Abstract PD10-07: Hormone-Receptor Expression and Activity of Trastuzumab-Based Therapy in HER2-Positive Advanced Breast Cancer Patients

Background: Hormone receptors (HR) and the human epidermal growth factor receptor 2 (HER2) are key biological factors in breast cancer. Gene expression profile studies indicate that HER2-positive/HR-positive and HER2-positive/HR-negative tumors fall into two distinct subtypes. These two subtypes carry a different prognosis in the absence of HER2-targeting. Furthermore, a relationship has been documented between increasing HR expression and reduced chemoresponsiveness. Despite these differences, HER2-positive abvanced breast cancer patients are usually treated with a unified approach of combining chemotherapy with an HER2-targeting agent, regardless of HR status. We studied the association between hormone receptor (HR) expression and the clinical outcome of women with HER2-positive advanced breast cancer receiving chemotherapy plus trastuzumab.

Methods: The effect of HR expression on overall response rate (ORR) and progression-free survival (PFS) to trastuzumab-based treatment was studied by univariate and multivariate analysis. HR positivity was defined as 1% or more tumor cells positive for the estrogen (ER) and/or for the progesterone (PgR) receptor by immunohistochemistry. For both ER and PgR, we studied different thresholds to identify levels of expression associated with the clinical outcomes of interest.

Results: 227 consecutive advanced breast cancer patients receiving trastuzumab plus chemotherapy between June 1999 and November 2008 at two Institutions were retrospectively analyzed. One hundred eleven patients (49%) had HR-positive tumors. Compared with low or no expression, high expression of ER (30% or more) predicted reduced probability of tumor response to trastuzumab plus chemotherapy (multivariate odds ratio 0.422, 95% confidence interval-C.I. 0.222-0.803, p = 0.009). In patients with HR-positive tumors the addition of maintenance endocrine therapy to trastuzumab after the completion of chemotherapy was associated with a significant increase in progression-free survival (hazard ratio-HR 0.521, 95% C.I. 0.3325-0.836, p = 0.007). Patients with HR-positive tumors not receiving maintenance endocrine therapy had similar PFS than patients with HR-negative tumors (HR 0.914, 95% C.I. 0.654-1.279, p = 0.601). In patients not receiving maintenance endocrine therapy, high ER expression (30% or more cells) was associated with non-significant trend towards reduced risk of progression, compared with patients with low or absent ER expression (HR 0.747, 95% C.I. 0.516-1.081, p = 0.122). Conclusions: Our results suggest a predictive role of HR expression in HER2-positive tumors. Further investigation in this patient subset is warranted to optimize the use of HER2-targeting agents, chemotherapy and endocrine therapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD10-07.

Nasal OEC transplantation promotes respiratory recovery in a subchronic rat model of cervical spinal cord contusion

Engraftment of nasal olfactory ensheathing cells (OEC) is considered as a promising therapeutic strategy for spinal cord repair and one clinical trial has already been initiated. However, while the vast majority of fundamental studies were focused on the recovery of locomotor function, the efficiency of this cellular tool for repairing respiratory motor dysfunction, which affects more than half of paraplegic/tetraplegic patients, remains unknown. Using a rat model that mimics the mechanisms encountered after a cervical contusion that induces a persistent hemi-diaphragmatic paralysis, we assessed the therapeutic efficiency of a delayed transplantation (2 weeks post-contusion) of nasal OECs within the injured spinal cord. Functional recovery was quantified with respiratory behavior tests, diaphragmatic electromyography and neuro-electrophysiological recording of the phrenic motoneurons while axogenesis was evaluated using immunohistochemistry. We show that 3 months post-transplantation, nasal OECs improve i) breathing movements, ii) activities of the ipsilateral diaphragm and corresponding phrenic nerve, and iii) axonal sprouting in the injury site. We also demonstrate that this functional partial recovery is mediated by the restoration of ipsilateral supraspinal command. Our study brings further evidence that olfactory ensheathing cells could have clinical application especially in tetraplegic patients with impaired breathing movements. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.

