CD22 CAR T cells demonstrate high response rates and safety in pediatric and adult B-ALL: Phase 1b results

Chimeric antigen receptor (CAR) T cells targeting CD22 (CD22-CAR) provide a therapeutic option for patients with CD22+ malignancies with progression after CD19-directed therapies. Using on-site, automated, closed-loop manufacturing, we conducted parallel Phase 1b clinical trials investigating a humanized CD22-CAR with 41BB costimulatory domain in children and adults with heavily treated, relapsed/refractory (r/r) B-ALL. Of 19 patients enrolled, 18 had successful CD22-CAR manufacturing, and 16 patients were infused. High grade (3-4) cytokine release syndrome (CRS) and immune effector-cell-associated neurotoxicity syndrome (ICANS) each occurred in only one patient; however, three patients experienced immune-effector-cell-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS). Twelve of 16 patients (75%) achieved CR with an overall 56% MRD-negative CR rate. Duration of response was overall limited (median 77 days), and CD22 expression was downregulated in 4/12 (33%) available samples at relapse. In summary, we demonstrate that closed-loop manufacturing of CD22-CAR T cells is feasible and is associated with a favorable safety profile and high CR rates in pediatric and adult r/r B-ALL, a cohort with limited CD22-CAR reporting.

Single-center randomized trial of T-reg graft alone vs T-reg graft plus tacrolimus for the prevention of acute GVHD

ABSTRACT

Allogeneic hematopoietic cell transplantation (HCT) is a curative therapy for hematological malignancies for which graft-versus-host disease (GVHD) remains a major complication. The use of donor T-regulatory cells (Tregs) to prevent GVHD appears promising, including in our previous evaluation of an engineered graft product (T-reg graft) consisting of the timed, sequential infusion of CD34+ hematopoietic stem cells and high-purity Tregs followed by conventional T cells. However, whether immunosuppressive prophylaxis can be removed from this protocol remains unclear. We report the results of the first stage of an open-label single-center phase 2 study (NCT01660607) investigating T-reg graft in myeloablative HCT of HLA-matched and 9/10-matched recipients. Twenty-four patients were randomized to receive T-reg graft alone (n = 12) or T-reg graft plus single-agent GVHD prophylaxis (n = 12) to determine whether T-reg graft alone was noninferior in preventing acute GVHD. All patients developed full-donor myeloid chimerism. Patients with T-reg graft alone vs with prophylaxis had incidences of grade 3 to 4 acute GVHD of 58% vs 8% (P = .005) and grade 3 to 4 of 17% vs 0% (P = .149), respectively. The incidence of moderate-to-severe chronic GVHD was 28% in the T-reg graft alone arm vs 0% with prophylaxis (P = .056). Among patients with T-reg graft and prophylaxis, CD4+ T-cell-to-Treg ratios were reduced after transplantation, gene expression profiles showed reduced CD4+ proliferation, and the achievement of full-donor T-cell chimerism was delayed. This study indicates that T-reg graft with single-agent tacrolimus is preferred over T-reg graft alone for the prevention of acute GVHD. This trial was registered at www.clinicaltrials.gov as #NCT01660607.

Improved outcomes for relapsed/refractory Hodgkin lymphoma after autologous transplantation in the era of novel agents

The treatment landscape of relapsed/refractory (R/R) classic Hodgkin lymphoma (cHL) has evolved significantly over the past decade after the approval of brentuximab vedotin (BV) and the programmed death-1 (PD-1) inhibitors. We evaluated how outcomes and practice patterns have changed for patients with R/R cHL who underwent autologous hematopoietic cell transplantation (AHCT) at our institution from 2011 to 2020 (N = 183) compared with those from 2001 to 2010 (N = 159) and evaluated prognostic factors for progression-free survival (PFS) and overall survival (OS) in both eras. OS was superior in the modern era with a trend toward lower nonrelapse mortality beyond 2 years after transplant. Among patients who progressed after AHCT, 4-year postprogression survival increased from 43.3% to 71.4% in the modern era, reflecting increasing use of BV and the PD-1 inhibitors. In multivariable analysis for patients that underwent transplant in the modern era, age ≥45 years, primary refractory disease, and lack of complete remission pre-AHCT were associated with inferior PFS, whereas receipt of a PD-1 inhibitor-based regimen pre-AHCT was associated with superior PFS. Extranodal disease at relapse was associated with inferior OS. Our study demonstrates improved survival for R/R cHL after AHCT in the modern era attributed to more effective salvage regimens allowing for better disease control pre-AHCT and improved outcomes for patients who progressed after AHCT. Excellent outcomes were observed with PD-1 inhibitor-based salvage regimens pre-AHCT and support a randomized trial evaluating immunotherapy in the second line setting.

Effects of water quality on growth performance and health of nursery pigs

An experiment was conducted to determine the effects of providing drinking water of differing qualities on growth performance and health of nursery pigs. Weanling pigs (n = 450; 150 pigs/group; 10 pigs/pen) were assigned randomly to one of three experimental groups consisting of three water sources of varying qualities: 1) Water source A containing 1,410 ppm hardness (CaCO₃ equivalent), 1,120 ppm sulfates, and 1,500 ppm total dissolved solids (TDS); 2) Water source B containing 909 ppm hardness (CaCO₃ equivalent), 617 ppm sulfates, and 1,050 ppm TDS; and 3) Water source C containing 235 ppm hardness (CaCO₃ equivalent), 2 ppm sulfates, and 348 ppm TDS. Pigs were provided ad libitum access to their respective water sources for the duration of the study which began at weaning (21 d of age) and ended 40 d later (61 d of age). Individual pig weights were recorded weekly along with feed intake on a pen basis. Occurrences of morbidity and mortality were recorded daily. Subjective fecal scores were assigned on a pen basis and blood samples were used to evaluate blood chemistry, cytokine concentrations, and phagocytic activity. A differential sugar absorption test was used to assess intestinal permeability. Fecal grab samples were used to establish diet digestibility, and drinking behavior was video-recorded to assess pigs’ acceptance of water sources provided. The statistical model considered fixed effects of water source, room, and their interaction with the random effect of pen. A repeated measures analysis was conducted to determine the effects of water quality over time. There were no differences (P > 0.440) among water sources in average daily gain (A, 0.46 kg/d; B, 0.46 kg/d; C, 0.47 kg/d) or average daily feed intake (A, 0.68 kg/d; B, 0.69 kg/d; C, 0.71 kg/d). Overall mortality of pigs was 0.44% and did not differ across the three water sources. There were no differences in apparent total tract digestibility of the diet, intestinal permeability, immune parameters, or blood chemistry attributable to quality of water consumed by pigs. Pigs did not show an aversion to the water sources provided, because total time pigs spent at the drinker did not differ (P > 0.750) among water sources on days 1 through 3 of the experiment. These data indicate that the water sources of differing quality studied did not affect growth performance or health of nursery pigs.

Effects of increasing dietary inclusion of camelina cake on growth performance of growing-finishing pigs

The objective of this experiment was to determine the dietary inclusion rate of camelina cake (CC) that would support the growth performance of growing-finishing pigs similar to that of a corn-soybean meal-based diet. Pigs (n = 192; BW = 35.2 kg; Duroc x (Yorkshire x Landrace)), balanced for sex and initial weight, were assigned to pens (8 pigs/pen) and pens were assigned randomly to one of four dietary treatments (6 pens/treatment). Treatments consisted of a non GMO corn-soybean meal control diet (CON), or CON containing 5% (5CC), 10% (10CC), or 15% (15CC) camelina cake. Feed disappearance on a pen basis and individual body weights of pigs were recorded every other week to calculate average daily gain (ADG), average daily feed intake (ADFI), and gain to feed ratio (G:F) on a pen basis. Prior to harvest, real-time ultrasonic measurements of back fat depth and loin eye area were collected on all live pigs. Pigs were harvested as a single group at about 23 weeks of age at a commercial abattoir. Data were analyzed using Proc Glimmix with dietary treatment as a fixed effect and pen serving as the experimental unit. Growth performance data collected over time were analyzed using repeated measures within the Proc Glimmix procedure. Overall, pigs fed CON exhibited similar ADG to those consuming 5CC and higher ADG than pigs consuming 10CC and 15CC diets (1.10 kg vs. 1.05 kg for 10CC and 1.02 kg for 15CC; P < 0.05 for both mean comparisons). Pigs fed CON consumed more feed than pigs fed any of the CC diets (ADFI = 2.66 kg for CON vs. 2.46 kg for 5CC, 2.46 kg for 10CC and 2.47 kg for 15CC; P < 0.05 for all). These differences resulted in heavier (P < 0.05) CON-fed pigs at marketing than 10CC or 15CC-fed pigs. There were no differences in any carcass traits analyzed. From these data, we conclude that feeding up to 5% CC in corn-soybean meal-based diets did not negatively influence growth performance, or carcass traits of growing-finishing pigs.

Outcomes after delayed and second autologous stem cell transplant in patients with relapsed multiple myeloma

We evaluated the outcomes of 168 patients undergoing delayed or second autologous stem cell transplant (ASCT) for relapsed multiple myeloma (MM) from 2010 to 2019. Overall, 21% (n = 35) patients had received a prior transplant and 69% (n = 116) underwent transplant at first relapse. Overall, 27% patients had high-risk cytogenetics and 15% had ISS stage III disease. Stem cell collection was performed after relapse in 72% and 35% of patients received maintenance therapy. Median PFS from salvage treatment and transplant were 28 and 19 months, respectively. Median OS from salvage treatment and transplant was 69 and 55 months. Multivariate analysis revealed that ASCT in first relapse was associated with superior PFS (HR 0.63, p = 0.03) and OS (HR 0.59, p = 0.04) compared to later lines of therapy. In addition, PFS of ≥36 months with prior therapy was associated with improved PFS (HR 0.62, p = 0.04) and OS (HR 0.41, p = 0.01). Ninety-five patients underwent delayed transplant at first relapse, median PFS and OS from start of therapy was 30 and 69 months, and median OS from diagnosis was 106 months. These data may serve as a guide when counseling patients undergoing ASCT for relapsed MM and provide a benchmark in designing clinical trials of transplantation/comparative treatments for relapsed MM.

Phase 2 study of MGTA-145 + plerixafor for rapid and reliable hematopoietic stem cell (HSC) mobilization for autologous transplant in multiple myeloma

8023

Background: MGTA-145 (GroβT), a CXCR2 agonist, has shown promising activity for HSC mobilization with plerixafor in pre-clinical models and healthy volunteers. Methods: This phase 2 single center study evaluates HSC mobilization with MGTA-145 + plerixafor and same day apheresis in patients with multiple myeloma. Patients received plerixafor 0.24 mg/kg (0.16 mg/kg if renal dysfunction) SQ, followed 2 hours later by MGTA-145 (0.03 mg/kg) IV over 3-10 minutes and apheresis within 30 minutes. Mobilization was repeated for a second day if day 1 yield was < 6 x 106 CD34+ cells/kg. This interim analysis reports on mobilization in 10 patients (of 25 planned), including safety cohort of first 6 patients completing transplant. Primary endpoint is collection of 2 x 106 CD34+ cells/kg. Results: Median age was 63 years (range: 46-68), 50% were female, 22% had ISS stage 3 & 50% had high-risk FISH. Induction therapy was VRD in 7 and daratumumab + VRD in 3 patients; median induction duration: 4 months (3-6) & median lenalidomide exposure: 6 cycles (4-6), with > VGPR in 70%. Median total stem cell yield (CD34+ cells/kg x 106) was 7.1 (3-16.2), day 1 yield was 5.4 (1.1-16.2) & yield per apheresis session was 4 (1.1-16.2). 100% of patients met the primary endpoint of collecting sufficient HSCs in < 2 days of mobilization + apheresis to proceed to transplant (2 x 106 CD34+ cells/kg). Secondary endpoints of 4 and 6 x 106 CD34+ cells/kg in < 2 days were met in 90% & 80% patients. 30% patients underwent 1 apheresis, while 70% underwent 2 sessions. MGTA-145 was well tolerated. At least 1 adverse event (AE) was seen in 90% of patients, 20% had grade 2 AEs (anemia, hypokalemia) and 20% had grade 3 AEs (worsening of baseline grade 3 anemia; hypocalcemia); all resolved. Acute & transient bone pain was seen in 40% of patients (back-2, hip-1, sternum-1), all grade 1, all on day 1, & resolved without intervention after 6 minutes (3-10). All 6 patients in the safety cohort have completed transplant with melphalan 200 mg/m2. Median of 4.1 (3.4-5.6) x 106 CD34+ cells/kg were infused. All patients have engrafted timely (DiPersio Blood 2009); median time to neutrophil engraftment: 12 days (11-13) & platelet engraftment: 17 days (16-19). Apheresis graft analysis is available in these 6 patients. Grafts with MGTA-145+plerixafor showed high enrichment for CD90+CD45RA- among CD34+ cells, a CD34 subset of long term engrafting HSCs (median: 31% of CD34+ cells, 27-52), higher than seen with G-CSF (6%, Goncalves TCT 2021). 67% of grafts were minimal residual disease negative with next generation flow cytometry. Conclusions: This is the first study to evaluate the novel regimen of MGTA-145 + plerixafor for same day stem cell mobilization & collection in myeloma/hematologic malignancies, with 100% efficacy in interim analysis and the first to demonstrate successful engraftment in patients with cells collected with this GCSF free regimen. Clinical trial information: NCT04552743.

Effects of cooled floor pads combined with chilled drinking water on behavior and performance of lactating sows under heat stress

This study was conducted to evaluate whether cooled floor pads combined with chilled drinking water could alleviate negative impacts of heat stress on lactating sows. Thirty sows (Landrace × Yorkshire, Parity = 1 to 6) were housed in individual farrowing stalls in two rooms with temperatures being controlled at 29.4°C (0700-1900 hours) and 23.9°C (1900-0700 hours). Sows in one room (Cool), but not in the other room (Control) were provided cooled floor pads (21-22°C) and chilled drinking water (13-15°C). Behavior of sows (15 sows/treatment) was video recorded during farrowing, and days 1, 3, 7, 14, and 21 after farrowing. Videos were viewed continuously to register the birth time of each piglet, from which total farrowing duration and birth intervals were calculated. The number of drinking bouts and the duration of each drinking bout were registered for each sow through viewing videos continuously for 2 h (1530-1730 hours) each video-recording day. Postures (lying laterally, lying ventrally, sitting, and standing) were recorded by scanning video recordings at 5-min intervals for 24 h each video-recording day, and time budget for each posture was calculated. Rectal temperature and respiration rate were measured for all sows the day before and after farrowing, and then once weekly. Sow and litter performance was recorded. Data were analyzed using the Glimmix procedure of SAS. The cooling treatment did not affect sow behavior or litter performance. Sows in the Cool room had lower rectal temperature (P = 0.03) and lower respiration rate (P < 0.001), consumed more feed (P = 0.03), tended to have reduced weight loss (P = 0.07), and backfat loss (P = 0.07) during lactation than sows in the Control room. As lactation progressed, sows increased drinking frequency (P < 0.001) and time spent lying ventrally (P < 0.0001), standing (P < 0.001), and sitting (P < 0.0001), and decreased time spent lying laterally (P < 0.0001) in both Cool and Control rooms. While cooled floor pads combined with chilled drinking water did not affect sow behavior, they did alleviate heat stress partially, as indicated by decreased rectal temperature, respiration rate, weight, and backfat loss, and increased feed intake in lactating sows.

Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents

Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.

Autologous stem cell transplantation versus no transplant in patients above 70 with multiple myeloma

e20509

Background: We evaluated outcomes of patients with multiple myeloma (MM) ≥ 70 years who were seen for Autologous Stem Cell Transplant (ASCT) consult, based on whether they underwent transplant vs. non-transplant treatment. Methods: 138 patients with MM ≥ 70 years (median 71, range 70-78) were evaluated in the BMT clinic from 1/2010 to 11/2019 for a transplant consult. Results: Of the 138 patients, 53 proceeded to ASCT. ASCT was not pursued in 85 patients despite most (79%) being eligible for transplant. Reasons for deferring ASCT in eligible patients included patient preference (48%, n = 32) and physician preference (52%, n = 35). 68 patients were seen during first-line therapy, of which 29 underwent upfront transplant. The remainder were seen at second-line or beyond. There was no difference in baseline characteristics among the 113 patients with available follow-up (ASCT = 53, non-ASCT = 60), including median age (71 vs. 72 years, p = 0.4), high-risk cytogenetics (41% vs. 31%, p = 0.4), high-risk HCT-CI (32% vs. 20% p = 0.2), and ISS stage III (34% vs. 27%, p = 0.6). In the 53 patients who underwent transplant, conditioning melphalan dose was 200 mg/m2 (75%, n = 40) and 140 mg/m2 (25%, n = 13). Day 100 transplant related mortality was 0% (n = 0). Progression-free survival (PFS) and overall survival (OS) were compared in patients who were seen for consultation within 1 year of diagnosis (n = 80). With a median follow-up of 27 months, median PFS amongst patients ≥ 70 years undergoing ASCT (n = 39) was 47 months compared to 34 months in the non-ASCT (n = 41) group, p = 0.006. Median OS was not reached in either group. Estimated 5-years OS was 76% in the ASCT group and 82% in the non-ASCT group (p = 0.6). There was no difference in PFS of patients ≥ 70 undergoing ASCT compared to a cotemporaneous cohort of patients < 70 (n = 639) from our institution (47 vs. 57 months, p = 0.3). Conclusions: Selected patients ≥ 70 years with MM undergoing ASCT have better PFS compared to patients with similar characteristics who do not undergo ASCT. ASCT is safe in this older population and outcomes were similar compared to younger patients. [Table: see text]

Impact of proteasome inhibitor vs. IMiD maintenance therapy on outcomes of patients with high-risk multiple myeloma (HRMM)

e20557

Background: The ideal choice of maintenance therapy in patients with HRMM high-risk multiple myeloma remains unknown. We analyzed the outcomes of patients with HRMM undergoing transplant receiving different maintenance approaches. Methods: Patients with MM undergoing their first ASCT from 2012-19 within 1 year of diagnosis were identified from the prospectively maintained database of patients undergoing ASCT. HRMM was defined as having t(4;14), t(14;16), t(14;20), del17p13, or gain 1q detected on fluorescent in situ hybridization (FISH). Results: Of the 412 patients undergoing ASCT within 1 year of diagnosis, 333 had FISH data available and of these, 37% (124/333) patients had high-risk cytogenetics. Distribution of HR cytogenetics was as follows: deletion 17p: 37% (n = 46), t(4;14): 27% (n = 34), t(14;16) or t(14;20): 12% (n = 26), gain1q: 31% (n = 41). 9% (n = 12) had more than one HR abnormality. In patients with HRMM, median age at transplant was 59 years (range: 39 to 73), and 61% (n = 103) were males. 64% (n = 107) of high-risk patients received post-transplant maintenance therapy. Maintenance therapy in this group included a proteasome inhibitor (PI) in 34% (n = 29), immunomodulatory drug (IMiD) in 59% (n = 51), or both in 7% (n = 6). There was no difference in baseline characteristics of HRMM patients receiving PI vs. IMiD maintenance, except that patients with del17p were more likely to receive PI maintenance therapy (55% vs 28%, p = 0.01). (Table) After a median follow-up of 3.1 years from diagnosis, patients with HRMM had inferior PFS compared to patients with standard risk disease, with median PFS of 3 vs. 4.8 years, p < 0.001. Amongst the 86 HRMM patients receiving maintenance therapy, median PFS in patients receiving PI vs. IMiD vs. both PI + IMiD maintenance was 3 vs. 3.2 vs. 2.2 years, respectively, log-rank p = 0.7. In the sub-group of patients with 17p deletion, median PFS in the three groups was 3 vs. 2.9 vs. 2.2 years, respectively, log-rank p = 0.7. Conclusions: Patients with HRMM have inferior PFS compared to patients with standard risk disease. We observed similar outcomes in HRMM patients post-transplant regardless of the choice of maintenance therapy. [Table: see text]

Effects of tail docking and tail biting on performance and welfare of growing-finishing pigs in a confinement housing system

A study was conducted to evaluate the effect of tail docking on the welfare and performance of victimized pigs by tail biting and tail biters. Pigs ( = 240; 25.7 ± 2.9 kg average weight), including 120 pigs that were tail docked at birth and 120 pigs that remained with intact tails, were used. Pigs were housed in 8 pens of 30 pigs in a confinement barn for 16 wk, with 4 pens each housing pigs of both sexes with docked or intact tails. Tail biters and victimized pigs with damaged tails were identified during outbreaks of tail biting. Growth performance was monitored, and skin lesions on the tail, ears, and body were assessed. Blood samples were collected from focal tail biters, victimized pigs, and nonvictimized pigs for analysis of total serum protein, IgG, and substance P concentrations. When pigs were marketed, carcass weights and the number of pigs with carcass trim loss were recorded. During the growing-finishing period, 48% of pigs with docked tails and 89% of pigs with intact tails experienced lesions on their tails, including 5% of docked pigs and 30% of intact pigs identified as victimized pigs that experienced puncture wounds with signs of infection on their tails or loss of tails ( < 0.001). Victimized pigs tended to gain less weight ( = 0.07) between 17 and 21 wk of age than other pigs when tail biting prevailed in this study. Victimized pigs were more frequently ( = 0.04) sold for less than full value and had a lower dressing percentage ( < 0.001) compared with nonvictimized pigs. For victimized pigs, total serum protein and IgG concentrations were elevated 5 d after tails were injured, suggesting that tail damage can cause inflammation, which may lead to carcass abscesses and trim loss. Compared with victimized pigs and nonvictimized pigs, tail biters had lower total serum protein ( = 0.01) and IgG ( = 0.01) concentrations, indicating that tail biters may experience poor immune functions. Results of this study demonstrated that tail docking reduced tail damage in pigs kept in a confinement system. Tail damage can cause inflammation and reduce the value of market pigs. More research is needed to test whether compromised immune functions predispose pigs to tail biting.

Effect of floor space allowances on growth performance of finishing pigs marketed at 138 kilograms

Current floor space allowances were determined in research studies conducted 10 to 20 yr ago using pigs that were marketed at a BW of about 113 kg or less. Currently, pork producers are regularly marketing pigs that weigh over 128 kg. Given this precipitous increase in market weight, we conducted 2 experiments to determine if floor space allowances previously determined apply to pigs marketed at greater than 128 kg. Experiment 1 was conducted at 5 university research stations throughout the Upper Midwest region. In this experiment, we evaluated the growth performance, salivary cortisol concentrations, and lesion scores of pigs weighing between 27 and 138 kg provided 0.71, 0.80, 0.89, 0.98, or 1.07 m/pig of floor space. Within each station, group size (range = 6 to 19 pigs) remained constant across floor space treatments but pen size was altered to achieve the desired space allocations. There were 14 replicate pens for each treatment. Overall, increasing floor space allowance increased final BW (linear, = 0.04) and tended (linear, < 0.06) to increase ADG and ADFI. There were no improvements in final BW or ADG beyond 0.89 m/pig. The G:F was not influenced by increasing floor space allocation. Salivary cortisol concentrations and lesion scores were not affected by floor space allowances. Experiment 2 focused on floor space needs of pigs nearing market weight and was conducted at 4 research stations. Pigs weighing about 130 kg were assigned to pens that provided 0.71, 0.80, 0.89, 0.98, or 1.07 m/pig of floor space. Group size ranged from 4 to 11 pigs per pen but was constant across floor space treatments within station. The study lasted 2 wk and there were 8 replicate pens per treatment. As floor space allowance increased, ADG (0.86, 0.95, 0.95, 1.10, and 1.06 kg; linear, < 0.01), ADFI (3.03, 3.26, 3.22, 3.49, and 3.25 kg; quadratic, < 0.05), and final BW (145.6, 145.7, 146.4, 148.3, and 147.9 kg; linear, < 0.01) increased. Based on the results of these 2 experiments, pigs marketed at about 138 kg require at least 0.89 m/pig to support optimal growth performance. However, heavier pigs (about 148 kg) at the end of the finishing period require 0.98 m/pig.

Anti-Platelet-Derived Growth Factor Receptor Alpha Chain Antibodies Predict for Response to Nilotinib in Steroid-Refractory or -Dependent Chronic Graft-Versus-Host Disease

Imatinib has clinical activity in chronic graft-versus-host disease (cGVHD), a significant complication of allogeneic hematopoietic cell transplant. Nilotinib is a tyrosine kinase inhibitor that targets the same receptors as imatinib but with different affinities. We tested the hypothesis that nilotinib is safe and has clinical activity in cGVHD. Thirty-three participants were enrolled in a phase I/II dose escalation and dose extension clinical trial of nilotinib for the treatment of steroid-refractory or- dependent cGVHD (ClinicalTrials.gov, NCT01155817). We assessed safety, clinical response, and pretreatment anti-platelet-derived growth factor receptor alpha chain (anti-PDGFRA) antibody levels. The 200-mg dose was identified as the maximum tolerated dose and used for the phase II dose extension study. At 6 months the incidence of failure-free survival (FFS), cGVHD progression, and nilotinib intolerance resulting in its discontinuation was 50%, 23%, and 23%, respectively. cGVHD responses in skin, joints, and mouth were observed at 3 and 6 months based on improvement in respective National Institutes of Health organ severity scores. Pretreatment anti-PDGFRA antibody levels ≥ .150 optical density as measured by ELISA correlated with longer FFS time (P < .0005) and trended with time until cGVHD progression (P < .06) but not drug intolerance. Nilotinib may be effective for corticosteroid-resistant or -refractory cGVHD in some patients, but its use is limited by intolerable side effects. Selection of patients with high pretreatment anti-PDGFRA antibody levels might improve the risk-to-benefit ratio of nilotinib and better justify its side effects.

Effectiveness of different corn dried distillers grains with solubles feeding strategies and increasing the time intervals between the second Improvest dose and slaughter of immunologically castrated pigs on belly and pork fat quality

Effects of dried distillers grains with solubles (DDGS) feeding strategies (a corn-soybean meal (CS) fed continously; CS+40% DDGS fed continously; CS+40, 30, 20, or 10% DDGS in 4 phases, respectively; or CS+40% DDGS in phases 1 to 3 and CS in phase 4 before slaughter) on belly and pork fat quality of immunologically castrated (n=192) pigs were evaluated. All pigs received the first Improvest dose at 11week of age, and the second dose at 9, 7, or 5week before slaughter at 24week of age. Increasing the time interval of the second Improvest dose before slaughter reduced IV in all fat depots and increased belly thickness. Gradually decreasing dietary DDGS and DDGS withdrawal feeding strategies reduced IV in all fat depots. Calculated IV were greater using the Meadus et al. (2010) equation compared with using the AOCS (1998) equation because it includes more long-chain unsaturated fatty acids.

Improving Care With a Portfolio of Physician-Led Cancer Quality Measures at an Academic Center

PURPOSE

Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the manual data collection required is resource intensive, and reporting is delayed. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCPs) to identify, measure, and improve quality metrics that were meaningful to the care teams and their patients.

METHODS

Each CCP physician leader collaborated with the cancer quality team to identify metrics, abiding by established guiding principles. Financial incentive was provided to the CCPs if performance at the end of the study period met predetermined targets. Reports were developed and provided to the CCP physician leaders on a monthly or quarterly basis, for dissemination to their CCP teams.

RESULTS

A total of 15 distinct quality measures were collected in depth for the first time at this cancer center. Metrics spanned the patient care continuum, from diagnosis through end of life or survivorship care. All metrics improved over the study period, met their targets, and earned a financial incentive for their CCP.

CONCLUSION

Our quality program had three essential elements that led to its success: (1) engaging physicians in choosing the quality measures and prespecifying goals, (2) using automated extraction methods for rapid and timely feedback on improvement and progress toward achieving goals, and (3) offering a financial team-based incentive if prespecified goals were met.

Effects of adding minimally refined cottonseed oil or crude glycerol to diets containing 40% corn distiller's dried grains with solubles on growth performance, carcass characteristics, and pork fat firmness of growing-finishing pigs

Diets containing more than 20% distiller's dried grains with solubles (DDGS) reduce fat firmness in pork, but supplementation of cottonseed oil or crude glycerol may improve fat firmness. The objective of this study was to assess the effect of feeding minimally refined cottonseed oil or crude glycerol on growth performance, carcass composition, and fat quality of growing-finishing pigs. Mixed sex pigs ( = 216; 24 ± 4 kg initial BW) were blocked by BW and allotted to 1 of 3 dietary treatments: 1) a basal corn-soybean meal diet with 40% DDGS (CON), 2) CON diet plus 5% minimally refined cottonseed oil added throughout the experiment (COT), or 3) CON fed during the first 8 wk and CON + 8% crude glycerol fed during the last 6 wk of the experiment (GLY). Although diets were not isocaloric, total AA-to-ME ratios were calculated to be equal among diets. Carcass composition was estimated using real-time ultrasound 2 d before harvest. Gilts (16/treatment) closest to the mean BW of each pen were harvested (115 ± 8 kg BW), and bellies were retrieved for in-depth analysis of fat quality. Belly fat was sampled and analyzed for fatty acid composition. Overall, ADFI of pigs fed COT (2.30 kg/d) was less ( < 0.01) than that of pigs fed CON or GLY (2.47 and 2.49 kg/d, respectively). Pigs fed COT (0.93 kg/d) had greater ( < 0.01) ADG compared with pigs fed CON or GLY (0.88 and 0.87 kg/d, respectively). Greater ( < 0.01) G:F was observed for pigs fed COT (0.41) than for pigs fed CON or GLY diets (0.36 and 0.35, respectively). Final BW of pigs fed COT (124.3 kg) was greater ( < 0.01) than that of pigs fed CON or GLY (118.9 and 118.6 kg, respectively). Pigs fed COT had greater ( < 0.01) HCW (94.9 kg) compared with pigs fed CON or GLY (89.9 and 89.2 kg, respectively). No differences were observed for dressing percentage (75.7, 76.3, and 75.3%), fat-free carcass lean percentage (50.5, 49.7, and 50.0%), and belly flop angle (6.21, 8.57, and 6.06°) for CON, COT, and GLY, respectively. Pigs assigned to COT had higher ( < 0.01) melting point of belly fat compared with pigs assigned to CON or GLY (30.4 vs. 26.3 and 25.3°C, respectively). Pigs fed COT had increased ( < 0.05) SFA, PUFA, and iodine value (IV) compared with CON-fed pigs. Glycerol supplementation had no influence on SFA, MUFA, and PUFA concentrations or IV of belly, jowl, and back fat compared with CON. In conclusion, COT diets improved growth performance due to greater energy density, but carcass composition was not affected by treatments. In this experiment, feeding neither COT nor GLY improved fat firmness of pigs fed diets containing 40% DDGS.

