Eltrombopag Added to Immunosuppression in Severe Aplastic Anemia

BACKGROUND

A single-group, phase 1-2 study indicated that eltrombopag improved the efficacy of standard immunosuppressive therapy that entailed horse antithymocyte globulin (ATG) plus cyclosporine in patients with severe aplastic anemia.

METHODS

In this prospective, investigator-led, open-label, multicenter, randomized, phase 3 trial, we compared the efficacy and safety of horse ATG plus cyclosporine with or without eltrombopag as front-line therapy in previously untreated patients with severe aplastic anemia. The primary end point was a hematologic complete response at 3 months.

RESULTS

Patients were assigned to receive immunosuppressive therapy (Group A, 101 patients) or immunosuppressive therapy plus eltrombopag (Group B, 96 patients). The percentage of patients who had a complete response at 3 months was 10% in Group A and 22% in Group B (odds ratio, 3.2; 95% confidence interval [CI], 1.3 to 7.8; P = 0.01). At 6 months, the overall response rate (the percentage of patients who had a complete or partial response) was 41% in Group A and 68% in Group B. The median times to the first response were 8.8 months (Group A) and 3.0 months (Group B). The incidence of severe adverse events was similar in the two groups. With a median follow-up of 24 months, a karyotypic abnormality that was classified as myelodysplastic syndrome developed in 1 patient (Group A) and 2 patients (Group B); event-free survival was 34% and 46%, respectively. Somatic mutations were detected in 29% (Group A) and 31% (Group Β) of the patients at baseline; these percentages increased to 66% and 55%, respectively, at 6 months, without affecting the hematologic response and 2-year outcome.

CONCLUSIONS

The addition of eltrombopag to standard immunosuppressive therapy improved the rate, rapidity, and strength of hematologic response among previously untreated patients with severe aplastic anemia, without additional toxic effects. (Funded by Novartis and others; RACE ClinicalTrials.gov number, NCT02099747; EudraCT number, 2014-000363-40.).

Wada basins and chaotic invariant sets in the Hénon-Heiles system

The Hénon-Heiles Hamiltonian is investigated in the context of chaotic scattering, in the range of energies where escaping from the scattering region is possible. Special attention is paid to the analysis of the different nature of the orbits, and the the invariant sets, such as the stable and unstable manifolds and the chaotic saddle. Furthermore, a discussion on the average decay time associated to the typical chaotic transients, which are present in this problem, is presented. The main goal of this paper is to show, by using various computational methods, that the corresponding exit basins of this open Hamiltonian are not only fractal, but they also verify the more restrictive property of Wada. We argue that this property is verified by typical open Hamiltonian systems with three or more escapes.

[Induction of interleukin-6 by Borrelia burgdorferi in different cell cultures]

BACKGROUND

To determine variability, if exists, in interleukin-6 (IL-6) response by different cell cultures stimulated by Borrelia burgdorferi.

METHODS

Five human embryonic diploid fibroblast cell lines (three of them of lung origin) and four human synovial cell cultures were used. Induction of IL-6 was made with B. burgdorferi B31 culture and E. coli lipopolysaccharide (LPS). IL-6 was determined by a commercial EIA (Coaliza IL-6).

RESULTS

All cell cultures produced IL-6 under basal conditions and responded after adding E. coli LPS. The IL-6 production after B. burgdorferi stimulation was higher than that induced by LPS with three out the four synovial cell cultures and lowest with lung fibroblasts.

CONCLUSIONS

The ability of B. burgdorferi to stimulate IL-6 production depends on the nature and origin of cell cultures. This variability and the fact that the most reactive cell cultures were those of synovial precedence may correlated with some clinical aspects of the Lyme disease.

Patellar tendon avulsion after total knee arthroplasty. A new technique

Patellar tendon avulsion is a rare complication of total knee arthroplasty. An easy surgical technique that involves suturing the tendon into a groove carved in the tibial tubercle and tension band wiring is described. Two cases are presented, with an average follow-up period of 21 months. Good clinical results were obtained in each case. No postoperative complications occurred.