A Phase I Trial of Sirolimus with "7&3" Induction Chemotherapy in Patients with Newly Diagnosed Acute Myeloid Leukemia

Chemotherapy remains a primary treatment for younger AML patients, though many relapse. Data from our group have shown that highly phosphorylated S6 in blasts may predict response to sirolimus given with chemotherapy. We report the results of a phase I study of this combination in newly diagnosed AML and the pharmacodynamic analysis of pS6 before and after treatment. Subjects received sirolimus (12 mg on day 1, 4 mg daily, days 2-10), then idarubicin and cytarabine (days 4-10). Response was assessed at hematologic recovery or by day 42 using a modified IWG criteria. Fifty-five patients received sirolimus. Toxicity was similar to published 7 + 3 data, and 53% had high-, 27% intermediate-, and 20% favorable-risk disease. Forty-four percent of the high-risk patients entered into CR/CRp. Seventy-nine percent of the intermediate-risk subjects had a CR/CRp. All favorable-risk patients had a CR by day 42; 9/11 remained alive and in remission with a median follow-up of 660 days. Additionally, 41/55 patients had adequate samples for pharmacodynamic analysis. All patients demonstrated activation of S6 prior to therapy, in contrast to 67% seen in previous studies of relapsed AML. mTORC1 inhibition was observed in 66% of patients without enrichment among patients who achieved remission. We conclude that sirolimus and 7 + 3 is a well-tolerated and safe regimen. mTORC1 appears to be activated in almost all patients at diagnosis of AML. Inhibition of mTORC1 did not differ based on response, suggesting that AML cells may have redundant signaling pathways that regulate chemosensitivity in the presence of mTORC1 inhibition.

The two-step approach to allogeneic hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation (HSCT) provides the only potentially curative option for multiple hematological conditions. However, allogeneic HSCT outcomes rely on an optimal balance of effective immune recovery, minimal graft-versus-host disease (GVHD), and lasting control of disease. The quest to attain this balance has proven challenging over the past few decades. The two-step approach to HSCT was conceptualized and pioneered at Thomas Jefferson University in 2005 and remains the main platform for allografting at our institution. Following administration of the transplant conditioning regimen, patients receive a fixed dose of donor CD3+ cells (HSCT step one-DLI) as the lymphoid portion of the graft on day -6 with the aim of optimizing and controlling T cell dosing. Cyclophosphamide (CY) is administered after the DLI (days -3 and -2) to induce donor-recipient bidirectional tolerance. On day 0, a CD34-selected stem cell graft is given as the myeloid portion of the graft (step two). In this two-step approach, the stem cell graft is infused after CY tolerization, which avoids exposure of the stem cells to an alkylating agent, allowing rapid count recovery. Here, the two-step platform is described with a focus on key results from studies over the past two decades. Finally, this review details lessons learned and current strategies to optimize the graft-versus-tumor effect and limit transplant-related toxicities.

A Prospective, Randomized Trial Examining the Use of G-CSF Versus No G-CSF in Patients Post-Autologous Transplantation

