Programme for Harmonization to the International Scale in Latin America for BCR-ABL1 quantification in CML patients: findings and recommendations.

Objectives The quantitation of BCR-ABL1 mRNA is mandatory for chronic myeloid leukemia (CML) patients, and RT-qPCR is the most extensively used method in testing laboratories worldwide. Nevertheless, substantial variation in RT-qPCR results makes inter-laboratory comparability hard. To facilitate inter-laboratory comparative assessment, an international scale (IS) for BCR-ABL1 was proposed. Methods The laboratory-specific conversion factor (CF) to the IS can be derived from the World Health Organization (WHO) genetic reference panel; however, this material is limited to the manufacturers to produce and calibrate secondary reference reagents. Therefore, we developed secondary reference calibrators, as lyophilized cellular material, aligned to the IS. Our purpose was both to re-evaluate the CF in 18 previously harmonized laboratories and to propagate the IS to new laboratories. Results Our field trial including 30 laboratories across Latin America showed that, after correction of raw BCR-ABL1/ABL1 ratios using CF, the relative mean bias was significantly reduced. We also performed a follow-up of participating laboratories by annually revalidating the process; our results support the need for continuous revalidation of CFs. All participating laboratories also received a calibrator to determine the limit of quantification (LOQ); 90% of them could reproducibly detect BCR-ABL1, indicating that these laboratories can report a consistent deep molecular response. In addition, aiming to investigate the variability of BCR-ABL1 measurements across different RNA inputs, we calculated PCR efficiency for each individual assay by using different amounts of RNA. Conclusions In conclusion, for the first time in Latin America, we have successfully organized a harmonization platform for BCR-ABL1 measurement that could be of immediate clinical benefit for monitoring the molecular response of patients in low-resource regions.

Human mobility and COVID-19 initial dynamics.

Countries in Europe took different mobility containment measures to curb the spread of COVID-19. The European Commission asked mobile network operators to share on a voluntarily basis anonymised and aggregate mobile data to improve the quality of modelling and forecasting for the pandemic at EU level. In fact, mobility data at EU scale can help understand the dynamics of the pandemic and possibly limit the impact of future waves. Still, since a reliable and consistent method to measure the evolution of contagion at international level is missing, a systematic analysis of the relationship between human mobility and virus spread has never been conducted. A notable exceptions are France and Italy, for which data on excess deaths, an indirect indicator which is generally considered to be less affected by national and regional assumptions, are available at department and municipality level, respectively. Using this information together with anonymised and aggregated mobile data, this study shows that mobility alone can explain up to 92% of the initial spread in these two EU countries, while it has a slow decay effect after lockdown measures, meaning that mobility restrictions seem to have effectively contribute to save lives. It also emerges that internal mobility is more important than mobility across provinces and that the typical lagged positive effect of reduced human mobility on reducing excess deaths is around 14-20 days. An analogous analysis relative to Spain, for which an IgG SARS-Cov-2 antibody screening study at province level is used instead of excess deaths statistics, confirms the findings. The same approach adopted in this study can be easily extended to other European countries, as soon as reliable data on the spreading of the virus at a suitable level of granularity will be available. Looking at past data, relative to the initial phase of the outbreak in EU Member States, this study shows in which extent the spreading of the virus and human mobility are connected. The findings will support policymakers in formulating the best data-driven approaches for coming out of confinement and mostly in building future scenarios in case of new outbreaks.

Deficient Skeletal Muscle Regeneration after Injury Induced by a Clostridium perfringens Strain Associated with Gas Gangrene.

Gas gangrene, or clostridial myonecrosis, is usually caused by Clostridium perfringens and may occur spontaneously in association with diabetes mellitus, peripheral vascular disease, or some malignancies but more often after contamination of a deep surgical or traumatic lesion. If not controlled, clostridial myonecrosis results in multiorgan failure, shock, and death, but very little is known about the muscle regeneration process that follows myonecrosis when the infection is controlled. In this study, we characterized the muscle regeneration process after myonecrosis caused in a murine experimental infection with a sublethal inoculum of C. perfringens vegetative cells. The results show that myonecrosis occurs concomitantly with significant vascular injury, which limits the migration of inflammatory cells. A significant increase in cytokines that promote inflammation explains the presence of an inflammatory infiltrate; however, impaired interferon gamma (IFN-γ) expression, a reduced number of M1 macrophages, deficient phagocytic activity, and a prolongation of the permanence of inflammatory cells lead to deficient muscle regeneration. The expression of transforming growth factor ß1 (TGF-ß1) agrees with the consequent accumulation of collagen in the muscle, i.e., fibrosis observed 30 days after infection. These results provide new information on the pathogenesis of gas gangrene caused by C. perfringens, shed light on the basis of the deficient muscle regenerative activity, and may open new perspectives for the development of novel therapies for patients suffering from this disease.

Digestion-resistant maltodextrin effects on colonic transit time and stool weight: a randomized controlled clinical study.

PURPOSE: Increased awareness of the importance of dietary fibre has led to increased interest in "functional" fibre components like digestion-resistant maltodextrin (RMD). This randomized, placebo-controlled, double-blind study assessed the effects of RMD in the colonic transit time (CTT) and defecation characteristics (frequency, stool volume and consistency). METHODS: Sixty-six healthy adult volunteers (32 men) who did not have a daily defecation habit had a 7-day run-in period before the 21-day intervention period with RMD or placebo. CTT and segmental CTT (SCTT) were assessed by a single abdominal X-ray film taken at the end of both periods after radiopaque marker ingestion. Defecation characteristics and intestinal functions were also assessed, which were self-reported by patients. Intragroup comparisons were evaluated by Student's paired t test, Bonferroni test and Chi-square test, while time comparisons by analysis of variance (ANOVA) and time-by-treatment interaction by repeated-measures ANOVA. RESULTS: Fifty-seven subjects were assessed for CTT (placebo, n = 28; RMD, n = 29). In the RMD group, the total CTT, left SCTT and rectosigmoidal SCTT decreased significantly compared to baseline (p < 0.01 each; -13.3, -4.7, -8.7 h, respectively). Significant differences between groups were observed in total CTT and left SCTT. Significant time-by-treatment interaction was observed in the RMD group for stool volume (p = 0.014), increasing 56 % compared to baseline (p < 0.01), while remained unchanged in the placebo group. Stool consistency was improved only in the RMD group (p < 0.01). No adverse effects related to study products were observed. CONCLUSIONS: The results show that RMD improved CTT, stool volume, stool consistency and some intestinal functions in a healthy population.

Thermodiffusion, molecular diffusion and Soret coefficients of aromatic+n-alkane binary mixtures.

In the present work, we have measured the thermodiffusion coefficient of 51 binary liquid mixtures at 25 oC. These mixtures correspond to the series of the aromatics toluene and 1-methylnaphthalene with n-alkanes nCi (i = 6, 8, 10, 12, and 14) at different mass fractions in the whole range. For that, we have used the thermogravitational technique. It is shown that the thermodiffusion coefficient is a linear function of the mass fraction in all the mixtures. Extrapolating the lines, we obtain the thermodiffusion coefficient in dilute solutions of n-alkanes for both toluene and 1-methylnaphthalene. These limiting values show a linear dependence with the inverse of the product of the molecular weights. In addition, we have measured the molecular diffusion coefficient of all the mixtures at 0.5 of mass fraction and at 25 oC, by the sliding symmetric tubes technique. It is observed that the product of this coefficient with the viscosity at the same concentrations takes a constant value for each of the series considered. Finally, we have also determined the Soret coefficient of the equimass mixtures by the combination of the measurements of thermodiffusion and molecular diffusion coefficients.

Contribution to the benchmark for ternary mixtures: Determination of Soret coefficients by the thermogravitational and the sliding symmetric tubes techniques.

