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In this work, the aerobic biodegradability of the process water (PW) produced by hydrothermal carbonization (HTC) of dewatered anaerobic digested sludge and the toxicity assessment in regard to the heterotrophic activated biomass of a conventional activated sludge systems, are described. Such assessments are not yet reported in other scientific papers, so this paper seeks to contribute to the increase of knowledge regarding the valorization of the HTC process applied in a wastewater treatment plant (WWTP). For such purpose, two different respirometric techniques were applied - multi-OUR respirometry and manometric respirometry. PW resulted highly biodegradable: 83% of total COD was biodegradable, with a 58% of readily biodegradable (rbCOD) fraction. The BOD5/COD ratio was 0.42. Further, it was characterized by a high concentration of volatile fatty acids (VFAs) (i.e. 2031 mg/L), of which the major constituent was acetic acid (i.e. 80%), an easily degradable intermediate of many biological processes. Both the respirometric techniques showed that the assessed PW, after being diluted accordingly with the WWTP real operational conditions, did not imply short-term toxic effects on the activated sludge, neither using fresh biomass nor keeping the same one. According to these results, the recirculation of PW at the water line of WWTPs represents a promising approach not affected by specific toxicity issues, especially when the HTC process is integrated into a WWTP scheme.
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Esgotos , Água , Biomassa , Ácidos Graxos Voláteis , Águas ResiduáriasRESUMO
To find the path that minimizes the time to navigate between two given points in a fluid flow is known as Zermelo's problem. Here, we investigate it by using a Reinforcement Learning (RL) approach for the case of a vessel that has a slip velocity with fixed intensity, Vs, but variable direction and navigating in a 2D turbulent sea. We show that an Actor-Critic RL algorithm is able to find quasioptimal solutions for both time-independent and chaotically evolving flow configurations. For the frozen case, we also compared the results with strategies obtained analytically from continuous Optimal Navigation (ON) protocols. We show that for our application, ON solutions are unstable for the typical duration of the navigation process and are, therefore, not useful in practice. On the other hand, RL solutions are much more robust with respect to small changes in the initial conditions and to external noise, even when Vs is much smaller than the maximum flow velocity. Furthermore, we show how the RL approach is able to take advantage of the flow properties in order to reach the target, especially when the steering speed is small.
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Glioblastoma multiforme (GBM) and primary central nervous system lymphoma (PCNSL) are malignant cerebral neoplasms associated with poor prognosis. Early diagnosis and subsequent planning of adequate treatment strategy are relevant to improve survival and reduce neurological deficit. Two groups of patients affected by GBM and PCNSL were compared to identify: (1) factors influencing the time necessary to obtain a correct diagnosis; (2) the influence of the interval time from clinical onset to diagnosis on the prognosis. Fifty-six patients (28 PCNSL and 28 GBM, 23 females and 33 males) referred to the same hospital setting were retrospectively evaluated. The mean age at diagnosis was 61 years. The two groups were comparable in terms of age, sex, clinical symptoms at onset and performance status. There was no relevant difference in time span from clinical onset to first neuroimaging examination, while time span from first neuroimaging to final morphological diagnosis was much longer in PCNSL patients (p = 0.008). Multivariate Cox regression analysis, including both PCNSL and GBM cases, showed a significant association of the overall survival with: time to diagnosis (HR 0.06), age at onset (HR 1.04). Our results show a significant diagnostic delay in PCNSL cases. Age at onset of disease and time to diagnosis emerge as clinical factors affecting overall survival in both groups. Stereotactic-guided biopsy should be chosen as routine method to early diagnose PCNSL. The clinical relevance of early diagnosis in GBM and PCNSL needs to be emphasized to maximize the overall survival in both neoplasms.
