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BackgroundMost patients with juvenile myelomonocytic leukemia (JMML) are curable only with allogeneic hematopoietic cell transplantation (HCT). However, the current standard conditioning regimen, busulfan-cyclophosphamide-melphalan (Bu-Cy-Mel), may be associated with higher risks of morbidity and mortality. ASCT1221 was designed to test whether the potentially less-toxic myeloablative conditioning regimen containing busulfan-fludarabine (Bu-Flu) would be associated with equivalent outcomes.ProcedureTwenty-seven patients were enrolled on ASCT1221 from 2013 to 2015. Pre- and post-HCT (starting Day +30) mutant allele burden was measured in all and pre-HCT therapy was administered according to physician discretion.ResultsFifteen patients were randomized (six to Bu-Cy-Mel and nine to Bu-Flu) after meeting diagnostic criteria for JMML. Pre-HCT low-dose chemotherapy did not appear to reduce pre-HCT disease burden. Two patients, however, received aggressive chemotherapy pre-HCT and achieved low disease-burden state; both are long-term survivors. All four patients with detectable mutant allele burden at Day +30 post-HCT eventually progressed compared to two of nine patients with unmeasurable allele burden (P=0.04). The 18-month event-free survival of the entire cohort was 47% (95% CI, 21-69%), and was 83% (95% CI, 27-97%) and 22% (95% CI, 03-51%) for Bu-Cy-Mel and Bu-Flu, respectively (P=0.04). ASCT1221 was terminated early due to concerns that the Bu-Flu arm had inferior outcomes.ConclusionsThe regimen of Bu-Flu is inadequate to provide disease control in patients with JMML who present to HCT with large burdens of disease. Advances in molecular testing may allow better characterization of biologic risk, pre-HCT responses to chemotherapy, and post-HCT management.

Levin, Noam ... et. al.-- 21 pages, 6 figures, 1 table, supplementary material https://doi.org//10.3354/meps10857, The Mediterranean Sea’s biodiversity and ecosystems face many threats due to anthropogenic pressures. Some of these include human population growth, coastal urbanization, accelerated human activities, and climate change. To enhance the formation of a science-based system of marine protected areas in the Mediterranean Sea, data on the spatial distribution of ecological features (abiotic variables, species, communities, habitats, and ecosystems) is required to inform conservation scientists and planners. However, the spatial data required is often lacking. In this review, we aimed to address the status of our knowledge for 3 major types of spatial information: bathymetry, classification of marine habitats, and species distributions. To exemplify the data gaps and approaches to bridge them, we examined case studies that systematically prioritize conservation in the Mediterranean Sea. We found that at present the data required for conservation planning is generally more readily available and of better quality for the European countries located in the Western Mediterranean Sea. Additionally, the Mediterranean Sea is lagging behind other marine regions where rigorous criteria for conservation planning has been applied in the past 20 yr. Therefore, we call upon scientists, governments, and international governmental and non-governmental organizations to harmonize current approaches in marine mapping and to develop a framework that is applicable throughout the Mediterranean region. Such coordination between stakeholders is urgently needed before more countries undertake further extensive habitat mapping, so that future conservation planning can use integrated spatial datasets, M.C. was funded by the Marie Curie Career EU Integration Grant Fellowships to the BIOWEB project and by the Spanish National Program Ramon y Cajal. S.F. was supported by the project CoCoNET funded by the EU. S.G. was supported by the project NETMED co-funded by the European Social Fund and the Greek State. G.R. was funded by the Marie Curie Career EU Reintegration Grant and the EU 7th Framework Programme for the project Vectors of Change in Oceans and Seas Marine Life, Impact on Economic Sectors (VECTORS). J.J.H thanks MASTS for funding

Artificial night lights pose a major threat to multiple species. However, this threat is often disregarded in conservation management and action because it is difficult to quantify its effect. Increasing availability of high spatial-resolution satellite images may enable us to better incorporate this threat into future work, particularly in highly modified ecosystems such as the coastal zone. In this study we examine the poten- tial of satellite night light imagery to predict the distribution of the endangered loggerhead (Caretta caret- ta) and green (Chelonia mydas) sea turtle nests in the eastern Mediterranean coastline. Using remote sensing tools and high resolution data derived from the SAC-C satellite and the International Space Sta- tion, we examined the relationship between the long term spatial patterns of sea turtle nests and the intensity of night lights along Israel's entire Mediterranean coastline. We found that sea turtles nests are negatively related to night light intensity and are concentrated in darker sections along the coast. Our resulting GLMs showed that night lights were a significant factor for explaining the distribution of sea turtle nests. Other significant variables included: cliff presence, human population density and infra- structure. This study is one of the first to show that night lights estimated with satellite-based imagery can be used to help explain sea turtle nesting activity at a detailed resolution over large areas. This approach can facilitate the management of species affected by night lights, and will be particularly useful in areas that are inaccessible or where broad-scale prioritization of conservation action is required.