Clinical impact of panel-based error-corrected next generation sequencing versus flow cytometry to detect measurable residual disease (MRD) in acute myeloid leukemia (AML)

We accrued 201 patients of adult AML treated with conventional therapy, in morphological remission, and evaluated MRD using sensitive error-corrected next generation sequencing (NGS-MRD) and multiparameter flow cytometry (FCM-MRD) at the end of induction (PI) and consolidation (PC). Nearly 71% of patients were PI NGS-MRD⁺ and 40.9% PC NGS-MRD⁺ (median VAF 0.76%). NGS-MRD⁺ patients had a significantly higher cumulative incidence of relapse (p = 0.003), inferior overall survival (p = 0.001) and relapse free survival (p < 0.001) as compared to NGS-MRD^- patients. NGS-MRD was predictive of inferior outcome in intermediate cytogenetic risk and demonstrated potential in favorable cytogenetic risk AML. PI NGS-MRD^- patients had a significantly improved survival as compared to patients who became NGS-MRD^- subsequently indicating that kinetics of NGS-MRD clearance was of paramount importance. NGS-MRD identified over 80% of cases identified by flow cytometry at PI time point whereas FCM identified 49.3% identified by NGS. Only a fraction of cases were NGS-MRD^- but FCM-MRD⁺. NGS-MRD provided additional information of the risk of relapse when compared to FCM-MRD. We demonstrate a widely applicable, scalable NGS-MRD approach that is clinically informative and synergistic to FCM-MRD in AML treated with conventional therapies. Maximum clinical utility may be leveraged by combining FCM and NGS-MRD modalities.

Biodegradable dendritic Boltorn™ nanoconstructs: A promising avenue for cancer theranostics

The family of Boltorn™ H40 dendrimers is an imperative subclass of hyperbranched biodegradable polymers (HBPs), which has received mounting attention as a result of its inimitable chemical, physical and biodegradable properties. These properties embrace three-dimensional dendrimeric nanoarchitecture to avert tanglement between polymer branches, adequate spatial cavities for increased encapsulation of guest molecules, good solubility as well as low viscosity to improve processability, and a huge number of surface functional groups for chemical manipulations. Similarly, low toxicity, non-immunogenicity, and natural biodegradation are significant and critical advantages in therapeutic applications as compared to other dendritic polymers. All these characteristics of Boltorn™ H40 are of pronounced importance for planning and developing advanced targeted cargo delivery carriers for cancer therapy. The present review highlights the applications of Boltorn™ H40 HBPs for the transport of chemotherapeutic agents to manage various types of cancers.

Field investigation into unsaturated flow and transport in a fault: model analyses

Results of a fault test performed in the unsaturated zone of Yucca Mountain, Nevada, were analyzed using a three-dimensional numerical model. The fault was explicitly represented as a discrete feature and the surrounding rock was treated as a dual-continuum (fracture-matrix) system. Model calibration against seepage and water-travel-velocity data suggests that lithophysal cavities connected to fractures can considerably enhance the effective fracture porosity and therefore retard water flow in fractures. Comparisons between simulation results and tracer concentration data also indicate that matrix diffusion is an important mechanism for solute transport in unsaturated fractured rock. We found that an increased fault-matrix and fracture-matrix interface areas were needed to match the observed tracer data, which is consistent with previous studies. The study results suggest that the current site-scale model for the unsaturated zone of Yucca Mountain may underestimate radionuclide transport time within the unsaturated zone, because an increased fracture-matrix interface area and the increased effective fracture porosity arising from lithophysal cavities are not considered in the current site-scale model.