This work is part of an international project for the research on the transport properties in ternary mixtures. Six different teams have analysed the same mixture by independent techniques in order to compare the results and validate the techniques. This work is the contribution of the team of Mondragon Unibertsitatea for ground conditions measurements. This team has measured the thermodiffusion coefficients by the thermogravitational techniques and the molecular diffusion coefficients by the Sliding Symmetric Tubes technique. The Soret coefficients have been determined by the combination of the thermodiffusion and molecular diffusion coefficients. The mixture chosen for the study is the one formed by 1,2,3,4-tetrahydronaphtalene, isobutylbenzene and n-dodecane at mass fraction of 80% of THN, 10% of IBB and 10% of n C12, and at 25°C. The good agreement between the results of the different teams shows the validity of the techniques used in this work.

Soret coefficients of the ternary mixture 1,2,3,4-tetrahydronaphthalene + isobutylbenzene + n-dodecane.

In this work, the transport coefficients of the ternary mixtures of the diffusion coefficient measurements in ternary mixtures 1 project were determined. The analyzed ternary mixtures are formed by 1,2,3,4-tetrahydronaphthalene, isobutylbenzene, and dodecane (nC12) at different compositions. In all cases, the analysis was carried out at 25 °C. The thermodiffusion coefficients were measured by a new thermogravitational column, and the molecular diffusion coefficients were determined by the sliding symmetric tubes technique. Finally, the Soret coefficients were ascertained from the measurements of the thermodiffusion and molecular diffusion coefficients. In addition, two new quantitative correlations which enable the prediction of the thermodiffusion and Soret coefficients of a ternary mixture are presented. The comparison between the experimental and the predicted data shows a good agreement. The presented results help to complete the lack of experimental data in ternary mixtures. In addition, this work improves the fundamental understanding of multicomponent mixtures.

Mass effect on the Soret coefficient in n-alkane mixtures.

We have determined the Soret coefficient of different equimolar and non equimolar n-alkane mixtures from measurements of the molecular diffusion and thermal diffusion coefficients. It is shown that equimolar mixtures behave as isotopic-like mixtures in which only the mass effect contributes to the Soret effect. In non equimolar mixtures, a small linear dependence with the molar fraction is observed. Finally, we have obtained a new correlation, which allows the determination of the Soret coefficient of n-alkane mixtures using the data of viscosity, the thermal expansion coefficient of the pure components, and the density of the equimolar mixture.

The phylogenetic position of the Critically Endangered Saint Croix ground lizard Ameiva polops: revisiting molecular systematics of West Indian Ameiva.

The phylogenetic position of the critically endangered Saint Croix ground lizard Ameiva polops is presently unknown and several hypotheses have been proposed. We investigated the phylogenetic position of this species using molecular phylogenetic methods. We obtained sequences of DNA fragments of the mitochondrial ribosomal genes 12S rDNA and 16S rDNA for this species. We aligned these sequences with published sequences of other Ameiva species, which include most of the Ameiva species from the West Indies, three Ameiva species from Central America and South America, and one from the teiid lizard Tupinambis teguixin, which was used as outgroup. We conducted Maximum Likelihood and Bayesian phylogenetic analyses. The phylogenetic reconstructions among the different methods were very similar, supporting the monophyly of West Indian Ameiva and showing within this lineage, a basal polytomy of four clades that are separated geographically. Ameiva polops grouped in a cluster that included the other two Ameiva species found in the Puerto Rican Bank: A. wetmorei and A. exsul. A sister relationship between A. polops and A. wetmorei is suggested by our analyses. We compare our results with a previous study on molecular systematics of West Indian Ameiva. 

Cryptic Genetic Diversity in the Coastal Isopod Alloniscus oahuensis from the Pacific Ocean.

The isopod sub-order Oniscidea includes over 3,700 species and is known to occur in all terrestrial environments, except those at extreme elevations and polar latitudes. Current estimates of the biodiversity of the Oniscidea may be underestimates, as recent molecular studies have uncovered high levels of cryptic diversity in several taxa in the sub-order. High levels of cryptic diversity have been found in coastal species, species from remote and isolated regions, and species with complex taxonomic histories. Alloniscus oahuensis is a good candidate to harbor cryptic diversity, as it is a coastal isopod species with a geographic range that spans several remote and isolated archipelagos in the Pacific Ocean and has a complex taxonomic history. In this study, we used sequences for three mitochondrial genes and one nuclear gene to determine whether A. oahuensis harbors highly divergent lineages that may represent cryptic species. By characterizing 60+ A. oahuensis individuals from 17 localities from various Pacific Ocean archipelagos, we uncovered two deeply divergent lineages with disjunct distributions. The levels of genetic divergence observed amongst the two lineages match or exceed those reported across other cryptic species in the Oniscidea, suggesting that A. oahuensis may represent a cryptic species complex in need of a taxonomic revision. The extremely low lineage diversities within A. oahuensis indicate that the lineages may have spread across the Pacific Ocean recently, potentially due to anthropogenic activity.

Cryptic diversity and phylogeographic patterns of Deto echinata (Isopoda: Detonidae) in southern Africa.

Recent phylogeographic studies of poorly-dispersing coastal invertebrates in highly biodiverse regions have led to the discovery of high levels of cryptic diversity and complex phylogeographic patterns that suggest isolation, geological, and ecological processes have shaped their biodiversity. Studies of southern African coastal invertebrates have uncovered cryptic diversity for various taxa and phylogeographic patterns that, although sharing some similarities across taxa, do differ. These findings underscore the need for additional studies to better understand the biodiversity levels, distributional patterns, and processes responsible for producing coastal biodiversity in that region. The coastal isopod Deto echinata is of particular interest, as its complex taxonomic history, poor dispersal capabilities, and broad geographic distribution suggest the potential for cryptic diversity. We use mitochondrial and nuclear sequences to characterize D. echinata individuals from localities ranging from northern Namibia to Glentana, about 2,500 km along the coastline on the south coast of South Africa. These are used to assess whether D. echinata harbors cryptic genetic diversity and whether phylogeographic distributional patterns correlate with those previously documented for other coastal isopods in the region. Analysis of mitochondrial and nuclear sequences revealed two deeply-divergent lineages that exhibit a distributional break in the Cape Peninsula region. These findings suggest D. echinata is a cryptic species complex in need of taxonomic revision and highlight the need for further taxonomic and phylogeographic studies of similarly poorly-dispersing coastal invertebrates in southern Africa.

Immunomodulatory effect of 5-azacytidine (5-azaC): potential role in the transplantation setting.

Cytokine genes are targets of multiple epigenetic mechanisms in T lymphocytes. 5-azacytidine (5-azaC) is a nucleoside-based DNA methyltransferase inhibitor that induces demethylation and gene reactivation. In the current study, we analyzed the effect of 5-azaC in T-cell function and observed that 5-azaC inhibits T-cell proliferation and activation, blocking cell cycle in the G(0) to G(1) phase and decreasing the production of proinflammatory cytokines such as tumor necrosis factor-alpha and interferon-gamma. This effect was not attributable to a proapoptotic effect of the drug but to the down-regulation of genes involved in T-cell cycle progression and activation such as CCNG2, MTCP1, CD58, and ADK and up-regulation of genes that induce cell-growth arrest, such as DCUN1D2, U2AF2, GADD45B, or p53. A longer exposure to the drug leads to demethylation of FOXP3 promoter, overexpression of FOXP3, and expansion of regulatory T cells. Finally, the administration of 5-azaC after transplantation prevented the development of graft-versus-host disease, leading to a significant increase in survival in a fully mismatched bone marrow transplantation mouse model. In conclusion, the current study shows the effect of 5-azaC in T lymphocytes and illustrates its role in the allogeneic transplantation setting as an immunomodulatory drug, describing new pathways that must be explored to prevent graft-versus-host disease.

