Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia

Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.

The detection of post-traumatic angle recession by gonioscopy in a population-based glaucoma survey

BACKGROUND

Blunt trauma is responsible for most eye injuries in urban populations. Anterior chamber angle recession has been reported to be the most common sign of previous blunt trauma to the eye. The cumulative lifetime prevalence of post-traumatic angle recession has not been reported previously, and the relation between angle recession and glaucoma in a population-based setting is unknown.

METHODS

As part of a population-based glaucoma survey, gonioscopy was performed on 987 (82.7%) of 1194 inhabitants of the village of Mamre, near Cape Town, South Africa, who were 40 years of age or older.

RESULTS

Some degree of angle recession was identified in one eye of 60 people and in both eyes of 86 people. Men were affected more than three times as often as women in the fifth, sixth, and seventh decades. The cumulative lifetime prevalence of angle recession in this community was 14.6%. The prevalence of glaucoma in people with angle recession was 5.5% (8/146). Of 87 eyes with 360 degrees of angle recession, only 7 (8.0%) had glaucoma. Excessive alcohol consumption was significantly related to the presence of angle recession in women (P < 0.001). The prevalence of monocular blindness due to trauma was 2.5% (25/987).

CONCLUSION

Although the importance of the study may be limited to this community, the findings suggest that future population-based studies of ocular trauma should include gonioscopy on all individuals examined. Secondary glaucomas, especially those related to trauma, should be screened for in developing countries when trying to establish the prevalence of potential visual loss from glaucoma.

Corticosteroids in corneal graft rejection: double versus single pulse therapy

In a previous study, we reported that a single intravenous pulse of 500 mg of methylprednisolone is more effective than oral prednisone in reversing rejection in patients who present early with severe endothelial rejection. In addition, the grafts that survived were less likely to undergo a further rejection episode. This study investigates whether a second pulse given at 24 h (n = 31) or at 48 h (n = 29) has any advantage over a single pulse (n = 30). All three treatment regimens were equally effective in reversing rejection (74.2%, 79.3%, and 83.3%, respectively), and there was no statistical difference in graft survival. An additional pulse therefore appears to offer no advantage over single pulse therapy. In high-risk grafts, current therapy has been reported to be less effective in reversing graft rejection. This study showed no significant difference between high- and low-risk grafts, indicating that pulse therapy may have a particular role in these difficult cases.

The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, western Cape, South Africa

OBJECTIVE

To determine the prevalence of primary angle closure glaucoma in the so-called Cape people of mixed ethnic background.

DESIGN

A population-based prevalence study.

SETTING

Mamre, a village near Cape Town, South Africa.

PARTICIPANTS

Individuals aged 40 years or older. Historically, their ancestors were Southeast Asians and indigenous Africans and, to a lesser extent, Europeans. Of a total of 1194 people, 987 (82.7%) were examined.

MAIN OUTCOME MEASURE

Primary angle closure glaucoma was diagnosed in individuals with previous acute or intermittent symptoms of angle closure and in individuals with an "occludable" angle and an intraocular pressure of greater than 21 mm Hg or a glaucomatous visual field.

MAIN RESULTS

An age-related trend toward hypermetropia was found, which was greatest in women older than age 50 years. Gonioscopy identified Shaffer grade 1 angles in 89 (9%) of 987 subjects. The prevalence of primary angle closure glaucoma was 2.3% (23 subjects) and increased with age in both sexes. Women were affected more than four times as often as men and the sex difference persisted across all age groups. In comparison, the prevalence of primary open angle glaucoma was 1.5% (15 subjects). Primary glaucoma (angle closure plus open angle) was the leading cause of bilateral blindness in the community, with a prevalence rate of 0.5% (five subjects).

CONCLUSIONS

This study identified primary angle closure glaucoma as a significant public health problem in the Western Cape Province. Because of the ethnic back-ground of the people studied, these findings may also apply to the populations of Southeast Asia.

Differentiation of alcoholic from brain-damaged patients by the Psychiatric-Organic (P-O) special scale of the MMPI

The value of the Psychiatric-Organic (P-O) special scale of the MMPI for the separation of the alcoholic from brain-damaged patients was investigated. A sample of 55 males containing 30 brain-damaged patients and 25 alcoholic patients, was administered the MMPI. Statistical analysis yielded significant difference. Clinical implications of the results are discussed.