Forested watersheds provide the highest water quality among all land cover types, but the benefit of this ecosystem service depends on landscape context

Conversion of natural land cover can degrade water quality in water supply watersheds and increase treatment costs for Public Water Systems (PWSs), but there are few studies that have fully evaluated land cover and water quality relationships in mixed use watersheds across broad hydroclimatic settings. We related upstream land cover (forest, other natural land covers, development, and agriculture) to observed and modeled water quality across the southeastern US and specifically at 1746 PWS drinking water intake facilities. While there was considerable complexity and variability in the relationship between land cover and water quality, results suggest that Total Nitrogen (TN), Total Phosphorus (TP) and Suspended Sediment (SS) concentrations decrease significantly with increasing forest cover, and increase with increasing developed or agricultural cover. Catchments with dominant (>90 %) agricultural land cover had the greatest export rates for TN, TP, and SS based on SPARROW model estimates, followed by developed-dominant, then forest- and other-natural-dominant catchments. Variability in modeled TN, TP, and SS export rates by land cover type was driven by variability in natural background sources and catchment characteristics that affected water quality even in forest-dominated catchments. Both intake setting (i.e., run-of-river or reservoir) and upstream land cover were important determinants of water quality at PWS intakes. Of all PWS intakes, 15 % had high raw water quality, and 85 % of those were on reservoirs. Of the run-of-river intakes with high raw water quality, 75 % had at least 50 % forest land cover upstream. In addition, PWS intakes obtaining surface water supply from smaller upstream catchments may experience the largest losses of natural land cover based on projections of land cover in 2070. These results illustrate the complexity and variability in the relationship between land cover and water quality at broad scales, but also suggest that forest conservation can enhance the resilience of drinking water supplies.

Assessment of hydrologic vulnerability to urbanization and climate change in a rapidly changing watershed in the Southeast U.S

This study assessed the combined effects of increased urbanization and climate change on streamflow in the Yadkin-Pee Dee watershed (North Carolina, USA) and focused on the conversion from forest to urban land use, the primary land use transition occurring in the watershed. We used the Soil and Water Assessment Tool to simulate future (2050-2070) streamflow and baseflow for four combined climate and land use scenarios across the Yadkin-Pee Dee River watershed and three subwatersheds. The combined scenarios pair land use change and climate change scenarios together. Compared to the baseline, projected streamflow increased in three out of four combined scenarios and decreased in one combined scenario. Baseflow decreased in all combined scenarios, but decreases were largest in subwatersheds that lost the most forest. The effects of land use change and climate change were additive, amplifying the increases in runoff and decreases in baseflow. Streamflow was influenced more strongly by climate change than land use change. However, for baseflow the reverse was true; land use change tended to drive baseflow more than climate change. Land use change was also a stronger driver than climate in the most urban subwatershed. In the most extreme land use and climate projection the volume of the 1-day, 100 year flood nearly doubled at the watershed outlet. Our results underscore the importance of forests as hydrologic regulators buffering streamflow and baseflow from hydrologic extremes. Additionally, our results suggest that land managers and policy makers need to consider the implications of forest loss on streamflow and baseflow when planning for future urbanization and climate change adaptation options.

Terra incognita: The unknown risks to environmental quality posed by the spatial distribution and abundance of concentrated animal feeding operations

Concentrated animal feeding operations (CAFOs) pose wide ranging environmental risks to many parts of the US and across the globe, but datasets for CAFO risk assessments are not readily available. Within the United States, some of the greatest concentrations of CAFOs occur in North Carolina. It is also one of the only states with publicly accessible location data for classes of CAFOs that are required to obtain water quality permits from the U.S. Environmental Protection Agency (EPA); however, there are no public data sources for the large number of CAFOs that do not require EPA water quality permits. We combined public records of CAFO locations with data collected in North Carolina by the Waterkeeper and Riverkeeper Alliances to examine the distribution of both permitted and non-permitted CAFOs across the state. Over half (55%) of the state's 6646 CAFOs are located in the Coastal Plain, a low-lying region vulnerable to flooding associated with regular cyclonic and convective storms. We identified 19% of CAFOs ≤ 100 m of the nearest stream, and some as close as 15 m to the nearest stream, a common riparian buffer width for water quality management. Future climate scenarios suggest large storm events are expected to become increasingly extreme, and dry interstorm periods could lengthen. Such extremes could exacerbate the environmental impacts of CAFOs. Understanding the potential impacts of CAFO agroecosystems will require remote sensing to identify CAFOs, fieldwork to determine the extent of environmental footprints, and modeling to identify thresholds that determine environmental risk under changing conditions.

Warmer temperatures reduce net carbon uptake, but do not affect water use, in a mature southern Appalachian forest

Increasing air temperature is expected to extend growing season length in temperate, broadleaf forests, leading to potential increases in evapotranspiration and net carbon uptake. However, other key processes affecting water and carbon cycles are also highly temperature-dependent. Warmer temperatures may result in higher ecosystem carbon loss through respiration and higher potential evapotranspiration through increased atmospheric demand for water. Thus, the net effects of a warming planet are uncertain and highly dependent on local climate and vegetation. We analyzed five years of data from the Coweeta eddy covariance tower in the southern Appalachian Mountains of western North Carolina, USA, a highly productive region that has historically been underrepresented in flux observation networks. We examined how leaf phenology and climate affect water and carbon cycling in a mature forest in one of the wettest biomes in North America. Warm temperatures in early 2012 caused leaf-out to occur two weeks earlier than in cooler years and led to higher seasonal carbon uptake. However, these warmer temperatures also drove higher winter ecosystem respiration, offsetting much of the springtime carbon gain. Interannual variability in net carbon uptake was high (147 to 364 g C m^-2 y^-1), but unrelated to growing season length. Instead, years with warmer growing seasons had 10% higher respiration and sequestered ~40% less carbon than cooler years. In contrast, annual evapotranspiration was relatively consistent among years (coefficient of variation = 4%) despite large differences in precipitation (17%, range = 800 mm). Transpiration by the evergreen understory likely helped to compensate for phenologically-driven differences in canopy transpiration. The increasing frequency of high summer temperatures is expected to have a greater effect on respiration than growing season length, reducing forest carbon storage.

Forest biogeochemistry in response to drought

Trees alter their use and allocation of nutrients in response to drought, and changes in soil nutrient cycling and trace gas flux (N2 O and CH4 ) are observed when experimental drought is imposed on forests. In extreme droughts, trees are increasingly susceptible to attack by pests and pathogens, which can lead to major changes in nutrient flux to the soil. Extreme droughts often lead to more common and more intense forest fires, causing dramatic changes in the nutrient storage and loss from forest ecosystems. Changes in the future manifestation of drought will affect carbon uptake and storage in forests, leading to feedbacks to the Earth's climate system. We must improve the recognition of drought in nature, our ability to manage our forests in the face of drought, and the parameterization of drought in earth system models for improved predictions of carbon uptake and storage in the world's forests.

Drought limitations to leaf-level gas exchange: results from a model linking stomatal optimization and cohesion-tension theory

We merge concepts from stomatal optimization theory and cohesion-tension theory to examine the dynamics of three mechanisms that are potentially limiting to leaf-level gas exchange in trees during drought: (1) a 'demand limitation' driven by an assumption of optimal stomatal functioning; (2) 'hydraulic limitation' of water movement from the roots to the leaves; and (3) 'non-stomatal' limitations imposed by declining leaf water status within the leaf. Model results suggest that species-specific 'economics' of stomatal behaviour may play an important role in differentiating species along the continuum of isohydric to anisohydric behaviour; specifically, we show that non-stomatal and demand limitations may reduce stomatal conductance and increase leaf water potential, promoting wide safety margins characteristic of isohydric species. We used model results to develop a diagnostic framework to identify the most likely limiting mechanism to stomatal functioning during drought and showed that many of those features were commonly observed in field observations of tree water use dynamics. Direct comparisons of modelled and measured stomatal conductance further indicated that non-stomatal and demand limitations reproduced observed patterns of tree water use well for an isohydric species but that a hydraulic limitation likely applies in the case of an anisohydric species.

