Assessment of immunochemotherapy and stem cell transplantation on EBV-associated hemophagocytic lymphohistiocytosis in children: a systematic review and meta analysis

BACKGROUND AND OBJECTIVES

Although immunochemotherapy had been reported to be effective initial treatment for patients with Epstein Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH), and stem cell transplantation (SCT) was employed for patients with refractory disease, the long-term outcome of these patients underwent such treatment remained uncertain. The main purpose of this study was to make a primary system review on the outcome of EBV-HLH patients treated with immunochemotherapy and/or SCT.

MATERIAL AND METHODS

A system review and meta analysis was conducted on studies which collected from published PubMed and China Knowledge Resource Integrated Database (CNKI). The analysis was based on clinical characteristics and follow-up. Search strategy and selection criteria were identified by relevant articles, the period was defined from January 1990 to October 2010. Search terms included all relevant terms. English and Chinese language papers were reviewed.

RESULTS

A total of 11 articles include 342 EBV-HLH patients that were identified with our search terms fulfilled the eligibility criteria. Overall 104/342 patients (30.4%) died at the end of respective study. In 288 patients who did not receive SCT, 93/288 patients (32.3%) patients died. While in 54 patients who underwent SCT, 11/54 patients (20.4%) died at the end of respective study. Four articles had the contents both of immunochemotherapy and SCT. When using a meta analysis compared the mortality between immunochemotherapy and SCT groups, there was no statistical significance could be found, the Odds Ratio is 1.10 (0.43-2.84), (p = 0.84). When compared the mortality between SCT group and total EBV-HLH patients, there was still no statistical significance could be found, the Odds Ratio is 0.99 (0.39-2.53), (p = 0.98).

CONCLUSION

Etoposide-containing immunochemotherapy and SCT both decreased the mortality in EBV-HLH patients in the past decade. There was not enough evidence to suggest that SCT is better than immunochemotherapy in children with EBV-HLH. And such result may justify further research.

P1-06-15: A Genomic Predictor Developed from Breast Cancer Cell Lines Predicts Both Disease-Free Survival and Overall Survival in Breast Cancer Patients Treated with Doxorubicin and Cyclophosphamide: A Collaborative Project of the NSABP and Precision Therapeutics

Background: A cell line-derived multigene predictor of tumor response to doxorubicin + cyclophosphamide (MGP-AC) has been shown to predict the pathological complete response (pCR) in breast cancer patients from the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-27. However, a cell line-derived MPG for doxorubicin + cyclophosphamide + docetaxel (MGP-ACT) was not predictive in patients from B-27. The purpose of this study was to further assess the performance of these predictors on disease-free survival (DFS) and overall survival (OS) in the same patient populations.

Methods: NSABP B-27 was a 3-arm trial of 2411 early-stage breast cancer patients randomized to receive 4 cycles of preoperative doxorubicin+cyclophosphamide (AC) or 4 cycles of AC followed by 4 cycles of docetaxel either pre-op (AC+T) or post-op (AC→T). MGPs for AC and ACT were developed based on the in vitro assay and microarray genomic profiles of 40 breast cancer cell lines. A higher MGP score indicates lower chemoresponse sensitivity.

Results: 322 patients with available microarray data were included for this analysis (103 treated with AC, 102 with AC+T, and 117 with AC→T). For patients treated with AC, a higher MGP-AC score was significantly associated with increased risk of disease progression (standardized hazard ratio [HR] [SD set to 1]=1.48, 95% confidence interval [CI]=1.02−2.15, p=0.043) or death (standardized HR=1.66, 95% CI=1.06−2.62, p=0.028) after adjusting for clinical covariates (ER status, clinical tumor size, lymph node status, and age). The addition of MGP-AC to the clinical model improves the accuracy in predicting five-year DFS: the area under the ROC curve improved from 63% to 72%. For patients treated with AC+T or AC→T, MGP-ACT was not predictive of either DFS (standardized HR=1.03, 95% CI=0.78−1.37, p=0.818) or OS (standardized HR=1.05, 95% CI=0.73−1.51, p=0.8).

Conclusions: A cell line-derived MGP for AC that was predictive of pCR was also predictive of DFS and OS in breast cancer patients treated with neoadjuvant AC. The MGP for ACT, which was not predictive for pCR, was not predictive of either DFS or OS in patients who received docetaxel after AC.

The B-27 study was funded by NCI PHS grants U10-CA-37377, U10-CA-69974, U10-CA-12027, U10-CA-69651, and U24-CA-114732, and received additional support from sanofi-aventis.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-06-15.

Evaluation of the performance of breast cancer cell line–derived multigene predictors of chemotherapy response in multiple clinical trials

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Background: While various multi-gene predictors (MGPs) of chemotherapy response have been developed based on cancer patient primary tissues or cancer cell-lines, the accuracy and consistency of these predictors remain a concern in clinical validation studies. In this study we developed four unique MGPs for chemotherapy response from breast cancer cell lines and performed a systematic evaluation of the performance of these MGPs using data from five distinct clinical trials.

Methods: Forty-six immortalized breast cancer cell-lines were exposed to various concentrations of drug combinations [paclitaxel, 5-fluorouracil, doxorubicin, cyclophosphamide (TFAC); 5-fluorouracil, doxorubicin, cyclophosphamide (FAC); 5-fluorouracil, epirubicin, cyclophosphamide (FEC) and epirubicin, cyclophosphamide (EC)] using an in vitro chemosensitivity assay. Utilizing publicly available breast cancer cell-line microarray data, genes highly associated with in vitro chemosensitivity were selected as candidate MGPs. Five independent and publicly available clinical trials were used for validation. In three of these clinical trials patients were treated by TFAC, while EC, FAC or FEC were used in the other two trials. All five studies involved neoadjuvant chemotherapy treatment, and pathologic complete response (pCR) was used as the endpoint. The association of MGPs with pCR was assessed using receiver-operator curve (ROC) analysis and area under the ROC (AUC) was used to evaluate the performance of prediction.

Results: In five independent clinical trials, the MGPs predicted patient pCR to EC, FAC/FEC and three TFAC treatments with an AUC of, 0.671, 0.632, 0.735, 0.738 and 0.647 respectively.

Conclusions: In the five independent clinical trials in which patients were treated by various chemotherapy agents, the performance of MGPs is promising. These results demonstrate the feasibility of using breast cancer cell-line derived MGPs to predict breast cancer patients’ chemotherapy responses.

Comparison of the GMFM-66 and the PEDI Functional Skills Mobility domain in a group of Chinese children with cerebral palsy

BACKGROUND

Previous research has suggested there is a high level of comparability between the Gross Motor Function Measure-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility domain. However, there are only a few studies that have examined the correlations between these instruments. The purpose of this study was to determine the correlation between the GMFM-66 and the PEDI Functional Skills Mobility domain scaled scores in a group of Chinese children with spastic cerebral palsy, at the ages of 12-70 months, in order to explore the feasibility of using them interchangeably.

METHODS

Secondary data analysis was conducted of data collected during a prospective international collaborative study that used the GMFM-66 and the PEDI to examine the impact of treatment. This study examined the Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain at six time points over the course of 28 consecutive weeks for 115 Chinese children who participated at baseline.

RESULTS

Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain ranged from 0.83 to 0.90 for the six time points of data collection, with statistically significant P-values <0.0001 for each correlation.

CONCLUSIONS

These results support previous research that the GMFM-66 and the PEDI Functional Skills Mobility domain are complementary assessments that may be used interchangeably when it is not possible to administer both.

Study on Creep Behavior of PP/CaCO3 Molded by Vibration Injection Molding at Different Vibration Frequency and Vibration Pressure

Vibration injection molding technology has achieved some good properties, such as high impact strength and high tensile strength. Although many researchers have proved that the short-time mechanical properties of the polymer could be improved by vibration-injection molding technology, the long-time mechanical properties, such as the creep behavior, have not been paid enough attention. In this paper, the creep behavior of the calcium carbonate filled polypropylene (PP/CaCO3) prepared at various vibration conditions has been observed. The influences of the vibration pressure and the frequency on the mechanical properties and creep behavior were investigated via creep test and tensile test. Firstly, the tensile fracture strain reached the maximum (11%) at 0.72 Hz. Moreover, with the increasing vibration pressure amplitude, the tensile fracture strain would decrease. The changing tendency of tensile strength is basically contrary with the change of the tensile fracture strain. Secondly, when the vibration frequency reaches the 0.72 Hz, the tensile creep is larger than that of other frequencies samples at 50 MPa; meanwhile, the tensile creep of these PP/CaCO3 parts, which has been prepared at 0.48 Hz, decreases with the increasing vibration pressure amplitude. Finally, the dynamic mechanics analysis (DMA) and the wide-angle X-ray diffraction (WAXD) were adopted to analyze the reason of the creep behavior change. The different macromolecular chains mobility caused the different creep behavior.

Adjuvant chemotherapy for gastric cancer: Less drug, same efficacy

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Background: Adjuvant chemotherapy is proved to improve survival in gastric cancer by meta-analyses. However, no evidence showed the best regimen. We conducted a retrospective analysis to compare triplets with doublets in the adjuvant setting.

Methods: We collected data from January 2004 to December 2008 from patients performed radical surgery and adjuvant chemotherapy. Doublets were defined as 5-FU 750 mg/m2 (d1- 5) or capecitabine 1,000 mg/m2 (d1-14) plus cisplatin 60 mg/m2 (d1) or oxaliplatin 130 mg/m2 (d1), while triplets had epirubicin 50 mg/m2 (d1) added. Chemotherapy was initiated within 6 weeks after surgery, repeated every three weeks and planned for 6 cycles. Patients were followed up in the outpatient clinic until death or April 30, 2010. Cox proportional-hazard model and chi-square test were used to test statistical difference.

Results: A total of 316 patients (210 in doublets, 106 in triplets) had a median follow-up time of 47 months. 77 patients died at the end of follow-up (3-year survival of 67.4%).Two groups were well balanced except age (median age of 57 in doublets, 51 in triplets, p < 0.001). All the patients tolerated well, with few grade 3/4 side effects (21.9% in doublets, 30.2% in triplets, p = 0.107). Two groups had similar disease-free survival (median DFS, 16 months vs. 23 months, p = 0.656) and overall survival (3-year survival rate, 59.6% vs. 64.8%, p = 0.293). Subgroup analysis showed the same benefit on survival between the two groups.

Conclusions: Our study suggested doublets and triplets had the same efficacy as the adjuvant chemotherapy. Furthermore, doublets seem more cost-effective.

[Table: see text]

No significant financial relationships to disclose.

Abstract P2-09-39: Multi-Gene Predictors Developed from Breast Cancer Cell Lines To Predict Response to Chemotherapy: A Validation Study on US Oncology Study 02-103

PURPOSE: Multi-gene predictors (MGPs) of response to multidrug chemotherapy regimens were developed using an in vitro chemoresponse assay in which cell lines were exposed to chemotherapy. The goal of this study was to assess the predictive value of these MGPs using clinical breast cancer patient gene expression data from a clinical trial. METHOD: US Oncology 02-103 was a phase II trial in which women with stage II/III breast cancer were treated with neoadjuvant chemotherapy consisting of four cycles of fluorouracil/epirubicin/cyclophosphamide (FEC) followed by four cycles of docetaxel/capecitabine (TX). Most HER-2 positive patients also received trastuzumab. MGPs of FEC, TX and TFEC (docetaxel/fluorouracil/epirubicin/cyclophosphamide) sensitivity were developed using in vitro assay results from breast cancer cell lines exposed to these drug combinations and publicly-available gene expression data for the same cell lines. MGPs were not developed for trastuzumab treatment. Area under the receiver-operator curve (AUC) was used to evaluate the performance of the three MGPs’ to predict patient pathologic complete response (pCR). Patients who did or did not receive trastuzumab were evaluated separately. Validation was performed blindly and the predictors were applied without knowledge of patient clinical outcome. RESULTS: Eighty-six patients had genomic data available and were included in this analysis. The predictive performance of the FEC, TX and TFEC MGPs were AUCs of 0.72, 0.69, and 0.73, respectively, in the patients who received FEC-TX chemotherapy without trastuzumab (n=61). Within this group, higher AUCs were observed in ER-negative patients compared to ER-positive patients (0.69, 0.72, 0.74 vs. 0.64, 0.54, 0.62, respectively). The prediction accuracies were low (AUCs = 0.43, 0.56 and 0.43) for patients who received trastuzumab together with chemotherapy (n=25) as expected, indicating that the MGPs may have the potential to be regimen-specific.

CONCLUSION: Cell line-derived MGPs of multidrug chemotherapy regimens showed promising performance in this blinded validation study, particularly among patients with ER-negative breast cancers. Further clinical data are needed to confirm this finding.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-39.

Abstract P3-08-02: Pharmacogenomic Predictors of Patient Response to Chemotherapy Derived from Breast Cancer Cell Lines Combining Knowledge-Based and Data-Driven Methods

Background: Responses of breast cancer patients to chemotherapy treatments vary considerably, and population treatment response rates remain low. To improve patient outcomes, genomic profiles have been used to identify patients who would benefit from specific treatments. Several studies have used cancer cell lines to develop pharmacogenomic predictors by identifying genes associated with drug response. However, pharmacogenomic predictors derived by this data-driven approach may not readily elucidate the underlying mechanisms associated with drug responses, because the identified predictors by computational methods may not directly associate with drug responses considering the complex genetic regulatory network. To overcome this issue, we proposed a strategy to integrate data-driven methods with biological knowledge-based approaches to identify genomic predictors. We then applied this approach to breast cancer cell lines to identify genomic predictors of paclitaxel-5-fluorouracil-doxorubicin-cyclophosphamide (TFAC), the identified predictors are then evaluated by their ability to predict the clinical outcome of the breast cancer patients who are treated by TFAC. Material: Thirty immortalized breast cancer cell lines were exposed to various concentrations of TFAC using a chemosensitivity assay. Area under the dose-response curves was calculated to measure chemoresponses. Gene expression profiles of the 30 cell lines, the expression profiles as well as the pathologic complete response (pCR) information of 133 breast cancer patients treated by TFAC were publicly available. Methods: We performed pathway enrichment analysis in breast cancer cell lines to assess the association between drug response and curated gene sets predefined by molecular signature database. Pathways with p-value less than 0.01 were considered enriched. The genes from the enriched pathways whose expression values were highly correlated with drug sensitivity were selected as the pharmacogenomic predictors. To validate these predictors, the performances of their prediction for patients’ pCR were evaluated using principle component regression method.

Results: Using pathway enrichment analysis, 17 pathways were identified to be related to TFAC drug response. These pathways are related to different biological functions, including breast cancer ER status and BRCA type, immune response, differentiation, and drug response. Using supervised principal component regression, 59 genes involved in at least one of these 17 pathways were selected as genomic predictors. The prediction accuracy of patient pCR was 0.70, sensitivity was 0.71, and specificity was 0.70. Conclusion: By combining knowledge-based and data-driven methods, we have identified 59 genes from breast cancer cell lines as pharmacogenomic predictors of drug response to TFAC. These results support the viability of using breast cancer cell lines to predict breast cancer patient response to chemotherapy. Further functional study of these pharmacogenomic predictors will extend our understanding of individual drug response and facilitate personalized treatment.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-08-02.

Abstract P2-09-10: Feasibility Assessment of Pharmacogenomic Predictors Developed from Breast Cancer Cell Lines To Predict Breast Cancer Patient Pathological Response in Neoadjuvant Chemotherapy

Background: Studies of developing pharmacogenomic predictors from cancer cell lines to predict cancer patient clinical response and outcome to chemotherapy have yielded both positive and negative results. The variability in these results may arise from the noise inherent of microarray technology as well as the small sample size of in cell line studies. Therefore, it is greatly needed to evaluate the feasibility of using cell lines to develop pharmacogenomic predictors of patient pathological response. Material and Methods: Thirty breast cancer cell lines were exposed to 10 concentrations of paclitaxel-5-fluorouracil-doxorubicin-cyclophosphamide (TFAC) to measure in vitro chemosensitivity. Two independent and publicly available microarray datasets (Hoeflich and Neve) on these breast cancer cell lines together with the chemosensitivity results were used to identify pharmacogenomic predictors from each dataset. Two independent clinical trials (Hess and Popovici) with publically available data, having 130 and 100 patients respectively, were used as test sets to validate the accuracy of the pharmacogenomic predictors. All patients received TFAC as neoadjuvant therapy and the gene expression profiles of patients were assessed before receiving chemotherapy treatment. The patient's pathological complete response (pCR) was determined after treatment to evaluate the chemotherapy efficacy.

The pharmacogenomic predictors developed from each of the cell line studies were evaluated for their ability to predict patient pCR in each of the clinical trials using the supervised principle component regression method.

Results: The pharmacogenomic predictors identified from the Hoeflich and Neve cell line data (training sets) predicted pCR of the patients in the two clinical trials (test sets) with 64%-68% accuracy, 70%-87% sensitivity, and 60%-67% specificity when 100 genes were selected as pharmacogenomic predictors (Table 1).

Conclusions: The four independent prediction results generated in this study demonstrate the feasibility of using breast cancer cell lines to identify pharmacogenomic predictors of response to chemotherapy treatment for breast cancer patients. Future studies will examine the use of drug responses from primary cultures of patient tumors to develop pharmacogenomic predictors of breast cancer patient responses to chemotherapy treatment.

Table 1. Prediction of breast cancer patients’ pCR by pharmacogenomic predictors derived from breast cancer cell lines.

Diffusion-Weighted MRI in Predicting the Efficacy of Neoadjuvant Chemotherapy of Breast Cancer

Objective: To approach the apparent diffusion coefficient(ADC) obtained on diffusion weighted imaging (DWI) in predicting the response of breast cancer to neoadjuvant chemotherapy.Methods: 53 locally advanced breast cancer patients participated in this prospective study on neoadjuvant chemotherapy. All patients were treated with weekly neoadjuvant paclitaxel plus carboplatin for 4 cycles. DWI and ADC value were examined before chemotherapy(the first time point), after the first and the forth cycle of chemotherapy(the second and the third time point). Patients were categorized as high responders if their ADC at the second time point were higher by 2 times the standard deviation than the mean pre-chemotherapy ADC, and otherwise the patients were considered as low responders. Logistic regression was conducted to examine the independent factors predictive of clinical complete response(CR) and pathologic complete response(pCR).Results: CR was documented in 13 patients (24.5%); partial response in 36 patients (67.9%); stable disease in 4 patients (7.5%) and no patient had progressive disease. 11 patients(20.8%) have achieved pCR. There was a strong positive correlation between the percentage changes in ADC value at the third time points and the degree of the tumor reduction. A significant increase in ADC value was observed at the second time point compared with the first time point (1.104±0.117×10-3mm2/s, 1.220±0.158×10-3mm2/s, P&lt;0.001), while the decrease of the longest diameter of the tumors measured by physical examination, ultrasound or MRI or the tumor volumn measured by MRI were not (P&gt;0.05). Logistic regression revealed that percentage changes of ADC value at the second time point were significantly associated with CR(P=0.022, hazard ratio[HR] =1.08, 95% confidence interval[CI]: 1.01∼1.16) and pCR(P=0.022, HR =1.11, 95%CI: 1.02∼1.21). The AUC value of the receiver operating characteristic curve were 0.721(95%CI: 0.512∼0.931, P=0.017) and 0.775(95%CI: 0.598∼0.952, P=0.005) in the two diagnostic tests for CR and pCR, and the sensitivity and specificity were 76.9%, 63.6% and 77.5%, 90.5%, respectively. According to categorizing system described above, 10 patients(18.9%) were considered as high responders and 43 patients(81.1%) low responders. 7 patients(70%) of the high responders have achieved clinical CR and pCR while for the low responders there were only 6 patients(14.0%) and 4 patients (9.3%) proven to have CR and pCR. The difference have both reached statistical significance(P=0.001, P&lt;0.001). Logistic regression confirmed that the categorizing system was independently predictive of CR(P=0.006, HR=42.26, 95%CI: 2.86∼624.08) and pCR(P=0.013, HR=25.19, 95%CI: 2.00∼318.91). Taking this categorizing system as a dignostic test, the sensitivity and specificity were 53.8% and 92.5% for CR and 63.6% and 92.9% for pCR, respectively.Conclusions: The change of ADC value obtained on DWI after the first cycle of neoadjuvant chemotherapy occured prior to the morphologic changes of the tumor and at this time ADC value could to some extent predict the efficacy of neoadjuvant chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4025.

Estrogen Receptor Expression: Possible Predictor of Pathological Complete Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients

BackgroundEstrogen receptor(ER) status has been found to correlate inversely to pathologic complete response (pCR) rates of neoadjuvant chemotherapy(NAC) of breast cancer. However, not all ER-positive breast cancer respond equally to NAC. The present study aimed to determine the relationship between different ER expression level with pCR in locally advanced breast cancer(LABC) patients who have received NAC.MethodsA retrospective study of 332 female unilateral LABC patients undergoing NAC was performed. All patients were confirmed as invasive breast cancer before treated with NAC, including VE (vinorelbine, epirubicin), CEF (cyclophosphamide, epirubicin, fluorouracil) and PCb regimen (paclitaxel, carboplatin). All patients underwent radical surgery and pCR was defined as the absence of invasive breast cancer in both breast and axillary lymph nodes. ER status were checked using the established immunohistochemical(IHC) method and defined as negative, weakly positive(1+), medium positive(2+) and strongly positive(3+). Binary logistic regression was performed to determine the independent predictors of pCR.ResultsER negativity, 1+, 2+ and 3+ were found in 156, 108, 37 and 31 patients, of which 42(26.9%), 21(19.4%), 3(8.1%) and 1 patients(3.2%) have achieved pCR. Binary logistic regression showed that different ER expression level(P=0.021) and HER2 status(P=0.007, hazard ratio[HR] =2.557, 95% confidence interval[CI]: 1.297∼5.038) were significantly associated with the pCR rates. pCR was much more likely to occur in patients with ER-negative(P=0.024, HR =13.119, 95% CI: 1.402∼122.774) or ER 1+(P=0.025, HR=12.928, 95% CI: 1.388∼120.390) tumors than those with ER 3+ tumors.ConclusionER weekly positive patients also gain considerable benefit from NAC, which is probably less effective in ER strongly positive patients in terms of pCR.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1104.

Prediction of Response to Paclitaxel by ChemoFx assay Correlates with Estrogen Receptor Status and Changes in Apoptosis Pathway in Human Breast Cancers

Background: Paclitaxel belongs to the taxane family of therapeutics, which have emerged as critically important drugs for breast cancer treatment. In addition to inhibiting cell growth by interfering with microtubule disassembly, its mechanism of action also includes induction of apoptosis. Recent studies suggest that besides being a key predictor for endocrine therapy response, Estrogen Receptor (ER) status also influences sensitivity of breast cancer to paclitaxel, with ER negative tumors being more responsive to the drug.Methods: The ChemoFx live cell chemoresponse assay was performed on 25 breast cancer cell lines (10 ER+ and 15 ER-). These cells were treated with a range of 10 doses of paclitaxel for 72 hours before DAPI staining of nuclei and counting. AUC (Area Under Curve) values were calculated and additional statistical analysis was performed on the resulting dose-response curves. Differential gene expression analysis was conducted to compare ER+ (n=82) and ER- (n=51) breast cancer patients using a public Microarray database. In addition, 2 of the 25 breast cancer cell lines, T47D (ER+) and SKBR3 (ER-), were treated with paclitaxel, lysed, and analyzed with Western blotting to detect cleaved caspase-3 and cleaved PARP expression, with beta-actin employed as a normal control.Results: The ChemoFx assay results revealed that none of the ER+ cells were categorized as R (responsive) to paclitaxel, with seven NR (non-responsive) and one IR (intermediate responsive). On the contrary, of the 15 ER- cell lines, three were categorized as R, only four were categorized as NR, and eight were categorized as IR. Statistical analysis suggested that paclitaxel responsiveness based on ChemoFx assay correlates with ER status (Chi-square test, p&lt;0.05), with ER- breast tumors being more responsive to paclitaxel. Microarray analysis revealed differential expressions of genes implicated in the apoptosis pathway (q&lt; 0.05) in ER+ and ER- breast cancers. Western blot analysis showed that paclitaxel induced cleaved caspase-3 and cleaved PARP expressions, both of which are indicators of activation of apoptosis, in SKBR3 cells (ER-), but not in T47D cells (ER+).Conclusions: ER status appears to predict in part, the response of breast cancer cells to paclitaxel as determined by the ChemoFx assay. ER-negative breast cancer cells are more likely to be responsive, which is consistent with established clinical findings. Our assay also distinguishes between NR/IR and R to paclitaxel within the ER- population. Similar ChemoFx assays are being performed on primary cultures from ER+ and ER- breast cancer patient specimens. Results from RNA microarray and Western blot analyses indicate that differences in gene expression in the apoptosis pathway, and in activation of apoptosis pathway, namely changes in expressions of cleaved PARP and cleaved caspase-3 in response to paclitaxel, may explain differences in the responsiveness of ER+ and ER- breast cancers to paclitaxel. This also suggests a potential role of cleaved PARP and cleaved caspase-3 as biomarkers in addition to ER for prediction of paclitaxel responsiveness in breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2028.