Evaluation of a Warning System for Controlling Primary Infections of Grapevine Downy Mildew

A warning system based on (i) a model that simulates the development of all cohorts of Plasmopara viticola oospores, from oospore germination to infection; (ii) short-term weather forecasts; and (iii) a mobile phone short message system was tested in Northern Italy, from 2006 to 2008. An unsprayed control was compared with a "Warning A" treatment (WA, fungicides were applied whenever the warning system predicted an infection period), a "Warning B" treatment (WB, fungicides were applied as in the WA treatment but only when the relative dimension of any oospore cohort predicted by the model exceeded a threshold), and a "grower" treatment (fungicides were applied according to a conventional schedule). Average disease incidence on leaves was reduced by up to 90% in sprayed plots compared with unsprayed plots. On bunches, efficacy was always >90% at fruit set; when most berries were touching, efficacy was higher for the WA (96%) than for grower (89%) and WB (85%) treatments. On average, 6.8 fungicide sprays were applied following the grower's schedule; use of the warning system reduced applications by about one-half (WA treatment) or two-thirds (WB treatment). The grower's schedule had an average cost of 337 €/ha; the average saving with the WA and the WB treatments was 174 and 224 €/ha, respectively.

The longin SNARE VAMP7/TI-VAMP adopts a closed conformation

SNARE protein complexes are key mediators of exocytosis by juxtaposing opposing membranes, leading to membrane fusion. SNAREs generally consist of one or two core domains that can form a four-helix bundle with other SNARE core domains. Some SNAREs, such as syntaxin target-SNAREs and longin vesicular-SNAREs, have independent, folded N-terminal domains that can interact with their respective SNARE core domains and thereby affect the kinetics of SNARE complex formation. This autoinhibition mechanism is believed to regulate the role of the longin VAMP7/TI-VAMP in neuronal morphogenesis. Here we use nuclear magnetic resonance spectroscopy to study the longin-SNARE core domain interaction for VAMP7. Using complete backbone resonance assignments, chemical shift perturbations analysis, and hydrogen/deuterium exchange experiments, we conclusively show that VAMP7 adopts a preferentially closed conformation in solution. Taken together, the closed conformation of longins is conserved, in contrast to the syntaxin family of SNAREs for which mixtures of open and closed states have been observed. This may indicate different regulatory mechanisms for SNARE complexes containing syntaxins and longins, respectively.

Functional characterization of high levels of meningioma 1 as collaborating oncogene in acute leukemia

Retroviral expression of leukemogenic oncogenes in the murine hematopoietic system is essential but not sufficient to induce acute leukemia. Proviral integration-mediated elevated expression of the meningioma 1 (MN1) oncogene suggested MN1 acting as cooperating event in mixed-lineage leukemia 1 (MLL) and eleven nineteen leukemia (ENL)-induced murine leukemia. Indeed, co-expression of MN1 with MLL-ENL enhanced transformation in vivo, and resulted in a significantly reduced latency for induction of an aggressive acute leukemia when compared with MN1 or MLL-ENL alone. In addition, co-expression of MN1 increased the granulocyte macrophage progenitor cell population with leukemia-initiating properties as shown in secondary transplantation experiments. Gene expression profiling experiments identified putative downstream MN1 targets, of which FMS-like tyrosine kinase 3 (FLT3) and CD34 were upregulated in both MN1-overexpressing murine leukemias and in pediatric acute leukemias with high MN1 levels. Interestingly, small interfering RNA (siRNA)-mediated MN1 knockdown resulted in cell cycle arrest and impaired clonogenic growth of human leukemia cell lines with high MN1 levels. Our work shows for the first time that high MN1 levels are important for the growth of leukemic cells, and that increased MN1 expression can synergize with MLL-ENL and probably other transforming fusion genes in leukemia induction through a distinct gene expression program that is able to expand the leukemia-initiating cell population.