Recurrent activating mutations of CD28 in peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of mature T-cell neoplasms with a poor prognosis. Recently, mutations in TET2 and other epigenetic modifiers as well as RHOA have been identified in these diseases, particularly in angioimmunoblastic T-cell lymphoma (AITL). CD28 is the major co-stimulatory receptor in T cells which, upon binding ligand, induces sustained T-cell proliferation and cytokine production when combined with T-cell receptor stimulation. We have identified recurrent mutations in CD28 in PTCLs. Two residues-D124 and T195-were recurrently mutated in 11.3% of cases of AITL and in one case of PTCL, not otherwise specified (PTCL-NOS). Surface plasmon resonance analysis of mutations at these residues with predicted differential partner interactions showed increased affinity for ligand CD86 (residue D124) and increased affinity for intracellular adaptor proteins GRB2 and GADS/GRAP2 (residue T195). Molecular modeling studies on each of these mutations suggested how these mutants result in increased affinities. We found increased transcription of the CD28-responsive genes CD226 and TNFA in cells expressing the T195P mutant in response to CD3 and CD86 co-stimulation and increased downstream activation of NF-κB by both D124V and T195P mutants, suggesting a potential therapeutic target in CD28-mutated PTCLs.

Complex forest dynamics indicate potential for slowing carbon accumulation in the southeastern United States

Over the past century forest regrowth in Europe and North America expanded forest carbon (C) sinks and offset C emissions but future C accumulation is uncertain. Policy makers need insights into forest C dynamics as they anticipate emissions futures and goals. We used land use and forest inventory data to estimate how forest C dynamics have changed in the southeastern United States and attribute changes to land use, management, and disturbance causes. From 2007-2012, forests yielded a net sink of C because of net land use change (+6.48 Tg C yr⁻¹) and net biomass accumulation (+75.4 Tg C yr⁻¹). Forests disturbed by weather, insect/disease, and fire show dampened yet positive forest C changes (+1.56, +1.4, +5.48 Tg C yr⁻¹, respectively). Forest cutting caused net decreases in C (−76.7 Tg C yr⁻¹) but was offset by forest growth (+143.77 Tg C yr⁻¹). Forest growth rates depend on age or stage of development and projected C stock changes indicate a gradual slowing of carbon accumulation with anticipated forest aging (a reduction of 9.5% over the next five years). Additionally, small shifts in land use transitions consistent with economic futures resulted in a 40.6% decrease in C accumulation.

Divergent phenological response to hydroclimate variability in forested mountain watersheds

Mountain watersheds are primary sources of freshwater, carbon sequestration, and other ecosystem services. There is significant interest in the effects of climate change and variability on these processes over short to long time scales. Much of the impact of hydroclimate variability in forest ecosystems is manifested in vegetation dynamics in space and time. In steep terrain, leaf phenology responds to topoclimate in complex ways, and can produce specific and measurable shifts in landscape forest patterns. The onset of spring is usually delayed at a specific rate with increasing elevation (often called Hopkins' Law; Hopkins, 1918), reflecting the dominant controls of temperature on greenup timing. Contrary with greenup, leaf senescence shows inconsistent trends along elevation gradients. Here, we present mechanisms and an explanation for this variability and its significance for ecosystem patterns and services in response to climate. We use moderate-resolution imaging spectro-radiometer (MODIS) Normalized Difference Vegetation Index (NDVI) data to derive landscape-induced phenological patterns over topoclimate gradients in a humid temperate broadleaf forest in southern Appalachians. These phenological patterns are validated with different sets of field observations. Our data demonstrate that divergent behavior of leaf senescence with elevation is closely related to late growing season hydroclimate variability in temperature and water balance patterns. Specifically, a drier late growing season is associated with earlier leaf senescence at low elevation than at middle elevation. The effect of drought stress on vegetation senescence timing also leads to tighter coupling between growing season length and ecosystem water use estimated from observed precipitation and runoff generation. This study indicates increased late growing season drought may be leading to divergent ecosystem response between high and low elevation forests. Landscape-induced phenological patterns are easily observed over wide areas and may be used as a unique diagnostic for sources of ecosystem vulnerability and sensitivity to hydroclimate change.

Future species composition will affect forest water use after loss of eastern hemlock from southern Appalachian forests

Infestation of eastern hemlock (Tsuga canadensis (L.) Carr.) with hemlock woolly adelgid (HWA, Adelges tsugae) has caused widespread mortality of this key canopy species throughout much of the southern Appalachian Mountains in the past decade. Because eastern hemlock is heavily concentrated in riparian habitats, maintains a dense canopy, and has an evergreen leaf habit, its loss is expected to have a major impact on forest processes, including transpiration (E(t)). Our goal was to estimate changes in stand-level E(t) since HWA infestation, and predict future effects of forest regeneration on forest E(t) in declining eastern hemlock stands where hemlock represented 50-60% of forest basal area. We used a combination of community surveys, sap flux measurements, and empirical models relating sap flux-scaled leaf-level transpiration (E(L)) to climate to estimate the change in E(t) after hemlock mortality and forecast how forest E(t) will change in the future in response to eastern hemlock loss. From 2004 to 2011, eastern hemlock mortality reduced annual forest E(t) by 22% and reduced winter E(t) by 74%. As hemlock mortality increased, growth of deciduous tree species--especially sweet birch (Betula lenta L.), red maple (Acer rubrum L.), yellow poplar (Liriodendron tulipifera L.), and the evergreen understory shrub rosebay rhododendron (Rhododendron maximum L.)--also increased, and these species will probably dominate post-hemlock riparian forests. All of these species have higher daytime E(L) rates than hemlock, and replacement of hemlock with species that have less conservative transpiration rates will result in rapid recovery of annual stand E(t). Further, we predict that annual stand E(t) will eventually surpass E(t) levels observed before hemlock was infested with HWA. This long-term increase in forest E(t) may eventually reduce stream discharge, especially during the growing season. However, the dominance of deciduous species in the canopy will result in a permanent reduction in winter E(t) and possible increase in winter stream discharge. The effects of hemlock die-off and replacement with deciduous species will have a significant impact on the hydrologic flux of forest transpiration, especially in winter. These results highlight the impact that invasive species can have on landscape-level ecosystem fluxes.

Clinical and molecular characterization of diffuse large B-cell lymphomas with 13q14.3 deletion

BACKGROUND

Deletions at 13q14.3 are common in chronic lymphocytic leukemia and are also present in diffuse large B-cell lymphomas (DLBCL) but never in immunodeficiency-related DLBCL. To characterize DLBCL with 13q14.3 deletions, we combined genome-wide DNA profiling, gene expression and clinical data in a large DLBCL series treated with rituximab, cyclophosphamide, doxorubicine, vincristine and prednisone repeated every 21 days (R-CHOP21).

PATIENTS AND METHODS

Affymetrix GeneChip Human Mapping 250K NspI and U133 plus 2.0 gene were used. MicroRNA (miRNA) expression was studied were by real-time PCR. Median follow-up of patients was 4.9 years.

