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T cell based immunotherapies can be applicable to acute myeloid leukemia (AML). Therefore, the selection of optimal T cells, cell manufacturing, and therapeutic T cell engineering are essential for the development of effective adoptive T cell therapies for AML. Autologous tumor-infiltrating lymphocytes (TILs) have been in clinical trials to treat solid malignancies. Herein, we assessed whether TILs can be isolated from the bone marrow (BM) of AML patients, expanded ex vivo and utilized as a novel therapeutic strategy for AML. To this end, firstly we analyzed the immunophenotypes of a series of primary BM samples from AML patients (N = 10) by flow cytometry. We observed a variable amount of CD3+ TILs (range ∼2.3–∼32.6% of mononuclear cells) among BM samples. We then developed a novel protocol that produced a three-log ex vivo expansion of TILs isolated from AML patient BM (N = 10) and peripheral blood (PB) (N = 10), including from patients with a low number of CD3+ T cells, within 3, 4 weeks. Further, we identified previously described naïve T cells (CCR7+CD95-/or CD62L+CD45RA+) in AML BM and PB samples, which seemed to be required for a successful TILs ex vivo expansion. Finally, we showed that the expanded TILs could: (1) cause cytotoxicity to autologous AML blasts ex vivo (90.6% in control without T cell treatment vs. 1.89% in experimental groups with PB derived T cells and 1.77% in experimental groups with BM derived TILs, p

Simple Summary Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations that develop in up to 10–15% of immunosuppressed recipients of solid organ transplantation (SOT), bone marrow and/or hematopoietic stem cell allograft. Its prevalence is expected to rise as transplant numbers increase. We performed a single-center retrospective study on the characteristics and outcomes of PTLD at our center in the rituximab era. Infants have been suggested to be a unique population of patients who develop PTLD later due to delayed Epstein–Barr virus (EBV) infection and the presence of maternal antibodies. We found that when compared to older cohorts, infant recipients of SOT had a numerically longer time to PTLD diagnosis. Epstein–Barr virus (EBV) positivity has not been shown to impact survival of patients with PTLD, but we suggest that EBV viral load at time of diagnosis could be investigated further as a marker of survival in patients with EBV-positive PTLD. Abstract Post-transplant lymphoproliferative disorders (PTLDs) are lymphoid or plasmacytic proliferations ranging from polyclonal reactive proliferations to overt lymphomas that develop as consequence of immunosuppression in recipients of solid organ transplantation (SOT) or allogeneic bone marrow/hematopoietic stem cell transplantation. Immunosuppression and Epstein–Barr virus (EBV) infection are known risk factors for PTLD. Patients with documented histopathologic diagnosis of primary PTLD at our institution between January 2000 and October 2019 were studied. Sixty-six patients with PTLD following SOT were followed for a median of 9.0 years. The overall median time from transplant to PTLD diagnosis was 5.5 years, with infant transplants showing the longest time to diagnosis at 12.0 years, compared to pediatric and adolescent transplants at 4.0 years and adult transplants at 4.5 years. The median overall survival (OS) was 19.0 years. In the monomorphic diffuse large B-cell (M-DLBCL-PTLD) subtype, median OS was 10.7 years, while median OS for polymorphic subtype was not yet reached. There was no significant difference in OS in patients with M-DLBCL-PTLD stratified by quantitative EBV viral load over and under 100,000 copies/mL at time of diagnosis, although there was a trend towards worse prognosis in those with higher copies.