Quantitative detection of pear-pathogenic Stemphylium vesicarium in orchards

ABSTRACT Isolates of Stemphylium vesicarium causing brown spot of pear can be distinguished from nonpathogenic isolates of S. vesicarium from pear or from other hosts on the basis of distinctive amplified fragment length polymorphism fingerprinting profiles. DNA fragments specific for isolates pathogenic to pear were identified and a quantitative polymerase chain reaction (PCR) was developed on the sequence from one of these specific DNA loci. This TaqMan PCR has a high sensitivity with a dynamic range for reliable quantification between 1 ng and 100 fg of DNA. The method detected pear-pathogenic isolates of S. vesicarium originating from four different European countries and various regions within those countries. No cross-reaction was found with either the nonpathogenic isolates of S. vesicarium tested or isolates belonging to other Stemphylium spp. or related fungi. The pathogen was detected on leaves with brown-spot symptoms originating from six different locations in The Netherlands, Italy, and Spain. Pear-pathogenic S. vesicarium populations were monitored on crop residues in two Dutch orchards between October 2007 and October 2008. Brown spot had been observed at both orchards at the end of the growing season of 2007. In one location, pear-pathogenic S. vesicarium was detected only sporadically on crop residues and no brown-spot symptoms were observed on fruit in 2008. At the other location, a pathogenic population was found on fallen pear leaves and on other crop residues but this population decreased during winter. From the beginning of the growing season in 2008 onward, the pathogen population could not be detected and the disease incidence was only 0.6%. The TaqMan PCR will allow more detailed studies on epidemiology of brown spot and on the effect of disease control measures.

Comparative analysis of plant genomes allows the definition of the "Phytolongins": a novel non-SNARE longin domain protein family

Background

Subcellular trafficking is a hallmark of eukaryotic cells. Because of their pivotal role in the process, a great deal of attention has been paid to the SNARE proteins. Most R-SNAREs, or "longins", however, also possess a highly conserved, N-terminal fold. This "longin domain" is known to play multiple roles in regulating SNARE activity and targeting via interaction with other trafficking proteins. However, the diversity and complement of longins in eukaryotes is poorly understood.

Results

Our comparative genome survey identified a novel family of longin-related proteins, dubbed the "Phytolongins" because they are specific to land plants. Phytolongins share with longins the N-terminal longin domain and the C-terminal transmembrane domain; however, in the central region, the SNARE motif is replaced by a novel region. Phylogenetic analysis pinpoints the Phytolongins as a derivative of the plant specific VAMP72 longin sub-family and allows elucidation of Phytolongin evolution.

Conclusion

"Longins" have been defined as R-SNAREs composed of both a longin domain and a SNARE motif. However, expressed gene isoforms and splice variants of longins are examples of non-SNARE motif containing longins. The discovery of Phytolongins, a family of non-SNARE longin domain proteins, together with recent evidence on the conservation of the longin-like fold in proteins involved in both vesicle fusion (e.g. the Trs20 tether) and vesicle formation (e.g. σ and μ adaptin) highlight the importance of the longin-like domain in protein trafficking and suggest that it was one of the primordial building blocks of the eukaryotic membrane-trafficking machinery.

Age dependency of regional impedance indices regardless of clinical stage in patients with cirrhosis of the liver

PURPOSE

To prospectively assess if ageing itself induces modifications of the impedance indices (resistance and pulsatility indexes) of hepatic, splenic, superior mesenteric and renal arteries in patients with liver cirrhosis.

MATERIALS AND METHODS

78 consecutive patients with cirrhosis (41 males, 37 females, Child-Pugh score 7 [range 5 - 12]) were studied by colour-Doppler ultrasound. The resistance index (RI) and pulsatility index (PI) were determined in the main hepatic artery, intraparenchymal branches of hepatic, splenic, and renal arteries, and superior mesenteric artery; clinical data were simultaneously collected. Logistic regression analysis was performed to assess the relative impact of age, severity of liver disease and other relevant variables on the increase of impedance indices. Linear regression analysis was used to identify a coefficient to adjust RIs and PIs to age.

RESULTS

Resistance and pulsatility indices of all the vessels studied except of the superior mesenteric artery showed a direct correlation with age (e. g. splenic artery RI: R = 0.520, p < 0.0001), and correlated most strongly with Child-Pugh score (e. g. right renal artery PI: R = 0.462, p < 0.0001). Age was associated independently with increased PI and RI in hepatic, splenic and renal arterial districts. In these vessels, the RI threshold of normality can be adjusted to the decade of age adding a correction of 0.03.

CONCLUSION

Ageing itself induces an increase of hepatic, splenic and renal impedance indices in cirrhotic patients. The threshold of normality for these indices in cirrhosis should be adjusted according to the patients' age.

Association between iron overload and osteoporosis in patients with hereditary hemochromatosis

SUMMARY

In 87 patients with hereditary hemochromatosis, osteoporosis was detected in 25%, and osteopenia in 41%. Bone mineral density was independently associated with BMI, ALP levels, hypogonadism/menopause, and the amount of iron removed to reach depletion, but not with cirrhosis. Osteoporosis is influenced by iron overload in hemochromatosis.