Medical treatment of craniosynostosis: recombinant Noggin inhibits coronal suture closure in the rat craniosynostosis model

INTRODUCTION - The mechanisms underlying craniosynostosis remains unknown. However, mutations in FGFR2 are associated with craniosynostotic syndromes. We previously compared gene expression patterns of patent and synostosing coronal sutures in the nude rat and demonstrated down regulation of Noggin in synostosing sutures. Noggin expression is also suppressed by FGF2 and constitutive FGFR2 signaling [Warren et al. (2003) Nature, vol. 422, pp. 625-9; McMahon et al. (1998) Genes Dev, vol. 12, pp. 1438-52]. Thus, we therefore hypothesized that the addition of rhNoggin to prematurely fusing sutures should prevent synostosis. MATERIALS AND METHODS - Cohorts of nude rats were subjected to: 1) surgical elevation of the coronal suture (shams); 2) surgical elevation and placement of normal or FGFR2 mutant human osteoblasts onto the underlying dura (xenotransplants); or 3) xenotransplantation with co-application of heparin acrylic beads soaked with recombinant human (rh) Noggin. Eleven days post-surgery the sutures were harvested, stained, and histologically examined. RESULTS - Animals that received control osteoblasts, sham surgery, or no surgery demonstrated normal skull growth and coronal suture histology, whereas animals transplanted only with FGFR2 mutant osteoblasts showed evidence of bridging synostosis on the calvarial dural surface. Sutures treated with FGFR2 mutant osteoblasts and rhNoggin remained patent. CONCLUSION - The chimeric nude rate model is a viable model of craniosynostosis. FGFR2 mutations in osteoblasts induce bridging osteosynthesis demonstrating one of the mechanisms for premature suture fusion. Topical application of rhNoggin protein prevents craniosynostosis in the weanling nude rat xenotransplantation model of syndromic craniosynostosis.

Postsurgical drainage and the risk of breast cancer recurrence in Chinese breast cancer patients

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Background: Clinical investigations suggest that while primary breast cancer surgical removal favorably modifiers the natural history of breast cancer. Postoperative drainage, a surgery-derived discharge after breast cancer surgery, reflecting some biological features of surgical stimulation, was assessed and explored its relationship with breast cancer recurrence in this study. Methods: A total of 1445 women undergoing surgery between Jan 1, 2000 and Dec31, 2002 in Cancer Hospital of Fudan University, Shanghai, China was retrospectively studied. Survival curves were performed with Kaplan-Meier method and the predictive value of postsurgical drainage was estimated using proportional Cox regression model. Conclusions: The larger drainage volume POD 1 is a useful marker, suggesting a greater stimulation to surgical treatment compared to the lower ones. Awareness of the relationship between early surgery-stimulated effects and harmful wound healing response might help to explore new strategies to block or deplete these harmful effects, resulting in improving patients' survival.

No significant financial relationships to disclose.

Demographic features and prognostic profiles of breast cancer patients presenting with nipple discharge in Chinese population

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Background: Breast cancer patients with nipple discharge (ND) may constitute a distinct clinical entity compared to those without ND, which has not been well elucidated in previous reports. We sought to analyze the demographic features and prognostic profiles of breast cancer patients presenting with nipple discharge in Chinese population. Methods: A total of 3234 patients, categorized as ND (2.47%) and non-nipple discharge (NND; 97.53%) according to different initial signs, were retrospectively analyzed. Survival curves were performed with Kaplan-Meier method and annual recurrence hazard was estimated by hazard function. Results: ND group tended to have smaller tumors and less axillary lymph node (ALN) involvement than NND group (P < 0.05). In the univariate analysis, we found significantly different recurrence-free survivals (RFS) between subgroups (P = 0.0182), with the rate of 77.78% for ND group and 72.46% for the other at the 11th year respectively. In Cox proportional hazards regression analysis, we found that tumor size (P < 0.001), ALN status (P < 0.001) were independent prognostic factors for RFS. To further evaluate whether prognostic effect of ND status remained unabated over time, the test for lack of proportionality was performed. However, it was statistically significant (global test, P = 0.039), which hinted at a demand for the employment of Cox non-proportional hazards regression in this analysis. In time dependent Cox model, ND status (P = 0.0495) as well as ERBB2 status (P = 0.017), tumor size (P < 0.001), ALN status (P < 0.001) were independent prognostic factors when ND and ERBB2 status were taken as time-varying covariates. Annual hazard rates for recurrence remained lower on ND group until approximately 4.5 years after surgery, while the situation was just the opposite thereafter. Conclusions: Our findings suggested that demographic features and prognostic profiles were quite different between breast cancers presenting with and without ND in Chinese population, which may indirectly uncover distinct biological behaviors and potentially enlighten novel therapeutic approaches for patients with different initial signs.

No significant financial relationships to disclose.