The coronavirus disease 2019 (COVID-19) pandemic has led to a declaration of a Public Health Emergency of International Concern by the World Health Organization. As of May 18, 2020, there have been more than 4.7 million cases and over 316,000 deaths worldwide. COVID-19 is caused by a highly infectious novel coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to an acute infectious disease with mild-to-severe clinical symptoms such as flu-like symptoms, fever, headache, dry cough, muscle pain, loss of smell and taste, increased shortness of breath, bilateral viral pneumonia, conjunctivitis, acute respiratory distress syndromes, respiratory failure, cytokine release syndrome (CRS), sepsis, etc. While physicians and scientists have yet to discover a treatment, it is imperative that we urgently address 2 questions: how to prevent infection in immunologically naive individuals and how to treat severe symptoms such as CRS, acute respiratory failure, and the loss of somatosensation. Previous studies from the 1918 influenza pandemic have suggested vitamin D’s non-classical role in reducing lethal pneumonia and case fatality rates. Recent clinical trials also reported that vitamin D supplementation can reduce incidence of acute respiratory infection and the severity of respiratory tract diseases in adults and children. According to our literature search, there are no similar findings of clinical trials that have been published as of July 1st, 2020, in relation to the supplementation of vitamin D in the potential prevention and treatment for COVID-19. In this review, we summarize the potential role of vitamin D extra-renal metabolism in the prevention and treatment of the SARS-CoV-2 infection, helping to bring us slightly closer to fulfilling that goal. We will focus on 3 major topics here: Vitamin D might aid in preventing SARS-CoV-2 infection: Vitamin D: Overview of Renal and Extra-renal metabolism and regulation. Vitamin D: Overview of molecular mechanism and multifaceted functions beyond skeletal homeostasis. Vitamin D: Overview of local immunomodulation in human infectious diseases. Anti-viral infection. Anti-malaria and anti-systemic lupus erythematosus (SLE). Vitamin D might act as a strong immunosuppressant inhibiting cytokine release syndrome in COVID-19: Vitamin D: Suppression of key pro-inflammatory pathways including nuclear factor kappa B (NF-kB), interleukin-6 (IL-6), and tumor necrosis factor (TNF). Vitamin D might prevent loss of neural sensation in COVID-19 by stimulating expression of neurotrophins like Nerve Growth Factor (NGF): Vitamin D: Induction of key neurotrophic factors. .

Current treatment approaches for older adult patients with acute myeloid leukemia (AML) are often toxic and lack efficacy. Active vitamin D3 (1,25(OH)2D3) has been shown to induce myeloid blast differentiation but at concentrations that have resulted in unacceptable, off-target hypercalcemia in clinical trials. In our study, we found that the combination of 1,25(OH)2D3 and the hypomethylating agent (HMA) 5-Azacytidine (AZA) enhanced cytotoxicity and differentiation, and inhibited proliferation of several AML cell lines (MOLM-14, HL60) and primary AML patient samples. This observation was corroborated by our RNA sequence analysis data in which VDR, CD14, and BAX expression were increased, and FLT-3, PIM1 and Bcl-2 expression were decreased. To address the hypercalcemia issue, we genetically engineered MOLM-14 cells to constantly express CYP27B1 (the VD3 activating enzyme, 1-α-hydroxylase-25(OH)D3) through lentiviral transduction procedures. Subsequently, we used these cells as vehicles to deliver the CYP27B1 enzyme to the bone marrow of AML mice. We observed that AML mice with CYP27B1 treatment had longer overall survival compared to no treatment and displayed no significant change in calcium level.

Here, we report a unique acute myeloid leukemia (AML) bone marrow-derived mesenchymal stem cell (MSC) with both mesenchymal and endothelial potential, which we have named Mesenchymal Cancer Stem Cells (MCSCs). These MCSCs are CD90-CD13-CD44+ and differ from MSCs in isolation, expansion, differentiation, immunophenotype, and cytokine release profile. Furthermore, blocking CD44 inhibited the proliferation and cluster formation of early MCSCs with lower ICAM-1 protein levels. Similar CD90-CD44+ cancer stem cells have been reported in both gastric and breast cancers, which grew in floating spheres in vitro and exhibited mesenchymal features and high metastatic/tumorigenic capabilities in vivo. Our novel discovery provides the first evidence that certain AMLs may be comprised of both hematopoietic and stromal malignant cells. Targeting MCSCs and their cytokine release has potential as a novel therapeutic approach in AML.