INTRODUCTION

To analyze prevalence, clinical characteristics and genetic background associated with osteoporosis in a retrospective study in Italian patients with hereditary hemochromatosis (HHC).

METHODS

In 87 consecutive patients with HHC, bone mineral density was systematically evaluated by dual energy x-ray absorptiometry of the lumbar spine (n = 87) and femoral neck (n = 66).

RESULTS

Osteoporosis was detected in 22 (25.3%), and osteopenia in 36 (41.4%) patients. Mean Z scores were -0.92 +/- 1.42 at lumbar spine and -0.35 +/- 1.41 at femoral neck. Lumbar spine T-score was independently associated with total ALP (p = 0.002), hypogonadism/menopause (p = 0.026), and iron overload (p = 0.033 for ferritin and p = 0.017 for iron removed). We observed a borderline significance for BMI (p = 0.069) and smoking status (p = 0.086). Lumbar spine osteoporosis was independently associated with lower BMI (OR 0.73, 95% CI 0.54-0.94), total ALP (OR 1.17, 95% CI 1-1.39 per 10 unit increase) and the amount of iron removed (OR 1.53, 95% CI 1-2.5 per 5 g increase). HFE genotypes did not differ between patients with and without osteoporosis.

CONCLUSIONS

Osteoporosis is observed in a quarter of unselected patients with HHC, independently of the genetic background, and is associated with ALP, hypogonadism, body weight, and severity of iron overload.

Predicting the dynamics of ascospore maturation of Venturia pirina based on environmental factors

Airborne ascospores of Venturia pirina were trapped at two sites in northern Italy in 2002 to 2008. The cumulative proportion of ascospores trapped at each discharge was regressed against the physiological time. The best fit (R(2) = 0.90, standard error of estimates [SEest] = 0.11) was obtained using a Gompertz equation and the degree-days (>0 degrees C) accumulated after the day on which the first ascospore of the season was trapped (biofix day), but only for the days with > or =0.2 mm rain or < or =4 hPa vapor pressure deficit (DDwet). This Italian model performed better than the models developed in Oregon, United States (R(2) = 0.69, SEest = 0.16) or Victoria, Australia (R(2) = 0.74, SEest = 0.18), which consider only the effect of temperature. When the Italian model was evaluated against data not used in its elaboration, it accurately predicted ascospore maturation (R(2) = 0.92, SEest = 0.10). A logistic regression model was also developed to estimate the biofix for initiating the accumulation of degree-days (biofix model). The probability of the first ascospore discharge of the season increased as DDwet (calculated from 1 January) increased. Based on this model, there is low probability of the first ascospore discharge when DDwet < or =268.5 (P = 0.03) and high probability (P = 0.83) of discharge on the first day with >0.2 mm rain after such a DDwet threshold.

Physical activity is negatively associated with the metabolic syndrome in the elderly

BACKGROUND

An inverse association between physical activity and metabolic syndrome has been reported in several cohorts, but very few specific studies are available in the elderly, in whom neurological and musculo-skeletal diseases are expected to lead to a remarkable age-related decline of physical activity.

AIM AND DESIGN

The relationships among physical activity, insulin resistance and metabolic syndrome were assessed in a cross-sectional study concerning 1144 subjects aged 65-91 years resident in Pianoro (northern Italy). Household and leisure-time activities were assessed by a self-administered questionnaire (Physical Activity Scale for Elderly--PASE). Routine clinical and biochemical data (including fasting insulin) were used to assess insulin resistance [Homeostasis Model Assessment (HOMA) method] and the prevalence of metabolic syndrome.

RESULTS

All PASE scores were inversely correlated with waist circumference, triglycerides and HOMA index, with highest significance for leisure-time activities (P < or = 0.005). The PASE score for household activities was also correlated inversely with blood glucose (P < 0.05), and directly with HDL cholesterol (P < 0.001). In logistic regression analysis, the metabolic syndrome was more prevalent among sedentary subjects (corresponding to the low tertile of leisure-time activities) than in the remaining more active population (odds ratio 1.51, 95% confidence interval 1.12-2.03, P = 0.007), independently of possible confounders.

CONCLUSION

Physical activity is inversely associated with insulin resistance and the metabolic syndrome even in the elderly. Community programs favoring physical activity are expected to significantly improve the health status in these subjects.