Luminal group may give more benefit for invasive micropapillary carcinoma component breast cancer patients: experience from Cancer Hospital Fudan University

Abstract #6152

Objective: Comparative studies on clinical features and outcomes of very rare invasive micropapillary carcinoma of breast cancer of 4 subtypes by immunohistochemistry staining.&#x2028; Methods: From Aug 2005 to Mar 2008, a total of 52 breast cancer patients(BCPs) with an invasive micropapillary component (IMPC) among 1951 Chinese BCPs with complete of clinicopathologic data in our institution were enrolled into a retrospective analysis. We characterized all these 52 patients and analyzed using various parameters.&#x2028; Results: The 52 cases of breast carcinoma with an IMPC all occurred in women. Mean age was 51 years (range from 26-82). All of these patients had breast masses; one also had metastasis to the supraclavicular lymph node at the time of diagnosis., mean tumor size was 2.83cm(T2), 23.08%(12/52) was pure invasive micropapillary carcinoma, and lymph node positive percentage was 75.59 %( 36/51).Fifty one patients received surgery, while one of them lost the chance of surgery. Forty of them received the modified mastectomy while one was performed lumpectomy due to old age. One was performed LAND alone and four were performed lumpectomy and sentinel lymph node biopsy.&#x2028; By using IHC staining, when we regard HER2/neu 0 and +as negative. The Luminal A group, Luminal B, trip-negative, HER2+ /ER- were 76.92% (40/52), 11.54 %( 6/52), 7.69 %( 4/52), 3.85 %( 2/52), respectively. Compared to the database of 2005 breast cancer carcinoma in our institution, there was more Luminal A group patients than the whole group (P=0.01, chi-square test.), more Luminal B (P=0.028, Fisher exact possibility test), less trip-negative group (P=0.001, chi-square test). The positive lymph node among the Luminal A group, Luminal B, trip-negative, HER2+ /ER- were 65%,80%, 100%, 100%, respectively, while the lymphvascular invasion were 55%,33.33%,50%,50%,respectively, Mulifocality in Luminal A was 25% , 16.67% in Luminal B , while 50% in both trip-negative and HER2+/ER-.&#x2028; Twenty-one of them received both anthracyclines and Taxane, while 27 only received anthracyclines, Four patients only were received only AIs due to old age. All the luminal group patients received endrocine therapy after chemo. After nearly 14 months (2∼34 months) follow up, thirty-six women were disease free, one had local recurrence, and 1 had lung metastasis, while 1 had ovary carcinoma when the diagnosis of breast malignant, one patient lost following up due to mental disorder. Among the luminal B, one had metastasis when diagnosis, others were disease free. One woman of the trip-negative died of non-breast cancer disease,the HER2+/ER- group was no recurrence or metastasis.&#x2028; Discussion: The prelimary results showed that more luminal group in the IMPC may get benefit from the endocrine therapy. However the number of these cases is small and follow-up time is not very long, further studies are necessary to explain these rare and unique pattern of invasive carcinoma.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6152.

Time distributions and prognosis factors of breast cancer recurrence in different sites after operation

Abstract #2080

Objective Our study aims to analyze the breast caner patients with different sites of recurrence, and to have knowledge of the regular patterns and influence factors of metastastic breast cancer.&#x2028; Methods We performed a retrospective study of 210 female breast cancer patients who were continuously followed up in our hospital from January 2005 to May 2007 and had complete data of metastasis. The clinical and biological characteristics were compared between the patients with organ metastases (lung, liver, brain) and non-viscera metastases (lymph node, bone).&#x2028; Results Cox regression analysis-hazard function showed that patients with elder age (RR=0.927 95%CI 0.877∼0.981, P=0.008) and HER-2 negative(RR=0.253 95%CI 0.076∼0.836, P=0.024)tended to develop non-viscera metastases, while patients with larger tumors (RR=3.832 95%CI 1.073∼13.687, P=0.039) tended to develop organ metastasesp.&#x2028; &#x2028; When stratified by the prognostic factors, the annual risk hazard curve of the patients with high risk of recurrence had double peaks at the second year and the ninth years after mastectomy respectively, and it was significantly higher than those of the patients with middle and low risk.[figure1]Annual risk hazard curves of both local relapse and metastasis also showed a double-peaked pattern. The curves for lymph node, bone, lung and liver metastasis showed a similar pattern, but all the peaks of curve emerged later than that of the local relapse.&#x2028; &#x2028; Conclusion Patients with different clinical and biological characteristics may develop recurrence in different sites. There are certain regular patterns of time distribution for different metastasis sites after mastectomy. The local recurrence may be the foreboding for the metastasis and we should pay attention to the local relapse signs especially in the patients with high risk.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2080.

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A comparison of tumor characteristics between ER+/PR+ and ER+/PR- breast tumors in Chinese women

21097

Background: Although breast caner patients with any one of the two sex hormone receptors positive can be treated with endocrine therapy, many clinical data showed that there was different response to endocrine therapy for patients with ER+/PR+ and with ER+/PR- tumors. The aim of this study was to find out the factors related to PR expression by comparing the ER+/PR+ tumors and ER+/PR- tumors clinically and biologically. Methods: Between January 1990 to August 2006, 5,191 female breast cancer patients with known ER/PR expression status who received operation in our hospital were enrolled onto this retrospective study. Clinical and biological features of 2,227 patients with ER+/PR+ tumors were compared with those of 909 patients with ER+/PR- tumors. χ2 test was used for univariate analysis and logistic regression for multivariate analysis. Disease-free survival (DFS) and overall survival (OS) was calculated using Kaplan-Meier analyses, and all statistical tests were two-sided. Results: The peak onset age of patients with ER+/PR+ tumors and ER+/PR- tumors was 50, and it was significantly higher than that of patients with ER- tumors, which is 48(P=0.001). Univariate analysis showed that ER+/PR- tumors were larger in size, had more lymph nodes of metastasis, were higher in tumor grade than ER+/PR+ tumors. Furthermore, the expression of ER and CathepsinD was significantly lower, and CerbB-2 expression was higher in ER+/PR- tumors than in ER+/PR+ tumors. Multivariate analysis indicated that positive PR expression was associated with the level of ER(OR=1.792, P=0.000), CathepsinD(OR=1.380, P=0.035)and CerbB-2(OR=0.639, P=0.007). DFS(P=0.004) and OS(P=0.009) were higher among patients with PR-expressing tumors than with PR- negative tumors. Conclusions: ER+/PR+ tumors and ER+/PR- tumors may have the same etiology which is different from that of ER- tumors. Because of low ER level and changes of the expression of CerbB-2 and CathepsinD, the tumors that lacked PR expression display more aggressive features and have worse prognosis. According to these differences, new target of therapy and endocrine regimen may provide the possibility of improving the response and prognosis of endocrine therapy for patients with ER+/PR- tumors.

No significant financial relationships to disclose.