RESULTS

Deletions at 13q14.3, comprising DLEU2/MIR15A/MIR16, occurred in 22/166 (13%) cases. The deletion was wider, including also RB1, in 19/22 cases. Samples with del(13q14.3) had concomitant specific aberrations. No reduced MIR15A/MIR16 expression was observed, but 172 transcripts were significantly differential expressed. Among the deregulated genes, there were RB1 and FAS, both commonly deleted at genomic level. No differences in outcome were observed in patients treated with R-CHOP21.

CONCLUSIONS

Cases with 13q14.3 deletions appear as group of DLBCL characterized by common genetic and biologic features. Deletions at 13q14.3 might contribute to DLBCL pathogenesis by two mechanisms: deregulating the cell cycle control mainly due RB1 loss and contributing to immune escape, due to FAS down-regulation.

Imidacloprid movement in soils and impacts on soil microarthropods in southern Appalachian eastern hemlock stands

Imidacloprid is a systemic insecticide effective in controlling the exotic pest (hemlock woolly adelgid) in eastern hemlock () trees. Concerns over imidacloprid impacts on nontarget species have limited its application in southern Appalachian ecosystems. We quantified the movement and adsorption of imidacloprid in forest soils after soil injection in two sites at Coweeta Hydrologic Laboratory in western North Carolina. Soils differed in profile depth, total carbon and nitrogen content, and effective cation exchange capacity. We injected imidacloprid 5 cm into mineral soil, 1.5 m from infested trees, using a Kioritz soil injector. We tracked the horizontal and vertical movement of imidacloprid by collecting soil solution and soil samples at 1 m, 2 m, and at the drip line from each tree periodically for 1 yr. Soil solution was collected 20 cm below the surface and just above the saprolite, and acetonitrile-extractable imidacloprid was determined through the profile. Soil solution and extractable imidacloprid concentrations were determined by high-performance liquid chromatography. Soil solution and extractable imidacloprid concentrations were greater in the site with greater soil organic matter. Imidacloprid moved vertically and horizontally in both sites; concentrations generally declined downward in the soil profile, but preferential flow paths allowed rapid vertical movement. Horizontal movement was limited, and imidacloprid did not move to the tree drip line. We found a negative relationship between adsorbed imidacloprid concentrations and soil microarthropod populations largely in the low-organic-matter site; however, population counts were similar to other studies at Coweeta.

Can forest management be used to sustain water-based ecosystem services in the face of climate change?

Forested watersheds, an important provider of ecosystems services related to water supply, can have their structure, function, and resulting streamflow substantially altered by land use and land cover. Using a retrospective analysis and synthesis of long-term climate and streamfiow data (75 years) from six watersheds differing in management histories we explored whether streamflow responded differently to variation in annual temperature and extreme precipitation than unmanaged watersheds. We show significant increases in temperature and the frequency of extreme wet and dry years since the 1980s. Response models explained almost all streamflow variability (adjusted R2 > 0.99). In all cases, changing land use altered streamflow. Observed watershed responses differed significantly in wet and dry extreme years in all but a stand managed as a coppice forest. Converting deciduous stands to pine altered the streamflow response to extreme annual precipitation the most; the apparent frequency of observed extreme wet years decreased on average by sevenfold. This increased soil water storage may reduce flood risk in wet years, but create conditions that could exacerbate drought. Forest management can potentially mitigate extreme annual precipitation associated with climate change; however, offsetting effects suggest the need for spatially explicit analyses of risk and vulnerability.

Impact of Imidacloprid for Control of Hemlock Woolly Adelgid on Nearby Aquatic Macroinvertebrate Assemblages

Imidacloprid, a systemic insecticide that acts on the nervous system, is currently being used to control hemlock woolly adelgid (Adelges tsugae Annand), which is damaging hemlock trees. The objective of this study was to determine whether soil injection with imidacloprid for hemlock woolly adelgid control near streams adversely affects aquatic invertebrates. Eastern hemlocks (Tsuga canadensis) in the watersheds surrounding four streams in the southern Appalachian region of Georgia and North Carolina were treated with imidacloprid. Addie Branch was the only stream that exhibited a possible effect from imidacloprid treatment. However, the data followed the same pattern as the other treatment streams, but with a more pronounced decrease in taxa due to adult emergence. Only a trace amount of imidacloprid was detected in one water sample from Holcomb Tributary over a period of 2 years, and no effect was observed on the aquatic macroinvertebrates in that stream. However, caution should be used when applying these results to other areas with different soil types (e.g., low organic matter content) that may not bind imidacloprid as tightly. Our results indicate that soil injections of imidacloprid can safely be used in the southern Appalachian area to control hemlock woolly adelgid.

An international phase II trial of single-agent lenalidomide for relapsed or refractory aggressive B-cell non-Hodgkin's lymphoma

BACKGROUND

Lenalidomide is an immunomodulatory agent with antitumor activity in B-cell malignancies. This phase II trial aimed to demonstrate the safety and efficacy of lenalidomide in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), follicular grade 3 lymphoma (FL-III), or transformed lymphoma (TL).

METHODS

Patients received oral lenalidomide 25 mg on days 1-21 every 28 days as tolerated or until progression. The primary end point was overall response rate (ORR).

RESULTS

Two hundred and seventeen patients enrolled and received lenalidomide. The ORR was 35% (77/217), with 13% (29/217) complete remission (CR), 22% (48/217) partial remission, and 21% (45/217) with stable disease. The ORR for DLBCL was 28% (30/108), 42% (24/57) for MCL, 42% (8/19) for FL-III, and 45% (15/33) for TL. Median progression-free survival for all 217 patients was 3.7 months [95% confidence interval (CI) 2.7-5.1]. For 77 responders, the median response duration lasted 10.6 months (95% CI 7.0-NR). Median response duration was not reached in 29 patients who achieved a CR and in responding patients with FL-III or MCL. The most common adverse event was myelosuppression with grade 4 neutropenia and thrombocytopenia in 17% and 6%, respectively.

CONCLUSION

Lenalidomide is well tolerated and produces durable responses in patients with relapsed or refractory aggressive non-Hodgkin's lymphoma.

A Phase 1b/2 trial of mapatumumab in patients with relapsed/refractory non-Hodgkin's lymphoma

Background:

We conducted a multicentre Phase 1b/2 trial to evaluate the safety and efficacy of mapatumumab, a fully human agonistic monoclonal antibody to the tumour necrosis factor-related apoptosis-inducing ligand receptor 1 (TRAIL-R1) in patients with relapsed non-Hodgkin's lymphoma (NHL).

Methods:

Forty patients with relapsed or refractory NHL were treated with either 3 or 10 mg kg⁻¹ mapatumumab every 21 days. In the absence of disease progression or prohibitive toxicity, patients received a maximum of six doses.

Results:

Mapatumumab was well tolerated, with no patients experiencing drug-related hepatic or other dose-limiting toxicity. Three patients with follicular lymphoma (FL) experienced clinical responses, including two with a complete response and one with a partial response. Immunohistochemistry staining of the TRAIL-R1 suggested that strong staining in tumour specimens did not appear to be a requirement for mapatumumab activity in FL.

Conclusions:

Mapatumumab is safe and has promising clinical activity in patients with FL.