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Neoplasias do Sistema Nervoso Central/diagnóstico , Glioblastoma/diagnóstico , Linfoma/diagnóstico , Idade de Início , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Medula Óssea/patologia , Neoplasias do Sistema Nervoso Central/patologia , Diagnóstico Tardio , Feminino , Seguimentos , Glioblastoma/patologia , Humanos , Estimativa de Kaplan-Meier , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Tempo , Tomografia Computadorizada por Raios XRESUMO
Identification and extraction of vortical structures and of waves in a disorganised flow is a mayor challenge in the study of turbulence. We present a study of the spatio-temporal behavior of turbulent flows in the presence of different restitutive forces. We show how to compute and analyse the spatio-temporal spectrum from data stemming from numerical simulations and from laboratory experiments. Four cases are considered: homogeneous and isotropic turbulence, rotating turbulence, stratified turbulence, and water wave turbulence. For homogeneous and isotropic turbulence, the spectrum allows identification of sweeping by the large-scale flow. For rotating and for stratified turbulence, the spectrum allows identification of the waves, precise quantification of the energy in the waves and in the turbulent eddies, and identification of physical mechanisms such as Doppler shift and wave absorption in critical layers. Finally, in water wave turbulence the spectrum shows a transition from gravity-capillary waves to bound waves as the amplitude of the forcing is increased.
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We show transmission of 20 wavelength-division-multiplexed (WDM) × 960-Gb/s space-division-multiplexed 32QAM modulated channels (spectral efficiency (SE) of 15 bits/s/Hz) over 60 km of few-mode fiber (FMF) with inline few-mode EDFA (FM-EDFA). Soft-decision FEC was implemented and used to achieve error-free transmission.
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We demonstrate three possible scenarios for upgrading current single-mode transmission networks with high capacity few-mode fiber technology using mode-division multiplexing (MDM). The results were obtained from measurements over a number of field-deployed single-mode fiber links with an additional experimental in-line amplified few-mode fiber link. The results confirm the viability of employing MDM using few-mode fiber technology to gradually replace legacy optical systems.
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BACKGROUND: Neoplastic T-cell recruitment into the skin is a critical step in the pathogenesis of mycosis fungoides (MF), and the cutaneous T-cell attracting chemokine, CTACK/CCL27, might be involved. OBJECTIVES: To investigate the clinical and prognostic significance of CTACK/CCL27 levels in patients with early-stage MF. METHODS: Serum samples and skin biopsy specimens were collected from 15 patients at the time of diagnosis and after the end of treatment with psoralen plus ultraviolet A/interferon alfa-2b combination therapy. Serum samples were also collected from 20 healthy donors as controls. CTACK/CCL27 serum levels were analysed by enzyme-linked immunosorbent assays. CTACK/CCL27 tissue expression was determined by immunohistochemistry on skin biopsy specimens taken at diagnosis and after therapy. Event-free survival was taken as the primary clinical outcome. RESULTS: In patients with MF at diagnosis, CTACK/CCL27 serum levels were not significantly different from healthy controls, whereas CTACK/CCL27 expression in the skin was increased in 87% of cases compared with normal controls. After therapy, all patients obtained a clinical complete remission, serum levels did not change significantly and tissue expression remained abnormal in 80% of patients, even if complete histological remission was recorded. Serum levels were not significantly different in cases with different intensity of cutaneous immunostaining. Eight patients experienced a relapse: the combination of high CTACK/CCL27 levels both in sera and skin increased the probability of experiencing an event at 51 months from 36% to 83%. CONCLUSIONS: Our data seem to indicate that CTACK/CCL27 levels in skin and sera after therapy might be correlated with risk of recurrence.