The rule of mortality risk in young women (≤35 years) with primary breast cancer

21098

Background: The prognosis of young women (=35 years) is poorer than that of women over 35 years, which may indicate that they bear different biologic characteristics. However, such data is still not available at home and abroad as the rule of mortality risk in young women and its distinction from that in women over 35 years. We sought to investigate the clinical characteristics, prognosis and the rule of mortality risk in young women (=35 years) with primary breast cancer. Methods: We performed a retrospective study of 2331 female unilateral breast cancer patients undergoing surgery in our hospital from January 1990 to October 2005.They were divided into two groups with the cut-off of 35 years. Selection criteria included complete data on the following: age, tumor size, axillary nodal status, estrogen receptor (ER) status, menopausal status.Overall survival curve was estimated by Kaplan-Meier method and annual mortality hazard by hazard function. Their clinicopathologic indices, overall survival curve and annual mortality hazard were analyzed. Results: There was statistical significance between =35 years and >35 years group in terms of tumor size( P =0.0231), axillary nodal status( P <0.001) and estrogen receptor status( P =0.064). 10-year overall survival was 72% and 79% ( P = 0.0081), respectively, for =35 years and >35 years group. Although annual mortality hazard curve for both groups showed double-peaked pattern, there also exist some differences. Mortality surges for =35 years patients appeared earlier than those for >35 years counterparts. Moreover, =35 years group showed a minor increase between double peaks, which cannot be found in >35 years group. Conclusions: Between the two groups, different tumor biology leads to the discrepancy of overall survival and mortality pattern, which might indicate distinct principles and measures in the follow-up and treatment for young patients to provide the possibility of improving the therapeutic effect and reducing the mortality hazard.

No significant financial relationships to disclose.

Genetic variability of group A and B human respiratory syncytial viruses isolated from 3 provinces in China

The genetic variability of HRSV in China was studied using nucleotide sequencing of the hypervariable C-terminal region of the G protein gene and phylogenetic analysis on 80 isolates obtained from three children's hospitals over a period of three epidemic seasons, 1990/1991, 2000/2001, and 2003/2004. The results showed that 76/80 of these isolates belonged to group A and 4/80 belonged to group B. Phylogenetic analysis revealed that most of the group A isolates were genotype GA2 (74/76 isolates), and the other two isolates were GA3 and GA5. All group B isolates clustered into genotype GB3. There was substantial variation among the GA2 isolates, with nucleotide sequence and amino acid homologies ranging from 88.1-100% and 78.4-100%, respectively, in the hypervariable C-terminal region of the G protein gene. One group B virus, HRSV/Beijing/B/04/11, contained a 60-nucleotide duplication in the C-terminal region of the G protein, which was similar to what has been reported previously for isolates in several countries. This is the first report on the genetic diversity of human respiratory syncytial virus isolated during epidemic periods from children in China. These data provided a preliminary evaluation of patterns of circulation and the genetic diversity of isolates associated with HRSV epidemics within China.

Key Feature Extraction for Fatigue Identification using Random Forests

Electroencephalogram (EEG) might be the most predictive and reliable physiological indicator of mental fatigue. However, the extraction of key features from massive EEG data for mental fatigue identification remains a challenge. The objective of this study is to identify the key EEG features in relationship to mental fatigue, from a broad pool of EEG features generated by quantitative EEG (qEEG) techniques, using Random Forests (RF), which is a recently developed machine learning algorithm. The method is applied to key EEG feature extraction for 5-level mental fatigue identification using the five subjects' EEG data recorded in 25-hour fatigue experiments. RF produces significant feature reduction with little compromise of the classification performance. The identified key EEG features also indicate that electrode locations in frontal and occipital regions of the brain are most important for adequate representation of the deactivation of functional lobes of the brain, which is consistent with the anatomical areas known to be involved in mental fatigue. It is also interesting to discover that the four frequency bands are all important for the mental fatigue identification.

Phenotypic characterization of Streptococcus pneumoniae biofilm development

Streptococcus pneumoniae is among the most common pathogens associated with chronic otitis media with effusion, which has been hypothesized to be a biofilm disease. S. pneumoniae has been shown to form biofilms, however, little is known about the developmental process, the architecture, and the changes that occur upon biofilm development. In the current study we made use of a continuous-culture biofilm system to characterize biofilm development of 14 different S. pneumoniae strains representing at least 10 unique serotypes. The biofilm development process was found to occur in three distinct stages, including initial attachment, cluster formation, and biofilm maturation. While all 14 pneumococcal strains displayed similar developmental stages, the mature biofilm architecture differed significantly among the serotypes tested. Overall, three biofilm architectural groups were detected based on biomass, biofilm thickness, and cluster size. The biofilm viable cell counts and total protein concentration increased steadily over the course of biofilm development, reaching approximately 8 x 10(8) cells and approximately 15 mg of protein per biofilm after 9 days of biofilm growth. Proteomic analysis confirmed the presence of distinct biofilm developmental stages by the detection of multiple phenotypes over the course of biofilm development. The biofilm development process was found to correlate not only with differential production of proteins but also with a dramatic increase in the number of detectable proteins, indicating that biofilm formation by S. pneumoniae may be a far more complex process than previously anticipated. Protein identification revealed that proteins involved in virulence, adhesion, and resistance were more abundant under biofilm growth conditions. A possible role of the identified proteins in biofilm formation is discussed.

NMR spectroscopy of hydrogen adsorption on single-walled carbon nanotubes after exposure to high pressure

Hydrogen storage properties of single-walled carbon nanotubes (CNTs) after exposure to a pressure of 14.3 MPa are studied by (1)H nuclear magnetic resonance spectroscopy. The nanotubes were carefully pre-characterized using inductively coupled plasma mass spectrometry (ICP-MS), transmission electron microscopy (TEM), and Raman spectroscopy. We have shown previously that at ambient temperature in the pressure range from 0 to 1.5 MPa, hydrogen adsorption is fast and reversible and must be described as physisorption. However, exposure to a much higher pressure (14.3 MPa) of hydrogen leads to slower desorption kinetics where longer exposure causes greater hydrogen uptake. Our data suggest that interstitial sites and the tube interior may be identified as these strong adsorption sites.

Media remodeling – the result of stent induced media necrosis and repair

Background: Stents have been introduced clinically to help maintaining the patency of the vascular lumen after balloon angioplasty. To ensure a sufficient lumen of the stented vessel, oversized stents are frequently used. However especially deployment of oversized stents may lead to mechanical injury of the intima and media of the vessel wall. The aim of the study was to characterize the vascular lesions and repair processes within the first 4 weeks after implantation of oversized stents in the rabbit carotid artery and thereby contribute to the understanding of vascular remodeling during stent implantation. Methods: Oversized stents were implanted in the carotid artery of Chinchilla rabbits. Rabbits were sacrificed 3, 7, 14, and 28 days after stent implantation and a detailed histologic and immunohistochemical analysis was performed. Results: The carotid artery was expanded by a factor of 1.3–1.5, leading to a constant dilatation of the vessel. The struts were deeply impressed in the vessel wall, resulting in a disruption of the intima, thrombus formation, media compression and segmental media necrosis. The necrotic media was repopulated by smooth muscle cells by day 7. In contrast to the intima lesions, necrotic areas of the media were not invaded by an inflammatory infiltrate. Formation of neointima, characterized by a confluent layer of endothelial cells and deposition collagen fibers started in close vicinity of the struts. Conclusions: Being part of a high-pressure system, the arterial vessel apparently adapts to constant dilatation. Deployment of oversized stents caused intima disruption, media necrosis of varying degree and constant dilatation of the vessel wall. Necrosis and repopulation of smooth muscle cells of the media took place within the first 4 weeks, leading to the speculation whether the repopulating SMC are more resistant to the constant pressure.

Adoptive transfer of donor-derived immunity by liver transplantation: a potential avenue to prevent hepatitis B virus reinfection

Immunity to hepatitis B has been successfully transferred by bone marrow transplantation, but has also occurred after liver transplantation (LTx). This study was designed to analyse the influence of alloreactivity and immunosuppression, on the efficacy of adoptive immune transfer to hepatitis B by liver transplantation. Orthotopic LTx (n = 34) were performed in three rat strain combinations representing different genetic constellations. Donors had been vaccinated twice with recombinant hepatitis B surface antigen while recipients were unimmunized. Half of the allogeneic recipients were immunosuppressed with cyclosporin A. All animals were monitored weekly for the presence of anti-hepatitis B surface antibodies (anti-HBs). Effective anti-HBs titres were detected in 85% (29/34) of liver recipients and lasted from 2 to 10 weeks. Donor titre above >15 000 mIU/mL ensured a 100% seroconversion rate in the recipients. The maximal anti-HBs titre in recipients represented 0.06% approximately 0.76% of the donor titre. Rejection reduced the adoptive immune transfer, which was protected by immunosuppression. These observations suggest that transfer of functionally active donor lymphocytes, deriving from the graft, contributed to the donor-derived immune response in the recipient. Further studies to augment the donor-derived immune response are warranted to ensure a therapeutic effect for the recipient at risk of reinfection.

Acquisition of a specific and potent PTP1B inhibitor from a novel combinatorial library and screening procedure

Protein-tyrosine phosphatases (PTPases) form a large family of enzymes that serve as key regulatory components in signal transduction pathways. Defective or inappropriate regulation of PTPase activity leads to aberrant tyrosine phosphorylation, which contributes to the development of many human diseases including cancers and diabetes. For example, recent gene knockout studies in mice identify PTP1B as a promising target for anti-diabetes/obesity drug discovery. Thus, there is intense interest in obtaining specific and potent PTPase inhibitors for biological studies and pharmacological development. However, given the highly conserved nature of the PTPase active site, it is unclear whether selectivity in PTPase inhibition can be achieved. We describe a combinatorial approach that is designed to target both the active site and a unique peripheral site in PTP1B. Compounds that can simultaneously associate with both sites are expected to exhibit enhanced affinity and specificity. We also describe a novel affinity-based high-throughput assay procedure that can be used for PTPase inhibitor screening. The combinatorial library/high-throughput screen protocols furnished a small molecule PTP1B inhibitor that is both potent (K(i) = 2.4 nm) and selective (little or no activity against a panel of phosphatases including Yersinia PTPase, SHP1, SHP2, LAR, HePTP, PTPalpha, CD45, VHR, MKP3, Cdc25A, Stp1, and PP2C). These results demonstrate that it is possible to acquire potent, yet highly selective inhibitors for individual members of the large PTPase family of enzymes.

Early diagnosis and monitoring of active HCMV infection in children with systemic lupus erythematosus

OBJECTIVE

To investigate the prevalence and features of active human cytomegalovirus (HCMV) infection in children with systemic lupus erythematosus (SLE) and evaluate the diagnostic value of the HCMV using antigenemia assay, serum polymerase chain reaction (PCR) and serology test.

METHODS

Twenty-one SLE children undergoing immunosuppressive therapy were enrolled in this study. Immunofluorescence assay, PCR and serology tests were used to determine HCMV pp65 and p72 antigens in leukocytes, HCMV DNA in sera, and HCMV specific IgM and IgG antibodies, respectively. As a control group, twenty-one immunocompetent children with skeletal malformation were involved in this study. Statistical analysis was performed using Chi-square test or Fisher's exact test (Systat, USA), P values less than 0.05 were considered significant.

RESULTS

Active HCMV infection was diagnosed in 28.6% (6/21) of SLE patients, with none in the control group; the difference between the two groups was significant (P = 0.027). Two out of 6 SLE patients developed active HCMV infection before immunosuppressive therapy and the remaining 4 patients developed SLE after immunosuppressive therapy. Among the 21 SLE children, HCMV pp65 antigenemia was detected in 5 patients, p72 antigenemia in 3 patients, serum HCMV DNA in 9 patients, serum HCMV-specific IgM in 2 patients, and IgG in 19 patients. The sensitivity and specificity for diagnosis of active HCMV infection were 83.3% and 100%, respectively for pp65 antigenemia; 50% and 100% for p72 antigenemia; 100% and 80% for serum PCR; 33.3% and 100% for HCMV IgM serology; 50% and 100% for HCMV IgG serology.

CONCLUSIONS

Compared with the control group, active HCMV infection is much more frequent in SLE children, and can occur before treatment with immunosuppressive agents, but most often occur after immunosuppressive therapy. In comparison with the other techniques used in this study, the pp65 antigenemia assay seems to be a better method for the early diagnosis and monitoring of active HCMV infection in children with SLE.