Effect of time interval between the second Improvest® dose and slaughter and corn dried distillers grains with solubles feeding strategies on carcass composition, primal cutout, and pork quality of immunologically castrated pigs

Effects of dried distillers grains with solubles (DDGS) feeding strategies on carcass composition, primal cutout, and lean quality of immunologically castrated (IC; n=863) pigs were evaluated, and consisted of: 1) corn-soybean meal (CS) diet (PCon); 2) CS+40% DDGS (NCon); 3) CS+40, 30, 20, or 10% DDGS fed in phases 1 to 4, respectively (SD); or 4) CS+40% DDGS fed in phase 1 to 3 and CS in phase 4 (WD). All pigs received the first dose of Improvest® at 11weeks. of age, and the second dose was administered at either 9, 7, or 5weeks. before slaughter at 24weeks. of age. The SD and WD improved carcass dressing percentage and resulted in intermediate primal cut yields and pork loin quality compared with pigs fed PCon and NCon. Increasing the time interval between second dose of Improvest® and slaughter increased adipose tissue accretion but did not affect lean quality of pork.

Redesigning care to lower episode costs in bone marrow transplantation

16

Background: Increased scrutiny over costs of cancer care has led to the introduction of episode-based payment by federal and commercial insurers. National average billed charges for autologous and allogeneic transplant episodes of care are approximately $375K and $925K, respectively. Through comprehensive analysis of claims data, we identified leading drivers of cost in BMT episodes (which span 30 days before transplant through 60-100 days post-transplant) and cost reduction opportunities. By redesigning care delivery, we can reduce post-transplant admissions and potentially improve the health and patient experience for this population. Methods: From September 1, 2013 – February 28, 2015, SHC performed 221 allogeneic and 241 autologous transplants. We analyzed internal claims data to map costs of BMT episodes, including pre-transplant, transplant (index), and post-transplant phases of care using standardized cost categories including room accommodations, medications, medical and surgical supplies, imaging, and labs. Results: 67% of episode cost was associated with pre-transplant and index phases. In both phases, patients’ treatment closely matched defined protocols. Imaging, medications, and blood utilization met clinical indications. The largest opportunity was seen in the post-transplant phase for patients with multiple myeloma who received autologous transplants. On average, episodes with post-transplant admissions were 35% more costly than episodes without post-transplant admissions. Many of these patients are admitted 5-9 days after transplant due to neutropenic fever, have short LOS, and receive empiric antibiotics. An estimated 37% of post-transplant admissions, totaling $790,000 in annualized cost, may be prevented with additional outpatient support. Conclusions: A multidisciplinary team proposed redesigning care to safely shift treatment from the inpatient to outpatient setting. Strategies include expanding Infusion Treatment Area and home pharmacy capacity and partnering with home health agencies.

Improving care with portfolio of physician-led cancer quality measures at an academic center

49

Background: Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the required manual data collection is slow and resource-intensive. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCP). Methods: CCP physician leaders (MD) identified two measures that were meaningful to their team and patients. The quality team worked with hospital and university analytics teams to develop metrics and reports. Hospital leadership provided financial incentives (FI) for each CCP if jointly set targets were met. Results: 16 metrics were identified and measured for 13 CCPs (Table). Measures spanned from new diagnosis (ND) through end of life or survivorship care, and were a mix of process and outcome measures. To build and manage metrics required 2 full-time equivalent data analysts and quality specialists over 12 months. CCP MDs received monthly reports for dissemination to their team. Almost all measures improved or maintained initial high levels (*). FI awards will be used for quality improvement, education, and team-building, as determined by CCP MDs. Conclusions: A successful quality reporting system with measured improvements takes considerable engagement and resources, including FI, data systems, and staff to build, manage, and improve measures. This may not be feasible or sustainable for centers in the current fiscal environment. [Table: see text]

Growth performance of immunologically castrated pigs slaughtered at 5, 7, or 9 weeks after the second Improvest dose and fed diets containing corn dried distillers grains with solubles

Growth performance of immunologically castrated (IC) pigs (863 total) was determined at increasing time intervals between the second Improvest (gonadotropin releasing factor analog-diphtheria toxoid conjugate; Zoetis Inc., Florham Park, NJ) dose and slaughter (TD) and with 4 different dried distillers grains with solubles (DDGS) feeding strategies (FS) in a 4 × 3 factorial arrangement of treatments. The feeding period was divided into 4 separate diet phases. Dietary treatments included 1) corn-soybean meal control diets (PCon), 2) a gradual decrease of dietary DDGS inclusion rate from 40%, 30%, 20%, and 10% in phases 1 to 4 (GD), respectively, 3) feeding 40% DDGS diets in phases 1 to 3 and removal of DDGS from the phase 4 diet (WD), and 4) feeding 40% DDGS diets in all 4 phases (NCon). Pigs received the second Improvest dose at 9 (TD9), 7 (TD7), or 5 (TD5) wk before slaughter. In each group, all pigs were slaughtered on the same day. There were no 3-way interactions among FS, TD, and week of feeding period for any measure of growth performance. Pigs fed PCon and WD had greater ( < 0.05) overall ADFI than pigs fed NCon, especially when slaughtered 9 wk after the second Improvest dose (2.45 and 2.44 vs. 2.31 ± 0.08 kg/d, respectively). This response was partly due to withdrawing DDGS from the diet at 19 wk of age (WD), which led to a tendency ( < 0.10) for increased ADFI from the wk 19 to 21 interval to the wk 21 to 24 interval (3.26 vs. 3.51 ± 0.09 kg/d, respectively). During the same time period, ADFI was unchanged ( > 0.05) in pigs fed PCon, GD, and NCon. Overall G:F was improved ( < 0.05) in TD5 pigs compared with TD9 pigs and tended ( < 0.10) to be improved compared with TD7 pigs. Final BW was similar among pigs fed GD, WD, and PCon (123.1, 122.3, and 125.3 kg, respectively), but pigs fed PCon and GD had greater ( < 0.05) BW than pigs fed NCon (120.0 kg). Throughout the growing-finishing period, BW was similar among TD treatments. The GD FS was more effective than the WD FS in maintaining overall G:F (0.424 and 0.414 ± 0.005, respectively) and ADG (0.94 and 0.93 ± 0.03 kg/d, respectively), which were similar ( > 0.05) to those of pigs fed PCon (0.427 ± 0.005 and 0.96 ± 0.03 kg/d, respectively). Growth performance of pigs fed GD more closely reflected that of pigs fed PCon than that of pigs fed WD. Delaying the second dose of Improvest from 9 to 5 wk before slaughter resulted in improved growth performance.

Pork fat quality of pigs fed distillers dried grains with solubles with variable oil content and evaluation of iodine value prediction equations

Back, belly, and jowl fat samples of pigs fed control corn-soybean meal-based diets and diets containing 4 sources of distillers dried grains with solubles (DDGS) were used to determine the impact of feeding DDGS with variable oil content on pork fat quality and to evaluate the precision and accuracy of published iodine value (IV) prediction equations. Dietary treatments consisted of 4 corn-soybean meal diets containing 40% DDGS from different sources with 10.7, 5.6, 14.2, or 16.0% ether extract (EE; as-fed) content. Diets did not contain any other supplemental lipid sources. Regardless of fat depot, SFA content (g/100 g fat) of pigs fed 5.6% EE DDGS (35.4) was greater ( < 0.05) than that of pigs fed 14.2 or 16.0% EE DDGS sources (34.4 and 30.2, respectively) and tended to be greater ( < 0.10) than that of pigs fed 10.7% EE DDGS (34.6). Pigs fed 10.7 and 14.2% EE DDGS had greater ( < 0.01) SFA concentration than pigs fed 16.0% EE DDGS. Regardless of fat depot, MUFA content (g/100 g fat) of pigs fed 10.7, 5.6, and 14.2% DDGS sources were similar (43.7, 43.1, and 43.0, respectively) but were greater ( < 0.01) than that of pigs fed 16.0% EE DDGS (40.0). A dietary treatment × fat depot interaction was observed for PUFA ( < 0.05) and IV ( = 0.079). Pigs fed 10.7, 5.6, and 14.2% DDGS sources had reduced ( < 0.01) PUFA concentration and IV compared with pigs fed 16.0% EE DDGS, but the magnitude of responses in PUFA and IV to the variable oil content of DDGS was greater in backfat than in belly and jowl fat. Carcass fat IV data were used to evaluate prediction error (PE) and bias of published carcass fat IV prediction equations. Equations using dietary C18:2 content or IV product as a single predictor resulted in highly variable PE (g/100 g) ranging from 3.43 to 8.36 and bias (g/100 g) ranging from -5.05 to 5.66. Using equations that included additional diet composition information and pig growth performance factors decreased PE (3.27 to 4.73) and bias (-3.37 to 1.73) of prediction for backfat compared with equations only based on the characteristics of dietary lipid, but this improvement was limited in the prediction for belly and jowl fat. Predictions based on percentage of DDGS in diets had the greatest PE (6.66 to 9.19) and bias (5.53 to 8.00).