Measurement system for systematic hydrological characterization of unsaturated fractured welded tuff in a mined underground tunnel

A field investigation of unsaturated flow through a lithophysal unit of fractured welded tuff containing lithophysal cavities has been initiated. To characterize flow in this spatially heterogeneous medium, a systematic approach has been developed to perform tests in boreholes drilled at regular intervals in an underground tunnel (drift). The purpose of the testing is to quantify the amounts of water seeping into the drift versus the amount of water moving around the drift when released into boreholes at many equidistant locations along the drift. In this paper, we describe the test equipment system that has been built for this purpose. Because the field-scale measurements--of liquid flow in the unsaturated, fractured rocks--require continuous testing for periods of days to weeks, the control of test equipment has been fully automated, allowing operation with no human presence at the field site. Preliminary results from the first set of tests indicate that, while the effects of evaporation on characterization of hydrological properties of the rock can be significant, these effects can be controlled and quantified. These tests give insight into the role of the cavities as potential storage during the initial transient flow prior to the breakthrough of water at the drift crown, as well as the role of connected fractures that provide the subsequent quasi-steady flow. In addition to the stated purpose of realizing the flow partitioning, the results yield values for the effective porosity in the pathways for liquid flow in the regions tested thus far.

On the physics of unstable infiltration, seepage, and gravity drainage in partially saturated tuffs

To improve understanding of the physics of dynamic instabilities in unsaturated flow processes within the Paintbrush nonwelded unit (PTn) and the middle nonlithophysal portion of the Topopah Spring welded tuff unit (TSw) of Yucca Mountain, we analyzed data from a series of infiltration tests carried out at two sites (Alcove 4 and Alcove 6) in the Exploratory Studies Facility (ESF), using analytical and empirical functions. The analysis of infiltration rates measured at both sites showed three temporal scales of infiltration rate: (1) a macro-scale trend of overall decreasing flow, (2) a meso-scale trend of fast and slow motion exhibiting three-stage variations of the flow rate (decreasing, increasing, and [again] decreasing flow rate, as observed in soils in the presence of entrapped air), and (3) micro-scale (high frequency) fluctuations. Infiltration tests in the nonwelded unit at Alcove 4 indicate that this unit may effectively dampen episodic fast infiltration events; however, well-known Kostyakov, Horton, and Philip equations do not satisfactorily describe the observed trends of the infiltration rate. Instead, a Weibull distribution model can most accurately describe experimentally determined time trends of the infiltration rate. Infiltration tests in highly permeable, fractured, welded tuff at Alcove 6 indicate that the infiltration rate exhibits pulsation, which may have been caused by multiple threshold effects and water-air redistribution between fractures and matrix. The empirical relationships between the extrinsic seepage from fractures, matrix imbibition, and gravity drainage versus the infiltration rate, as well as scaling and self-similarity for the leading edge of the water front are the hallmark of the nonlinear dynamic processes in water flow under episodic infiltration through fractured tuff. Based on the analysis of experimental data, we propose a conceptual model of a dynamic fracture flow and fracture-matrix interaction in fractured tuff, incorporating the time-dependent processes of water redistribution in the fracture-matrix system.

Field tracer-transport tests in unsaturated fractured tuff

This paper presents the results of a field investigation in the unsaturated, fractured welded tuff within the Exploratory Studies Facility (ESF) at Yucca Mountain, NV. This investigation included a series of tests during which tracer-laced water was released into a high-permeability zone within a horizontal injection borehole. The tracer concentration was monitored in the seepage collected in an excavated slot about 1.6 m below the borehole. Results showed significant variability in the hydrologic response of fractures and the matrix. Analyses of the breakthrough curves suggest that flow and transport pathways are dynamic, rather than fixed, and related to liquid-release rates. Under high release rates, fractures acted as the predominant flow pathways, with limited fracture-matrix interaction. Under low release rates, fracture flow was comparatively less dominant, with a noticeable contribution from matrix flow. Observations of tracer concentrations rebounding in seepage water, following an interruption of flow, provided evidence of mass exchange between the fast-flowing fractures and slow- or non-flowing regions. The tests also showed the applicability of fluorinated benzoate tracers in situations where multiple tracers of similar physical properties are warranted.