Contemporary, prospective data regarding the impact of granulocyte-colony stimulating factor (G-CSF) on outcomes after autologous hematopoietic stem cell transplantation (Auto-HSCT) in an era when stem cell grafts are more qualitatively robust are limited. Recent retrospective analyses have not supported a beneficial effect of post-transplantation G-CSF use on major outcomes after Auto-HSCT leading to strategies to delay or eliminate the use of G-CSF altogether in this context. To test the hypothesis that the infusion of consistently higher doses of stem cells (defined as ≥4 × 10⁶/kg) in Auto-HSCT will obviate the need for post-transplantation G-CSF. If so, the impact of withholding G-CSF will be noninferior to the use of G-CSF in terms of length of stay (LOS). The specific objectives were to conduct a prospective, randomized clinical trial primarily examining the impact of post-transplantation G-CSF on LOS, and secondarily on engraftment, infectious complications, antibiotic usage, and incidence of engraftment syndrome after Auto-HSCT in patients receiving versus not receiving G-CSF after Auto-HSCT. Patients with multiple myeloma or non-Hodgkin lymphoma (NHL) who underwent Pegfilgrastim plus Plerixafor-primed stem cell collection followed by Auto-HSCT were randomized to the G-CSF group (receive G-CSF starting at day 3 after Auto-HSCT) or the no G-CSF group (G-CSF withheld after Auto-HSCT). Seventy patients per arm were planned to demonstrate the primary endpoint of noninferiority in LOS between the G-CSF and the no G-CSF groups. Patient outcomes in the two groups were followed up and compared after Auto-HSCT, and an interim analysis for futility was planned when accrual reached 50%.The primary finding of this study was that despite only a 2-day longer median absolute neutrophil count (ANC) recovery in the no G-CSF arm (median 11 versus 13 days; P = .001), LOS was 4 days longer in patients not treated with G-CSF (median 11 days versus 15 days; P = .001). G-CSF use was associated with more robust incremental daily increases in ANC once recovered (P = .001), fewer days of febrile neutropenia (P = .001), and fewer days on antibiotics (P = .001), potentially contributing to this disproportionate finding. Inferiority in LOS in the no G-CSF group was demonstrated on the interim analysis, and the study was closed at the half-way point. There were no significant group differences in platelet recovery, documented infections, hospital readmissions, or overall survival at 1 year. Engraftment syndrome occurred in 54.3% of patients and was not related to G-CSF use. These results suggest that the increased LOS associated with the omission of G-CSF is largely due to concerns regarding the potential for infection in patients without a stable, recovered ANC in a hospital setting. Engraftment syndrome represented a significant source of febrile neutropenia further contributing to patient safety concerns and requires strategies to decrease its incidence. Infectious complications and death were not affected by the omission of G-CSF supporting a carefully monitored outpatient approach to Auto-HSCT in which white blood cell growth factor is eliminated or given as needed for documented infection. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Outcomes of two-step haploidentical allogeneic stem cell transplantation in elderly patients with hematologic malignancies

Allogeneic hematopoietic stem cell transplantation (allo-SCT) remains the best curative option for the majority of patients with hematologic malignancies (HM); however, many elderly patients are excluded from transplant and outcome data in this population is still limited. The novel two-step graft engineering approach has been the main platform for allo-SCT at Thomas Jefferson University since 2006. Following administration of the preparative regimen, we infuse donor lymphocytes, followed by cyclophosphamide to induce bidirectional tolerance, then infusion of CD34-selected cells. A total of 76 patients ≥ 65 years old with HM underwent haploidentical (haplo) allo-SCT on the two-step transplant platform between 2007 and 2021. The median time to neutrophil engraftment was 11 days and platelet engraftment was 18 days. With a median follow up of 44 months, the 3-year overall survival (OS) and progression-free survival (PFS) were 36.3% and 35.6%, respectively. The cumulative incidences of non-relapse mortality (NRM) and relapse at 3 years were 43.5% and 21.0% at 3 years, respectively. The cumulative incidence of grade III-IV acute graft-versus-host-disease (GVHD) was 11.1% at 6 months, and chronic GVHD requiring treatment was 15.1% at 2 years. The two-step haplo allo-SCT is a novel alternative platform for high-risk older HM patients, achieving fast engraftment, low relapse rates and promising survival.

The Two-Step Allogeneic Stem Cell Transplant Approach Results in Rapid Engraftment and Excellent Outcomes in Patients with Lymphoid Malignancies