Effects of feeding diets containing distillers' dried grains with solubles and wheat middlings with equal predicted dietary net energy on growth performance and carcass composition of growing-finishing pigs

This experiment evaluated the effects of feeding distillers' dried grains with solubles (DDGS) and wheat middlings (WM) in diets with similar estimated NE content on growth performance and carcass characteristics of growing-finishing pigs. Pigs ( = 384; 29.1 ± 3.6 kg initial BW) were blocked by initial BW, and within blocks, pens were randomly allotted to 1 of 4 dietary treatments (8 pigs/pen and 12 replicates/treatment) in a 4-phase feeding program (29 to 50, 50 to 75, 75 to 100, and 100 to 120 kg BW). Dietary treatments were arranged in a 2 × 2 factorial design and formulated to consist of: 1) corn and soybean meal (CON), 2) CON with 30% DDGS, 3) CON with 15% WM, and 4) CON with 30% DDGS and 15% WM. Diets met or exceeded nutrient requirements published by the and were formulated to contain the same concentrations of standardized ileal digestible (SID) Lys and meet or exceed minimum SID AA to Lys ratios within phases. No significant interactions for DDGS × WM × phase or DDGS × WM were observed for all growth performance criteria. Pigs fed diets containing 30% DDGS had reduced ( < 0.05) ADFI (1.76 vs. 1.86 kg/d) and ADG (0.85 vs. 0.91 kg/d) compared with pigs fed diets with no DDGS in phase 1 but not in other phases. The G:F of pigs fed diets containing DDGS was not different during phase 1 to 3 but was greater ( < 0.01) in phase 4 (0.313 vs. 0.291) compared with that of pigs fed diets with no DDGS. Pigs fed diets containing 15% WM had similar ADFI and G:F but reduced ( < 0.05) ADG (0.86 vs. 0.90 kg/d) compared with pigs fed diets without WM in phase 1, but no difference in ADG was observed in phases 2 to 4. No DDGS × WM interaction was observed for carcass traits. Pigs fed diets containing 30% DDGS had reduced ( < 0.01) HCW (86.5 vs. 89.9 kg), carcass yield (72.3 vs. 73.6%), LM area (45.0 vs. 47.9 cm), and percentage of carcass fat-free lean (52.1 vs. 53.4%), but backfat depth was not affected compared with pigs fed diets with no DDGS. Pigs fed diets containing 15% WM had lower carcass yield (72.7 vs. 73.1%; < 0.05) and HCW (87.7 vs. 88.7 kg; < 0.10) than pigs fed diets with no addition of WM, but other carcass traits were not affected. In conclusion, overall ADG and G:F were not affected by feeding 30% DDGS or 15% WM when diets were formulated on the NE basis, but more accurate and dynamic estimation of NE content for DDGS sources is needed to optimize caloric efficiency at different physiological ages of pigs.

Impact of synthetic antioxidants on lipid peroxidation of distiller's dried grains with solubles and distiller's corn oil stored under high temperature and humidity conditions

This experiment evaluated the effect of antioxidants, oil content in distiller's dried grains with solubles (DDGS), quality of distiller's corn oil, and storage time on lipid peroxidation. A source of low-oil DDGS (LO-DDGS; 5.0% ether extract [EE], as-fed basis), high-oil DDGS (HO-DDGS; 13.0% EE, as-fed basis), and 2 sources of distiller's corn oil (DCO; 1.20, 0.08, and 0.48% moisture, insoluble impurities, and unsaponifiables [MIU], respectively [DCO-1], and 1.20, 0.01, and 0.10% MIU, respectively [DCO-2]) were obtained. Each of the 4 ingredients was divided into 18 representative subsamples (approximately 908 g for DDGS or 2 kg of DCO). Six subsamples of each ingredient were mixed with either no supplemental antioxidants (CON), Rendox-CQ (REN; 1,000 mg/kg EE; Kemin, Industries, Des Moines, IA), or Santoquin-Q4T (SAN; 1,500 mg/kg EE; Novus International, St. Louis, MO). Each mixture ( = 72) was split into thirds, and 1 portion was immediately frozen at -20°C (d 0). Two portions were stored under hot (38.6 ± 0.1°C) and humid conditions (94.0 ± 0.3% relative humidity) for 14 or 28 d. The MIXED procedure of SAS was used to evaluate the effects of ingredient, antioxidant, storage time, and interactions, with d-0 values used as a covariate. From d 14 to 28, peroxide value (PV), -anisidine value (AnV), and thiobarbituric acid reactive substances (TBARS) of DCO and DDGS increased by 3- to 4-fold ( < 0.05). Over the entire storage period, PV of DCO-1 and HO-DDGS (12.3 ± 0.3 and 12.6 ± 0.3 mEq O/kg oil, respectively) exceeded ( < 0.05) that of DCO-2 and LO-DDGS (9.6 ± 0.3 and 9.3 ± 0.3 mEq O/kg oil, respectively). Adding REN or SAN ( < 0.05) reduced TBARS and AnV relative to CON (TBARS = 11.0 ± 0.2 mg malondialdehyde Eq/kg oil and AnV = 6.5 ± 0.2) over the entire period (mean of d 14 and 28), but TBARS and AnV did not differ ( > 0.05) between antioxidants (TBARS = 6.1 ± 0.2 and 5.9 ± 0.2 mg malondialdehyde Eq/kg oil, respectively, and AnV = 1.9 ± 0.2 and 1.8 ± 0.2 for REN and SAN, respectively). The PV on d 14 and 28 and overall was less ( < 0.05) when either antioxidant was added relative to CON (16.0 mEq O/kg) and was greater for ingredients treated with SAN ( < 0.05) compared with REN (8.8 ± 0.2 and 8.0 ± 0.2 mEq O/kg oil for SAN and REN, respectively). In summary, antioxidants reduced peroxidation of DDGS and DCO by approximately 50% during 28 d of storage at 38.6°C and 94.0% relative humidity, but neither antioxidant completely stabilized the ingredients.

Effects of adding supplemental tallow to diets containing 30% distillers dried grains with solubles on growth performance, carcass characteristics, and pork fat quality in growing-finishing pigs

Crossbred pigs (n = 315) were blocked by initial BW (6.8 ± 1.1 kg) and randomly assigned to 1 of 4 dietary treatments to evaluate the effects of dietary inclusion of tallow and corn distillers dried grains with solubles (DDGS) on pig growth, carcass traits, and pork fat quality. Diets consisted of a corn-soybean meal control diet (CON) and another 3 corn-soybean meal diets containing 5% tallow (T), 30% DDGS (D), or 5% tallow plus 30% DDGS (TD) in a 2 × 2 factorial arrangement of treatments. Diets were formulated to contain similar levels of available P and standardized ileal digestible Lys:ME among treatments. Pigs were housed in 40 pens, with 7 to 8 pigs per pen, to provide 10 replicates per treatment. Overall ADG did not differ among treatments. Compared with CON (2.76 kg/d) and T (2.59 kg/d), feeding 30% DDGS reduced the ADFI (interaction, P > 0.05) of pigs when fed with 5% tallow (2.45 kg/d for TD) but not when fed alone (2.76 kg/d for D). There was no effect of DDGS on overall G:F, but pigs fed diets with tallow had greater (P < 0.01) G:F (0.4) than pigs fed no tallow (0.37). Feeding tallow increased (P < 0.01) HCW, carcass yield, and backfat depth of pigs independent of DDGS. Feeding DDGS reduced (P < 0.01) belly firmness, as measured by belly flop angle, independent of tallow (D = 71.8° and TD = 57.7° vs. CON = 134.0° and T = 113.4°) and tallow also tended to reduce belly firmness (P < 0.10). Feeding DDGS and tallow reduced the concentration of SFA in belly fat, while the concentration of MUFA were increased (P < 0.01) by feeding tallow but not DDGS. Conversely, feeding DDGS increased (P < 0.01) the concentration of PUFA in belly fat but there was no effect of tallow. An interaction (P = 0.03) between DDGS and tallow for iodine value (IV) of belly fat was observed, in which addition of tallow or DDGS increased the IV of belly fat (64.22 for T and 71.22 for D vs. 59.01 for CON) but addition of both reduced IV (67.88 for TD). The IV of belly fat and backfat were correlated (P < 0.01) with the IV product of the diet fed in phase 3 (r = 0.49 and r = 0.81, respectively). In conclusion, adding 5% tallow to 30% DDGS diets improved G:F and carcass yield while reducing the IV of belly fat. However, pork fat firmness as measured by belly flop angle was not improved.

