Projecting Climate Dependent Coastal Flood Risk With a Hybrid Statistical Dynamical Model

Numerical models for tides, storm surge, and wave runup have demonstrated ability to accurately define spatially varying flood surfaces. However these models are typically too computationally expensive to dynamically simulate the full parameter space of future oceanographic, atmospheric, and hydrologic conditions that will constructively compound in the nearshore to cause both extreme event and nuisance flooding during the 21st century. A surrogate modeling framework of waves, winds, and tides is developed in this study to efficiently predict spatially varying nearshore and estuarine water levels contingent on any combination of offshore forcing conditions. The surrogate models are coupled with a time-dependent stochastic climate emulator that provides efficient downscaling for hypothetical iterations of offshore conditions. Together, the hybrid statistical-dynamical framework can assess present day and future coastal flood risk, including the chronological characteristics of individual flood and wave-induced dune overtopping events and their changes into the future. The framework is demonstrated at Naval Base Coronado in San Diego, CA, utilizing the regional Coastal Storm Modeling System (CoSMoS; composed of Delft3D and XBeach) as the dynamic simulator and Gaussian process regression as the surrogate modeling tool. Validation of the framework uses both in-situ tide gauge observations within San Diego Bay, and a nearshore cross-shore array deployment of pressure sensors in the open beach surf zone. The framework reveals the relative influence of large-scale climate variability on future coastal flood resilience metrics relevant to the management of an open coast artificial berm, as well as the stochastic nature of future total water levels.

Converting microwave and telecom photons with a silicon photonic nanomechanical interface

Practical quantum networks require low-loss and noise-resilient optical interconnects as well as non-Gaussian resources for entanglement distillation and distributed quantum computation. The latter could be provided by superconducting circuits but existing solutions to interface the microwave and optical domains lack either scalability or efficiency, and in most cases the conversion noise is not known. In this work we utilize the unique opportunities of silicon photonics, cavity optomechanics and superconducting circuits to demonstrate a fully integrated, coherent transducer interfacing the microwave X and the telecom S bands with a total (internal) bidirectional transduction efficiency of 1.2% (135%) at millikelvin temperatures. The coupling relies solely on the radiation pressure interaction mediated by the femtometer-scale motion of two silicon nanobeams reaching a Vπ as low as 16 μV for sub-nanowatt pump powers. Without the associated optomechanical gain, we achieve a total (internal) pure conversion efficiency of up to 0.019% (1.6%), relevant for future noise-free operation on this qubit-compatible platform.

AB0698 REAL CLINICAL PRACTICE IN THE CONTROL OF REPORTED OUTCOMES BY THE PATIENT (PROS) DIAGNOSED WITH PSORIATIC ARTHRITIS AND/OR ANKYLOSING SPONDYLITIS WHO BEGIN TREATMENT WITH SECUKINUMAB. A PROSPECTIVE MULTICENTRIC STUDY

Background:

Objectives:

Analyse the effect of secukinumab in terms of the patient´s own variables, specifically: fatigue, sleep, pain and quality of life in patients with psoriatic arthritis or spondyloarthritis.

Methods:

A multicentric longtitudinal observational prospective study was carried out at 6 months in patients who begin treatment with secukinumab. At the start and after 6 months the following data was collected on the outcome: pain through an visual analogue scale (VAS), fatigue using the FACIT-fatigue scale, sleeping problems using the insomnia severity index (ISI) and quality of life with the EuroQol-3L-5D and the PsAQoL.

The sample can be described in terms of the distribution of the variables through measures of central tendency.It was analysed if the change after 6 months was statistically relevant using Student´s t-test for paired data in the case of FACIT, VAS, PsAQoL and ISI and chi-squared for the dimensions of the EQ-5D. The size of the effect of each of the measurements taken was calculated using Cohen’s D. the results are given grouped by disease and globally. The analysis was carried out using Stata v12 (College Station Tx, USA)

Results:

In table 1, the changes in the scales of normal distribution can be seen. Apart from general VAS, all the scales experience significant relevant changes. The PROs preferred by the patient with the best therapeutic response is the quality of sleep. The adjustment of the regression models does not produce changes in the results, apart from small adjustments to the condidence intervals (final column table 1). The subdomain in which the most significant change in the EQ-5D is produced is in that of pain and discomfort.

Conclusion:

After 6 months patients who begin treatment with secukinumab, present with improvements in all sizes of the effects of the treatment in the various studied scales. The improvement achieves global and generalised statistical significance after 6 months of study. The greatest effect is on sleep, quality of life and fatigue.

The measurements of the outcomes reported by the patients are a clinical value added to our objective evaluations of the health and activity of the disease, and allow us, in a more integrated and comprehensive manner, to undertake a more exact and close evaluation of their state of health and wellbeing.

Disclosure of Interests:

JUAN JOSE LERMA: None declared, Antonio Gracia: None declared, Antonio Perez: None declared, Amalia Rueda: None declared, Clara Molina: None declared, M. Dolores Pastor: None declared, Isabel Balaguer Trull: None declared, Inmaculada Valiente: None declared, Cristina Campos Fernández: None declared, Javier Calvo: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)

Shift in the Balance between Circulating Thrombospondin-1 and Vascular Endothelial Growth Factor in Cancer Patients: Relationship to Platelet α-Granule Content and Primary Activation

Tumoral angiogenesis is regulated by the balance between factors that activate and inhibit angiogenesis. Elevated levels of activators have been associated with a poor prognosis in cancer patients, but little is known about the net balance between circulating activators and inhibitors in these patients. This study was designed to determine whether the balance between circulating concentrations of the angiogenesis inhibitor TSP-1 and the activator VEGF differs from that in healthy persons, and to shed light on the possible role of platelets in this balance. Twenty-five cancer patients and 18 healthy subjects were included. Serum and plasma concentrations of VEGF, TSP-1 and PF4 were measured by ELISA. Our results showed that in healthy subjects the balance between the TSP-1 and VEGF concentrations in serum and in serum minus plasma was twice to three times as high as in cancer patients (p<0.05). The theoretical TSP-1 content per platelet was greater in healthy subjects than in patients (94 vs. 53.6 ng/mL, p<0.05), and platelet activation (determined indirectly as the plasma concentration of PF4) was greater in cancer patients (129 vs. 48 IU/mL, p<0.01). Platelet activation correlated significantly with serum concentration of TSP-1 (r=0.470, p=0.018) and showed a tendency toward correlation with plasma concentration of TSP-1 (r=0.382, p=0.059). Our findings show that the circulating TSP-1/VEGF balance is diminished in cancer patients. Platelet activation may play an important role in this decrease and may ultimately lead to increased angiogenic activity in these patients.

First Report of "Candidatus Liberibacter solanacearum" on Tomato in El Salvador

In April of 2012, tomato plants (Solanum lycopersicum) grown near the town of Yuroconte in the municipality of La Palma, Chalatenango, El Salvador, were observed with symptoms resembling those of "Candidatus Liberibacter solanacearum" infection. The symptoms included overall chlorosis, severe stunting, leaf cupping, excessive branching of axillary shoots, and leaf purpling and scorching (1,2,3). Disease incidence in several fields in the area ranged from 40 to 60%. Heavy infestations of the potato/tomato psyllid, Bactericera cockerelli, were observed in the affected fields and this insect has been shown to transmit "Ca. L. solanacearum" to tomato and other solanaceous species (1,2,3). Leaf samples and psyllids were collected from one of the fields and total DNA was purified from the leaves of 8 and 10 symptomatic and asymptomatic plants, respectively (2,3). DNA was also extracted from the psyllids and the samples were tested by PCR for species confirmation. PCR oligonucleotide primers specific for both 16S rDNA (OA2 and OI2c) and a gene for a surface antigen for the outer membrane protein (OMB) (OMB 1482f and 2086r) of "Ca. L. solanacearum" were used to confirm the presence of the bacterium in infected tomatoes (1). Four of the eight symptomatic tomatoes (50%) tested positive for "Ca. L. solanacearum" using both primer pairs and all asymptomatic plants were negative for the bacterium. The collected psyllids were first identified through a morphological key, then verified using species-specific PCR primers (CO1 F3 and CO1 meltR) that generated a 94-bp fragment that was consistent with DNA from B. cockerelli (4). Amplicons generated with DNA from two plant samples with each primer pair were cloned and four clones of each of the four amplicons were sequenced. BLASTn analysis of the 16S rDNA consensus sequences from the clones (1,168 bp; deposited in GenBank as Accession Nos. KC768318 and KC768319) showed 100% identity to "Ca. L. solanacearum" sequences in GenBank (HM246509 and HM245242, respectively). Two OMB consensus sequences were 98% identical (deposited in GenBank as KC768326 and KC768327) and both sequences were 97 to 100% identical to a number of "Ca. L. solanacearum" sequences in GenBank (e.g., CP002371, FJ914617, JN848754, and JN848752). To our knowledge, this is the first report of "Ca. L. solanacearum" associated with tomato in El Salvador and the first formal report of the bacterium in the country. This bacterium has caused millions of dollars in losses to the tomato industry in New Zealand, Mexico and the United States (2,3). Tomatoes are an economically important commodity in Central America and are severely damaged by "Ca. L. solanacearum" infection. The confirmation of "Ca. L. solanacearum" infections in El Salvador alerts the agricultural sector to the presence of this serious pathogen. References: (1) J. M. Crosslin. Southwest. Entomol. 36:125, 2011. (2) L. W. Liefting et al. Plant Dis. 93:208, 2009. (3) J. E. Munyaneza et al. Plant Dis. 93:1076, 2009. (4) K. D. Swisher et al. Environ. Entomol. 41:1019, 2012.