The two-step graft engineering approach has been the main platform for allogeneic hematopoietic cell transplantation (allo-HCT) at Thomas Jefferson University since 2005. We have previously described separating donor lymphocytes infusion followed by cyclophosphamide for bidirectional tolerization from CD34-selected hematopoietic grafts in haploidentical and matched related donors. We analyzed 60 patients with high-risk lymphoid malignancies who underwent a two-step allo-HCT from 2008-2020. The majority of patients received haploidentical (82%) and (20%) patients received matched related stem cell grafts. Patients underwent transplant for DLBCL (n = 17, 28%), CLL (n = 10, 17%), follicular lymphoma (n=8, 13%), and Hodgkin lymphoma (n = 7, 12%). Eight patients (13%) had prior high dose chemotherapy. Thirty patients (50%) had HCT-CI ≥ 3; 20 patients (33%) had CIBMTR RDRI high or very high-risk disease. The median age for the group was 56 years (range 24-75). Neutrophils engrafted at a median of 11 days (range from 9 to 16 days) and platelets engrafted at a median of 16 days (range from 13 to 37 days). With a median follow up of six years, the 3-year probability of overall survival and disease-free survival were 62.9% (95% confidence interval is 49.3% to 73.8%) and 60.2% (95% confidence interval is 46.4% to 71.6%) respectively. The cumulative incidence of relapse at 3 years was 11.9% (confidence interval 0.052-0.216). The cumulative incidence of non-relapse mortality at 3 years was 30.1% (confidence interval 0.191-0.420). The cumulative incidence of grade 2-4 acute GVHD at one year was 45% (95% confidence interval 0.322 to 0.570). The cumulative incidence of grade 3-4 acute GVHD at one year was 5% (95% confidence interval 0.013 to 0.126). The cumulative incidence of cGVHD at 3 years was 15.2% (95% confidence interval 0.075 to 0.254). In conclusion, the two-step approach achieved excellent outcomes in high-risk lymphoid malignancies with rapid neutrophil and platelet recovery.

Design and Implementation of a Multipurpose Information System for Hematopoietic Stem-Cell Transplantation on the Basis of the Biomedical Research Integrated Domain Group Model

PURPOSE

An important obstacle to cancer research is that nearly all academic cancer centers maintain substantial collections of highly duplicative, poorly quality-assured, nonintercommunicating, difficult-to-access data repositories. It is inherently clear that this state of affairs increases costs and reduces quality and productivity of both research and nonresearch activities. We hypothesized that designing and implementing a multipurpose cancer information system on the basis of the Biomedical Research Integrated Domain (BRIDG) model developed by the National Cancer Institute and its collaborators might lessen the duplication of effort inherent in capturing, quality-assuring, and accessing data located in multiple single-purpose systems, and thereby increases productivity while reducing costs.

METHODS

We designed and implemented a core data structure on the basis of the BRIDG model and incorporated multiple entities, attributes, and functionalities to support the multipurpose functionality of the system. We used the resultant model as a foundation upon which to design and implement modules for importing preexisting data, capturing data prospectively, quality-assuring data, exporting data to analytic files, and analyzing the quality-assured data to support multiple functionalities simultaneously. To our knowledge, our system, which we refer to as the Cancer Informatics Data System, is the first multipurpose, BRIDG-harmonized cancer research information system implemented at an academic cancer center.

RESULTS

We describe the BRIDG-harmonized system that simultaneously supports patient care, teaching, research, clinical decision making, administrative decision making, mandated volume-and-outcomes reporting, clinical quality assurance, data quality assurance, and many other functionalities.

CONCLUSION

Implementation of a highly quality-assured, multipurpose cancer information system on the basis of the BRIDG model at an academic center is feasible and can increase access to accurate data to support research integrity and productivity as well as nonresearch activities.

An Examination of Cytomegalovirus, Socioeconomic Status, Race, and Ethnicity on Outcomes after Haploidentical Hematopoietic Transplantation