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Antineoplásicos/uso terapêutico , Quimiocina CCL27/metabolismo , Interferon-alfa/uso terapêutico , Micose Fungoide/tratamento farmacológico , Terapia PUVA/métodos , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Micose Fungoide/sangue , Recidiva Local de Neoplasia/etiologia , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Mesenchymal stromal cells (MSC) are promising candidates for cell therapy and tissue engineering and may be used to treat acute graft-versus-host disease (GvHD). However, major obstacles for their clinical use are the required cell dose and the biosafety and potential immunogenicity of fetal bovine serum (FBS), which is a crucial supplement of all media currently used for the culture of MSC. METHODS: In this study MSC were successfully expanded after selection of CD271 cells from human bone marrow (BM) mononuclear cells in medium supplemented with 10% pooled allogeneic human serum. RESULTS: We isolated MSC from 10 healthy donor BM by plastic adherence and immunomagnetic selection of the CD271(+) fraction and expanded MSC in medium supplemented with pooled human allogeneic serum and animal serum. We isolated a homogeneous multipotent population by CD271(+) selection with a proliferation rate that was higher than MSC isolated by plastic adherence, 6.8+/-1.57 compared with 2.07+/-1.40 logs. Similar to cells generated in animal serum medium, MSC from allogeneic human serum were positive for mesenchymal markers and negative for hematopoietic markers; moreover they expressed embryonic stem cell genes. A normal karyotype and differentiation capacity into adipogenic, osteogenic and chondrogenic lineages and neurosphere-like structures were preserved throughout long-term culture. DISCUSSION: Expansion of MSC is both feasible and large with a CD271-selected population in medium supplemented with 10% pooled allogeneic human serum, without loss of multipotent differentiation capacity or karyotype alterations.
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Células da Medula Óssea/citologia , Proliferação de Células , Células-Tronco Mesenquimais/citologia , Proteínas do Tecido Nervoso/biossíntese , Receptores de Fator de Crescimento Neural/biossíntese , Células Estromais/citologia , Animais , Antígenos de Diferenciação/genética , Antígenos de Diferenciação/metabolismo , Bovinos , Adesão Celular , Diferenciação Celular , Linhagem da Célula , Separação Celular , Células Cultivadas , Meios de Cultura , Citometria de Fluxo , Histocompatibilidade , Humanos , Células-Tronco Mesenquimais/metabolismo , Soro , Células Estromais/metabolismoRESUMO
BACKGROUND: Mesenchymal stromal cells (MSC) have been identified in a variety of fetal and adult tissues, including bone marrow (BM), fetal blood and liver. We report on the isolation, expansion and differentiation in vitro of MSC-like cells from chorionic villi (CV). METHODS: We evaluated 10 samples of CV collected at the first trimester (gestational age 11-13 weeks). We only used cells taken from back-up culture after a successful karyotype analysis. CV cells were characterized by morphologic, immunophenotypic and molecular analysis. The differentiation ability of mesenchymal and neural lineages was detected using specific culture conditions. Cell expansion was assessed after plating cells at different densities in different media, supplemented with animal and human serum. RESULTS: CV cells showed a homogeneous population of spindle-shaped cells after the first passage. Cells expressed CD90, CD105, CD73, CD44, CD29 and CD13 but not CD45, CD14, CD34 and CD117. They expressed Oct-4, Rex-1, GATA-4 and nestin, which characterize the undifferentiated stem cell state. They differentiated into osteocytes, adipocytes, chondrocytes and neuronal cells. Cell expansion was greater than that of adult BM-derived MSC, 9 logs with fetal bovine serum and 6 logs with human serum. Despite their high proliferative capacity, we did not observe any karyotypic abnormalities after culture. DISCUSSION: Our study shows that CV cells have better potential for expansion than adult stem cells. They can proliferate in a medium with human allogeneic serum and can differentiate into mesenchymal and neural lineages. CV cells may be an excellent cell source for therapeutic applications.
