with COPD treated with salmeterol or tiotropium, and could become an important treatment for these patients

Cleavage fracture micromechanisms in simulated heat affected zones of S690 high strength steels

High strength steels are widely used for structural applications, where a combination of excellent strength and ductile-to-brittle transition (DBT) properties are required. However, such a combination of high strength and toughness can be deteriorated in the heat affected zone (HAZ) after welding. This work aims to develop a relationship between microstructure and cleavage fracture in the most brittle areas of welded S690 high strength structures: coarse-grained and intercritically reheated coarse-grained HAZ (CGHAZ and ICCGHAZ). Gleeble thermal simulations were performed to generate three microstructures: CGHAZ and ICCGHAZ at 750 and 800 °C intercritical peak temperatures. Their microstructures were characterised, and the tensile and fracture properties were investigated at − 40 °C, where cleavage is dominant. Results show that despite the larger area fraction of martensite-austenite (M-A) constituents in ICCGHAZ 750 °C, the CGHAZ is the zone with the lowest fracture toughness. Although M-A constituents are responsible for triggering fracture, their small size (less than 1 μm) results in local stress that is insufficient for fracture. Crack propagation is found to be the crucial fracture step. Consequently, the harder auto-tempered matrix of CGHAZ leads to the lowest fracture toughness. The main crack propagates transgranularly, along {100} and {110} planes, and neither the necklace structure at prior austenite grain boundaries of ICCGHAZs nor M-A constituents are observed as preferential sites for crack growth. The fracture profile shows that prior austenite grain boundaries and other high-angle grain boundaries (e.g., packet and block) with different neighbouring Bain axes can effectively divert the cleavage crack. Moreover, M − A constituents with internal sub-structures, which have high kernel average misorientation and high-angle boundaries, are observed to deflect and arrest the secondary cracks. As a result, multiple pop-ins in load-displacement curves during bending tests are observed for the investigated HAZs.</p

Cleavage fracture micromechanisms in simulated heat affected zones of S690 high strength steels

High strength steels are widely used for structural applications, where a combination of excellent strength and ductile-to-brittle transition (DBT) properties are required. However, such a combination of high strength and toughness can be deteriorated in the heat affected zone (HAZ) after welding. This work aims to develop a relationship between microstructure and cleavage fracture in the most brittle areas of welded S690 high strength structures: coarse-grained and intercritically reheated coarse-grained HAZ (CGHAZ and ICCGHAZ). Gleeble thermal simulations were performed to generate three microstructures: CGHAZ and ICCGHAZ at 750 and 800 °C intercritical peak temperatures. Their microstructures were characterised, and the tensile and fracture properties were investigated at − 40 °C, where cleavage is dominant. Results show that despite the larger area fraction of martensite-austenite (M-A) constituents in ICCGHAZ 750 °C, the CGHAZ is the zone with the lowest fracture toughness. Although M-A constituents are responsible for triggering fracture, their small size (less than 1 μm) results in local stress that is insufficient for fracture. Crack propagation is found to be the crucial fracture step. Consequently, the harder auto-tempered matrix of CGHAZ leads to the lowest fracture toughness. The main crack propagates transgranularly, along {100} and {110} planes, and neither the necklace structure at prior austenite grain boundaries of ICCGHAZs nor M-A constituents are observed as preferential sites for crack growth. The fracture profile shows that prior austenite grain boundaries and other high-angle grain boundaries (e.g., packet and block) with different neighbouring Bain axes can effectively divert the cleavage crack. Moreover, M − A constituents with internal sub-structures, which have high kernel average misorientation and high-angle boundaries, are observed to deflect and arrest the secondary cracks. As a result, multiple pop-ins in load-displacement curves during bending tests are observed for the investigated HAZs.Team Vera PopovichSteel & Composite StructuresShip Hydromechanics and StructuresTeam Jilt Sietsm

Additive manufacturing of functionally graded inconel 718: Effect of heat treatment and building orientation on microstructure and fatigue behaviour

This paper addresses the effect of the post-process heat treatments on the microstructure and fatigue crack growth behaviour of the functionally graded (FG) laser powder bed fusion (L-PBF) Inconel 718 (IN718) superalloy. Sets of samples were additively manufactured (AM) altering the process parameters, namely the laser power, the laser scanning speed, layer thickness, hatch distance, and beam distribution function, resulting in distinctly different microstructures. Two categories of samples underwent heat treatment (HT) and hot isostatic pressing followed by HT (HIP+HT), while one category was kept in the as-processed (AP) condition to reveal the effects of the post-treatments. Additionally, to study the effect of microstructural anisotropy, samples were printed in horizontal (H) and vertical (V) building directions. To better understand the behaviour of the FG materials, non-graded (NG) L-PBF samples and wrought material were investigated as references. Significant variations in terms of porosity, grain size and elongation, crystallographic texture, and content of the strengthening precipitates or detrimental phases were found in different AM groups. The fatigue behaviour of the NG and FG materials was also studied by conducting three-point bending tests. Findings in terms of the role of different microstructures on the fatigue-crack initiation and fatigue crack growth rate are presented and discussed for all samples. The study demonstrated that heat treatments can enhance the damage tolerance of L-PBF IN718 to the level of wrought material. Interestingly, the effect of the roughness induced crack closure was found to be a function of build orientation, especially in the low stress ratio regime.Team Vera Popovic

Bendamustine as part of conditioning of autologous stem cell transplantation in patients with aggressive lymphoma: a phase 2 study from the GELTAMO group

We conducted a phase 2 trial to evaluate the safety and efficacy of bendamustine instead of BCNU (carmustine) in the BEAM (BCNU, etoposide, cytarabine and melphalan) regimen (BendaEAM) as conditioning for autologous stem-cell transplantation (ASCT) in patients with aggressive lymphomas. The primary endpoint was 3-year progression-free survival (PFS). Sixty patients (median age 55 [28–71] years) were included. All patients (except one who died early) engrafted after a median of 11 (9–72) and 14 (4–53) days to achieve neutrophil and platelet counts of >0.5 × 109/l and >20 × 109/l, respectively. Non-relapse mortality at 100 days and 1 year were 3.3% and 6.7%, respectively. With a median follow-up of 67 (40–77) months, the estimated 3-year PFS and overall survival (OS) were 58% and 75%, respectively. Patients in partial response at study entry had significantly worse PFS and OS than patients who underwent ASCT in complete metabolic remission, and this was the only prognostic factor associated with both PFS (Relative risk [RR], 0.27 [95% confidence interval {CI} [0.12–0.56]) and OS (RR, 0.40 [95% CI 0.17–0.97]) in the multivariate analysis. BendaEAM conditioning is therefore a feasible and effective regimen in patients with aggressive lymphomas. However, patients not in complete metabolic remission at the time of transplant had poorer survival and so should be considered for alternative treatment strategies