Effects of adding supplemental tallow to diets containing distillers dried grains with solubles on fatty acid digestibility in growing pigs

An experiment was conducted to measure the apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of fatty acids in diets containing 0 or 30% corn distillers dried grains with solubles (DDGS) and 0, 5, or 10% tallow. Barrows (n = 24; initial BW = 25 kg) were surgically fitted with a T-cannula at the distal ileum. Pigs (n = 4/diet) were randomly assigned to diets: corn-soybean meal control (CON), CON plus 5% tallow (5T0D), CON plus 10% tallow (10T0D), CON plus 30% DDGS (0T30D), CON plus 5% tallow and 30% DDGS (5T30D), and CON plus 10% tallow and 30% DDGS (10T30D). Eight replicates per treatment were achieved by randomizing diets among pigs for a second collection period. Each pig was fed their respective diet for a 5-d adaptation period followed by 3-d fecal collection and 2-d ileal digesta collection periods. The AID and ATTD of fatty acids was calculated using the index method and acid-insoluble ash as an indigestible marker. When tallow was added to diets with 0% DDGS, there was no effect on AID of palmitic acid (C16:0) or SFA, while AID of stearic acid (C18:0) was increased (66.87% for CON, 72.06% for 5T0D, and 76.81% for 10T0D; P < 0.01). However, when diets contained 30% DDGS, the AID of all SFA was reduced as levels of tallow increased C16:0 (77.62% for 0T30D, 69.66% for 5T30D, and 68.43% for 10T30D), C18:0 (85.87% for 0T30D, 64.08% for 5T30D, and 61.25% for 10T30D), and SFA (79.88% for 0T30D, 68.23% for 5T30D, and 66.29% for 10T30D). The AID of MUFA was not affected when tallow was added to diets with 30% DDGS but actually increased in 5T0D and 10T0D. The amount of apparent ileal digested fatty acids increased with the addition of DDGS and tallow regardless of their digestibility. Amounts of ileal digested MUFA and PUFA increased when both DDGS (P < 0.01) and tallow (P < 0.01) were included in the diet compared to when either ingredient was excluded. For ileal digestible SFA, an interaction (P < 0.01) between DDGS and tallow was observed. Interactions between DDGS and tallow were observed for ATTD of all fatty acids (P < 0.01), except for linoleic acid and PUFA, which were not affected by dietary treatment. The amount of ileal digestible PUFA increased with tallow addition independent from the inclusion level of DDGS and it was a function the dietary concentration of the fatty acid. Adding tallow to corn-soybean based diets increased the amount of digested SFA, but in diets with DDGS, the increment in amount of ileal digestible SFA was less prominent due to lesser digestibility of SFA.

Effect of feeding peroxidized dried distillers grains with solubles to sows and progeny on growth performance and metabolic oxidative status of nursery pigs

This experiment evaluated the effects of including peroxidized corn dried distillers grains with solubles (DDGS) in diets for sows and nursery pigs on growth performance, vitamin E (VE), and Se status, and the incidence of mulberry heart disease (MHD) of nursery pigs. Sows (n = 12) were fed corn-soybean meal diets (C-SBM) or C-SBM diets with DDGS (40% and 20% in gestation and lactation, respectively) for 3 parities. In the third parity, 108 weaned pigs (BW = 6.6 ± 0.36 kg) were blocked by BW within litter, assigned to pens (2 pigs/pen; 5 and 4 pens per litter for groups 1 and 2, respectively), and pens were assigned 1 of 3 nursery diets: 1) corn-soybean meal (CON), 2) 30% peroxidized DDGS (Ox-D), and 3) 30% Ox-D with 5 × NRC (1998) level of VE (Ox-D+5VE) for 7 wk, in a 2 × 3 factorial arrangement of sow and nursery diets (n = 9 pens/treatment). The peroxidized DDGS source in nursery diets contained concentrations of thiobarbituric acid reactive substances (TBARS) and peroxide values that were 25 and 27 times greater than a reference corn sample. Sow colostrum, milk, and serum, as well as pig serum and liver samples, were analyzed for α-tocopherol and Se concentrations. Pig serum was analyzed for glutathione peroxidase activity (GPx), TBARS, and sulfur-containing AA (SAA). Pig hearts were evaluated for gross and histopathological lesions indicative of MHD, but none were detected. Pigs from sows fed DDGS tended to have reduced (P = 0.07) VE in serum during lactation and reduced VE at weaning (P < 0.01; 5.6 vs. 6.7 ± 0.1 µg/mL) compared with pigs from sows fed C-SBM. Inclusion of DDGS in sow diets reduced the VE status of pigs during lactation, but not in the nursery when MHD can be a concern. Pigs fed Ox-D+5VE (P = 0.08) tended to have, and those fed Ox-D (P = 0.04) had greater ADFI than pigs fed CON, but ADG was not affected (P > 0.1) by nursery diet. Feeding Ox-D or Ox-D+5VE increased (P < 0.05) serum α-tocopherol compared with CON (2.5, 2.8, and 3.4 ± 0.09 µg/mL, respectively), but TBARS and GPx were not affected by nursery diet. Serum concentration of SAA was 40% to 50% greater (P < 0.01) for pigs fed Ox-D or Ox-D+5VE compared with those fed C-SBM, which was likely due to greater (P < 0.01) SAA intake for pigs fed Ox-D. The antioxidant properties of SAA may have spared VE and Se and masked any effect of Ox-D on metabolic oxidation status. Therefore, increasing the dietary VE concentration was unnecessary in nursery diets containing Ox-D.

Influence of thermally oxidized vegetable oils and animal fats on energy and nutrient digestibility in young pigs

A total of 108 barrows (6.67 ± 0.03 kg BW) were assigned to 12 dietary treatments in a 4 × 3 factorial design plus a corn-soybean meal control diet to evaluate the effect of lipid source and peroxidation level on DE, ME, and apparent total tract digestibility (ATTD) of DM, GE, ether extract (EE), N, and C in young pigs. Main effects were lipid source (corn oil [CN], canola oil [CA], poultry fat [PF], and tallow [TL]) and peroxidation level (original lipids [OL], slow oxidation [SO] of lipids heated for 72 h at 95°C, or rapid oxidation [RO] of lipids heated for 7 h at 185°C). Pigs were provided ad libitum access to diets for 28 d followed by an 8-d period of controlled feed intake equivalent to 4% BW daily. Diets were formulated based on the ME content of CA with the standardized ileal digestible Lys, Met, Thr, Trp, total Ca, and available P:ME balanced relative to NRC (1998) recommendations. Lipid peroxidation analysis indicated that compared with the OL, SO and RO had a markedly increased concentrations of lipid peroxidation products, and the increase of peroxidation products in CN and CA were greater than those in PF and TL. Addition of lipids to diets increased (P < 0.05) ATTD of EE and tended to improve (P = 0.06) ATTD of GE compared with pigs fed the control diet. Feeding CN or CA increased (P < 0.05) ATTD of DM, GE, EE, N, and C compared with feeding TL, while feeding PF improved (P < 0.05) ATTD of GE and EE and tended to increase (P = 0.06) ATTD of C compared with TL. Pigs fed CN had increased (P = 0.05) percentage N retention than pigs fed TL. No peroxidation level effect or interaction between lipid source and peroxidation level on DE and ME was observed. Lipid source tended (P = 0.08) to affect DE but not ME values of experimental lipids (P > 0.12). Digestible energy values for CA (8,846, 8,682, and 8,668 kcal/kg) and CN (8,867, 8,648, and 8,725 kcal/kg) were about 450 kcal/kg greater than that of TL (8,316, 8,168, and 8,296 kcal/kg), with PF being intermediate (8,519, 8,274, and 8,511 kcal/kg), for OL, SO, and RO lipids, respectively, respectively. In conclusion, lipid source affected ATTD of dietary DM, GE, EE, N, and C, and N retention and tended to influence the DE value of the lipid but did not significantly affect their ME value. Rapid and slow heating of lipids used in this study increased lipid peroxidation products but had no detectable effects on nutrient and energy digestibility as well as DE and ME values of the various lipids.

Methods to create thermally oxidized lipids and comparison of analytical procedures to characterize peroxidation

The objective of this experiment was to evaluate peroxidation in 4 lipids, each with 3 levels of peroxidation. Lipid sources were corn oil (CN), canola oil (CA), poultry fat, and tallow. Peroxidation levels were original lipids (OL), slow-oxidized lipids (SO), and rapid-oxidized lipids (RO). To produce peroxidized lipids, OL were either heated at 95°C for 72 h to produce SO or heated at 185°C for 7 h to produce RO. Five indicative measurements (peroxide value [PV], p-anisidine value [AnV], thiobarbituric acid reactive substances [TBARS] concentration, hexanal concentration, 4-hydroxynonenal [HNE] concentration, and 2,4-decadienal [DDE]) and 2 predictive tests (active oxygen method [AOM] stability and oxidative stability index [OSI]) were performed to quantify the level of oxidation of the subsequent 12 lipids with varying levels of peroxidation. Analysis showed that a high PV accurately indicated the high level of lipid peroxidation, but a moderate or low PV may be misleading due to the unstable characteristics of hydroperoxides as indicated by the unchanged PV of rapidly oxidized CN and CA compared to their original state (OL). However, additional tests, which measure secondary peroxidation products such as AnV, TBARS, hexanal, HNE, and DDE, may provide a better indication of lipid peroxidation than PV for lipids subjected to a high level of peroxidation. Similar to PV analysis, these tests may also not provide irrefutable information regarding the extent of peroxidation because of the volatile characteristics of secondary peroxidation products and the changing stage of lipid peroxidation. For the predictive tests, AOM accurately reflected the increased lipid peroxidation caused by SO and RO as indicated by the increased AOM value in CN and CA but not in poultry fat and tallow, which indicated a potential disadvantage of the AOM test. Oxidative stability index successfully showed the increased lipid peroxidation caused by SO and RO in all lipids, but it too may have disadvantages similar to AnV, TBARS, hexanal, DDE, and HNE because OSI directly depends on quantification of the volatile secondary peroxidation products. To accurately analyze the peroxidation damage in lipids, measurements should be determined at appropriate time intervals by more than 1 test and include different levels of peroxidation products simultaneously.