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Diferenciação Celular , Vilosidades Coriônicas/fisiologia , Células-Tronco Mesenquimais/citologia , Primeiro Trimestre da Gravidez , Biomarcadores/análise , Proliferação de Células , Células Cultivadas , Feminino , Perfilação da Expressão Gênica , Humanos , Imunofenotipagem , Cariotipagem , Células-Tronco Mesenquimais/fisiologia , GravidezRESUMO
The engraftment ability of mesenchymal cells was investigated in 26 patients receiving allogeneic transplantation from HLA-identical siblings with reduced-intensity conditioning (RIC). The stem cell source was bone marrow (BM) in eight patients and G-CSF-mobilized peripheral blood hematopoietic cells in 18 cases. A total of 32 patients engrafted very quickly and the chimerism evaluation (both on myeloid and on lymphoid subsets) showed that they were full donor by day 60. At the time of the study they were in complete hematological remission and displayed a full donor hematopoiesis. Two patients showed early disease progression while one did not engraft. Forty-eight out-marrow samples harvested from the 26 patients generated a marrow stromal layer adequate for the chimerism evaluation. Monocyte-macrophage contamination of marrow stromal layers was always reduced below 2% by repeated trypsinizations and treatment with the leucyl-leucine (leu-leu) methyl ester. The chimerism evaluation was performed by PCR analysis of STRs microsatellites and the amelogenin locus, by using capillary electrophoresis (CE) and by FISH analysis in case of the sex mismatch. In eight patients, a partial donor origin of stromal cells was shown (7-86% cells of donor). The source of hematopoietic cells was BM in three patients and mobilized peripheral blood in the other five.
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Sobrevivência de Enxerto/imunologia , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais/imunologia , Condicionamento Pré-Transplante/métodos , Adulto , Idoso , Células Cultivadas , Quimerismo , Progressão da Doença , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Transplante HomólogoRESUMO
Post-remission therapy in acute myeloid leukemia (AML) remains problematic. It has been demonstrated that younger patients can maintain longer complete remissions (CR) with aggressive post-remission therapies after induction treatment: allogeneic (allo), autologous (auto) stem cell transplantation (SCT), or intensive chemotherapy (ICC). The purpose of our study was to identify the most important randomized and controlled studies comparing these three therapeutic options, in order to draw conclusions and possible suggestions for post-remission therapy of AML, according to the evidence based medicine (EBM) rules. We performed an exhaustive analysis of the literature, searching either in electronic databases or among the references of the identified articles (hand searching). We searched the MEDLINE computer database for reports from 1985 through January 2005 and selected for analysis the clinical trials conducted over adults affected by newly diagnosed AML aged less than 65 years. The study design had to satisfy strict methodological criteria and must consider global mortality and/or disease free survival as primary outcomes. Overall we found 7750 papers; by using the limits "clinical trial" as publication type, "all adults 19+ years", we were able to select 344 papers. Among these, a further selection was made, based on two main clinical queries: 1) is auto-SCT superior to ICC/no other therapy in improving DFS and/or OS in adult AML patients in first CR? 2) is allo-SCT superior to auto-SCT/other therapeutic options in improving DFS and/or OS in adult AML patients in first CR? Concerning the first query, a possible advantage of auto-SCT over ICC was not clearly supported by data from clinical trials; there is no evidence that auto-SCT is superior in terms of OS to chemotherapy. Nevertheless, the reported TRM has been significantly reduced within the past years. Thus, the percentage of patients suitable for auto-SCT in CR has increased. Moreover, the scarce data concerning the comparison between auto-SCT and chemotherapy in different subsets of patients are unable to suggest a differentiated approach in patients with high-risk, standard-risk or low-risk AML. Data from the literature show that patients with unfavorable risk disease are more often addressed to allo-SCT and patients with low-risk disease receive more often intensive consolidation chemotherapy. Concerning the second query, interpretation of data from the main prospective studies about the role of allo-SCT in previously untreated AML is not easy. The first problem is the lack of real randomized clinical trials; in fact, according to the reported studies, AML patients generally receive allo-SCT on the basis of donor availability (the so called "genetic randomization"). The second problem is the frequent absence of intention to treat analysis. Despite methodological limitations, it was possible to compare allo-SCT with auto-SCT on a donor versus no-donor analysis and within risk groups. No overall benefit of allo-grafting on survival was demonstrated by any trial. In conclusion, the EBM approach highlighted the limitations observed in the published studies concerning consolidation therapy in AML; some suggestions, emerging from non-randomized, as well as randomized studies, are adequate, but not conclusive. This point, coupled with the intrinsic complexity to study AML biological heterogeneity, is probably a major obstacle to draw conclusive evidences for consolidation therapy in AML. These observations should plan to address new randomized studies on AML therapy; however, due to the emergence of genetic subgroups and new drugs targeting specific abnormalities, these trials should probably be designed directly focusing on the single entities. In this way, the cure of AML could eventually become the cure of each specific AML subset with its peculiar biological, molecular and prognostic features.