Previous analyses of the effects of race and socioeconomic status (SES) on outcomes after hematopoietic stem cell transplantation (HSCT) have suggested that minority populations and those in disadvantaged groups have inferior outcomes. However, the results of these studies have been inconsistent, potentially due to a multitude of factors, both medical and nonmedical, that have confounded results. In haploidentical (HI) HSCT, an expanding approach with the potential to enfranchise more minority patients, data on the effect of race and SES on outcomes are very limited. To identify and potentially correct factors that negatively impact outcomes after HI HSCT in disadvantaged groups at our institution, we performed a retrospective, multivariable analysis of the impact of race and SES as single and combined variables on HI HSCT outcomes of relapse, transplantation-related mortality, acute and chronic graft-versus-host disease (GVHD), and overall survival (OS). In addition to controlling for race and SES, all patients had HI donors and were treated with the same 2-step approach, with consistent T cell dosing and GVHD prophylaxis to further reduce the impact of confounders in this complex area. The study cohort of 239 patients was 71% Caucasian, 19.7% African American, 4.6% Hispanic, and 4.2% Asian. The majority of minority patients were in areas of higher deprivation (P = .001) and had the highest incidence of cytomegalovirus (CMV) seropositivity (P = .001) and the lowest likelihood of possessing a CMV immunodominant (IMD) allele (P = .001), which was previously associated with an OS benefit. Positive CMV serostatus was highly linked to post-transplantation CMV reactivation (P = .001) which was associated with higher relapse rates (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.06 to 2.30; P = .026), higher TRM (HR, 2.10; 95% CI, 1.09 to 4.05; P = .027), and lower OS (HR, 1.77; 95% CI, 1.18 to 2.65; P = .006). The lack of a CMV IMD allele largely replicated the results of CMV reactivation on HSCT results. Although race and SES did not directly correlate with either OS or relapse incidence, non-Caucasians in a more disadvantaged group had a higher incidence of chronic GVHD (HR, 2.55; 95% CI, 1.08 to 6.01; P = .033) compared with Caucasians and minorities in less disadvantaged groups. Regardless of SES, minorities had a lower incidence of acute GVHD than Caucasians in a more advantaged SES group (HR, 0.52; 95% CI, 0.30 to 0.90; P = .020). The primary finding of this study is that CMV reactivation was the major driver of mortality after HI HSCT. CMV reactivation may have be associated with poor HSCT outcomes in HI HSCT recipients in disadvantaged areas, most of whom were minorities. The data suggest that the prevention of post-transplantation CMV reactivation possibly could have a major impact on HI HSCT outcomes, especially in minority recipients. The finding of different GVHD manifestations between races are intriguing and merits further study.

Quantum Rabi Oscillations in Coherent and in Mesoscopic Cat Field States

The simple resonant Rabi oscillation of a two-level system in a single-mode coherent field reveals complex features at the mesoscopic scale, with oscillation collapses and revivals. Using slow circular Rydberg atoms interacting with a superconducting microwave cavity, we explore this phenomenon in an unprecedented range of interaction times and photon numbers. We demonstrate the efficient production of cat states, which are the quantum superposition of coherent components with nearly opposite phases and sizes in the range of few tens of photons. We measure cuts of their Wigner functions revealing their quantum coherence and observe their fast decoherence. This experiment opens promising perspectives for the rapid generation and manipulation of nonclassical states in cavity and circuit quantum electrodynamics.

The Presence of a CMV Immunodominant Allele in the Recipient Is Associated With Increased Survival in CMV Positive Patients Undergoing Haploidentical Hematopoietic Stem Cell Transplantation

Specific major histocompatibility (MHC) class I alleles dominate anti-CMV responses in a hierarchal manner. These CMV immunodominant (IMD) alleles are associated with a higher magnitude and frequency of cytotoxic lymphocyte responses as compared to other human leukocyte antigen (HLA) alleles. CMV reactivation has been associated with an increased incidence of graft-vs.-host disease and non-relapse mortality, as well as protection from relapse in HLA-matched HSCT settings. Less is known about the impact of CMV reactivation on these major outcomes after haploidentical (HI) HSCT, an increasingly applied therapeutic option. In HI HSCT, the efficiency of the immune response is decreased due to the immune suppression required to cross the MHC barrier as well as MHC mismatch between presenting and responding cells. We hypothesized that the presence of a CMV IMD allele would increase the efficiency of CMV responses after HI HSCT potentially impacting CMV-related outcomes. In this retrospective, multivariable review of 216 HI HSCT patients, we found that CMV+ recipients possessing at least 1 of 5 identified CMV IMD alleles had a lower hazard of death (HR = 0.40, p = 0.003) compared to CMV+ recipients not possessing a CMV IMD allele, and an overall survival rate similar to their CMV- counterparts. The analysis delineated subgroups within the CMV+ population at greater risk for death due to CMV reactivation.

