Cytomegalovirus-specific T cells are primed early after cord blood transplant but fail to control virus in vivo

A disadvantage of umbilical cord blood transplantation (UCBT) is the delay in immune reconstitution, placing patients at increased risk for infections after transplant. Cytomegalovirus (CMV) in particular has been shown to cause significant morbidity in patients undergoing UCBT. Here, we comprehensively evaluate the development of CD4(+) and CD8(+) T-cell responses to CMV in a cohort of patients that underwent double UCBT. Our findings demonstrate conclusively that a diverse polyclonal CMV-specific T-cell response derived from the UCB graft is primed to viral antigens as early as day 42 after UCBT, but these T cells fail to achieve sufficient numbers in vivo to control CMV reactivations. This is not due to an inherent inability of UCB-derived T cells to proliferate, as these T cells underwent rapid proliferation in vitro. The TCR diversity and antigen specificity of CMV-specific T cells remained remarkably stable in the first year after transplant, suggesting that later control of virus replication results from improved function of T cells primed early after transplant and not from de novo responses derived from later thymic emigrants. Ex vivo expansion and adoptive transfer of CMV-specific T cells isolated from UCBT recipients early after transplant could augment immunity to CMV.

Abstract OT1-1-09: Opti-HER HEART: A prospective, multicenter, single-arm, phase II study to evaluate the safety of neoadjuvant liposomal doxorubicin plus paclitaxel, trastuzumab, and pertuzumab in patients with operable HER2-positive breast cancer

Background: In recent years, the concomitant use of two anti-HER2 therapies has been generating great expectations. Of note, despite the high activity reported by several studies, none has ever included a chemotherapeutic regimen with anthracyclines. The therapeutic value of anthracyclines in HER2-positive breast cancer (BC) has been well established. However, the feasibility of their combination with trastuzumab is still controversial. Liposomal anthracyclines, on the other hand, may offer a safer alternative. Of note, in our institutional experience using a regimen of liposomal doxorubicin plus weekly paclitaxel and trastuzumab as standard neoadjuvant therapy for stage II-III breast cancer (BC) patients reach a pathological complete response (pCR) rate of 65%, without any grade 3/4 cardiac toxicity.

Trial Design: This study seeks to optimize the treatment of patients with operable HER2-positive BC, while minimizing cardiac risk, by combining dual anti-HER2 blockade plus a taxane and a liposomal anthracycline. In this single-arm, phase II clinical trial, patients will receive neoadjuvant therapy for six 21-day cycles. Regimen consists of: trastuzumab 4 mg/kg loading dose on Day 1 of Cycle 1, then 2 mg/kg on Days 8 and 15 and on Days 1, 8, and 15 of subsequent cycles; pertuzumab 840 mg loading dose on Day 1 of Cycle 1, then 420 mg on Day 1 of the following cycles; liposome-encapsulated doxorubicin 50 mg/m2 on Day 1 of each cycle; and, paclitaxel 80 mg/m2 on Days 1, 8, and 15 of each cycle. ECG will be performed at baseline and every planned visit. Left ventricular ejection fraction (LVEF) decline will be assessed at baseline, weeks 6 and 12, before surgery, and every 3 months thereafter during the adjuvant period, for a total of 12 months. In order to assess biomarkers of cardiac injury, blood samples will be collected at the same time points. An initial safety run-in phase is included, in which the first ten enrolled patients undergo an intensified safety monitoring for cardiac and hematological adverse events.

Eligibility: Female patients 18–74 years old with primary HER2-positive invasive breast cancer eligible for definitive surgery, with adequate cardiac function.

Specific aims: The primary objective is to assess cardiac safety, measured by the incidence of symptomatic cardiac events and by asymptomatic LVEF decline. Secondary objectives include efficacy, breast conservation rate, additional safety and tolerability, and predictive biomarkers of cardiotoxicity.

Statistical methods: Assuming that the incidences of cardiac events with regimens containing anti-HER2 agents are 3% for symptomatic and 15% for asymptomatic, 83 patients will be required to reject the null hypothesis with 80% confidence. Additionally, efficacy will be evaluated by pCR rates.