Impaired expression of DICER, DROSHA, SBDS and some microRNAs in mesenchymal stromal cells from myelodysplastic syndrome patients.

UNLABELLED: Background Recent findings suggest that a specific deletion of Dicer1 in mesenchymal stromal cell-derived osteoprogenitors triggers several features of myelodysplastic syndrome in a murine model. Our aim was to analyze DICER1 and DROSHA gene and protein expression in mesenchymal stromal cells (the osteoblastic progenitors) obtained from bone marrow of myelodysplastic syndrome patients, in addition to microRNA expression profile and other target genes such as SBDS, a DICER1-related gene that promotes bone marrow dysfunction and myelodysplasia when repressed in a murine model. DESIGN AND METHODS: Mesenchymal stromal cells from 33 bone marrow samples were evaluated. DICER, DROSHA and SBDS gene expression levels were assessed by real-time PCR and protein expression by Western blot. MicroRNA expresion profile was analyzed by commercial low-density arrays and some of these results were confirmed by individual real-time PCR. RESULTS: Mesenchymal stromal cells from myelodysplastic syndrome patients showed lower DICER1 (0.65±0.08 vs. 1.91±0.57; P=0.011) and DROSHA (0.62±0.06 vs. 1.38±0.29; P=0.009) gene expression levels, two relevant endonucleases associated to microRNA biogenesis, in comparison to normal myelodysplastic syndrome. These findings were confirmed at protein levels by Western blot. Strikingly, no differences were observed between paired mononuclear cells from myelodysplastic syndrome and controls. In addition, mesenchymal stromal cells from myelodysplastic syndrome patients showed significant lower SBDS (0.63±0.06 vs. 1.15±0.28; P=0.021) gene expression levels than mesenchymal stromal cells from healthy controls. Furthermore, mesenchymal stromal cells from myelodysplastic syndrome patients showed an underlying microRNA repression compared to healthy controls. Real-time PCR approach confirmed that mir-155, miR-181a and miR-222 were down-expressed in mesenchymal stromal cells from myelodysplastic syndrome patients. Conclusions This is the first description of an impaired microRNA biogenesis in human mesenchymal stromal cells from myelodysplastic syndrome patients, where DICER1 and DROSHA gene and protein downregulation correlated to a gene and microRNA abnormal expression profile, validating the animal model results previously described.

Simultaneous analysis of the expression of 14 genes with individual prognostic value in myelodysplastic syndrome patients at diagnosis: WT1 detection in peripheral blood adversely affects survival.

Several studies have evaluated the prognostic value of the individual expression of certain genes in patients with myelodysplastic syndromes (MDS). However, none of them includes their simultaneous analysis by quantitative polymerase chain reaction (PCR). We evaluated relative expression levels of 14 molecular markers in 193 peripheral blood samples from untreated MDS patients using real-time PCR. Detectable WT1 expression levels, low TET2, and low IER3 gene expression were the only markers showing in univariate analysis a poor prognostic value for all treatment-free (TFS), progression-free (PFS), and overall survival (OS). In multivariate analysis, molecular parameters associated with a shorter TFS were: WT1 detection (p = 0.014), low TET2 (p = 0.002), and low IER3 expression (p = 0.025). WT1 detection (p = 0.006) and low TET2 (p = 0.006) expression were associated with a shorter PFS when multivariate analysis was carried out by including only molecular markers. Molecular values with an independent value in OS were: WT1 detection (p = 0.003), high EVI1 expression (p = 0.001), and undetectatable p15-CDKN2B (p = 0.037). WT1 expressers were associated with adverse clinical-biological features, high IPSS and WPSS scoring, and unfavorable molecular expression profile. In summary, detectable WT1 expression levels, and low TET2 and low IER3 expression in peripheral blood showed a strong association with adverse prognosis in MDS patients at diagnosis. However, WT1 was the only molecular marker displaying an independent prognostic value in both OS and TFS.