Recovery of nitrogen pools and processes in degraded riparian zones in the southern appalachians

Establishment of riparian buffers is an effective method for reducing nutrient input to streams. However, the underlying biogeochemical processes are not fully understood. The objective of this 4-yr study was to examine the effects of riparian zone restoration on soil N cycling mechanisms in a mountain pasture previously degraded by cattle. Soil inorganic N pools, fluxes, and transformation mechanisms were compared across the following experimental treatments: (i) a restored area with vegetation regrowth; (ii) a degraded riparian area with simulated effects of continued grazing by compaction, vegetation removal, and nutrient addition (+N); and (iii) a degraded riparian area with simulated compaction and vegetation removal only (-N). Soil solution NO(3)(-) concentrations and fluxes of inorganic N in overland flow were >90% lower in the restored treatment relative to the degraded (+N) treatment. Soil solution NO(3)(-) concentrations decreased more rapidly in the restored treatment relative to the degraded (-N) following cattle (Bos taurus) exclusion. Mineralization and nitrification rates in the restored treatment were similar to the degraded (-N) treatment and, on average, 75% lower than in the degraded (+N) treatment. Nitrogen trace gas fluxes indicated that restoration increased the relative importance of denitrification, relative to nitrification, as a pathway by which N is diverted from the receiving stream to the atmosphere. Changes in soil nutrient cycling mechanisms following restoration of the degraded riparian zone were primarily driven by cessation of N inputs. The recovery rate, however, was influenced by the rate of vegetation regrowth.

Simulated effects of sulfur deposition on nutrient cycling in class I wilderness areas

We predicted the effects of sulfate (SO(4)) deposition on wilderness areas designated as Class I air quality areas in western North Carolina using a nutrient cycling model (NuCM). We used three S deposition simulations: current, 50% decrease, and 100% increase. We measured vegetation, forest floor, and root biomass and collected soil, soil solution, and stream water samples for chemical analyses. We used the closest climate stations and atmospheric deposition stations to parameterize NuCM. The areas were: Joyce Kilmer (JK), Shining Rock (SR), and Linville Gorge (LG). They differ in soil acidity and nutrients, and soil solution and stream chemistry. Shining Rock and LG have lower soil solution base cation and higher acidic ion concentrations than JK. For SR and LG, the soil solution Ca/Al molar ratios are currently 0.3 in the rooting zone (A horizon), indicating Al toxicity. At SR, the simulated Ca/Al ratio increased to slightly above 1.5 after the 30-yr simulation regardless of S deposition reduction. At LG, Ca/Al ratios ranged from 1.6 to 2.4 toward the end of the simulation period, the 100% increase scenario had the lower value. Low Ca/Al ratios suggest that forests at SR and LG are significantly stressed under current conditions. Our results also suggest that SO(4) retention is low, perhaps contributing to their high degree of acidification. Their soils are acidic, low in weatherable minerals, and even with large reductions in SO(4) and associated acid deposition, it may take decades before these systems recover from depletion of exchangeable Ca, Mg, and K.

Distinctive patterns of BCL6 molecular alterations and their functional consequences in different subgroups of diffuse large B-cell lymphoma

Gene expression profiling of diffuse large B-cell lymphoma (DLBCL) has revealed biologically and prognostically distinct subgroups: germinal center B-cell-like (GCB), activated B-cell-like (ABC) and primary mediastinal (PM) DLBCL. The BCL6 gene is often translocated and/or mutated in DLBCL. Therefore, we examined the BCL6 molecular alterations in these DLBCL subgroups, and their impact on BCL6 expression and BCL6 target gene repression. BCL6 translocations at the major breakpoint region (MBR) were detected in 25 (18.8%) of 133 DLBCL cases, with a higher frequency in the PM (33%) and ABC (24%) subgroups than in the GCB (10%) subgroup. Translocations at the alternative breakpoint region (ABR) were detected in five (6.4%) of 78 DLBCL cases, with three cases in ABC and one case each in the GCB and the unclassifiable subgroups. The translocated cases involved IgH and non-IgH partners in about equal frequency and were not associated with different levels of BCL6 mRNA and protein expression. BCL6 mutations were detected in 61% of DLBCL cases, with a significantly higher frequency in the GCB and PM subgroups (>70%) than in the ABC subgroup (44%). Exon-1 mutations were mostly observed in the GCB subgroup. The repression of known BCL6 target genes correlated with the level of BCL6 mRNA and protein expression in GCB and ABC subgroups but not with BCL6 translocation and intronic mutations. No clear inverse correlation between BCL6 expression and p53 expression was observed. Patients with higher BCL6 mRNA or protein expression had a significantly better overall survival. The biological role of BCL6 in translocated cases where repression of known target genes is not demonstrated is intriguing and warrants further investigation.

Tsuga canadensis (L.) Carr. mortality will impact hydrologic processes in southern Appalachian forest ecosystems

Eastern hemlock (Tsuga canadensis (L.) Carr.) is one of the principal riparian and cove canopy species in the southern Appalachian Mountains. Throughout its range, eastern hemlock is facing potential widespread mortality from the hemlock woolly adelgid (HWA). If HWA-induced eastern hemlock mortality alters hydrologic function, land managers will be challenged to develop management strategies that restore function or mitigate impacts. To estimate the impact that the loss of this forest species will have on the hydrologic budget, we quantified and modeled transpiration over a range of tree sizes and environmental conditions. We used heat dissipation probes, leaf-level gas-exchange measurements, allometric scaling, and time series modeling techniques to quantify whole-tree and leaf-level transpiration (E(L)) of eastern hemlock. We monitored trees ranging from 9.5 to 67.5 cm in diameter along a riparian corridor in western North Carolina, USA during 2004 and 2005. Maximum rates of daily tree water use varied by diameter and height, with large trees transpiring a maximum of 178-186 kg H2O x tree(-1) x d(-1). Values of E(L) could be predicted from current and lagged environmental variables. We forecasted eastern hemlock E(L) for inventoried stands and estimated a mean annual transpiration rate of 63.3 mm/yr for the hemlock component, with 50% being transpired in the winter and spring. In typical southern Appalachian stands, eastern hemlock mortality would thus reduce annual stand-level transpiration by approximately 10% and reduce winter and spring stand-level transpiration by approximately 30%. Eastern hemlock in the southern Appalachians has two distinct ecohydrological roles: an evergreen tree that maintains year-round transpiration rates and a riparian tree that has high transpiration rates in the spring. No other native evergreen in the southern Appalachians will likely fill the ecohydrological role of eastern hemlock if widespread mortality occurs. With the loss of this species, we predict persistent increases in discharge, decreases in the diurnal amplitude of streamflow, and increases in the width of the variable source area.

Patients with grade 3 follicular lymphoma have prolonged relapse-free survival following anthracycline-based chemotherapy: the Nebraska Lymphoma Study Group Experience

BACKGROUND

The aim of the study was to determine the outcome and clinical features predictive of survival in patients with follicular lymphoma (FL) treated aggressively and to determine the rate of disease-specific mortality in patients with grade 3 FL (FL3).

MATERIALS AND METHODS

Four hundred and twenty-one patients with FL who were treated with various anthracycline-based chemotherapy regimens were included in this retrospective study.

RESULTS

Patients with FL3 and a diffuse component of >50% had the worst outcome, with a hazard ratio of dying of 2.2 (95% CI 1.4-3.4) compared with patients with FL1 or FL2, and a ratio of 1.6 (95% CI 1.02-2.5) compared with FL3 with a diffuse component of < or =50% by multivariate analysis (P = 0.0026). Patients with FL3a had an outcome similar to those with FL3b. In patients with FL3 and a diffuse component of < or =50%, the overall and event-free survival curves showed a plateau for patients younger than 60 years of age. However, there were no differences in the cumulative incidence of relapse/progression or lymphoma-specific/treatment-related mortality between the two age groups.

CONCLUSIONS

Less than half of the patients with FL3 and a diffuse component of < or =50% treated with anthracycline-based combination chemotherapy will relapse and relapses are uncommon after 6 years. Older patients should be offered the same aggressive chemotherapy as younger patients.

Adjustments in hydraulic architecture of Pinus palustris maintain similar stomatal conductance in xeric and mesic habitats

We investigated relationships between whole-tree hydraulic architecture and stomatal conductance in Pinus palustris Mill. (longleaf pine) across habitats that differed in soil properties and habitat structure. Trees occupying a xeric habitat (characterized by sandy, well-drained soils, higher nitrogen availability and lower overstory tree density) were shorter in stature and had lower sapwood-to-leaf area ratio (A(S):A(L)) than trees in a mesic habitat. The soil-leaf water potential gradient (psiS - psiL) and leaf-specific hydraulic conductance (kL) were similar between sites, as was tissue-specific hydraulic conductivity (Ks) of roots. Leaf and canopy stomatal conductance (gs and Gs, respectively) were also similar between sites, and they tended to be somewhat higher at the xeric site during morning hours when vapour pressure deficit (D) was low. A hydraulic model incorporating tree height, A(S):A(L) and psiS-psiL accurately described the observed variation in individual tree G(Sref) (G(S) at D = 1 kPa) across sites and indicated that tree height was an important determinant of G(Sref) across sites. This, combined with a 42% higher root-to-leaf area ratio (A(R):A(L)) at the xeric site, suggests that xeric site trees are hydraulically well equipped to realize equal--and sometimes higher potential for conductance compared with trees on mesic sites. However, a slightly more sensitive stomatal closure response to increasing D observed in xeric site trees suggests that this potential for higher conductance may only be reached when D is low and when the capacity of the hydraulic system to supply water to foliage is not greatly challenged.

Long-term update of a phase II study of rituximab in combination with CHOP chemotherapy in patients with previously untreated, aggressive non-Hodgkin's lymphoma

The present study aimed to determine the long-term safety and efficacy of chimeric anti-CD 20 antibody rituxan (rituximab, Biogen IDEC, San Diego, CA, USA; Genentech, South San Francisco, CA, USA) in combination with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy in previously untreated patients with aggressive non-Hodgkin's lymphoma (NHL). Thirty-three patients with previously untreated aggressive B-cell NHL received six infusions of rituximab (375 mg/m(2) per dose) on day 1 of each cycle of CHOP chemotherapy, given on day 3 of each cycle of therapy. Currently, the patients now have a median follow-up of 63 months (range 34 - 82 months). The overall response (OR) rate was 94% and the complete response (CR) rate was 61% at the end of therapy. Of the 33 patients, 2 patients experienced disease progression and subsequently died of their disease, 2 patients experienced disease progression but were alive at last follow-up following additional therapy, and 2 patients died without experiencing disease progression: one due to a cerebral vascular accident at 9 months after therapy and a second patient due to small cell lung carcinoma at 55 months. The 5-year survival rate was 88% (95% confidence interval (CI) 72 - 97) and the 5-year progression-free survival was 82% (95% CI 64 - 93). There were no long-term adverse events noted directly related to the rituximab. The long-term follow-up of patients in this phase II trial of rituximab with CHOP chemotherapy for previously untreated aggressive NHL demonstrates a high response rate, which remains very durable with high 5-year overall and progression-free survivals.

Hematopoietic stem cell transplantation in mantle cell lymphoma

BACKGROUND

Patients with mantle cell lymphoma (MCL) have in general, lower response rates and overall survival (OS) than those with other B-cell non-Hodgkin's lymphomas. The role of hematopoietic stem cell transplantation (HSCT) in MCL is unclear. Hence we decided to study the clinical course of patients who received autologous and allogeneic HSCT for MCL.

METHODS

Ninety-seven patients, (80 patients-autologous; 17 patients-allogeneic) who received a HSCT for mantle cell lymphoma were included in the study.

RESULTS

The complete response rates at day 100 between the two groups were similar (73% vs. 62%). Day-100 mortality was higher in the allogeneic HSCT group (19% vs. 0%) (P < 0.01). The estimated 5-year relapse rates, 5-year event-free survival (EFS) and 5-year OS among the allogeneic HSCT patients were 21%, 44% and 49%, respectively, similar to 56%, 39% and 47% in the autologous group. Ten patients received HyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone + high-dose methotrexate and cytarabine) +/- rituximab prior to transplant. There have been no relapses or deaths amongst these patients at a median follow-up of 16 months.

CONCLUSIONS

Patients treated with allogeneic HSCT had a lower relapse rate, but similar EFS and OS to autologous HSCT. Treatment of MCL with HyperCVAD +/- rituximab followed by HSCT seems promising.

Initial Effects of Prescribed Fire on Quality of Soil Solution and Streamwater in the Southern Appalachian Mountains

Prescribed burning is being used in the Conasauga River Watershed in southeastern Tennessee and northern Georgia by National Forest managers to restore degraded pine/oak communities. The purpose of these burns is to restore shortleaf pine (Pinus echinata Miller)/mixed-oak forestswith more diverse understories, which include native bluestem grasses (Andropogon gyrans Ashe and Schizachyrium scoparium (Michx.) Nash). Although burning might be an effective tool for restoring these stands to a shortleaf pine/mixed-oak/bluestem grass community type, it isnot known whether these restoration burns will have a negative impact on water quality. Six subwatersheds (similar in vegetation, soil type, stream size and location, and disturbance history) were located within the Conasauga River Watershed. Four of the sites were burned in Mar. 2001, andtwo sites were designated as controls. To evaluate initial effects of prescribed burning on water quality, we measured soil solution and streamwater nutrient concentrations and streamwater sediment concentration (TSS; total suspended solids) weekly over a 10-month period. Consistent with goalsof the land managers, all the prescribed fires resulted in low- to moderate-intensity and low-severity fires. Soil solution and streamwater NO−3-N and NH+4-N did not increase after burning on any of the sites. We found no differences inTSS between burn and control streams in any of the sample periods. In addition, we found no detectable differences between control and burned sites for concentrations of PO3−4, SO2−4, Ca2+, Mg2+, K+,or pH in soil solution or streamwater. Thus, these prescribed restoration fires did not have a significant effect on soil solution and stream chemistry or stream sediment (TSS) concentrations. Our results suggest that low-intensity, low-severity fires, such as those in this study, could beused as a tool to restore vegetation structure and composition in these mixed pine-hardwood ecosystems without negatively impacting water quality. South. J. Appl. For. 29(1):5–15.

Determination of the relative uptake of ground vs. surface water by Populus deltoides during phytoremediation

The use of plants to remediate polluted groundwater is becoming an attractive alternative to more expensive traditional techniques. In order to adequately assess the effectiveness of the phytoremediation treatment, a clear understanding of water-use habits by the selected plant species is essential. We examined the relative uptake of surface water (i.e., precipitation) vs. groundwater by mature Populus deltoides by applying irrigation water at a rate equivalent to a 5-cm rain event. We used stable isotopes of hydrogen (D) and oxygen (18O) to identify groundwater and surface water (irrigation water) in the xylem sap water. Pretreatment isotopic ratios of both deuterium and 18O, ranked from heaviest to lightest, were irrigation water > groundwater > xylem sap. The discrepancy in preirrigation isotopic signatures between groundwater and xylem sap suggests that in the absence of a surface source of water (i.e., between rain events) there is an unknown amount of water being extracted from sources other than groundwater (i.e., soil surface water). We examined changes in volumetric soil water content (%), total hourly sapflux rates, and trichloroethene (TCE) concentrations. Following the irrigation treatment, volumetric soil water increased by 86% and sapflux increased by as much as 61%. Isotopic signatures of the xylem sap became substantially heavier following irrigation, suggesting that the applied irrigation water was quickly taken up by the plants. TCE concentrations in the xylem sap were diluted by an average of 21% following irrigation; however, dilution was low relative to the increase in sapflux. Our results show that water use by Populus deltoides is variable. Hence, studies addressing phytoremediation effectiveness must account for the relative proportion of surface vs. groundwater uptake.