Cutaneous B-Cell Lymphoblastic Lymphoma

B-cell lymphoblastic lymphoma (B-LBL) is a malignant neoplasm of immature B cells that accounts for only 10% of all cases of lymphoblastic lymphoma. Most commonly, B-LBL presents as bony lesions, but in rare cases, the disease manifests cutaneously. We present a case of simultaneous cutaneous and systemic presentation of B-LBL in an otherwise healthy 28-year-old man in which the lymphoblastic infiltrate stained positive for CD79a, Tdt, CD10, and CD20. A diagnosis of cutaneous B-LBL was made, and systemic work-up revealed widespread involvement of the skin, bone, and lymph nodes. Review of all currently described cases of cutaneous B-LBL with or without systemic involvement revealed that the most frequently positive tumor markers were CD79a (92.3%), Tdt (90.6%), and CD10 (83.3%). Systemic involvement of B-LBL was found in nearly half of all cases with cutaneous presentation.

Comprehensive geriatric assessment prior to autologous stem cell transplant as a predictor of patient outcomes: A retrospective review

e23023

Background: While autologous stem cell transplant (ASCT) has been shown to be safe and effective in the geriatric population, age alone is not a sufficient predictor of outcomes. Minimal data exists regarding the use of a comprehensive geriatric assessment (CGA) tool prior to ASCT as a predictor of patient outcomes. This study aims to assess our institution’s pre-ASCT CGA on its ability to predict transplant-related outcomes in the elderly. Methods: We retrospectively analyzed all patients age 65 years of age and older (n = 68) who received ASCT at Thomas Jefferson University Hospital between 2012 and 2018 for multiple myeloma (MM) (n = 52), AL amyloidosis (n = 1), combined MM/amyloidosis (n = 2), B-NHL (n = 11), T cell lymphoma (n = 2), and Hodgkin lymphoma (n = 1). The CGA consists of 13 components, culminating in an overall frailty status. Kaplan-Meier survival estimates were used to assess overall survival (OS) and progression free survival (PFS), and multivariable logistic regression and Cox proportional hazard regression were used to determine associations between CGA variables and relevant post-ASCT outcomes. Results: Among the 68 patients (43 males, 25 females) who received ASCT, the median age was 68 years (range 65-78). Fifty-one patients (75%) underwent pre-transplant CGA. Among the entire cohort, 2-year OS and PFS were 95.4% and 79.6%, respectively. Median OS was not reached, and median PFS was 48.5 months. There was no difference in OS between patients who underwent CGA and those who did not (P = 0.937). Multivariate analysis revealed that none of the variables in the CGA were predictive of patient outcomes, such as OS, length of stay on ASCT admission, 30-day readmissions, and falls. Conclusions: This single-institution data suggests that ASCT is safe and highly effective in geriatric patients. Undergoing a CGA was not associated with improved outcomes, and none of the CGA components including frailty status were predictive of outcomes in this preliminary data set. Our data suggest that further refinement of the CGA may improve its predictive ability. Future studies examining additional outcomes, including patient-reported quality-of-life outcomes, are warranted.

Influence of experimental parameters on the side reactions of hydrosilylation of allyl polyethers studied by a fractional factorial design

Comprehensive study of the hydrosilylation of allyl polyethers using the methodology of a design of experiments.

Relapsed Multiple Myeloma Presenting as Intracranial Plasmacytoma and Malignant Pericardial Effusion following Recent Allogeneic Stem Cell Transplantation

Although rare, both central nervous system and pericardial involvement of myeloma have been well described in the literature. Their simultaneous occurrence in relapsed disease, however, has not been previously reported. This case describes a 54-year-old female who was treated for high-risk multiple myeloma with multiregimen chemotherapy and allogeneic hematopoietic stem cell transplantation. Four months after transplant, she was found to have relapsed disease manifesting as an extraosseous, intracranial plasmacytoma and simultaneous malignant pericardial effusion. Her disease characteristics, treatment course, radiologic and pathologic findings are described in detail, and we review the previous literature to determine the various aspects of her disease that may have contributed to her aggressive clinical course.