Effects of feeding diets containing highly peroxidized distillers dried grains with solubles and increasing vitamin E levels to wean-finish pigs on growth performance, carcass characteristics, and pork fat composition

Lipid peroxidation in animal feed can negatively affect growth performance and meat quality. Weanling pigs (n = 432; BW = 6.6 ± 0.4 kg) were used to evaluate the effects of feeding peroxidized distillers dried grains with solubles (DDGS) with 3 levels of vitamin E (α-tocopheryl acetate) on growth performance, carcass composition, fatty acid composition of pork fat, and lipid peroxidation in LM. The DDGS source used in this study contained the highest thiobarbituric acid reactive substances (TBARS) value, peroxide value, and total S content (5.2 ng malondialdehyde/mg oil, 84.1 mEq/kg oil, and 0.95%, respectively) among 30 DDGS sources sampled. Pens within blocks were assigned randomly to 1 of 6 diets in a 2 × 3 factorial arrangement of treatments with 8 pens per treatment and 9 pigs per pen. Pigs were fed a corn-soybean meal (CON) or 30% peroxidized DDGS (Ox-DDGS) diets with 3 levels of vitamin E: none supplemented (No-E), NRC (1X-E), or 10X NRC (10X-E). Compared to CON, inclusion of 30% Ox-DDGS in diets reduced (P < 0.001) final BW (110 vs. 107 kg), overall ADG (0.76 vs. 0.74 kg/d), and G:F (0.39 vs. 0.37). Increasing dietary vitamin E concentrations improved G:F (P = 0.03) of pigs fed 10X-E and 1X-E vs. No-E diets (0.39 and 0.39 vs. 0.38, respectively). Hot carcass weight, dressing percentage, backfat depth, and LM area were reduced (P < 0.01) in pigs fed Ox-DDGS compared to CON, but percentage of fat-free carcass lean was not affected. Feeding Ox-DDGS increased (P < 0.001) PUFA concentration, particularly linoleic acid (P < 0.001), and iodine value (P < 0.001) in belly fat and backfat compared to pigs fed CON. Dietary vitamin E levels did not affect fatty acid profiles in belly or back fat. Loin muscle TBARS were measured to determine the lipid peroxidation level in pork loins. Although pigs were fed a Ox-DDGS source in this study, TBARS in LM were similar between Ox-DDGS and CON treatments. There was no interaction between Ox-DDGS and dietary vitamin E concentration in LM TBARS. Alpha-tocopherol concentration in LM was greater (P < 0.001) in 10X-E than No-E or 1X-E dietary treatments. Compared to CON, feeding Ox-DDGS increased α-tocopherol concentration in LM of pigs fed No-E (1.0 vs. 3.1 mg/kg; P = 0.005) but not in those fed 1X-E or 10X-E. These results indicate that feeding diets containing 30% Ox-DDGS to wean-finish pigs may negatively affect growth performance, but supplementation of additional vitamin E in the diet did not counteract these effects.

Prediction of the concentration of standardized ileal digestible amino acids in distillers dried grains with solubles

Values for the concentration of standardized ileal digestible (SID) CP, Lys, Met, Thr, and Trp from 34 sources of distillers dried grains with solubles (DDGS) were obtained from a series of 5 experiments with the objective of predicting the concentration of SID AA from physical and chemical assays. The concentration of NDF, ADF, hemicellulose, acid detergent insoluble CP (ADICP), and KOH soluble protein (SolCP) were measured and calculated in all DDGS sources. Likewise, particle size was measured and color of each source of DDGS was determined with a Minolta colorimeter and HunterLab spectrometer and was expressed as lightness (L*), redness (a*), and yellowness (b*). The HunterLab spectrometer also provided optical density that was recorded between 400 and 700 nm. Front face fluorescence was measured at 360 nm excitation and recorded from 380 to 600 nm. Multiple linear regression and principal components analyses were performed to predict the concentration of SID AA among DDGS sources, and predicted means as well as predicted residual sums of squares (PRESS) were calculated to estimate accuracy and precision of the model. Some correlations (P < 0.05) were observed between ADF, hemicellulose, ADICP, and SolCP with SID CP and AA but were generally low (r < 0.51). There was a greater association (R(2) = 0.40; P < 0.05) between L* and SID Lys among DDGS sources when L* was less than 50 than when samples had L* values greater than 50. In addition, a* was negatively correlated (P < 0.05) with SID CP (r = -0.41), Lys (r = -0.59), and Met (r = -0.50) whereas b* tended to be positively correlated (P < 0.10) with SID Lys (r = 0.31) and Trp (r = 0.30) and was correlated (P = 0.05) with SID Met (r = 0.43) and Thr (r = 0.36). There were no correlations between NDF or particle size with SID CP and AA. Optical density, along with CP, was highly predictive of SID Lys (R(2) = 0.97; PRESS = 0.05), Thr (R(2) = 0.94; PRESS = 0.06), and Trp (R(2) = 0.93; PRESS = 0.004) but not SID Met (R(2) = 0.39; PRESS = 0.12). Front face fluorescence was also highly predictive of SID Lys (R(2) = 0.99; PRESS = 0.07), Met (R(2) = 0.95; PRESS = 0.05), Thr (R(2) = 0.99; PRESS = 0.008), and Trp (R(2) = 0.99; PRESS = 0.006). In conclusion, correlations between ADICP, SolCP, NDF, particle size, and color measurements with SID AA concentrations were poor, but optical density and front face fluorescence methods appear to provide good predictions of SID AA concentrations in DDGS. However, these prediction equations need to be validated using samples of DDGS from a separate data set.

Effects of reduced nocturnal temperature on pig performance and energy consumption in swine nursery rooms

The objective of this investigation was to determine the effect of a reduced nocturnal temperature (RNT) regimen on performance of weaned pigs and energy consumption during the nursery phase of production. The age of weaned pigs assigned to experiments ranged from 16 to 22 d. In Exp. 1, 3 stations conducted 2 trials under a common protocol that provided data from 6 control rooms (CON; 820 pigs) and 6 RNT rooms (818 pigs). Two mirror-image nursery rooms were used at each station. Temperature in the CON room was set to 30°C for the first 7 d, then reduced by 2°C per week through the remainder of the experiment. Room temperature settings were held constant throughout the day and night. The temperature setting in the RNT room was the same as CON during the first 7 d, but beginning on the night of d 7, the room temperature setting was reduced 6°C from the daytime temperature from 1900 to 0700 h. The use of heating fuel and electricity were measured weekly in each room. Overall, ADG (0.43 kg), ADFI (0.62 kg), and G:F (0.69) were identical for CON and RNT rooms. Consumption of heating fuel [9,658 vs. 7,958 British thermal units (Btu)·pig(-1)·d(-1)] and electricity (0.138 vs. 0.125 kilowatt-hour (kWh)·pig(-1)·d(-1)] were not statistically different for CON and RNT rooms, respectively. In Exp. 2, 4 stations conducted at least 2 trials that provided data from 9 CON rooms (2,122 pigs) and 10 RNT rooms (2,176 pigs). Experimental treatments and protocols were the same as Exp. 1, except that the RNT regimen was imposed on the night of d 5 and the targeted nighttime temperature reduction was 8.3°C. Neither final pig BW (21.8 vs. 21.5 kg; SE = 0.64), ADG (0.45 vs. 0.44 kg; SE = 0.016), ADFI (0.61 vs. 0.60 kg; SE = 0.019), nor G:F (0.75 vs. 0.75; SE = 0.012) were different for pigs housed in CON or RNT rooms, respectively. Consumption of heating fuel and electricity was consistently reduced in RNT rooms for all 4 stations. Consumption of heating fuel (10,019 vs. 7,061 Btu·pig(-1)·d(-1); SE = 1,467) and electricity (0.026 vs. 0.021 kWh·pig-1·d-1; SE = 0.004) were lower (P < 0.05) in the RNT rooms compared with CON rooms. This represents a 30% reduction in heating fuel use and a 20% reduction in electrical use with no differences in pig growth performance or health. From these experiments, we conclude that imposing a RNT regimen from 1900 to 0700 h is effective in reducing energy costs in the nursery without compromising pig performance, which will reduce production costs and decrease emissions of greenhouse gases.

Relating centromeric topography in fixed human chromosomes to α-satellite DNA and CENP-B distribution

Despite extensive analyses on the centromere and its associated proteins, detailed studies of centromeric DNA structure have provided limited information about its topography in condensed chromatin. We have developed a method with correlative fluorescence light microscopy and atomic force microscopy that investigates the physical and structural organization of α-satellite DNA sequences in the context of its associated protein, CENP-B, on human metaphase chromosome topography. Comparison of centromeric DNA and protein distribution patterns in fixed homologous chromosomes indicates that CENP-B and α-satellite DNA are distributed distinctly from one another and relative to observed centromeric ridge topography. Our approach facilitates correlated studies of multiple chromatin components comprising higher-order structures of human metaphase chromosomes.

Effects of abrupt introduction and removal of high and low digestibility corn distillers dried grains with solubles from the diet on growth performance and carcass characteristics of growing-finishing pigs

Two experiments were conducted to evaluate the effects of feeding continuously a diet containing 40% dried distillers grains with solubles (DDGS) or intermittently diets containing 20 or 40% DDGS on growth performance and carcass quality of pigs. Responses of the pigs to abrupt introduction and removal of dietary DDGS with differing concentrations of standardized ileal digestible (SID) AA were also evaluated. In Exp. 1, crossbred pigs (n=216; initial BW=51.3±3.1 kg) were assigned randomly to 1 of 4 treatments, which included a corn-soybean meal control (CON), a 20% DDGS diet (D20), a switch between D20 and CON (D20-CON), and a switch between a 40% DDGS diet and CON (D40-CON) with 6 pens per treatment. Pigs abruptly introduced and removed from a 20% DDGS diet (D20-CON) exhibited no differences in growth performance or carcass quality compared with CON pigs. However, intermittently feeding a 40% DDGS diet (D40-CON) resulted in lighter HCW (P<0.05) compared with all other treatments. In Exp. 2, crossbred pigs (n=324; initial BW=33.2±3.0 kg) were assigned randomly to 1 of 6 treatments, including a corn-soybean meal control (CON), a 40% low SID AA DDGS diet (LD), a 40% high SID AA DDGS diet (HD), LD and CON diets alternated (LD-CON), HD and CON diets alternated (HD-CON), or HD and LD diets alternated (HD-LD) with 6 pens per treatment. Final BW and ADG were less (P<0.05) for LD and HD-LD pigs compared with CON pigs, but HD pigs tended to have reduced (P<0.10) final BW and ADG. Loin muscle area was smaller for LD and HD-LD pigs compared with CON pigs (P<0.05). Percentage carcass lean was not affected by dietary treatment. Backfat of DDGS-fed pigs was more unsaturated than CON pigs, but AA digestibility of DDGS did not affect this response. Digestibility of AA in DDGS can influence pig performance and carcass quality when fed at high concentrations (40% or more). The use of a high SID AA DDGS source may diminish some of the negative responses observed for growth performance and carcass characteristics when feeding high concentrations of DDGS if accurate values of SID AA are used in diet formulation. Periodic inclusion and removal of 40% DDGS from diets did not adversely affect growth performance or carcass quality regardless of the SID AA digestibility of the DDGS used. These results indicate that it is possible to abruptly incorporate and remove DDGS from grower-finisher swine diets without meaningful detrimental effects on growth performance or carcass quality.