Nest architecture and colony composition in two populations of Ectatomma ruidum sp. 2 (E. ruidum species complex) in southwestern Colombia.

Nest architecture plays a fundamental role in the adaptation of ants to their habitat, favoring the action of economically important species. Ectatomma ruidum sp. 2 (ruidum species complex) is a biological control agent in Neotropical agroecosystems, exhibiting high bioturbation impact due to high nest densities. The architecture and composition of 152 nests were studied in two Andean populations of southwestern Colombia, 24 of them being cast using the paraffin wax technique. Nest entrance was a single, circular, 4 mm hole at ground level, without any special external structure, connected to a single vertical tunnel communicating with successive half ellipsoidal chambers. Nests were extremely shallow (depth range: 28.7-35.4 cm), with an average of six chambers and an overall volume of 92.2 cm3 per nest. The deeper the chamber, the smaller its volume. Nest building was independent of plants or roots, and no surface or underground physical connections were found between neighboring nests. Few nests possessed a queen, and neither ergatoids nor microgynes were recorded. Despite significant interactions between localities and the number of both males and workers, queen presence had an overall highly positive effect on the number of workers and larvae and a negative one on the number of gynes. Overall, the studied Colombian populations of E. ruidum sp. 2 retained the simple nest structure described for other species of this species complex and for colonies of the same species from other geographical areas, though they constrasted in their extreme shallowness. Our data suggest that E. ruidum sp. 2, at the local level, does not follow the usual monodomic pattern of this species with facultative polygyny but, rather, has a polydomic pattern with monogyny, perhaps related to the extreme shallowness of the nests due to soil structure, which could significantly enhance the queen's reproductive inhibition previously reported for this species.

Redescription of Tylosmaindroni Giordani Soika, 1954 (Crustacea, Isopoda, Oniscidea) based on SEM and molecular data.

The woodlouse species Tylosmaindroni Giordani Soika, 1954 (Crustacea, Isopoda, Oniscidea) is redescribed from the Persian Gulf based on light and scanning electron microscopy. This species differs from the closely related T.exiguus Stebbing, 1910, from the Red Sea (coasts of Sudan and Eritrea), and Socotra Island, by pereopod 1 superior margin without a prominent projection and pleopod 2 endopod 2.3 times as long as exopod, vs. 3.6 in T.exiguus. A distribution map for T.maindroni is provided. In addition, we studied the molecular differentiation of five populations of T.maindroni from the Persian Gulf, based on partial cytochrome c oxidase subunit I (COI) gene sequences. The results revealed low levels of population structuring between the analyzed populations.

Mobility functional areas and COVID-19 spread.

This work introduces a new concept of functional areas called Mobility Functional Areas (MFAs), i.e., the geographic zones highly interconnected according to the analysis of mobile positioning data. The MFAs do not coincide necessarily with administrative borders as they are built observing natural human mobility and, therefore, they can be used to inform, in a bottom-up approach, local transportation, spatial planning, health and economic policies. After presenting the methodology behind the MFAs, this study focuses on the link between the COVID-19 pandemic and the MFAs in Austria. It emerges that the MFAs registered an average number of infections statistically larger than the areas in the rest of the country, suggesting the usefulness of the MFAs in the context of targeted re-escalation policy responses to this health crisis. The MFAs dataset is openly available to other scholars for further analyses.

Molecular stratification model for prognosis in cytogenetically normal acute myeloid leukemia.