Target accrual: Recruitment started in September 2012 and will include 83 patients across 20 sites in Spain. Trastuzumab and pertuzumab are kindly provided by Roche. The trial is supported by a grant from TEVA.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr OT1-1-09.

Incidence and predictors of ovarian function recovery (OFR) in breast cancer (BC) patients with chemotherapy-induced amenorrhea (CIA) who switched from tamoxifen to exemestane

BACKGROUND

Aromatase inhibitors (AIs) may promote ovarian function recovery (OFR). True incidence, predictors and impact on the outcome of OFR are unknown.

PATIENTS AND METHODS

We carried out a prospective study to assess ovarian function in estrogen receptor (ER)-positive BC patients on tamoxifen who had at least 2 years of chemotherapy-induced amenorrhea (CIA) and postmenopausal E2 levels. Patients switched to exemestane and underwent a series of investigations including vaginal ultrasound, antimullerian hormone, follicle stimulating hormone (FSH), and E2. E2 measurements were made using a clinical assay (direct) and a highly sensitive (indirect) immunoassay for comparison.

RESULTS

Both E2 assays (indirect versus direct) showed a similar incidence of OFR 32% (95% CI 19.5-44.5) versus 30% (95% CI 17.7-42.3) and median time to OFR 5.4 months (95% CI 1.2-9.6) versus 6.0 months (95% CI 4.8-7.1).On multivariate analysis, the mean age at the start of exemestane treatment was the only marker associated with probability of OFR (OR: 0.44, 0.24-0.78; P = 0.006). According to a receiver operating characteristic (ROC) analysis, age <48 years predicted for OFR (sensitivity: 59%; 1-specificity: 17%; AUC: 0.796; P = 0.001). Patients with OFR had higher mean E2 levels (43.6 versus 5.76 pmol/l; P = 0.001) and a reduced disease-free survival [DFS; HR 9.3 (95% CI 3.3-48.0; P = 0.04)] than those without it.

CONCLUSION

Even with a clinical and biochemical profile compatible with menopause, switching from tamoxifen to an AI should be avoided in patients <48 with CIA.

Migraine-triggered hemifacial spasm: three new cases

BACKGROUND

The occurrence of hemifacial spasm (HFS) during an episode of migraine has been seldom reported. Here we describe three new cases presenting with HFS in association with migraine attacks.

CASE RESULTS

Three patients (one woman and two men, aged 31-36 years) developed HFS in close temporal relationship with migraine headaches. All of them started having the muscle spasms after pain onset. Two of them had electromyographic evidence of facial nerve damage, and continued having HFS once the pain abated.

CONCLUSIONS

Migraine attacks may be associated with HFS. The appearance of HFS could be related to migraine activity. A mechanism of central hyperexcitability in connection with nociceptive inputs on the trigeminal nucleus caudalis and/or a dilation of vessels compressing the facial nerve at the root exit zone could lead to the development of HFS in predisposed patients. 'Migraine-triggered hemifacial spasm' could possibly be regarded as a complication of migraine.

Effects of terutroban, a thromboxane/prostaglandin endoperoxide receptor antagonist, on retinal vascularity in diabetic rats

BACKGROUND

The aim of the present study is to investigate the effectiveness of terutroban, a selective antagonist of the thromboxane/prostaglandin endoperoxide receptor, in preventing retinal ischaemia in a model of diabetes in rats.

METHODS

Experimental diabetes was induced with streptozotocin. Rats were distributed into five groups (n = 20): (1) non-diabetic rats, (2) rats with diabetes (DR) treated with vehicle, (3) DR treated with aspirin (2 mg/kg/day p.o.), (4) DR treated with terutroban (5 mg/kg/day p.o.), (5) DR treated with terutroban (30 mg/kg/day p.o.). The follow-up period was 3 months. The main assessment was the percentage of retinal surface covered with vessels permeable to peroxidase. Platelet aggregation, aortic prostacyclin and nitric oxide production, plasma levels of lipid peroxides (thiobarbituric-acid-reactive substances) and 3-nitrotyrosine and serum levels of IL-6 were evaluated.