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Medicina Baseada em Evidências , Leucemia Mieloide Aguda/tratamento farmacológico , Transplante de Células-Tronco/métodos , Adulto , Fatores Etários , Antineoplásicos/farmacologia , Ensaios Clínicos como Assunto/métodos , Intervalo Livre de Doença , Humanos , Indução de Remissão , Projetos de Pesquisa , Transplante Homólogo , Resultado do TratamentoRESUMO
This study correlates bone marrow changes after Rituximab (RTX) treatment with the clinical characteristics and outcome of 26 patients with small B-cell lymphomas. The percentage, phenotypic profile and clonality pattern of bone marrow lymphoid infiltrate were analysed before and after RTX treatment. Clinical, histological and molecular responses to RTX were correlated to the clinical outcome of the patients. Sixteen out of twenty-six patients obtained a complete clinical remission (CR). A favourable histology--follicular lymphoma (FL), hairy cell leukaemia (HCL) and marginal zone lymphoma (MZL)--was associated with a higher frequency of clinical CR and histological remission (HR), in comparison with mantle cell lymphoma (MCL), chronic lymphocytic leukaemia (CLL) and lymphoplasmacytic lymphoma (LPL). Two patterns of bone marrow HR were observed: 1) complete lymphoid cell disappearance (9 patients); or 2) nodular/interstitial T-cell infiltration (10 patients). Three histological persistence (HP) patterns were observed: 1) persistence of CD20+ small lymphoid cells in 1 patient with MCL; 2) loss of CD20 antigen expression in 4 patients with CLL; or 3) persistence only of clusters of monotypic plasma cells in 2 patients with LPL. CR and HR were strongly correlated. The percentage of lymphomatous infiltrate after RTX was higher in patients who subsequently died of the disease. Molecular response showed no correlations with the further clinical course in 12 patients achieving a complete clinical remission. In conclusion, bone marrow morphological and immunohistochemical analysis with a restricted panel of antibodies is useful to avoid 42% false positive and 85% false negative interpretations. Persistence of monoclonality after RTX might have a role in evaluating the molecular pattern of CD20-negative clones that can emerge after RTX as a tumoral escape to therapy.
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Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Medula Óssea/metabolismo , Medula Óssea/patologia , Linfoma de Células B/tratamento farmacológico , Linfoma de Células B/patologia , Adulto , Idoso , Anticorpos Monoclonais Murinos , Clonagem Molecular , Feminino , Seguimentos , Humanos , Linfócitos/imunologia , Linfoma de Células B/metabolismo , Masculino , Pessoa de Meia-Idade , Fenótipo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rituximab , Resultado do TratamentoRESUMO
Secretion of lysosomal enzymes by human monocytes in response to various stimuli and the effect of conditioned media from lymphocytes and neutrophils was studied. Monocytes were found to release beta-glucosaminidase in response to NH4Cl and to particles (zymosan, opsonised zymosan, asbestos and latex), but do not respond to some soluble stimuli like formyl-methionyl-leucyl-phenylalanine, phorbol myristate acetate, cytochalasin B, concanavalin A and N-acetylmuramyl-L-alanyl-D-isoglutamine. Neutrophil conditioned medium or neutrophil components did not have any effect on secretion. When treated with lymphokines the cells are more responsive, especially to zymosan. Even through there are similarities in the secretory activities of mouse macrophages and human monocytes, there are several differences both in the quantity of the response and in the mechanisms involved.