The hand arthropathy of hereditary hemochromatosis is strongly associated with iron overload

OBJECTIVE

To analyze the clinical characteristics and genetic background associated with the presence of hand arthropathy, as determined by radiological findings, in Italian patients with hereditary hemochromatosis (HHC).

METHODS

In 88 consecutive unselected patients with phenotypically expressed HHC, joint involvement was systematically evaluated in plain radiographs of hands, wrists, lumbar spine, pelvis, and knees. Risk factors considered were age, sex, body mass index, alcohol abuse, organ involvement at other sites, and indices of iron overload, including ferritin, transferrin saturation, and iron removed to reach depletion. HFE genotype was also considered. The independent role of risk factors was tested by logistic regression analysis.

RESULTS

Thirty-two subjects (36%) showed signs of metacarpophalangeal (MCP) arthropathy. Intercarpal, radiocarpal, and chondrocalcinosis were less frequent and occurred in association with MCP arthropathy. At multivariate analysis MCP arthropathy was independently associated with older age [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.1-1.33/yr; p = 0.0001], higher ferritin levels at diagnosis (OR 4.17, 95% CI 1.60-13.9 for values > 1000 ng/ml; p = 0.008), the presence of the C282Y +/+ and C282Y/H63D HFE genotypes (OR 2.69, 95% CI 1.09-7.87; p = 0.04), and higher percentage transferrin saturation (OR 1.05, 95% CI 1-1.1; p = 0.05). The severity of arthropathy was independently associated with older age (p = 0.03) and higher ferritin values (p = 0.05).

CONCLUSION

MCP arthropathy together with a typical pattern of joint involvement is observed in one-third of unselected patients with HHC, and is influenced by the duration and degree of the iron overload.

Influence of Weather Conditions on Infection of Peach Fruit by Taphrina deformans

ABSTRACT The effect of environment on the infection of peach fruit by Taphrina deformans was investigated using orchard observations under natural conditions (in 2001 to 2004) or in trees managed in such a way to exclude rainfall. These conditions were then validated using pot-grown peach plants exposed to single infection events and independent orchard observations. Leaf curl incidence was related to rainfall, length of wet periods, and the temperature during wetness and during the incubation period, as well as to the developmental stage of flowers and fruit. Weather conditions before petal fall did not influence fruit infection. After petal fall, rainfall and the duration of the wet period triggered by rainfall played a key role in infection occurrence. The minimum rainfall required for infection was 12 mm, with at least 24 h of wetness interrupted by no more than 4 h. No infection occurred when temperature was >/=17 degrees C during the wet period or >19 degrees C during incubation. Disease symptoms appeared on fruit after approximately 3 weeks of incubation, which is equivalent to 240- to 290-degree-days (base 0 degrees C). The period for fruit infection was relatively short being from petal fall until air temperature remained greater than 16 degrees C. During this period, the incidence of fruit that developed symptoms was closely related to the number of favorable events and the total wetness duration during such events.

Clinical aspect and survival rates in subject with oral cancer: a retrospective cohort study

AIM

The aim of this study was to describe and evaluate survival in a group of patients with oral malignant neoplasias, observed at the Unit of Oral Pathology and Medicine, University of Milan, between February 1995 and September 2005.

METHODS

This retrospective study considered the clinical histories and anamnestic profiles of a group of 108 patients with malignant oral neoplasms. A sample of 72 out of these 108 patients was identified, for whom follow-up data were available for at least 4 months from the date of diagnosis. Survival times for this group were then evaluated.

RESULTS

In this group of 108 patients, 103 were affected by squamous cell carcinoma. The ratio of male to female patients was 1.1:1.0 and the average age at the time of diagnosis was 64.9 years. In 44 out of 91 cases, the site affected was the tongue and in 28 out of 45 cases, the lesion was at an early stage (TNM 1 and 2) at the time of diagnosis. Survival in the group of 72 considered was 84% at 2 years from diagnosis and 55% at 5 years. Diagnosis before the age of 65 favoured a positive prognosis (P=0.01), as did lesions diagnosed at TNM 1 stage, though this was not statistically significant (P=0.1).

CONCLUSION

The data provided in this retrospective study were consistent with previous reports of survival rates at 5 years from diagnosis and the improved prognosis for patients diagnosed before the age of 65. The only finding that was different from previous studies was the gender distribution, which in this study was almost equal.