RESULTS

Diabetes induced a reduction in retinal vascularity (76.9%), aortic prostacyclin (37.8%) and nitric oxide production (35.0%), and increased platelet aggregation, lipid peroxides, 3-nitrotyrosine. When compared with vehicle-treated DR, terutroban increased the percentage of retinal surface covered by PVPP (38% for terutroban-5 and 61% for terutroban-30), aortic prostacyclin (188% for terutroban-5 and 146% for terutroban-30) and nitric oxide production (320% for terutroban-5 and 390% for terutroban-30). Moreover, terutroban reduced platelet reactivity (27.8–95.1%, according to the inducer), lipid peroxides (60.7% for terutroban-5 and 50.0% for terutroban-30), 3-nitrotyrosine (43.8% for terutroban-5 and 36.8% for terutroban-30) and IL-6 concentration (18.0% for terutroban-30). The effect of terutroban in retinal, nitrosative and aortic parameters was significantly higher than that of aspirin.

CONCLUSIONS

Terutroban significantly protected retinal vascularity from ischaemia in experimental diabetes, and this result could be attributed not only to its antiplatelet/antithrombotic activities but also to its vascular properties.

OT3-01-15: Phase III Trial Evaluating the Addition of Bevacizumab to Endocrine Therapy as First-Line Treatment for Advanced Breast Cancer: The LEA Study

Background

Retrospective clinical data suggest that high vascular endothelial growth factor (VEGF) levels in breast tumors are associated with a decreased response to endocrine therapy. We designed the randomized phase III LEA study of first-line bevacizumab in combination with endocrine therapy, to address the hypothesis that anti-VEGF treatment can prevent resistance to endocrine therapy in patients with advanced breast cancer sensitive to such treatment.

Methods: Postmenopausal patients with evaluable locally recurrent or metastatic breast cancer, HER2−negative- and estrogen receptor (ER)-and/or progesterone receptor (PgR)-positive disease, and eligible to receive hormonal treatment are candidates for this study. Patients are randomized to receive letrozole 2.5mg daily or fulvestrant, 250mg every 4 weeks (Arm A) or the same hormonal therapy plus bevacizumab 15mg/kg every 3 weeks (Arm B). The primary objective is to compare progression-free survival (PFS) between the treatment arms. Secondary endpoints are overall survival, time to treatment failure, overall response rate, response duration, clinical benefit rate and safety. In total, 344 patients (172 in each treatment arm) will be needed to detect a hazard ratio of 0.69 (corresponding to a median PFS of 9 months in Arm A and 13 months in Arm B) with a power of 80% and a two-tailed log-rank test at 0.05. With an expected drop-out rate of 10%, 378 patients will be included. Efficacy analysis will be triggered after 270 events.

Results: Recruitment began in November 2007. To date, 348 patients have been included in the study in Spain (n=244) and Germany (n=104). We anticipate completing recruitment by September 2011. Baseline characteristics of the first 334 randomized patients are shown in the table.

P2-12-17: Prospective Evaluation of the Conversion Rate of HER2, ER and PR between Primary Tumors and Corresponding Metastases. CONVERTHER/GEICAM 2009–03 Study

Introduction: A substantial number of small studies, most retrospective, have shown variable degrees of discordance in HER2, ER and PR expression between primary and metastatic breast cancer. This may have prognostic and therapeutic implications. These discordances could be triggered by tumor somatic mutations, intratumoral heterogeneity, or technical issues with receptor assayes. In this prospective study, we centrally analyzed and determined the changes in receptor status between primary tumor and corresponding metastases.

Methods: In 32 Spanish hospitals, patients where primary tumor sample was available, were prospectively included prior to the biopsy of the presumably metastatic lesion. Determinations of ER and PR status (assessed by immuhistochemistry [IHC]) and HER2 status (IHC and FISH) were centrally and blindly performed in both primary tumor and metastases. Concordance rate between local laboratories and central laboratory receptor determinations were analyzed. We also determined whether the biopsy results modified the oncologist initial treatment strategy.