Patient: Male, 60 Final Diagnosis: Atypical gelsolin amyloidosis Symptoms: Cranial nerve palsy • proximal muscle weakness Medication: — Clinical Procedure: — Specialty: Hematology Objective: Rare disease Background: Gelsolin amyloidosis is a very rare systemic disease presenting with a pathognomonic triad of corneal lattice dystrophy, cutis laxa, and polyneuropathy. The disease is mostly restricted to a Finnish population with known mutations (G654A, G654T) in exon 4 of the gelsolin gene. The mutations lead to errors in protein processing and folding, and ultimately leads to deposition of an amyloidogenic fragment in the extracellular space, causing the symptoms of disease. Case Report: We present a case of gelsolin amyloidosis in a male of African descent with an atypical clinical presentation including fevers, skin rash, polyneuropathy, and anemia. Gelsolin amyloidosis was diagnosed based on mass spectrometry of tissue samples. Importantly, a novel mutation in the gelsolin gene (C1375G) in exon 10 was found in this patient. His atypical presentation can possibly be attributed to the presence of a novel mutation in the gelsolin gene as the likely underlying cause of the syndrome. PCR primers were used to amplify the gelsolin gene from genomic DNA. Purified PCR products were then shipped to Eton Biosciences (San Diego, CA) for sequencing. Conclusions: This study carries several important lessons relevant to the practice of medicine. First, the differential diagnosis for multisystem disease presentations should always include amyloidosis. Second, despite what has been uncovered about the molecular biology of disease, there is always more that can be discovered. Finally, further work to verify the link between this mutation and the clinical syndrome is still needed, as are effective treatments for this disease.

// Leslimar Rios-Colon 1 , Christina K. Cajigas-Du Ross 1 , Anamika Basu 1 , Catherine Elix 1 , Ivana Alicea-Polanco 1 , Tino W. Sanchez 1 , Vinodh Radhakrishnan 1 , Chien-Shing Chen 2 , Carlos A. Casiano 1, 3 1 Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA 2 Department of Medicine, Division of Hematology/Medical Oncology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA 3 Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA Correspondence to: Carlos A. Casiano, email: ccasiano@llu.edu Keywords: chemoresistance, LEDGF/p75, prostate cancer, cell death, taxanes Abbreviations: prostate cancer (PCa), docetaxel (DTX), paclitaxel (PTX), cabazitaxel (CBZ), TNF related apoptosis inducing ligand (TRAIL). Received: June 14, 2016 Accepted: October 13, 2016 Published: February 14, 2017 ABSTRACT Prostate cancer (PCa) is associated with chronic prostate inflammation resulting in activation of stress and pro-survival pathways that contribute to disease progression and chemoresistance. The stress oncoprotein lens epithelium-derived growth factor p75 (LEDGF/p75), also known as DFS70 autoantigen, promotes cellular survival against environmental stressors, including oxidative stress, radiation, and cytotoxic drugs. Furthermore, LEDGF/p75 overexpression in PCa and other cancers has been associated with features of tumor aggressiveness, including resistance to cell death and chemotherapy. We report here that the endogenous levels of LEDGF/p75 are upregulated in metastatic castration resistant prostate cancer (mCRPC) cells selected for resistance to the taxane drug docetaxel (DTX). These cells also showed resistance to the taxanes cabazitaxel (CBZ) and paclitaxel (PTX), but not to the classical inducer of apoptosis TRAIL. Silencing LEDGF/p75 effectively sensitized taxane-resistant PC3 and DU145 cells to DTX and CBZ, as evidenced by a significant decrease in their clonogenic potential. While TRAIL induced apoptotic blebbing, caspase-3 processing, and apoptotic LEDGF/p75 cleavage, which leads to its inactivation, in both taxane-resistant and -sensitive PC3 and DU145 cells, treatment with DTX and CBZ failed to robustly induce these signature apoptotic events. These observations suggested that taxanes induce both caspase-dependent and -independent cell death in mCRPC cells, and that maintaining the structural integrity of LEDGF/p75 is critical for its role in promoting taxane-resistance. Our results further establish LEDGF/p75 as a stress oncoprotein that plays an important role in taxane-resistance in mCRPC cells, possibly by antagonizing drug-induced caspase-independent cell death.

Biobanks are facilities that collect, process, store, annotate, and distribute high-quality and well-maintained human biological specimens (biospecimens) for investigational use. They play a crucial role in biomarker research and contribute to our understanding about preventing, diagnosing, and treating diseases. Majority of the biospecimens are from patients volunteering to provide biospecimens that would normally be discarded after diagnostic or therapeutic procedures. Potential pathogens in collected biospecimens may contaminate the instruments and work space, leaving the personnel at risk of being infected. Meanwhile, cross-contamination can cause disastrous results during retrieval of information from the biospecimen. In this chapter, commonly used chemical germicides are introduced, including chlorine, alcohols, phenolics, aldehydes (formaldehyde, glutaraldehyde), quaternary ammonium compounds (Quats), iodophors, and hydrogen peroxide, with detailed steps on cleaning and decontaminating the biobank facility. We also discuss some of the major common biohazardous agents including tuberculosis, viruses (HIV, HBV, HCV), and prions.

Synovial sarcoma (SS) is an aggressive soft tissue sarcoma (STS) that typically occurs in the extremities near a joint. Metastatic disease is common and usually occurs in the lungs and lymph nodes. Surgical management is the mainstay of treatment with chemotherapy and radiation typically used as adjuvant treatment. Although chemotherapy has a positive impact on survival, the prognosis is poor if metastatic disease occurs. The biology of sarcoma invasion and metastasis remain poorly understood. Chromosomal translocation with fusion of the SYT and SSX genes has been described and is currently used as a diagnostic marker, although the full impact of the fusion is unknown. Multiple biomarkers have been found to be associated with SS and are currently under investigation regarding their pathways and mechanisms of action. Further research is needed in order to develop better diagnostic screening tools and understanding of tumor behavior. Development of targeted therapies that reduce metastatic events in SS, would dramatically improve patient prognosis.

Acute myeloid leukemia (AML) is characterized by the accumulation of malignant, transformed immature hematopoietic myeloid precursors that have lost their ability to differentiate and proliferate normally. Current treatment for AML requires intensive cytotoxic chemotherapy and results in significant morbidity and mortality, especially in older patients. Effective and better-tolerated treatment is urgently needed. Studies have shown that 1α,25-dihydroxyvitamin D3 (1,25-D3, active VD3) or vitamin D analogs (VDAs) can potently differentiate AML cells in vitro and ex vivo, which led to early clinical trials in AML and myelodysplastic syndrome patients. However, one major limiting factor in the clinical application of active VD3 or VDAs is the supraphysiologic dose required, which results in systemic hypercalcemia. Several important questions (i.e., dosage, method of delivery, metabolism of 1,25-D3 in situ, systemic hypercalcemia, and mechanisms of action of combination treatment) have to be addressed before vitamin D treatment can be applied to the clinical setting. This review focuses on 1,25-D3's mechanism of action in AML, preclinical data, and clinical trial outcomes, with an emphasis on major roadblocks to successful trials and suggestions for future directions.

Activation of the Protein Kinase B (PKB), or AKT pathway has been shown to correlate with acute myeloid leukemia (AML) prognosis. B55α-Protein Phosphatase 2A (PP2A) has been shown to dephosphorylate AKT at Thr-308 rendering it inactive. In fact, low expression of the PP2A regulatory subunit B55α was associated with activated phospho-AKT and correlated with inferior outcomes in AML. Despite this fact, no studies have specifically demonstrated a mechanism whereby B55α expression is regulated in AML. In this study, we demonstrate novel loss of function mutations in the PPP2R2A gene identified in leukemic blasts from three AML patients. These mutations eliminate B55α protein expression thereby allowing constitutive AKT activation. In addition, leukemic blasts with PPP2R2A gene mutation were more sensitive to treatment with the AKT inhibitor MK2206, but less responsive to the PP2A activator FTY720. Using leukemia cell lines, we further demonstrate that B55α expression correlates with AKT Thr-308 phosphorylation and predicts responsiveness to AKT inhibition and PP2A activation. Together our data illustrate the importance of the B55α-PP2A-AKT pathway in leukemogenesis. Screening for disruptions in this pathway at initial AML diagnosis may predict response to targeted therapies against AKT and PP2A.

Our previous studies have shown that lowering the dose of pegylated liposomal doxorubicin (PLD) and bortezomib in combination with intravenous dexamethasone on a longer 4-week cycle maintained efficacy and improved tolerability in both previously untreated and relapsed/refractory (R/R) multiple myeloma (MM) patients. Lenalidomide has shown efficacy in combination with bortezomib and dexamethasone but this combination has been poorly tolerated. We conducted this phase 2 study (clinicaltrials.gov identifier: NCT01160484) to evaluate whether a longer 4-week schedule using modified doses and schedules of IV dexamethasone (40 mg), bortezomib (1.0 mg/m(2)) and PLD (4.0 mg/m(2)) administered on days 1, 4, 8, and 11 with lenalidomide 10 mg daily on days 1-14 (DVD-R) would be effective and tolerated for patients with R/R MM. A total of 40 heavily pretreated patients were enrolled and 84.6% showed clinical benefit (complete response, 20.5%; very good partial response, 10.3%; partial response, 17.9%; minimal response, 35.9%) to the combination regimen. An additional 10.3% showed stable disease and 5.1% progressed while on study. The regimen was well tolerated, with a low incidence of adverse events such as fatigue (40%), thrombocytopenia (35%), neutropenia (35%), anemia (30%), peripheral neuropathy (25%) and pneumonia (15%). Thus, the DVD-R regimen is well tolerated and produces high response rates for patients with R/R MM.