First Report of Zebra Chip and 'Candidatus Liberibacter solanacearum' on Potatoes in Nicaragua

In September 2011, potato (Solanum tuberosum) tubers grown in Nicaragua outside of Estelí and Jinotega were observed with internal discoloration suggestive of zebra chip (ZC); and the plants showed foliar symptoms of chlorosis, leaf scorching, wilting, vascular discoloration, swollen nodes, twisted stems, and aerial tubers (3). Disease incidence ranged from 50 to 95% in eight fields ranging from 5 to 12 ha in the Estelí and Jinotega regions of Nicaragua. Leaf samples and psyllids were collected from two fields, and total DNA was purified from the leaves of 17 symptomatic and 10 asymptomatic plants. DNA was also extracted from 20 individual potato psyllids. Primers specific for 16S rDNA (OA2 and OI2c) and the surface antigen gene (OMB 1482f and 2086r) of Candidatus Liberibacter solanacearum (CLs) were used to confirm the presence of the pathogen in infected potatoes and insects (2). All symptomatic potato leaf samples tested positive for the presence of CLs using both primers, and no asymptomatic plants had positive results. Seven insects tested positive for the presence of CLs. 16S rDNA sequences obtained for all positive samples (1,071 bp) were identical and showed 99 to 100% identity to a number of rDNA sequences of CLs in GenBank (Accession Nos. HM246509 and FJ957897). 16S rDNA sequences from two CLs-infected plants, one from Estelí, Nicaragua (JX559779) and one from Jinotega, Nicaragua (JK559780), were deposited in GenBank. Identity of insects was done using a morphological key, and then verified as Bactericera cockerelli using a real-time PCR assay with melt temperature analysis of the cytochrome c oxidase 1 gene, as described by Chapman et al. (1). Sequencing of the amplified DNA yielded an approximately 63-bp read, with 100% homology to reference sequences of B. cockerelli (AY971886) and those obtained from psyllids collected in McAllen, TX, in 2010. B. cockerelli samples were collected from both locations. Similar to previous reports of ZC in new locations, foliar and tuber symptoms associated with ZC were observed in all eight fields in these two Nicaraguan potato-growing regions, specific PCR amplification with two primer pairs was completed, 16S rDNA sequence analyses showed 100% similarity to reference sequences of CLs, and the presence of potato psyllids which tested positive for the presence of CLs provide evidence that ZC is now present in Nicaragua. Potatoes rank in the top 20 commodities produced in Nicaragua, resulting in >$4.5M annual revenue. Because CLs has caused significant economic damage to potatoes in the United States, Mexico, Guatemala, and Honduras, this finding has significance for potato production in Central America. References: (1) R. I. Chapman et al. Southwest. Entomol. 37:475, 2012. (2) J. M. Crosslin. Southwest. Entomol. 36:125, 2011. (3) L. W. Liefting et al. Internat. J. Syst. Evol. Microbiol. 59:2274, 2009.

Adjuvant therapy with cetuximab for locally advanced squamous cell carcinoma of the oropharynx: results from a randomized, phase II prospective trial

BACKGROUND

Cetuximab combined with radiotherapy (RT) is a treatment option for head and neck cancer. The objectives of this randomized, phase II trial were to evaluate the efficacy and safety of cetuximab maintenance therapy following definitive RT with concomitant cetuximab in patients with oropharyngeal cancer.