Coherent Transfer between Low-Angular-Momentum and Circular Rydberg States

We realize a coherent transfer between a laser-accessible low-angular-momentum Rydberg state and the circular Rydberg level with maximal angular momentum. It is induced by a radio frequency field with a high-purity σ^{+} polarization resonant on Stark transitions inside the hydrogenic Rydberg manifold. We observe over a few microseconds more than 20 coherent Rabi oscillations between the initial Rydberg state and the circular level. We characterize these many-Rydberg-level oscillations and find them in perfect agreement with a simple model. This coherent transfer opens the way to hybrid quantum gates bridging the gap between optical communication and quantum information manipulations with microwave cavity and circuit quantum electrodynamics.

A new approach to examine the ability to control HCMV in patients after haploidentical stem cell transplantation

We utilized the recently developed approach (1) to examine HCMV-specific responses of CD8 T cells in patients who underwent haploidentical stem cell transplantation (HSCT) by analyzing the pattern of Ca2+ signaling in individual T cells assembled into a continuous monolayer after stimulation with HCMV peptide epitopes. Three groups of responding CD8+ T cells were identified: (i) T cells that rapidly develop sustained Ca2+ signaling typical for T-cell responses to a strong agonist peptide, (ii) T cells developing delayed but sustained Ca2+ signaling that is characteristic for T-cell responses to a weak agonist peptide, and (iii) T cells that revealed oscillating Ca2+ signaling indicative of suboptimal T cell activation. T cells showing sporadic and transient Ca2+ spikes were considered unresponsive. In patients whose immune system was still rebooting after transplant, HCMV was reactivated and this was mirrored by a very low fraction of HCMV-specific T cells, which mount rapid and sustained Ca2+ signaling, while the majority of responding T cells exhibited delayed or oscillating Ca2+ signaling. In contrast, a significant fraction of HCMV-specific T cells from patients who control the virus revealed rapid and sustained Ca2+ signaling. The ability to monitor patients’ immune system response to HCMV enables us to tailor treatment to better keep CMV in check.

Spatially controlled positioning of coordination polymer nanoparticles onto heterogeneous nanostructured surfaces

Prussian Blue Analog (PBA) nanoparticles were formed on a heterogeneous nanostructured surface made of an ordered nanoperforated titanium oxide thin film deposited on a gold layer. The study of the nanocomposite film by grazing-incidence wide angle X-ray scattering, infrared spectroscopy, scanning electron microscopy and atomic force microscopy shows that the PBA particles are precisely positioned within all the perforations of the oxide film over very large surface areas. Further investigation on the formation of the PBA particles demonstrates a decisive role of a heterogeneous nucleation of the coordination polymer driven by well-adjusted surfaces energies and reactant concentrations in the spatial positioning of the PBA particles. Thanks to the well-controlled positioning of the particles within the ordered nanoperforations, the latter were successfully used as nano crucibles for the local transformation of PBA into the corresponding metal alloy by heat treatment. The thin film heterostructure thus obtained, made of ferromagnetic islands isolated by diamagnetic walls, opens interesting perspectives for the design of magnetic storage devices.

Evaluating frequency and quality of pathogen-specific T cells

It is generally accepted that enumeration and characterization of antigen-specific T cells provide essential information about potency of the immune response. Here, we report a new technique to determine the frequency and potency of antigen-specific CD8 T cells. The assay measures changes of intracellular Ca²⁺ in real time by fluorescent microscopy in individual CD8 T cells responding to cognate peptides. The T cells form continuous monolayer, enabling the cells to present the peptides to each other. This approach allows us to evaluate the kinetics of intracellular Ca²⁺ signalling that characterizes the quality of T cell response. We demonstrate the usefulness of the assay examining the frequency and quality of cytomegalovirus-specific CD8 T cells from healthy donor and patient after haploidentical stem cell transplantation. The new assay has a potential to provide essential information determining the status of the immune system, disease morbidity, potency of therapeutic intervention and vaccine efficacy.

Characterization of T cell antigen specificity human blood is challenging due to the low clonal frequencies. Here the authors develop a fluorescent microscopy-based method to detect antigen-specific CD8 T cell activation, and apply it to characterize the anti-CMV repertoire.