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Acetilglucosaminidase/metabolismo , Hexosaminidases/metabolismo , L-Lactato Desidrogenase/metabolismo , Lisossomos/enzimologia , Monócitos/enzimologia , Membrana Celular/enzimologia , Células Cultivadas , Humanos , Linfócitos/metabolismo , Neutrófilos/metabolismo , Fagocitose , Estimulação QuímicaRESUMO
Clinical and biological data were evaluated using Desu univariate analyses or Cox multivariate analyses in a series of 1,777 chronic lymphocytic leukemia (CLL) patients from an Italian Cooperative Group. In univariate analyses, age and sex of patients, presence of bone marrow (BM; greater than or equal to 50%), and peripheral blood (PB; greater than or equal to 60,000/microL) lymphocytosis, anemia (hemoglobin [Hb] less than 11 g/dL), thrombocytopenia (less than 100,000/microL), direct Coombs' test positivity, hepatomegaly, splenomegaly, and extent of lymph node involvement were shown to be of significant prognostic value. Multivariate analyses, through a stepwise procedure, showed that the most important prognostic variables are Hb, hepatomegaly, lymph node involvement, PB lymphocytosis, and age and sex of patients. Further covariates would produce an improvement having a nonsignificant P value. Based on the results of multivariate analyses, a four-step staging using the significant variables of the Cox model is proposed.
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Leucemia Linfoide/patologia , Adulto , Idoso , Feminino , Humanos , Leucemia Linfoide/sangue , Leucemia Linfoide/imunologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Estatística como AssuntoRESUMO
PURPOSE: The aim of this multicenter randomized study was to compare conventional therapy with conventional plus high-dose therapy (HDT) and autologous bone marrow transplantation (ABMT) as front-line treatment for poor-prognosis non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Between October 1991 and June 1995, 124 patients, aged 15 to 60 years, with diffuse intermediate- to high-grade NHL (Working Formulation criteria), stages II bulky (> or = 10 cm), III, or IV were enrolled. Sixty-one patients were randomized to receive etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (VACOP-B) for 12 weeks and cisplatin, cytarabine, and dexamethasone (DHAP) as a salvage regimen (arm A), and 63 to receive VACOP-B for 12 weeks plus HDT and ABMT (Arm B). RESULTS: There was no significant difference in terms of complete remissions (CRS) in the two groups: 75% in arm A, and 73% in arm B. The median follow-up observation time was 42 months. The 6-year survival probability was 65% in both arms. There was no difference in disease-free survival (DFS) or progression-free survival (PFS) between the two groups. DFS was 60% and 80% (P = .1) and PFS was 48% and 60% (P = .4) for arms A and B, respectively. Procedure feasibility was the major problem. In arm B, 29% of enrolled patients did not undergo HDT and ABMT. A statistical improvement in terms of DFS (P = .008) and a favorable trend in terms of PFS (P = .08) for intermediate-/high- plus high-risk group patients assigned to HDT and ABMT was observed. CONCLUSION: In this study, conventional chemotherapy followed by HDT and ABMT as front-line therapy seems no more successful than conventional treatment in terms of overall results. However, our results suggest that controlled studies of HDT plus ABMT should be proposed for higher risk patients.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Linfoma não Hodgkin/terapia , Adolescente , Adulto , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Dexametasona/administração & dosagem , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Linfoma não Hodgkin/mortalidade , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Estudos Prospectivos , Terapia de Salvação , Taxa de Sobrevida , Vincristina/administração & dosagemRESUMO
The objective of the study was to evaluate the incidence, characteristics, treatment and outcome of acute megakaryoblastic leukemia (AMeL) in patients enrolled in GIMEMA trials. Between 1982 and 1999, 3603 new consecutive cases of AML aged over 15 years were admitted to GIMEMA trials. Of them, 24 were AMeL. The incidence of AMeL among AML patients enrolled in GIMEMA trials was 0.6% (24/3603). Diagnosis was based on morphological criteria. Out of 11 cytogenetic studies performed two presented chromosome 3 abnormalities. Twelve patients (50%) reached a CR, five (21%) died in induction and seven (27%) were unresponsive. The median duration of CR was 35 weeks (range 10-441). Seven patients underwent transplantation procedures (1 BMT, 4 aBMT, 2 aPBSCT). Four patients died in CR due to chemotherapy-related complications. Comparing the CR rate between AMeL and the other cases of AML enrolled in GIMEMA trials, no differences were observed. These results were mirrored for different age groups. The median survival was 40 weeks. At present, after a follow-up of a minimum of 2 years, only two patients are alive in CR, all the others having died. A 5-year Kaplan-Meier curve shows a disease-free survival of 17% and an actuarial overall survival of 10%. AMeL is a rare form of AML. The CR duration and the overall survival in this group of patients are very poor, even if similar to those observed in other AML. Furthermore, a high number of deaths in CR were observed. On the basis of these data, a specific therapeutic approach, possibly with innovative treatments, should be evaluated.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Leucemia Megacarioblástica Aguda/terapia , Adolescente , Adulto , Idoso , Criança , Terapia Combinada , Análise Citogenética , Feminino , Humanos , Imunofenotipagem , Leucemia Megacarioblástica Aguda/mortalidade , Leucemia Megacarioblástica Aguda/patologia , Pessoa de Meia-Idade , Indução de Remissão , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The outcome of a cohort of 218 consecutive patients who failed to respond to a single course of standard daunorubicin plus ARAC (three + seven) induction regimen has been retrospectively evaluated to assess the characteristics of this group of AML patients and the effectiveness of second-line induction programs. Seventy-four of the 218 patients (33.9%) attained complete remission with salvage chemotherapies. The multivariate analysis of pretherapy characteristics of the patients showed that peroxidase positivity and age were the most important factors in determining whether or not the patient would have a favorable response to second-line induction regimen. In addition, comparison of marrow characteristics at diagnosis with those of marrow after the first-line therapy (marrow leukemic index, MLI) provided the greatest differences between second-line CR and resistant patients. Finally, peroxidase positivity and MLI predicted for remission duration and overall survival. Allogeneic BMT, however, appeared the most important factor for survival and event-free survival of remitting patients. These results are of importance when considering that better defined prognostic factors provide an objective rationale for selecting appropriate strategies for the treatment of patients who do not respond to a single course of induction regimen.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Leucemia Mieloide/tratamento farmacológico , Leucemia Mieloide/cirurgia , Doença Aguda , Terapia Combinada , Citarabina/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Indução de Remissão , Estudos Retrospectivos , Terapia de Salvação , Resultado do TratamentoRESUMO
Within 285 adult acute lymphoblastic leukemias (ALL) included in the multicenter GIMEMA 0496 trial and prospectively studied by conventional cytogenetics, 18 cases (6%) with long arm deletion of chromosome 6 (6q) were identified. These cases were divided into: (i) del(6q) only (n = 6); (ii) del(6q) plus other numerical and/or structural abnormalities (n = 8); (iii) del(6q) and other 'specific' translocations (n = 4). The biologic and clinical features of the patients carrying this anomaly, as well as their outcome, were compared with those of 267 patients without del(6q). A T cell phenotype was more frequently associated with del(6q) cases in general (P = 0.001) and particularly with cases presenting del(6q) as the isolated abnormality (P = 0.0027). No significant difference with respect to multidrug resistance (MDR)/P glycoprotein expression was observed between the two groups of patients (21% vs 28% of MDR-positive cases, respectively). A BCR-ABL fusion transcript was less frequently detected in cases with del(6q) (11%) compared with those without the anomaly (29%). p15 and p16 deletions were identified by Southern blot analysis in 21% of cases with del(6q) and in 26% of cases without del(6q). In this latter group, a T cell phenotype was less frequently associated with p15 and/or p16 deletion than in the group carrying del(6q) (36% vs 100% of cases, P = 0.011). Overall, patients with ALL and del(6q) had a high complete remission (CR) rate (83%); however, they had a lower 18 month event-free survival (31% vs 41%) and a higher relapse rate (70% vs 37%, P = 0.02) compared with patients without del(6q). To date, this is the largest series of adult ALL cases reported with del(6q) homogeneously treated, which have also been prospectively studied for MDR expression and for the detection of known fusion genes. This anomaly, as an isolated change, identifies a subset of cases with hyperleukocytosis (median WBC count 52 x 10(9)/l) and a strict correlation with a T cell phenotype. Overall, del(6q) seems to be associated with an unfavorable clinical outcome, although this finding will need to be confirmed by extended FISH analysis.