PATIENTS AND METHODS

Ninety-one patients with stage III-IV M0 oropharyngeal tumors were randomly assigned to the treatment with accelerated concomitant boost RT (69.9 Gy) + cetuximab or the same treatment with the addition of 12 consecutive weeks of cetuximab maintenance therapy. The primary end point was locoregional control (LRC) at 1 year.

RESULTS

LRC at 1 year was superior among patients in the experimental arm, treated with cetuximab maintenance (59% versus 47%). However, LRC was similar between both arms after 2 years of follow-up, as a result of increased locoregional recurrences after the first year in the maintenance group. Patients treated with adjuvant cetuximab do recover very soon from toxic effect after combined treatment.

CONCLUSIONS

Twelve weeks of cetuximab maintenance therapy after concomitant cetuximab + RT in locally advanced oropharyngeal carcinoma is feasible and improves clinical outcomes measured at 1 year. This improvement is not maintained after the second year suggesting that epidermal growth factor receptor blockade is not sufficient to completely eliminate the minimal residual disease.

Critical appraisal of pralatrexate in the management of difficult-to-treat peripheral T cell lymphoma

Aggressive T cell lymphomas are a subgroup of lymphomas with a particularly poor prognosis. This is especially true for patients with recurrent or refractory disease, who typically have limited response to salvage therapy and extremely poor overall survival. For this reason, there is a strong need to develop potentially active drugs for these malignancies. Pralatrexate is a novel antifolate designed to have high affinity for reduced folate carrier type 1. Preclinical and clinical studies have demonstrated that pralatrexate has significant activity against T cell lymphomas. The dose-limiting toxicity for pralatrexate is mucositis, which can be abrogated with folic acid and vitamin B12 supplementation. Pralatrexate is the first single agent approved for the treatment of patients with relapsed or refractory peripheral T cell lymphoma. This approval was based on an overall objective response rate observed in the pivotal study. The overall response rate was 29%, with a median duration of 10.1 months. This article reviews the biochemistry, preclinical experience, metabolism, and pharmacokinetics of pralatrexate, including the clinical experience with this agent in lymphoma. Future areas of development are now focused on identifying synergistic combinations of pralatrexate with other agents and the evaluation of predictive markers for clinical benefit.

Anti-angiogenic treatment (sunitinib) for disseminated malignant haemangiopericytoma: a case study and review of the literature

INTRODUCTION

A meningeal haemangiopericytoma (HP) is a mesenchymal tumour that makes up less than 1% of all CNS tumours. HPs arise from pericytes and present high rates of recurrence and distant metastasis. The primary treatment option is surgery. When the disease is disseminated, chemotherapy produces a weak and short-lived response; therefore, new drugs are needed.

CASE PRESENTATION

We describe the case of a 65-year-old woman with a 13-year history of recurrent HP. After local treatment with radiotherapy, she developed metastases that required systemic treatment, and treatment with sunitinib, an oral inhibitor of the vascular endothelial growth factor receptor and the platelet-derived growth factor receptor, was initiated. As a result, radiological stabilisation of the systemic disease was maintained for over 12 months.

CONCLUSIONS

Anti-angiogenic agents can be useful for treating disseminated HP, but further studies are needed to confirm their possible role in controlling metastatic disease.

Rituximab maintenance after R-CHOP in the first-line treatment of follicular lymphoma: A GOTEL phase II trial