Measuring frequency and quality of pathogen-specific T cells

The frequency and functional activity of pathogen-specific T cells reflect the effectiveness of immune responses. We have developed an assay to measure the frequency and efficacy of antigen-specific CD8 T cells. The assay measures changes of intracellular Ca2+ in real time by fluorescent microscopy in individual CD8 T cells, which are immobilized on a glass surface to form a monolayer enabling the cells to present cognate peptides to each other. The T cells were labeled with Ca2+ dependent fluorophore, and intracellular fluorescence in the cells was analyzed before and after stimulation with specific antigenic peptides. Subtraction of the fluorescent intensity measured prior and after the stimulation revealed responding T cells and the kinetics of intracellular Ca2+ accumulation. The proposed assay permits comparison of the same cell before and after stimulation providing a significant increase in the sensitivity and utility of the assay. We found that as little as 3–5 responding T cells among 1×104 CD8 T cells could be reliably detected and that as much as 100 T cells with different specificities could be identified in a single round of analysis. We utilized the assay to characterize the frequency and quality of human cytomegalovirus-specific CD8 T cells from peripheral blood of healthy donors and patients who underwent haploidentical stem cell transplantation. The data revealed potential diagnostic and prognostic values of the proposed assay.

A Two-Step Haploidentical Versus a Two-Step Matched Related Allogeneic Myeloablative Peripheral Blood Stem Cell Transplantation

Haploidentical stem cell transplantation (SCT) offers a transplantation option to patients who lack an HLA-matched donor. We developed a 2-step approach to myeloablative allogeneic hematopoietic stem cell transplantation for patients with haploidentical or matched related (MR) donors. In this approach, the lymphoid and myeloid portions of the graft are administered in 2 separate steps to allow fixed T cell dosing. Cyclophosphamide is used for T cell tolerization. Given a uniform conditioning regimen, graft T cell dose, and graft-versus-host disease (GVHD) prophylaxis strategy, we compared immune reconstitution and clinical outcomes in patients undergoing 2-step haploidentical versus 2-step MR SCT. We retrospectively compared data on patients undergoing a 2-step haploidentical (n = 50) or MR (n = 27) peripheral blood SCT for high-risk hematological malignancies and aplastic anemia. Both groups received myeloablative total body irradiation conditioning. Immune reconstitution data included flow cytometric assessment of T cell subsets at day 28 and 90 after SCT. Both groups showed comparable early immune recovery in all assessed T cell subsets except for the median CD3/CD8 cell count, which was higher in the MR group at day 28 compared with that in the haploidentical group. The 3-year probability of overall survival was 70% in the haploidentical group and 71% in the MR group (P = .81), while the 3-year progression-free survival was 68% in the haploidentical group and 70% in the MR group (P = .97). The 3-year cumulative incidence of nonrelapse mortality was 10% in the haploidentical group and 4% in the MR group (P = .34). The 3-year cumulative incidence of relapse was 21% in the haploidentical group and 27% in the MR group (P = .93). The 100-day cumulative incidence of overall grades II to IV acute GVHD was higher in the haploidentical group compared with that in the MR group (40% versus 8%, P < .001), whereas the grades III and IV acute GVHD was not statistically different between both groups (haploidentical, 6%; MR, 4%; P = .49). The cumulative incidence of cytomegalovirus reactivation was also higher in the haploidentical group compared to the MR group (haploidentical, 68%; MR, 19%; P < .001). There were no deaths from GVHD in either group. Using an identical conditioning regimen, graft T cell dose, and GVHD prophylaxis strategy, comparable early immune recovery and clinical outcomes were observed in the 2-step haploidentical and MR SCT recipients.