Assuntos
Deleção Cromossômica , Cromossomos Humanos Par 6 , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Adulto , Resistência a Múltiplos Medicamentos , Resistencia a Medicamentos Antineoplásicos , Humanos , Cariotipagem , Fenótipo , Reação em Cadeia da Polimerase , Leucemia-Linfoma Linfoblástico de Células Precursoras/fisiopatologia , PrognósticoRESUMO
Ex vivo pharmacological purging of bone marrow has been used to eliminate clonogenic tumor cells contaminating the autograft and potentially responsible of relapse. A considerable improvement of pharmacological purging would be achieved only if normal marrow progenitor cells could be selectively protected by the cytotoxicity of these agents. Amifostine (WR-2721; Ethyol), a phosphorylated aminothiol compound, has been shown to have this property both in vivo and in vitro. We describe here, an experimental model for ex vivo purging of peripheral blood progenitor cell (PBPC) collections based on the combination of 3 mg/ml of amifostine and the alkylating agent nitrogen mustard. Amifostine pretreatment resulted in a statistically significant protection of normal late and early progenitor cells. Under the same experimental conditions, we observed a 4-6 log reduction of contaminating leukemic cells (i.e., K-562 and CEM) and in contrast to the protection of normal peripheral blood progenitor cells, preincubation of contaminating K-562 or CEM with amifostine did not significantly alter the LD95 nitrogen mustard concentration. Moreover, when we tested fresh human leukemia progenitor cells, amifostine pretreatment sensitized the leukemic cells to the cytotoxic effects of NM.
Assuntos
Amifostina/uso terapêutico , Purging da Medula Óssea/métodos , Células-Tronco Hematopoéticas/efeitos dos fármacos , Leucemia Mieloide Aguda/terapia , Linfoma não Hodgkin/terapia , Mecloretamina , Animais , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Ensaio de Unidades Formadoras de Colônias , Citoproteção , Relação Dose-Resposta a Droga , Células Precursoras Eritroides/citologia , Células Precursoras Eritroides/efeitos dos fármacos , Transplante de Células-Tronco Hematopoéticas/métodos , Células-Tronco Hematopoéticas/citologia , Humanos , Leucemia Mieloide Aguda/patologia , Linfoma não Hodgkin/patologia , CamundongosRESUMO
The atmosphere is a nonlinear stratified fluid in which internal gravity waves are present. These waves interact with the flow, resulting in wave turbulence that displays important differences with the turbulence observed in isotropic and homogeneous flows. We study numerically the role of these waves and their interaction with the large-scale flow, consisting of vertically sheared horizontal winds. We calculate their space- and time-resolved energy spectrum (a four-dimensional spectrum) and show that most of the energy is concentrated along a dispersion relation that is Doppler shifted by the horizontal winds. We also observe that when uniform winds are let to develop in each horizontal layer of the flow, waves whose phase velocity is equal to the horizontal wind speed have negligible energy. This indicates a nonlocal transfer of their energy to the mean flow. Both phenomena, the Doppler shift and the absorption of waves traveling with the wind speed, are not accounted for in current theories of stratified wave turbulence.