Epidemiology of flavescence dorée in vineyards in northwestern Italy

ABSTRACT A serious outbreak of flavescence dorée (FD) was reported in Piemonte, northwestern Italy, in 1998, and since then, the disease has compromised the economy of this traditional wine-growing area, even following the application of compulsory insecticide treatments to control Scaphoideus titanus, the vector of the causal phytoplasma. Affected vines show severe symptoms, varying according to the cultivar, and are rogued to reduce disease spread. Following winter and pruning, a previously affected vine may appear symptomless and free of phytoplasmas in its aerial as well as its root system, even by nested-polymerase chain reaction assays. Such plants are considered to be "recovered". Since 1998 homogenous data on the incidence of newly infected, healthy, or recovered plants productivity, presence of vectors, and treatment schedules have been collected in seven severely affected vineyards of southern Piemonte for 5 years (1999 to 2003). Infectivity and recovery rates were also calculated each year. From 1999 to 2003, the average number of healthy plants decreased and the numbers of recovered plants and those with symptoms increased. Productivity of recovered vines, although lower than that of healthy ones, was always higher than that of vines with symptoms and was not influenced by the time elapsed from date of recovery. The relationships between the ln-transformed number of vectors trapped in the vineyards the previous year and the infection and the recovery rates were fitted by an exponential (R(2) = 0.95) and an asymptotic (R(2) = 0.93) model, respectively.

Assessment ofFusariuminfection in wheat heads using a quantitative polymerase chain reaction (qPCR) assay

The accuracy of a quantitative polymerase chain reaction assay in quantifying the DNA of trichothecene-producing F. culmorum and F. graminearum within harvested wheat grains and head tissue was evaluated in comparison with incidences of infected kernels and deoxynivalenol levels. In a first experiment, six durum and bread wheat varieties were grown in randomized plots for a 2-year period, and inoculated with Fusarium macroconidia at six growth stages between heading and dough ripening, to obtain a wide range of Fusarium head blight incidences. There was a close relationship between fungal DNA and the amount of deoxynivalenol, and this relationship was consistent over Fusarium species, wheat species and varieties, and over a wide range of Fusarium head blight infection. In a second experiment potted wheat plants were grown under environmentally controlled conditions and inoculated with the two Fusarium species at full flowering; head samples were collected before inoculation and after 6 h to 12 days, and processed by the quantitative polymerase chain reaction assay. This assay made it possible to detect the dynamic of fungal invasion in planta after infection had occurred, and to single out the presence of infection before the onset of the disease symptoms: A robust detection of the infection occurred within 18-24 h for F. culmorum, and within 2-9 days for F. graminearum.

Prophylactic treatment of haemophilia patients with inhibitors: clinical experience with recombinant factor VIIa in European Haemophilia Centres

Many patients with haemophilia develop inhibitors to factor VIII and require bypassing agents to provide haemostatic cover for limb- or life-threatening bleeding episodes. Due to the reduced risk of blood-borne pathogen transmission with recombinant products, on-demand recombinant factor VIIa (rFVIIa; NovoSeven is the treatment of choice for children with inhibitors. In haemophiliac patients without inhibitors, primary prophylaxis has been clinical practice for several years. This paper summarises 13 case histories of rFVIIa secondary prophylaxis for haemophilia patients with inhibitors. This was a retrospective survey of adult and paediatric severe haemophilia patients with inhibitors treated with rFVIIa from ten European Haemophilia Centres. There was a wide variation in administered rFVIIa dose, from 200-250 microg kg(-1) per week to 220 microg kg(-1) daily. In many cases, this was lower than the recommended on-demand dose of rFVIIa. In 12/13 cases, prophylaxis with rFVIIa considerably reduced the number of bleeding episodes compared with previous treatment. Eight/nine patients were satisfied or very satisfied with rFVIIa treatment, and in cases reporting subjective quality of life (QoL), all were improved, much improved, or significantly improved. In haemophilia patients with inhibitors, prophylaxis with rFVIIa is highly effective in reducing the number of bleeding episodes and results in good patient compliance and improved QoL. Randomised controlled trials are needed to confirm these findings. Results of a recently completed clinical trial on secondary prophylaxis with rFVIIa in frequently bleeding haemophilia patients with inhibitors are expected in late 2006.