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Background: The combination of intermediate-dose cytarabine plus mitoxantrone (IMA) can induce high complete remission rates with acceptable toxicity in elderly patients with acute myeloid leukemia (AML). We present the final results of a randomized-controlled trial comparing IMA with the standard 7+3 induction regimen consisting of continuous infusion cytarabine plus daunorubicin (DA).
Patients and methods: Patients with newly diagnosed AML>60 years were randomized to receive either intermediate-dose cytarabine (1000 mg/m(2) twice daily on days 1, 3, 5, 7) plus mitoxantrone (10 mg/m(2) days 1-3) (IMA) or standard induction therapy with cytarabine (100 mg/m(2) continuously days 1-7) plus daunorubicin (45 mg/m(2) days 3-5) (DA). Patients in complete remission after DA received intermediate-dose cytarabine plus amsacrine as consolidation treatment, whereas patients after IMA were consolidated with standard-dose cytarabine plus mitoxantrone.
Results: Between February 2005 and October 2009, 485 patients were randomized; 241 for treatment arm DA and 244 for IMA; 76% of patients were >65 years. The complete response rate after DA was 39% [95% confidence interval (95% CI): 33-45] versus 55% (95% CI: 49-61) after IMA (odds ratio 1.89, P = 0.001). The 6-week early-death rate was 14% in both arms. Relapse-free survival curves were superimposable in the first year, but separated afterwards, resulting in 3-year relapse-free survival rates of 29% versus 14% in the DA versus IMA arms, respectively (P = 0.042). The median overall survival was 10 months in both arms (P = 0.513).
Conclusion: The dose escalation of cytarabine in induction therapy lead to improved remission rates in the elderly AML patients. This did not translate into a survival advantage, most likely due to differences in consolidation treatment. Thus, effective consolidation strategies need to be further explored. In combination with an effective consolidation strategy, the use of intermediate-dose cytarabine in induction may improve curative treatment for elderly AML patients.
Multiple myeloma (MM) is a plasma cell malignancy with a significant heritable basis. Genome-wide association studies have transformed our understanding of MM predisposition, but individual studies have had limited power to discover risk loci. Here we perform a meta-analysis of these GWAS, add a new GWAS and perform replication analyses resulting in 9,866 cases and 239,188 controls. We confirm all nine known risk loci and discover eight new loci at 6p22.3 (rs34229995, P=1.31 × 10−8), 6q21 (rs9372120, P=9.09 × 10−15), 7q36.1 (rs7781265, P=9.71 × 10−9), 8q24.21 (rs1948915, P=4.20 × 10−11), 9p21.3 (rs2811710, P=1.72 × 10−13), 10p12.1 (rs2790457, P=1.77 × 10−8), 16q23.1 (rs7193541, P=5.00 × 10−12) and 20q13.13 (rs6066835, P=1.36 × 10−13), which localize in or near to JARID2, ATG5, SMARCD3, CCAT1, CDKN2A, WAC, RFWD3 and PREX1. These findings provide additional support for a polygenic model of MM and insight into the biological basis of tumour development.
The relationship between asparagine metabolism and protein concentration was investigated in soybean seed. Phenotyping of a population of recombinant inbred lines adapted to Illinois confirmed a positive correlation between free asparagine levels in developing seeds and protein concentration at maturity. Analysis of a second population of recombinant inbred lines adapted to Ontario associated the elevated free asparagine trait with two of four quantitative trait loci determining population variation for protein concentration, including a major one on chromosome 20 (linkage group I) which has been reported in multiple populations. In the seed coat, levels of asparagine synthetase were high at 50 mg and progressively declined until 150 mg seed weight, suggesting that nitrogenous assimilates are pre-conditioned at early developmental stages to enable a high concentration of asparagine in the embryo. The levels of asparaginase B1 showed an opposite pattern, being low at 50 mg and progressively increased until 150 mg, coinciding with an active phase of storage reserve accumulation. In a pair of genetically related cultivars, ∼2-fold higher levels of asparaginase B1 protein and activity in seed coat, were associated with high protein concentration, reflecting enhanced flux of nitrogen. Transcript expression analyses attributed this difference to a specific asparaginase gene, ASPGB1a. These results contribute to our understanding of the processes determining protein concentration in soybean seed.
Using the particle-resolved aerosol model PartMC-MOSAIC, we simulate the heterogeneous oxidation of a monolayer of polycyclic aromatic hydrocarbons (PAHs) on soot particles in an urban atmosphere. We focus on the interaction of the major atmospheric oxidants (O3, NO2, OH, and NO3) with PAHs and include competitive co-adsorption of water vapour for a range of atmospheric conditions. For the first time detailed heterogeneous chemistry based on the P¨oschl-Rudich-Ammann (PRA) framework is modelled on soot particles with a realistic size distribution and a continuous range of chemical ages. We find PAH half-lives, 1/2, on the order of seconds during the night, when the PAHs are rapidly oxidised by the gas-surface reaction with NO3. During the day, 1/2 is on the order of minutes and determined mostly by the surface layer reaction of PAHs with adsorbed O3. Such short half-lives of surface-bound PAHs may lead to efficient conversion of hydrophobic soot into more hygroscopic particles, thus increasing the particles’ aerosol-cloud interaction potential. Despite its high reactivity OH appears to have a negligible effect on PAH degradation which can be explained by its very low concentration in the atmosphere. An increase of relative humidity (RH) from 30% to 80% increases PAH half-lives by up to 50%for daytime degradation and by up to 100% or more for nighttime degradation. Uptake coefficients, averaged over the particle population, are found to be relatively constant over time for O3 (2×10-7 to 2×10-6) and NO2 (5×10-6 to 10-5) at the different levels of NOx emissions and RH considered in this study. In contrast, those for OH and NO3 depend strongly on the surface concentration of PAHs. We do not find a significant influence of heterogeneous reactions on soot particles on the gas phase composition. The derived half-lives of surfacebound PAHs and the time and particle population averaged uptake coefficients for O3 and NO2 presented in this paper can be used as parameterisations for the treatment of heterogeneous chemistry in large-scale atmospheric chemistry models.