Immunological and clinical effects of post-transplant G-CSF versus placebo in T-cell replete allogeneic blood transplant patients: Results from a randomized double-blind study

BACKGROUND

Immunological and clinical effects of post-transplant growth factor administration have not been well studied. This report describes the outcome and immune functions of a total of 50 HLA-matched related donor allogeneic blood stem-cell transplantation patients who received post-transplant G-CSF (10 microg/kg) or placebo.

METHODS

Immune status, including number of lymphocyte subsets and their functions, and serum immunoglobulin levels and clinical status--including GvHD, rate of relapse, event-free survival, and overall survival--were determined in the patients enrolled in this study.

RESULTS

Twenty-eight patients survived 1 year after transplant, and 15 patients had available results to compare immune function by randomization assignment. At 12 months post-transplant, immune parameters in G-CSF versus placebo groups showed no statistically significant differences in number of circulating lymphocyte subsets CD3, CD4, CD8, CD19 and CD56 in the two groups. There was no significant (NS) difference in immunoglobulin IgG, IgA and IgM levels, NK or LAK cell-mediated cytotoxicity levels, and mitogen-induced proliferation between post-transplant G-CSF and placebo group. In addition, the analyses of immune parameters at earlier time-points on Days 28, 100, 180, and 270 revealed that, except for LAK cytotoxicity at Day 100, there was no differences between the two groups. Fourteen of 26 patients are alive in the G-CSF arm and nine of 24 in the placebo arm. Median follow-up of surviving patients is 43 months. Four year overall and event-free survival in the G-CSF and the placebo group were 53% and 35% (NS), and 44% and 36% (NS) respectively. Bacterial or fungal infections were the cause of six of 12 deaths in the G-CSF arm (all bacterial) and of four of 15 deaths in the placebo arm (two deaths from Aspergillus) (P=0.26). Two patients relapsed in the G-CSF arm and three in the placebo arm. Four year cumulative incidences of relapse were 8% versus 13% in G-CSF versus placebo arms, respectively, (NS). Chronic GvHD developed in 14 of 19 100-day survivors after G-CSF (11 extensive stage), and in 17 of 20 (14 extensive stage) in the placebo arm. The 4-year cumulative incidence of chronic GvHD was 56% [95% confidence interval (CI) 24-88%] after G-CSF and 71% (95% CI 48-94%) after placebo; this difference was not statistically significant (log rank P=0.41).

CONCLUSION

In summary, there were no significant immunological or alterations in clinical benefit of post-transplant G-CSF administration in T-replete allotransplant recipients.

Differences in Surface Water Quality Draining Four Road Surface Types in the Southern Appalachians

Improved and unimproved roads can be the primary source of stream sediment in forested watersheds. We assessed differences in production of total suspended solids (TSS; ppm) from four road surface conditions in a Southern Appalachian watershed: (1) a 2-yr-old paved surface (P), (2) an improved gravel surface with controlled drainage and routine maintenance (RG), (3) an improved gravel surface with erosion and sediment control structures installed and routine maintenance (IG), and (4) an unimproved poorly maintained gravel surface (UG). Variation was high among and within road surface types. The P surface generated the least amount of TSS, which was comparable to control sites, while the UG surface generated the most. The P surface produced significantly less TSS than the UG surface, but not less than the IG and RG surfaces. Variation among road surface types was related to TSS travel distance below the road, precipitation amount, time of year, and the existence of functioning erosion and sediment control structures. TSS decreased with travel distance (P = -81% over 38.5 m, IG = -30% over 30.5 m, RG = -89% over 39.4 m, and UG = -22% over 28.1 m). Also in this study we assessed the delivery of total petroleum hydrocarbons (TPH; ppm) from the P surface and found concentrations of < 0.5 ppm, which are well below published USEPA and NC DENR TPH standards for sediment. Paving is an attractive option for reducing maintenance costs and sediment production and transport; however, levels of TPH from freshly applied asphalt are unknown. South. J. Appl. For. 27(2):100–106.

Transplantation of highly purified CD34+Thy-1+ hematopoietic stem cells in patients with recurrent indolent non-Hodgkin's lymphoma

PURPOSE

To evaluate the results of high-dose chemotherapy and transplantation of highly purified "mobilized" peripheral blood CD34+Thy-1+ hematopoietic stem cells (HSCs) in patients with recurrent indolent non-Hodgkin's lymphoma (NHL) or mantle cell lymphoma (MCL).

PATIENTS AND METHODS

Twenty-six patients with recurrent indolent NHL or MCL were mobilized witheither granulocyte colony-stimulating factor (G-CSF) alone or cyclophosphamide plus G-CSF. Apheresis was performed, and the product was purified using the Isolex immunomagnetic positive CD34+ cell selection device initially and subsequent high-speed flow-cytometric cell sorting for the final purification of CD34+Thy-1+ HSCs. The patients received high-dose chemotherapy with BEAC (carmustine, etoposide, cytarabine, and cyclophosphamide) followed by transplantation with the purified HSCs in 2 dose cohorts (cohort 1: > or =5 x 10(5) viable and pure HSC/kg; cohort 2: > or =3 x 10(5) HSC/kg).

RESULTS

We attempted to mobilize 26 patients with G-CSF alone. Six patients did not collect adequate cells with G-CSF alone; subsequent mobilization with cyclophosphamide plus G-CSF was attempted, but adequate CD34+Thy-1+ HSCs could not be collected on these 6 patients. Twenty patients underwent transplantation with the BEAC transplantation regimen followed by purified HSCs. Patients in cohort 1 engrafted at a median of day 12 to an absolute neutrophil count (ANC) >500/microL, a median of day 19 for platelet transfusion independence, and a median of day 20 for red blood cell transfusion independence. Patients in cohort 2 engrafted at a median of day 12 to an ANC >500/microL, a median of day 12 for platelet transfusion independence, and a median of day 12 for red blood cell transfusion independence. Fourteen of the 20 patients had significant infections reported at some point posttransplantation, including influenza, respiratory syncytial virus, pneumonitis, and Pneumocystis carinii pneumonia. With a median follow-up of 38 months, 8 of the 20 patients have had progressive lymphoma and 5 patients have died. The 3-year event-free survival is 55%, and overall survival is 78%.

CONCLUSIONS

CD34+Thy-1+ HSCs can be collected successfully from most lymphoma patients mobilized with G-CSF alone. The engraftment and disease outcomes in the patients in this small pilot study using these cells do not appear to be different from the outcomes of similar patients cited in the literature. However, the short- and long-term risks of infection were a concern in this patient population.

Randomized, multicenter, open-label study of pegfilgrastim compared with daily filgrastim after chemotherapy for lymphoma

PURPOSE

The primary objective was to assess the duration of grade 4 neutropenia (neutrophil count < 0.5 x 10(9)/L) after one cycle of chemotherapy with etoposide, methylprednisolone, cisplatin, and cytarabine in patients randomly assigned to receive one dose of pegfilgrastim or daily filgrastim after chemotherapy. Febrile neutropenia, neutrophil profiles, time to neutrophil recovery, pharmacokinetics, and safety were also assessed.