Results: A total of 236 patients were included. To today, 183 paired cases were centrally evaluated. Patients in first recurrence were 65% and the mean age was 57.2 years. Biopsy samples were taken from locoregional recurrence (25%), liver metastases (28%), bone metastases (11%), lung metastases (7%) and other locations (29%). In 6.6% of the biopsies normal tissue, benign lesion or secondary malignant neoplasm were seen. The changes in HER2, ER and PR were 17%, 26% and 35% (local lab) and 4%, 12% and 26% (central lab), respectively; and were independent of treatment given or biopsy localization. Concordance rate in HER2, ER and PR between local and central determination were 83%, 92% and 78% (kappa index 0.58, 0.80 and 0.55), respectively. Changes in receptor status lead to a modification in medical management in 16% of patients.

Conclusions: A remarkable discordance in receptor status, especially in the hormonal receptors, was found between primary tumor and metastases that implies a change in medical management in 16% of patients. These discordances were reduced but remained after performing in a high-quality central laboratory, so that they could only be partly explained by technical discrepancies in receptor assessments.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-17.

Adefovir serum levels do not differ between responders and nonresponders

Primary or secondary failure of adefovir dipivoxil (ADV) therapy of chronic hepatitis B is not infrequent. The reasons for suboptimal responses are not well defined. In HIV and hepatitis C virus infection, failure of antiviral drug therapy has been linked with low blood drug levels. We have studied 20 well-defined patients with chronic hepatitis B who were treated with ADV for drug and virus kinetics. Importantly, neither Cmax levels (mean 26 ng/mL, range 14-59 ng/mL) nor the time to maximal drug levels (mean 4 h, range 2-8 h) differed between patients showing a complete virological response to adefovir (n = 10), patients with secondary treatment failure (n = 7) and patients with suboptimal primary response (hepatitis B virus-DNA >10,000 IU/mL after 6 months of treatment; n = 3). Thus, adefovir treatment failure is unlikely to be due to an inability to mount sufficient drug levels in the blood.

Lack of enantiomeric influence on the brain cytoprotective effect of ibuprofen and flurbiprofen

R(-) enantiomers of the 2-arylpropionic acid derivatives ibuprofen and flurbiprofen weakly inhibit cyclooxygenase (COX) activity. However, a possible cytoprotective effect has been proposed. The aim of the study is to investigate the possible mechanism of this effect. An in vitro hypoxia-reoxygenation model in rat brain slices was used (n=6 rats per group). After reoxygenation, we measured LDH efflux (neuronal death), brain prostaglandin E(2) (PGE(2)) concentration, interleukins (IL)-1β and 10, oxidative and nitrosative stress (lipid peroxides, glutathione, 3-nitrotyrosine, and nitrites/nitrates). Anti-COX activity was measured in human whole blood. Racemic, R(-), and S(+) enantiomers of ibuprofen and flurbiprofen were tested. All compounds had a cytoprotective effect with IC(50) values in the range of 10(-5) M. R(-) enantiomers did not significantly inhibit brain PGE(2). The concentration of IL-1β was reduced by 53.1% by the racemic form, 30.6% by the S(+) and 43.2% by the R(-) enantiomer of ibuprofen. The IL-10 concentration increased significantly only with S(+)-flurbiprofen (33.1%) and R(-)-flurbiprofen (26.1%). Lipid peroxidation was significantly reduced by all three forms of flurbiprofen. Nitrite + nitrate concentrations were reduced by racemic, S(+), and R(-)-flurbiprofen. Peroxynitrite formation (3-nitrotyrosine) was significantly reduced by racemic and S(+)-ibuprofen. COX inhibition is not the main mechanism of cytoprotection for these compounds. Their influence on inflammatory mediators and oxidative and nitrosative stress could account for the potential cytoprotective effect of R(-) enantiomers.

Cytomegalovirus viral load and virus-specific immune reconstitution after peripheral blood stem cell versus bone marrow transplantation

Peripheral blood stem cell (PBSC) products contain more T cells and monocytes when compared with bone marrow (BM), leading to fewer bacterial and fungal infections. Cytomegelovirus (CMV) viral load and disease as well as CMV-specific immune reconstitution were compared in patients enrolled in a randomized trial comparing PSBC and BM transplantation. There was a higher rate of CMV infection and disease during the first 100 days after transplantation among PBSC recipients (any antigenemia/DNAemia: PBSC, 63% vs BM, 42%, P = .04; CMV disease: PBSC, 17% vs BM, 4%, P = .03). By 2 years, CMV disease rates were similar. The early increase in CMV events correlated temporarily with lower CMV-specific CD4(+) T helper and CD8(+) cytotoxic T lymphocyte function at 30 days after transplantation in PBSC recipients. By 3 months after transplantation and thereafter, CMV-specific immune responses were similar between BM and PBSC recipients. In conclusion, higher CMV infection and disease rates occurred in PBSC transplant recipients early after transplantation. These differences may be because of a transient delay in CMV-specific immune reconstitution following PBSC transplantation.