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Background: Rituximab maintenance have demonstrated improvements in progression-free and overall survival in relapsed patients with follicular lymphoma (FL). Ongoing trials are evaluating the benefit of rituximab maintenance following treatment of therapy-naive patients (pts) treated with rituximab-containing chemoinmunotherapy induction regimens. Methods: The current study evaluated the activity and toxicity of rituximab maintenance after chemoinmunotherapy in the first line treatment of advanced-stage FL. Pts with advanced stage FL were eligible. The induction treatment consisted in 8 courses of chemoinmunotherapy with R-CHOP (rituximab 375 mg/m2; cyclophosphamide 750 mg/m2; doxorubicin 50 mg/m2 and vincristine 2 mg). Pts entering a complete (CR) or partial remission (PR) received maintenance with 6 doses of rituximab (375 mg/m2/d) to be given every two months after the end of induction therapy. Results: From December 2004 to November 2006, 52 pts were included. Median age was 52 years (range, 36–85) and 26 pts were women. At baseline 32 (62%) pts had stage IV and 20 (38%) stage III. According to the Follicular Lymphoma International Prognostic Index (FLIPI), 8 pts (15%) had low risk disease, 24 pts (46%) intermediate risk, and 20 pts (39%) high risk disease. Six (12%) pts did not receive maintenance (3 pts progressed during induction, 2 pts refused maintenance and 1 pt had severe toxicity to induction). Of the 46 pts included in the maintenance phase, 32 (69%) were in CR/CRu and 14 pts (31%) in PR after induction therapy. Rituximab was well tolerated in the maintenance phase. Only 5 pts didn´t receive the 6 scheduled courses (toxicity: 1; progressive disease: 2; cardiovascular events: 2). Grade 3–4 toxicity occurred as follow: neutropenia in 4 pts (9%), and fever in 1 pt (2%). No severe infections were seen. After maintenance, 40 (87%) pts were in CR/CRu, 4 pts (9%) in PR and 2 (4%) progressed. With a median follow-up of 27 months, progression-free and overall survival at 30 months were 82% and 92%, respectively. Conclusions: Rituximab maintenance after first-line R-CHOP is safe and increase the complete remission rate obtained in the induction phase.

No significant financial relationships to disclose.

Phase II study of bevacizumab in combination with cisplatin and docetaxel as first-line treatment of patients (p) with metastatic non-squamous non-small cell lung cancer (NSCLC)

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Background: Bevacizumab (B), in addition to platinum-based chemotherapy, is indicated for 1st-line treatment of p with advanced NSCLC other than predominantly squamous cell histology. B has been shown to improve progression free survival (PFS) and overall survival (OS) when combined with cisplatin/gemcitabine and carboplatin/paclitaxel, respectively. However, there are limited data on the safety and efficacy of B in combination with other widely used chemotherapy doublets for NSCLC. This is a single-arm, open- labeled, single-stage phase II trial of cisplatin (C), docetaxel (D) and B for NSCLC. Methods: Eligibility criteria: chemo- naïve, stage IIIB wet or IV, non-squamous NSCLC, PS 0–1, no brain metastases and no history of gross hemoptysis. P received D (75 mg/m2), C (75 mg/m2), and B (15 mg/kg iv) on day 1 every 3 weeks for up to 6 cycles, followed by B 15 mg/kg alone every 3 weeks until disease progression or toxicity. Primary endpoint: PFS. Results: 50 p were enrolled (enrollment completed): 24% female, median age 60 (36–74), PS 1: 64%, adenocarcinoma: 72%; stage IV: 92%. Two p did not start treatment. Median follow-up is 5.3 months (range 0–13.6). Median number of cycles of B was 7 (range 0–18). 56% completed 6 cycles of treatment; 24% received ≥ 12 cycles of B. Most frequent grade ≥ 3 toxicities: diarrhea (14.6%), fatigue (14.6%), dyspnea (9.8%), anorexia (4.9%), alopecia (4.9%), esophagitis (4.9%), constipation (4.9%), mucositis (12.2%), proteinuria (4.9%); hematological toxicities: neutropenia (22%), febrile neutropenia (9.8%), leucopenia (14.6%), lymphopenia (4.9%). Of interest, 41.5% developed grade <3 epistaxis and 17% hypertension (1 p grade 3). One p died due to hemoptysis. 46 p were evaluable for response: 29 PRs (ORR: 63%). 18 of 48 p have experienced progression or death with a median SLP of 7.8 months (95% CI: 6.6-NR). Median OS is 13.5 months (95% CI: 12.7–13.6; 81.2% p censored); 1-year survival is 83.9% (95% CI: 67.4%-92.5%). Conclusions: Treatment with C, D and B, followed by maintenance B in 1st line of advanced non-squamous NSCLC shows an acceptable toxicity profile and promising efficacy. Final results will be presented.