PATIENTS AND METHODS

An open-label, randomized, phase II study was designed to compare the effects of a single subcutaneous injection of pegfilgrastim (sustained-duration filgrastim) 100 micro g/kg per chemotherapy cycle (n = 33) with daily subcutaneous injections of filgrastim 5 micro g/kg (n = 33) in patients receiving salvage chemotherapy for relapsed or refractory Hodgkin's or non-Hodgkin's lymphoma.

RESULTS

The incidence of grade 4 neutropenia in the pegfilgrastim and filgrastim groups was 69% and 68%, respectively. In addition, the mean duration of grade 4 neutropenia was similar in both groups (2.8 and 2.4 days, respectively). The results for the two groups were also not significantly different for febrile neutropenia, neutrophil profile, time to neutrophil recovery, or toxicity profile. A single subcutaneous injection of pegfilgrastim 100 micro g/kg produced a sustained serum concentration relative to daily subcutaneous injections of filgrastim. Filgrastim-treated patients received a median of 11 injections per cycle.

CONCLUSION

Pegfilgrastim was safe and well tolerated in this patient population. A single injection of pegfilgrastim per chemotherapy cycle provided neutrophil support with safety and efficacy similar to that provided by daily injections of filgrastim. Once-per-cycle administration of pegfilgrastim simplifies the management of neutropenia and may have important clinical benefits for patients and healthcare providers.

Therapeutic uses of MAbs directed against CD20

BACKGROUND

There are two main classes of Abs directed against the CD20 Ag that have been developed for therapeutic intent: unconjugated and radio-labeled Abs.

METHODS

The clinical results available from the large clinical trials utilizing both the unconjugated and radiolabelled Abs are summarized in this article.

DISCUSSION

Both of these classes of agents have shown promise in clinical trials both alone and in conjunction with conventional chemotherapy or high-dose chemotherapy and transplantation. Ongoing research with these agents will provide further evidence of the place in clinical practice for these agents.

Nitrogen trace gas emissions from a riparian ecosystem in southern Appalachia

In this paper, we present two years of seasonal nitric oxide (NO), ammonia (NH3), and nitrous oxide (N2O) trace gas fluxes measured in a recovering riparian zone with cattle excluded and adjacent riparian zone grazed by cattle. In the recovering riparian zone, average NO, NH3, and N2O fluxes were 5.8, 2.0, and 76.7 ng N m(-2) S(-1) (1.83, 0.63, and 24.19 kg N ha(-1) y(-1)), respectively. Fluxes in the grazed riparian zone were larger, especially for NO and NH3, measuring 9.1, 4.3, and 77.6 ng N m(-2) S(-1) (2.87, 1.35, and 24.50 kg N ha(-1) y(-1)) for NO, NH3, and N2O, respectively. On average, N2O accounted for greater than 85% of total trace gas flux in both the recovering and grazed riparian zones, though N2O fluxes were highly variable temporally. In the recovering riparian zone, variability in seasonal average fluxes was explained by variability in soil nitrogen (N) concentrations. Nitric oxide flux was positively correlated with soil ammonium (NH4+) concentration, while N2O flux was positively correlated with soil nitrate (NO3-) concentration. Ammonia flux was positively correlated with the ratio of NH4+ to NO3-. In the grazed riparian zone, average NH3 and N2O fluxes were not correlated with soil temperature, N concentrations, or moisture. This was likely due to high variability in soil microsite conditions related to cattle effects such as compaction and N input. Nitric oxide flux in the grazed riparian zone was positively correlated with soil temperature and NO3- concentration. Restoration appeared to significantly affect NO flux, which increased approximately 600% during the first year following restoration and decreased during the second year to levels encountered at the onset of restoration. By comparing the ratio of total trace gas flux to soil N concentration, we show that the restored riparian zone is likely more efficient than the grazed riparian zone at diverting upper-soil N from the receiving stream to the atmosphere. This is likely due to the recovery of microbiological communities following changes in soil physical characteristics.

The International Prognostic Factors Project score for advanced Hodgkin's disease is useful for predicting outcome of autologous hematopoietic stem cell transplantation

BACKGROUND

The International Prognostic Factors Project on Advanced Hodgkin's Disease developed a seven-factor prognostic score consisting of serum albumin, hemoglobin, gender, stage, age, leukocytosis and lymphocytopenia for newly diagnosed Hodgkin's disease patients who receive chemotherapy. The purpose of this study was to determine whether this prognostic score would also be useful for Hodgkin's disease patients undergoing autologous hematopoietic stem cell transplantation.

PATIENTS AND METHODS

We performed a retrospective review of 379 patients who had autologous transplants for Hodgkin's disease, at the University of Nebraska Medical Center between October 1984 and December 1999. Multivariate analysis was performed to determine whether the prognostic factors identified by the International Prognostic Factors Project adversely influenced event-free survival (EFS) or overall survival (OS).

RESULTS

Low serum albumin, anemia, age and lymphocytopenia were associated with poorer EFS and OS. Gender, stage and leukocytosis were not associated with significantly poorer outcomes. Estimated 10-year EFS was 38%, 23% and 7% for patients with 0-1, 2-3 or > or =4 of the adverse prognostic characteristics identified by the International Prognostic Factors Project, respectively.

CONCLUSIONS

The prognostic score for advanced disease is also useful for relapsed and refractory Hodgkin's disease patients undergoing high-dose therapy followed by autologous hematopoietic stem cell transplantation.

Pivotal study of iodine I 131 tositumomab for chemotherapy-refractory low-grade or transformed low-grade B-cell non-Hodgkin's lymphomas

PURPOSE

To evaluate the efficacy and safety of tositumomab and iodine I 131 tositumomab (Bexxar; Corixa Corp, Seattle, WA, and GlaxoSmithKline, Philadelphia, PA) in patients with chemotherapy-refractory low-grade or transformed low-grade non-Hodgkin's lymphoma (NHL) and to compare its efficacy to the patients' last qualifying chemotherapy (LQC) regimens.

PATIENTS AND METHODS

Sixty patients who had been treated with at least two protocol-specified qualifying chemotherapy regimens and had not responded or progressed within 6 months after their LQC were treated with a single course of iodine I 131 tositumomab.

RESULTS

Patients had received a median of four prior chemotherapy regimens. A partial or complete response (CR) was observed in 39 patients (65%) after iodine I 131 tositumomab, compared with 17 patients (28%) after their LQC (P <.001). The median duration of response (MDR) was 6.5 months after iodine I 131 tositumomab, compared with 3.4 months after the LQC (P <.001). Two patients (3%) had a CR after their LQC, compared with 12 (20%) after iodine I 131 tositumomab (P <.001). The MDR for CR was 6.1 months after the LQC and had not been reached with follow-up of more than 47 months after iodine I 131 tositumomab. An independent review panel verified that 32 (74%) of the 43 patients with nonequivalent durations of response (> 30 days difference) had a longer duration of response after iodine I 131 tositumomab (P <.001). Only one patient was hospitalized for neutropenic fever. Five patients (8%) developed human antimurine antibodies, and one (2%) developed an elevated TSH level after treatment. Myelodysplasia was diagnosed in four patients in follow-up.

CONCLUSION

A single course of iodine I 131 tositumomab was significantly more efficacious than the LQC received by extensively pretreated patients with chemotherapy-refractory, low-grade, or transformed low-grade NHL and had an acceptable safety profile.

