Minimal relapse risk and early normalization of survival for patients with Burkitt lymphoma treated with intensive immunochemotherapy: an international study of 264 real-world patients.

Non-endemic Burkitt lymphoma (BL) is a rare germinal centre B-cell-derived malignancy with the genetic hallmark of MYC gene translocation and with rapid tumour growth as a distinct clinical feature. To investigate treatment outcomes, loss of lifetime and relapse risk in adult BL patients treated with intensive immunochemotherapy, retrospective clinic-based and population-based lymphoma registries from six countries were used to identify 264 real-world patients. The median age was 47 years and the majority had advanced-stage disease and elevated LDH. Treatment protocols were R-CODOX-M/IVAC (47%), R-hyper-CVAD (16%), DA-EPOCH-R (11%), R-BFM/GMALL (25%) and other (2%) leading to an overall response rate of 89%. The two-year overall survival and event-free survival were 84% and 80% respectively. For patients in complete remission/unconfirmed, the two-year relapse risk was 6% but diminished to 0·6% for patients reaching 12 months of post-remission event-free survival (pEFS12). The loss of lifetime for pEFS12 patients was 0·4 (95% CI: -0·7 to 2) months. In conclusion, real-world outcomes of adult BL are excellent following intensive immunochemotherapy. For pEFS12 patients, the relapse risk was low and life expectancy similar to that of a general population, which is important information for developing meaningful follow-up strategies with increased focus on survivorship and less focus on routine disease surveillance.

Miniaturised marine tests as indicators of aromatic hydrocarbon toxicity: Potential applicability to oil spill assessment.

Assessing oil spill toxicity in real time is challenging due to dynamic field exposures and lack of simple, rapid, and sensitive tests. We investigated the relative sensitivity of two commercially available marine toxicity tests to aromatic hydrocarbons using the target lipid model (TLM). State of the art passive dosing in sealed vials was used to assess the sensitivity of brine shrimp (Artemia franciscana) and rotifer (Brachionus plicatilis). Organisms were exposed to toluene, 1-methylnaphthalene and phenanthrene for 24 h. Toxicity results were analysed using the TLM to estimate the critical target lipid body burden and support comparison to empirical data for 79 other aquatic organisms. Our findings demonstrate the applicability of passive dosing to test small volumes and indicate that the two rapid cyst-based assays are insensitive in detecting hydrocarbon exposures compared to other aquatic species. Our results highlight the limitations of applying these tests for oil pollution monitoring and decision-making.

Current issues confounding the rapid toxicological assessment of oil spills.

Oil spills of varying magnitude occur every year, each presenting a unique challenge to the local ecosystem. The complex, changeable nature of oil makes standardised risk assessment difficult. Our review of the state of science regarding oil's unique complexity; biological impact of oil spills and use of rapid assessment tools, including commercial toxicity kits and bioassays, allows us to explore the current issues preventing effective, rapid risk assessment of oils. We found that despite the advantages to monitoring programmes of using well validated standardised tests, which investigate impacts across trophic levels at environmentally relevant concentrations, only a small percentage of the available tests are specialised for use within the marine environment, or validated for the assessment of crude oil toxicity. We discuss the use of rapid tests at low trophic levels in addition to relevant sublethal toxicity assays to allow the characterisation of oil, dispersant and oil and dispersant mixture toxicity. We identify novel, passive dosing techniques as a practical and reproducible means of improving the accuracy and maintenance of nominal concentrations. Future work should explore the possibility of linking this tiered testing system with ecosystem models to allow the prediction and risk assessment of the entire ecosystem.

Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance.

Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL.