Rituximab, bendamustine, and lenalidomide in patients with aggressive B cell lymphoma not eligible for high-dose chemotherapy or anthracycline-based therapy: phase I results of the SAKK 38/08 trial

This phase I trial was designed to develop a new effective and well-tolerated regimen for patients with aggressive B cell lymphoma not eligible for front-line anthracycline-based chemotherapy or aggressive second-line treatment strategies. The combination of rituximab (375 mg/m(2) on day 1), bendamustine (70 mg/m(2) on days 1 and 2), and lenalidomide was tested with a dose escalation of lenalidomide at three dose levels (10, 15, or 20 mg/day) using a 3 + 3 design. Courses were repeated every 4 weeks. The recommended dose was defined as one level below the dose level identifying ≥2/6 patients with a dose-limiting toxicity (DLT) during the first cycle. Thirteen patients were eligible for analysis. Median age was 77 years. WHO performance status was 0 or 1 in 12 patients. The Charlson Comorbidity Index showed relevant comorbidities in all patients. Two DLTs occurred at the second dose level (15 mg/day) within the first cycle: one patient had prolonged grade 3 neutropenia, and one patient experienced grade 4 cardiac adverse event (myocardial infarction). Additional grade 3 and 4 toxicities were as follows: neutropenia (31 %), thrombocytopenia (23 %), cardiac toxicity (31 %), fatigue (15 %), and rash (15 %). The dose of lenalidomide of 10 mg/day was recommended for a subsequent phase II in combination with rituximab 375 mg/m(2) on day 1 and bendamustine 70 mg/m(2) on days 1 and 2.

Social support and quality of life of patients prior to stem cell or bone marrow transplantation

OBJECTIVES

To determine the positive and detrimental aspects of social support prior to allogeneic or autologous bone marrow transplantation/stem cell transplantation.

DESIGN

Cross-sectional.

METHODS

Patients completed the German version of the Illness-specific Social Support Scale (ISSS) and the Quality of Life (QoL) Questionnaire Core 30 (EORTC QLQ-C30).

RESULTS

Participants were 282 patients (62% autologous SCT, 39% women, 97% haematological malignancies, 72% with partner). We found satisfactory reliability values for both ISSS scales: positive support (Cronbach's alpha=.91) and problematic support (=.73). Patients living with a partner displayed higher scores in positive interaction than patients living alone (p<.001). Analysis showed a significant main effect of partnership, p<.001; F(1)=8.345, and better scores for women, p<1; F(1)=2.758. Furthermore, we determined a negative correlation between problematic interaction and emotional/social function (p<.001) and a positive correlation with insomnia, but no correlation between positive interaction, QLQ-C30, and Karnofsky's index.

CONCLUSIONS

We could distinguish between helpful and harmful support, and determine clinically important associations of problematic support. Partnership seems to be a major source of positive interaction.

By-passing in vitro screening--next generation sequencing technologies applied to antibody display and in silico candidate selection

In recent years, unprecedented DNA sequencing capacity provided by next generation sequencing (NGS) has revolutionized genomic research. Combining the Illumina sequencing platform and a scFv library designed to confine diversity to both CDR3, >1.9 × 10(7) sequences have been generated. This approach allowed for in depth analysis of the library's diversity, provided sequence information on virtually all scFv during selection for binding to two targets and a global view of these enrichment processes. Using the most frequent heavy chain CDR3 sequences, primers were designed to rescue scFv from the third selection round. Identification, based on sequence frequency, retrieved the most potent scFv and valuable candidates that were missed using classical in vitro screening. Thus, by combining NGS with display technologies, laborious and time consuming upfront screening can be by-passed or complemented and valuable insights into the selection process can be obtained to improve library design and understanding of antibody repertoires.

[Intrathoracic kidneys : review and case report]

Intrathoracic kidneys are rare and are often only diagnosed incidentally. The literature on intrathoracic kidneys in children and adults is reviewed and discussed, focusing on diagnostic procedures and surgical therapy. Additionally, the case of a 35-year-old woman with a relapse of a left-sided intrathoracic kidney after pregnancy is reported. Diagnostic procedures and the surgical management are discussed.

Social and behavioural aspects and their consequences in obese teenagers: importance of family's history

OBJECTIVES

Overweight, the metabolic syndrome and accompanying diseases are dramatically increasing problems. We investigated social and behavioral variables that influence overweight in adolescents and tested their influence on plasma markers related to diabetes and endothelial dysfunction.

METHODS

79 male adolescents were enrolled (age 13-17 years). Endothelial progenitor cells were counted by flow cytometry. Adiponectin and soluble E-selectin (sEselectin) were determined by ELISA.

RESULTS

Body weight differs significantly if the family's history was positive for arterial hypertension (p < 0.001), diabetes (p < 0.001), hypercholesterolemia (p<0.001), and coronary artery disease (CAD, p < 0.01). The hours of physical activity represent a predictor of BMI in linear regression analysis (p < 0.001; R(2) = 0.195). Markers for endothelial damage are altered in adolescents with positive family history for hyperlipidemia and CAD.

CONCLUSION

The family's history is an important variable influencing the body weight of teenagers. Via obesity and independently, it influences the early development of endothelial damage. It might serve to detect teenagers at risk for appropriate intervention.