Oligonucleotide enhanced cytotoxicity of Idarubicin for lymphoma cells

Oligonucleotides offer the potential to manipulate gene expression in targeted cells which might be exploitable for therapeutic benefit. The effects of combining a phosphorothioate oligonucleotide OL(1) p53, which transiently down-regulates p53 levels, with an anthracycline, Idarubicin, on the growth of wild-type p53 WMN gene-expressing lymphoma cells was evaluated. Fluorescent OL(1) p53, was used to demonstrate oligonucleotide uptake and retention by the WMN cells. Uptake was maximal at 24 hours and compared to baseline (0 hours) increasing apoptotic cells were evident in WMN cells treated with OL(1) (1 microM) alone and in combination with Idarubicin (0.2 nM) for 24 to 48 hours. In cells treated with OL(1) p53 and Idarubicin, truncated p53 message of a predicted 201 base pair length based on RNAase H cleavage of the OL(1) p53-p53 mRNA heteroduplex was detected after 7 hours of incubation. The message for p53 was transiently downregulated as detected by RT-PCR analysis at 24 hours, and protein levels transiently reduced at 36 hours, as shown by a quantitative Western blot. Corresponding to these events, the growth of WMN cells ceased after 48 hours in the concurrent presence of OL(1) p53 and Idarubicin and, the lymphoma cells were dead after 72 hours. No reduction in hematopoietic colony forming cell capacity of similarly treated hematopoietic progenitor cells harvested from cytokine-mobilized blood by apheresis was observed. Therefore, synergistic cytotoxicity of Idarubicin for lymphoma cells treated with an oligonucleotide targeting p53 message was demonstrated at oligonucleotide and Idarubicin concentrations which were minimally toxic to hematopoietic progenitor cells. This approach offers new opportunities for purging of lymphoma cells from hematopoietic harvests and systemic lymphoma therapy.

Outpatient treatment with (131)I-anti-B1 antibody: radiation exposure to family members

The Nuclear Regulatory Commission (NRC) regulations that govern release of patients administered radioactive material have been revised to include dose-based criteria in addition to the conventional activity-based criteria. A licensee may now release a patient if the total effective dose equivalent to another individual from exposure to the released patient is not likely to exceed 5 mSv (500 mrem). The result of this dose-based release limit is that now many patients given therapeutic amounts of radioactive material no longer require hospitalization. This article presents measured dose data for 26 family members exposed to 22 patients treated for non-Hodgkin's lymphoma with (131)I-anti-B1 antibody after their release according to the new NRC dose-based regulations.

METHODS

The patients received administered activities ranging from 0.94 to 4.77 GBq (25--129 mCi). Family members were provided with radiation monitoring devices (film badges, thermoluminescent or optically stimulated luminescent dosimeters, or electronic digital dosimeters). Radiation safety personnel instructed the family members on the proper wearing and use of the devices. Instruction was also provided on actions recommended to maintain doses to potentially exposed individuals as low as is reasonably achievable.

RESULTS

Family members wore the dosimeters for 2--17 d, with the range of measured dose values extending from 0.17 to 4.09 mSv (17--409 mrem). The average dose for infinite time based on dosimeter readings was 32% of the predicted doses projected to be received by the family members using the NRC method provided in regulatory guide 8.39.

CONCLUSION

Therapy with (131)I-anti-B1 antibody can be conducted on an outpatient basis using the established recommended protocol. The patients can be released immediately with confidence that doses to other individuals will be below the 5-mSv (500 mrem) limit.

Autologous hematopoietic stem cell transplantation for mantle cell lymphoma

This study evaluated the outcomes of patients who underwent high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (autoHSCT) for mantle cell non-Hodgkin's lymphoma and the effect of clinical and treatment characteristics. The clinical outcome and prognostic factors in 40 patients who underwent HDC and autoHSCT for mantle cell lymphoma between June 1991 and August 1998 were analyzed. With a median follow-up of 24 months for the surviving patients (range, 4-68 months), the 2-year overall survival was 65% and the 2-year event-free survival (EFS) was 36%. In univariate analysis, characteristics predictive of a poor EFS were blastic morphology (P = .019) and the patient having received 3 or more prior chemotherapy regimens (P = .004). In a multivariate analysis, the only factor associated with a poor EFS was the number of prior chemotherapy regimens. Those patients who received 3 or more prior therapies had a 2-year EFS of 0%, and those who received <3 therapies had a 2-year EFS of 45% (P = .004). Patients with mantle cell lymphoma can obtain prolonged EFS with HDC and autoHSCT; however, this strategy for prolonged EFS appears to work optimally in patients who are less heavily pretreated. Whether this therapy will increase the overall survival or EFS in patients receiving transplants in first complete remission will need to be tested in prospective randomized clinical trials.

Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

Although patients with relapsed Hodgkin's disease have a poor prognosis with conventional therapies, high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autotransplantation) may provide long-term progression-free survival. We reviewed data from the Autologous Blood and Marrow Transplant Registry (ABMTR) to determine relapse, disease-free survival, overall survival, and prognostic factors in this group of patients. Detailed records from the ABMTR on 414 patients with Hodgkin's disease in first relapse (n = 295) or second complete remission (CR) (n = 119) receiving an autotransplant from 1989 to 1995 were reviewed. Median age was 29 (range, 7-64) years. Median time from diagnosis to relapse was 18 (range, 6-219) months; median time from relapse to transplant was 5 (range, <1-215) months. Most patients received high-dose chemotherapy without total body irradiation for conditioning (n = 370). The most frequently used high-dose regimen was cyclophosphamide, BCNU, VP-16 (CBV) (n = 240). The graft consisted of bone marrow (n = 246), blood stem cells (n = 112), or both (n = 56). Median follow-up was 46 (range, 5-96) months. One hundred-day mortality (95% confidence interval) was 7 (5-9)%. One hundred and sixty-five of 295 patients (56%) transplanted in relapse achieved CR after autotransplantation. Of these, 61 (37%) recurred. Twenty-four of 119 patients (20%) transplanted in CR recurred. The probability of disease-free survival at 3 years was 46 (40-52)% for transplants in first relapse and 64 (53-72)% for those in second remission (P < 0.001). Overall survival at 3 years was 58 (52-64)% after transplantation in first relapse and 75 (66-83)% after transplantation in second CR (P < 0.001). In multivariate analysis, Karnofsky performance score <90% at transplant, abnormal serum LDH at transplant, and chemotherapy resistance were adverse prognostic factors for outcome. Progression of Hodgkin's disease accounted for 69% of all deaths. Autotransplantation should be considered for patients with Hodgkin's disease in first relapse or second remission. Future investigations should focus on strategies designed to decrease relapse after autotransplantation, particularly in patients at high risk for relapse.

Immunotherapy for non-Hodgkin's lymphoma

The first attempt at using monoclonal antibodies in lymphoma therapy, reported in 1980, was unsuccessful. Since that time, several immunotherapeutic approaches to treating non-Hodgkin's lymphoma have been developed, with varying degrees of success. These approaches are largely based on the fact that each lymphoma is a clone of identical cells with a unique immunoglobulin on its surface. This unique portion of the immunoglobulin--the idiotype--is an ideal target for therapy. Clinical trials with antibodies have mostly targeted CD20, which is present on 95% of all B-cell lymphomas, as well as CD19 and CD22. This concept of using the idiotype to broaden the antilymphoma effect and to use it as a vaccine model has recently been evaluated. This approach would theoretically produce an active immunization with induction of humoral and cellular responses that would be longer acting than passive antibodies alone. The response is heterogeneous and polyclonal, which may be an advantage. Studies of these approaches will be outlined in this article.