[SOD1-N196 mutation in a family with amyotrophic lateral sclerosis]

INTRODUCTION

N19S mutation is produced by substitution in the 139 position of SOD1 and was described by Mayeux in a patient with amyotrophic lateral sclerosis (ALS). He suggested that it did not have a causal effect as it was found in asymptomatic and sporadic cases. Other authors in later articles did not agree.

MATERIAL AND METHODS

We describe a family with 4 members with ALS patients and attempt to find the carrier of the N19S mutation of the propositus. Molecular studies were performed on 15 members of the family of a different order.

RESULTS

The ALS cases were found in the maternal line of the propositus. The presence of the mutation was detected in 3 people, the other two were asymptomatic. One of patients with ALS in the family, who died previously, did not have the mutation. Two of the sons of this case and another of the other case did not show it. On the other hand, N19S mutation was only present in paternal branch of the propositus, where there were no cases.

CONCLUSION

The described family supports the hypothesis by Mayeux and against that mutation N19S has pathological consequences, since mutation is only in the family line where there are no cases with ALS. In consequence, although the described case is included as a familiar form, it cannot be attributed to the mutation, and its relationship with N19S should be considered as casual.

Materias primas alternativas para la fabricación de cementos más ecoeficientes de baja energía

Debido a la magnitud del problema que representa el volumen de los residuos generados tanto por el desarrollo industrial como por el tecnológico, las investigaciones a escala mundial se están volcando en minimizar los impactos medioambientales que producen.En el presente trabajo, se dará una especial mención a los residuos procedentes de la incineración de residuos sólidos urbanos (RSU), que independientemente del sistema de incineración que se haya llevado a cabo, suponen un gran número de cenizas y escorias, que pueden ser valorizadas, o en su defecto, estabilizadas, de manera que reduzcan su impacto medioambiental.Entre las acciones que se están llevando a cabo para conseguir la minimización de estos residuos se encuentra, la valorización mediante su uso como materia prima secundaria o alternativa en la fabricación de cementos. Por todo ello, el objetivo del trabajo que nuestro grupo de investigación presenta a continuación, está basado en la síntesis de “cementos ecoeficientes” o “amigables” con el medio ambiente, en los que se ha empleado como materia prima secundaria, ceniza volante procedente de la incineración de residuos sólidos urbanos (CVIRSU). El innovador proceso de fabricación de estos cementos, supone un avance importante para el desarrollo sostenible de la industria, concretamente, la industria cementera. Este proceso implica una rebaja de la temperatura de clinkerización (< 1100ºC) y una minimización de las emisiones de CO2.

[Cerebrospinal fluid cytotoxicity in lateral amyotrophic sclerosis]

INTRODUCTION

The cytotoxicity of cerebrospinal fluid (CSF) in patients with lateral amyotrophic sclerosis in cell cultures that include neurons may be considered as a diffusion mechanism of the disease, due to the proximity of the CSF to the spinal column.

DEVELOPMENT

Various literature studies suggest that the motor neurons are more susceptible to cytotoxicity compared to other neuron cells, including glial, in cell cultures. The review of the composition of CSF in lateral amyotrophic sclerosis gives few clues on how this mechanism causes pre-apoptotic and apoptotic changes on the addition on CSF to the cultures, although it could be associated with the glutamate receptors, to a greater extent in those that respond to AMPA/kainate, and have a role in ion channels.

CONCLUSIONS

The cytotoxicity of CSF is a peculiarity of lateral amyotrophic sclerosis, which could explain some aspects of how the disease progresses. More studies are required in order to understand more about this mechanism, including better identification of patients from whom samples are obtained, as well as their characteristics, differentiating them into familial or sporadic.