Critical effect of pore characteristics on capillary infiltration in mesoporous films

Capillary phenomena governing the mass-transport (capillary filling, condensation/evaporation) has been experimentally investigated in around 20 different silica thin films exhibiting various porosities with pores dimension ranging from 2 to 200 nm. Films have been prepared by sol-gel chemistry combined with soft-templating approaches and controlled dip coating process. Environmental ellipsometric porosimetry combined with electronic microscopy were used to assess the porosity characteristics. Investigation of lateral capillary filling was performed by following the natural infiltration of water and ionic liquids at the edge of a sessile drop in open air or underneath a PDMS cover. The Washburn model was applied to the displacement of the liquid front within the films to deduce the kinetic constants. The role of the different capillary phenomena were discussed with respect to the porosity characteristics (porosity vol%, pore dimensions and constrictions). We show that correlation between capillary filling rate and pore dimensions is not straightforward. Generally, with a minimum of constrictions, faster filling is observed for larger pores. In the case of mesopores (<50 nm in diameter), the presence of bottle necks considerably slows down the infiltration rate. At such a small dimension, evaporation/capillary condensation dynamics, taking place at the meniscus inside the porosity, has to be considered to explain the transport mode. This fundamental study is of interest for applications involving liquids at the interface of mesoporous networks such as nanofluidics, purification, separation, water harvesting or heat transfer.

Recent advances in haploidentical stem cell transplantation

In the last two decades, new developments in haploidentical hematopoietic stem cell transplantation have made it a viable alternative donor option. Initially, allogeneic HSCT was limited to patients who had HLA-identical related donors. To provide options for patients lacking a matched related donor, registries of unrelated volunteer donors or cord blood units have been established with the hopes of providing a phenotypically well-matched stem cell product. The use of haploidentical donors broadens the application of HSCT more than these other approaches. In addition, the greater HLA mismatching associated with haploidentical HSCT may potentiate graft versus tumor (GVT) effects.

Probing the energy barriers and magnetization reversal processes of nanoperforated membrane based percolated media

Magnetization reversal processes in Co/Pt multilayers prepared on nanoperforated templates are probed by magnetization relaxation measurements. The signature of pinning controlled domain wall movement as expected for percolated media is identified. This contrasts with the nucleation-type reversal mechanism of a Co/Pt reference film prepared on a smooth substrate. A zero field energy barrier of 93kBT is determined by fluctuation field measurements and is elucidated by micromagnetic calculations using the nudged elastic band method. This value is sufficiently large to qualify the material as a promising percolated medium.

A two-step approach to allogeneic haploidentical hematopoietic stem cell transplantation

Strategies that exploit natural killer (NK) cell alloreactivity or attenuate rather than deplete T cells have resulted in improved outcomes after haploidentical hematopoietic stem cell transplantation (HSCT). However, no approach has consistently produced the triad of optimal immune reconstitution, avoidance of significant graft-versus-host disease (GVHD), and durable control of malignancy. We developed a two-step approach to haploidentical HSCT in which the lymphoid and myeloid portions of the graft are given in two separate steps in order to control and optimize T-cell dosing. The initial results from these trials have included robust immune reconstitution, low rates of toxicity and significant GVHD, and durable disease control in good-risk patients, as well as insights regarding a threshold for T-cell dosing above which graft-versus-tumor (GVT) effects might be expected. Patients who were not in remission at the time of HSCT had higher rates of relapse requiring efforts to further strengthen GVT effects. Second-generation trials are underway to further exploit changes in the dosing and timing of administration of T cells and to optimize donor selection in an effort to decrease relapse rates in high-risk patients.

[Urinary evaluations of drug consumption among workers having high risk of accident: technical difficulties, limits and possibilities of increasing efficacy of the law]

Urinary evaluations of drug consumption among workers having high risk of accident became compulsory in Italian legislation few years ago. We report results of 322.110 single urinary drug detections carried out between 2008 and 2011 on 35.789 subjects. We verified technical difficulties arisen during laboratory detections and organizational difficulties evidenced by Occupational Doctors during collections of samples. We screened 701 positive samples (1.96%), mostly to Cannabinoids and Cocaine, verified using first and second level screening according to national law. Many patients referred regular or irregular use of medicines active on Central Nervous System frequently ignoring their collateral effects. After the evidence of a positive result, during a second medical visit, many workers referred assumption of "natural diet supplements" acquired not in traditional commercial distributors. In two cases we have had the possibility of analyzing these supplements which have shown the presence of law concentrations of drugs in their compositions.