Long-term outcomes after high dose therapy and autologous haematopoietic cell rescue for refractory/relapsed Hodgkin lymphoma

The standard treatment for patients with refractory or relapsed Hodgkin lymphoma (HL) is high-dose chemotherapy and/or radiation with autologous haematopoietic cell rescue (AHCR). In this study, we assessed quality of life and evaluated the risk of late morbidity and mortality for HL patients who underwent AHCR. One hundred and fifty-four patients who underwent AHCR at Stanford University from 1988 to 2002 and survived ≥2 years were evaluated. Median follow-up was 10·2 years. There were 54 deaths, 34 from HL, 20 from other causes. The 10-year cumulative incidence of death from HL or other causes was 21·7% and 12·7%, respectively. Thirteen deaths were from second malignancies. The risk ratio of second malignancies was 8·0 [95% confidence interval (CI), 4·7-12·6] compared with the general population, and 3·0 (95% CI, 1·8-4·8) compared with HL patients not undergoing AHCR. The risk ratio of second malignancies was 1·5 (95% CI, 0·9-2·4) compared with HL patients receiving non-AHCR therapy. Overall quality of life did not differ from the general population, but AHCR survivors did note reduced functioning and some worse symptoms. AHCR survivors may be at increased risk of death from HL and other causes compared with the general population, but not compared with the HL population as a whole.

Sorting by parity to reduce aggression toward first-parity sows in group-gestation housing systems

Young sows are subordinate and vulnerable in group-housing systems because they usually lose most fights and suffer more injuries than mature sows at mixing. This study was conducted to evaluate effects of sorting by parity on reducing aggression and associated stress with the aim to improve welfare and performance of first-parity sows in a group-housed system. Sows and gilts (n = 180) from 6 breeding groups were used. Within each group, 2 groups of 15 females were mixed in each of 2 treatment pens after weaning and remained there throughout the entire gestation period. The control pen consisted of 11 multiparous and 4 first-parity sows, and the treatment pen consisted of 11 gilts and 4 first-parity sows. Before mixing and at the end of the gestation period, sows and gilts were weighed individually, assessed for BCS, and measured for backfat thickness. Injury scores were assessed before and 48 h after mixing and wean-to-mating intervals, farrowing rate, and litter performance at the subsequent farrowing were recorded for all females. Aggressive interactions involving first-parity sows were video recorded for 72 h immediately after mixing in each pen. Data were analyzed using the Glimmix procedure of SAS with a Poisson regression model for count data and a Gaussian model for continuous data. All females in treatment pens sustained fewer scratches (P = 0.01) after mixing than females in control pens. First-parity sows in treatment pens fought more frequently (P = 0.01), tended to fight for longer periods (P = 0.08), and won more fights (P = 0.04) of parallel pressing but had fewer injures (P = 0.03) after mixing, gained more BW (P = 0.01) during gestation, and had greater farrowing rates (P = 0.03) compared with first-parity sows in control pens. The results suggest that sorting by parity shielded first-parity sows from severe injuries caused by mixing-induced aggression so that their welfare and performance can be improved in group housing systems.

Technical note: a technique for ear vein catheterization in group-housed sows

No methods have been published for repeated blood sampling via an ear vein in group-housed sows. Therefore, the objective of this study was to develop a minimally invasive technique for the insertion of an ear vein catheter for repeated blood sampling in group-housed peripartum sows while minimizing any impact on production performance. Thirty-three multiparous pregnant sows were used including 18 catheterized sows and 15 control sows. In a group-farrowing barn, sows (8/room) shared a communal area and farrowed in individual, free-access pens. Treatment sows were anesthetized, and 1 ear was prepared aseptically 2 to 4 d before their expected farrowing date. A sterile needle was inserted into the largest and straightest portion of the vein, and the catheter, which was medical-grade microbore tubing, was inserted through the needle at least 24 cm. The needle was withdrawn, and the catheter was fixed into position and sutured to the ear. A blunt-end probe point cannula was glued onto the distal end of the catheter, and an adaptor injection cap with male Luer lock was placed on the end. The catheter was coiled and placed in a protective purse, which was cemented directly to the skin on the back of the shoulders. The catheter was flushed with heparinized saline to ensure patency. Once sows were able to stand, an elastic bandage was wrapped around the neck and upper body of the sow to hold the protective purse and exposed catheter in position. Blood samples were collected every 24 h, and catheters were flushed with heparinized saline after each collection. Fourteen of the 18 insertions were successful, and 11 of those remained functional for 4 d or more. Differences were not observed in reproductive performance between catheterized and noncatheterized sows.

Long-term outcome of patients with metastatic breast cancer treated with high-dose chemotherapy and transplantation of purified autologous hematopoietic stem cells

Metastatic breast cancer remains a major treatment challenge. The use of high-dose chemotherapy (HDCT) with rescue by autologous mobilized peripheral blood (MPB) is controversial, in part because of contamination of MPB by circulating tumor cells. CD34(+)Thy-1(+) selected hematopoietic stem cells (HSC) represent a graft source with a greater than 250,000-fold reduction in cancer cells. Here, we present the long-term outcome of a pilot study to determine feasibility and engraftment using HDCT and purified HSC in patients with metastatic breast cancer. Twenty-two patients who had been treated with standard chemotherapy were enrolled into a phase I/II trial between December 1996 and February 1998, and underwent HDCT followed by rescue with CD34(+)Thy-1(+) HSC isolated from autologous MPB. More than 12 years after the end of the study, 23% (5 of 22) of HSC recipients are alive, and 18% (4 of 22) are free of recurrence with normal hematopoietic function. Median progression-free survival (PFS) was 16 months, and median overall survival (OS) was 60 months. Retrospective comparison with 74 patients transplanted between February 1995 and June 1999 with the identical HDCT regimen but rescue with unmanipulated MPB indicated that 9% of patients are alive, and 7% are without disease. Median PFS was 10 months, and median OS was 28 months. In conclusion, cancer-depleted HSC following HDCT resulted in better than expected 12- to 14-year PFS and OS in a cohort of metastatic breast cancer patients. These data prompt us to look once again at purified HSC transplantation in a protocol powered to test for efficacy in advanced-stage breast cancer patients.

Adoptive immunotherapy with cytokine-induced killer cells for patients with relapsed hematologic malignancies after allogeneic hematopoietic cell transplantation

Donor leukocyte infusions induce remissions in some patients with hematologic malignancies who relapse after allogeneic hematopoietic cell transplantation (HCT); however, graft-versus-host disease (GVHD) remains the major complication of this strategy. Cytokine-induced killer (CIK) cells are a unique population of cytotoxic T lymphocytes that express the CD3(+)CD56(+) phenotype and show marked up-regulation of the natural killer cell receptor NKG2D (CD314). CIK cells are non-major histocompatibility complex-restricted and NKG2D-dependent in target recognition and cytotoxicity. We explored the feasibility of ex vivo expansion of allogeneic CIK cells in patients with relapsed hematologic malignancies after allogeneic HCT. Eighteen patients (median age, 53 years; range, 20-69 years) received CIK cell infusions at escalating doses of 1 × 10(7) CD3(+) cells/kg (n = 4), 5 × 10(7) CD3(+) cells/kg (n = 6), and 1 × 10(8) CD3(+) cells/kg (n = 8). The median expansion of CD3(+) cells was 12-fold (range, 4- to 91-fold). CD3(+)CD56(+) cells represented a median of 11% (range, 4%-44%) of the harvested cells, with a median 31-fold (range, 7- to 515-fold) expansion. Median CD3(+)CD314(+) cell expression was 53% (range, 32%-78%) of harvested cells. Significant cytotoxicity was demonstrated in vitro against a panel of human tumor cell lines. Acute GVHD grade I-II was seen in 2 patients, and 1 patient had limited chronic GVHD. After a median follow-up of 20 months (range, 1-69 months) from CIK infusion, the median overall survival was 28 months, and the median event-free survival was 4 months. All deaths were due to relapsed disease; however, 5 patients had longer remissions after infusion of CIK cells than from allogeneic HCT to relapse. Our findings indicate that this form of adoptive immunotherapy is well tolerated and induces a low incidence of GVHD, supporting further investigation as an upfront modality to enhance graft-versus-tumor responses in high-risk patient populations.

Tandem chemo-mobilization followed by high-dose melphalan and carmustine with single autologous hematopoietic cell transplantation for multiple myeloma

Single autologous hematopoietic cell transplant (AHCT) with high-dose melphalan prolongs survival in patients with multiple myeloma but is not curative. We conducted a study of intensive single AHCT using tandem chemo-mobilization with CY and etoposide followed by high-dose conditioning with melphalan 200 mg/m(2) plus carmustine 15 mg/kg. One hundred and eighteen patients in first consolidation (CON1) and 58 patients in relapse (REL) were transplanted using this intensified approach. Disease response improved from 32% very good PR (VGPR)+CR pre-mobilization to 76% VGPR+CR post transplant in CON1. With a median follow-up of 4.7 years, the median EFS was 2.8 years, and the median OS was 5.1 years in CON1. OS from time of transplant was significantly shorter for REL (3.4 years) compared with CON1 (5.1 years; P=0.02). However, OS from time of diagnosis was similar in REL (6.1 years) and CON1 (6.0 years; P=0.80). The 100-day non-relapse mortality in the CON1 and REL groups was 0% and 7%, respectively. In summary, intensified single AHCT with tandem chemo-mobilization and augmented high-dose therapy is feasible in multiple myeloma and leads to high-quality response rates.