We have evaluated 9 new molecular markers (ERG, EVI1, MLL-PTD, MN1, PRAME, RHAMM, and WT1 gene-expression levels plus FLT3 and NPM1 mutations) in 121 de novo cytogenetically normal acute myeloblastic leukemias. In the multivariate analysis, high ERG or EVI1 and low PRAME expressions were associated with a shorter relapse-free survival (RFS) and overall survival (OS). A 0 to 3 score was given by assigning a value of 0 to favorable parameters (low ERG, low EVI1, and high PRAME) and 1 to adverse parameters. This model distinguished 4 subsets of patients with different OS (2-year OS of 79%, 65%, 46%, and 27%; P = .001) and RFS (2-year RFS of 92%, 65%, 49%, and 43%; P = .005). Furthermore, this score identified patients with different OS (P = .001) and RFS (P = .013), even within the FLT3/NPM1 intermediate-risk/high-risk subgroups. Here we propose a new molecular score for cytogenetically normal acute myeloblastic leukemias, which could improve patient risk-stratification.

Bisphosphonate-related osteonecrosis of the jaw is associated with polymorphisms of the cytochrome P450 CYP2C8 in multiple myeloma: a genome-wide single nucleotide polymorphism analysis.

We have explored the potential role of genetics in the development of osteonecrosis of the jaw (ONJ) in multiple myeloma (MM) patients under bisphosphonate therapy. A genome-wide association study was performed using 500 568 single nucleotide polymorphisms (SNPs) in 2 series of homogeneously treated MM patients, one with ONJ (22 MM cases) and another without ONJ (65 matched MM controls). Four SNPs (rs1934951, rs1934980, rs1341162, and rs17110453) mapped within the cytochrome P450-2C gene (CYP2C8) showed a different distribution between cases and controls with statistically significant differences (P = 1.07 x 10(-6), P = 4.231 x 10(-6), P = 6.22 x 10(-6), and P = 2.15 x 10(-6), respectively). SNP rs1934951 was significantly associated with a higher risk of ONJ development even after Bonferroni correction (P corrected value = .02). Genotyping results displayed an overrepresentation of the T allele in cases compared with controls (48% vs 12%). Thus, individuals homozygous for the T allele had an increased likelihood of developing ONJ (odds ratio 12.75, 95% confidence interval 3.7-43.5).

Long FLT3 internal tandem duplications and reduced PML-RARα expression at diagnosis characterize a high-risk subgroup of acute promyelocytic leukemia patients.

BACKGROUND: Internal tandem duplications of the FLT3 gene (FLT3-ITDs) are frequent in patients with acute promyelocytic leukemia (APL), however its clinical impact remains controversial. DESIGN AND METHODS: We analyzed the prognostic significance of FLT3-ITD mutant level and size, as well as FLT3-D835 point mutations, PML-RARalpha expression and other predictive factors in 129 APL patients at diagnosis enrolled on the Spanish LPA96 (n=43) or LPA99 (n=86) PETHEMA trials. RESULTS: FLT3-ITDs and D835 mutations were detected in 21% and 9% of patients, respectively. Patients with increased ITD mutant/wild-type ratio or longer ITD size displayed shorter 5-year relapse-free survival (RFS) (P=0.048 and P<0.0001, respectively). However, patients with D835 mutations did not show differences in RFS or overall survival (OS). Moreover, patients with initial normalized copy number (NCN) of PML-RARalpha transcripts less than the 25(th) percentile had adverse clinical features and shorter 5-year RFS (P<0.0001) and OS (P=0.004) compared to patients with higher NCN. Patients with low NCN showed increased incidence of ITDs (P=0.001), with higher ratios (P<0.0001) and/or longer sizes (P=0.007). Multivariate analysis showed that long FLT3-ITD (P=0.001), low PML-RARalpha levels (P=0.004) and elevated WBC counts (>10x10(9)/L) (P=0.018) were independent predictors for shorter RFS. We identified a subgroup of patients with high WBC, long FLT3-ITD and low NCN of transcripts that showed an extremely bad prognosis (5-year RFS 23.4%, P<0.0001). CONCLUSIONS: In conclusion, FLT3-ITD size and PML-RARalpha transcript levels at diagnosis could contribute to improve the risk stratification in APL.