[Table: see text]

Endogenous lipid pneumonia in rats after subacute exposure to CdCl2

The objective of this report was to study lung cellular lesions in Wistar rats after subacute oral exposition to CdCl2. The experimental groups were exposed to CdCl2, through their drinking water in a concentration of 1 g/L, continuously for a period of 9 days. Histologically, all the exposed animals showed the incidence of interstitial pneumonia; hyperplasia of type II pneumocytes and Clara cells; the presence of foamy macrophages; and lesions linked to the existence of endogenous lipid pneumonia. Endogenous lipid pneumonia after CdCl2 exposure has not been previously described; and in its pathogenesis, hyperplasia of type II pneumocytes and Clara cells activation could play an important role.

[Importance of artificial nutrition in the resolution and etiologic diagnosis of severe chronic diarrhea: a propos of a case]

We present a case of severe chronic diarrhea requiring parenteral nutritional support to both cover the nutritional needs and allow for intestinal rest for later adaptation to enteral nutrition, altogether allowing for the etiologic diagnosis and disease healing.

Classical eyeblink conditioning during acute hypobaric hypoxia is improved in acclimatized mice and involves Fos expression in selected brain areas

This work attempts to evaluate the cognitive aspects of the acclimatization ability of mice submitted to simulated altitude. Critical altitudes were detected by evaluating open field activity, combined or not with object recognition tasks, at different acute simulated altitudes. Results showed impaired cognitive abilities at approximately 3,733 m and above. To evaluate acclimatization capabilities, mice submitted to hypobaric hypoxia at approximately 5,000 m for 1 wk were tested for learning and memory performances with classical eyeblink conditioning at the same altitude or at land altitude. Results showed total acclimatization in mice conditioned at approximately 5,000 m but no improved performance in those conditioned at land altitudes compared with controls. Selected brain sites of conditioned animals were analyzed by immunohistochemistry to detect expression of the protein product of the protooncogene c-fos (Fos) in relation to both motor learning processes and hypobaric conditions. In the nucleus of the solitary tract, a higher expression of Fos was found in the acute hypobaric conditioned animals than in control conditioned and nonconditioned animals. Similar patterns between groups were found in the other brain areas, mainly in the piriform cortex and area 1 of the cingulate cortex and in the hippocampus. Differences between hemispheres were detected only in acute hypobaric animals. The present results show that acclimatization to high altitude prevents the impairment of classical eyeblink conditioning evoked by hypobaric hypoxic conditions but does not improve this task when acquired under land conditions, although it could diminish the activation requirements for its performance.

Cost-effectiveness of rituximab maintenance therapy for patients with follicular lymphoma: The Spanish perspective

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Background: In patients with relapsed or refractory follicular lymphoma (FL) who attain a response with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or Rituximab + CHOP, maintenance treatment with Rituximab has shown to significantly improve overall survival (OS) (85% at 3 years vs. 77%, p=0.011) and progression free survival (PFS) (51,5 vs. 14.9 months, p<0.001) as compared to observation alone (OA). We analyzed the cost-effectiveness, from a Spanish perspective, of Rituximab maintenance therapy (375mg/m2 every 3 months until progression or for 2 years) versus OA according to the population and data described for the European Organization for Research Treatment of Cancer (EORTC) 20981 study (van Oers MHJ Blood 2006). Methods: Incremental cost-effectiveness was assessed through a deterministic, three health states model (disease-free, progression and death) transition model. Base case model: PFS and OS were extrapolated from EORTC 20981 data using a Weibull distribution, Rituximab maintenance benefit was assumed to last 5 years, 10 years time horizon, 3.5% discount rate on costs and benefits, and Spanish National Health Service perspective (direct costs only). Resource use was estimated from a Spanish expert panel and EORTC 20981 study. Unit costs were obtained from local databases (May 2006 €). Health states utility values were derived from an ad hoc study. Sensitivity analyses were performed for all mentioned variables. Results: For the base case, more quality-adjusted life years (QALY), life-years (LY) and progression-free survival years per patient on maintenance therapy were obtained versus OA (incremental values of 0.85, 0.94 and 1.46, respectively). Total cost per patient was higher with Rituximab than with OA (+8,026€). Incremental cost per QALY gained was 9,358€, with a cost per LY gained of 8.493€ and a cost per PFS year gained of 5,485€. In the sensitivity analysis, values ranged between 7.263€ and 22.160€ per QALY gained. Conclusions: This study confirms that in patients with relapsed /refractory FL who attain a response with further therapy, maintenance treatment with Rituximab compared to observation alone is cost-effective.

No significant financial relationships to disclose.