SummaryThe combination of pegylated liposomal doxorubicin (PLD), bortezomib anddexamethasone has shown efficacy in the treatment of multiple myeloma(MM) patients. Our earlier retrospective study suggested that modification ofthe doses, schedules and route of administration of these drugs appears toreduce toxicity without compromising anti-MM activity. As a result, weevaluated this modified drug combination in the frontline setting in aprospective multicentre phase II trial. Thirty-five previously untreated MMpatients were enrolled. Dexamethasone IV 40 mg, bortezomib 1 mg/m 2 andPLD 5 mg/m 2 were administered on days 1, 4, 8 and 11 of a 4-week cycle.Patients were treated to their maximum response plus two additional cycles.The treatment regimen was discontinued after a maximum of eight cycles.Our modified schedule and dosing regimen achieved a high overall responserate of 86%, while showing a marked decrease in the incidence and severityof peripheral neuropathy, palmar-plantar erythrodysesthesia and myelo-suppression compared to the standard dosing on a 3-week cycle using thesedrugs. This modified regimen of dexamethasone, bortezomib and PLD showsimproved tolerability and safety while maintaining a high response rate whencompared to standard treatment with these agents in the frontline setting.Keywords: multiple myeloma, dexamethasone, bortezomib, pegylated lipo-somal doxorubicin.

Background The purpose of this study was to compare quality of life and overall toxicity in patients with advanced non-small-cell lung cancer (NSCLC) treated with vinorelbine–gemcitabine (VG) or carboplatin–paclitaxel (Taxol) (CP). Patients and methods A total of 165 previously untreated patients were randomized to the two regimens. Quality of life was assessed by the Lung Cancer Symptom Scale (LCSS). Overall toxicity and secondary efficacy end points were evaluated by standard WHO criteria. Results There was no significant difference in overall quality of life between the two treatments. Neutropenia, thrombocytopenia, peripheral neuropathy, and alopecia, were more common in the CP arm, whereas constipation was more frequent in the VG arm. Response rates were 14.6% in the VG arm and 16.9% in the CP arm. Median survival times were 7.8 and 8.6 months, and 1 year survival rates were 38.4% and 31.9%, respectively. Conclusions Patients treated with VG experienced lower toxicity, but overall quality of life was similar in both arms. Efficacy seemed comparable between VG and CP. Our study shows that VG is a viable alternative to platinum-based chemotherapy in patients with advanced NSCLC.

The incidence, etiology, outcome, and risk factors for developing pneumonia late after hematopoietic stem cell transplantation (SCT) were investigated in 1359 patients transplanted in Seattle. A total of 341 patients (25% of the cohort) developed at least one pneumonic episode. No microbial or tissue diagnosis (ie clinical pneumonia) was established in 197 patients (58% of first pneumonia cases). Among the remaining 144 patients, established etiologies included 33 viral (10%), 31 bacterial (9%), 25 idiopathic pneumonia syndrome (IPS, 7%), 20 multiple organisms (6%), 19 fungal (6%), and 16 Pneumocystis carinii pneumonia (PCP) (5%). The overall cumulative incidence of first pneumonia at 4 years after discharge home was 31%. The cumulative incidences of pneumonia according to donor type at 1 and 4 years after discharge home were 13 and 18% (autologous/syngeneic), 22 and 34% (HLA-matched related), and 26 and 39% (mismatched related/unrelated), respectively. Multivariate analysis of factors associated with development of late pneumonia after allografting were increasing patient age (RR 0.5 for20 years, 1.2 for40 years, P=0.009), donor HLA-mismatch (RR 1.6 for unrelated/mismatched related, P=0.01), and chronic graft-versus-host disease (GVHD; RR 1.5, P=0.007). Our data suggest that extension of PCP prophylaxis may be beneficial in high-risk autograft recipients. Further study of long-term anti-infective prophylaxis based on patient risk factors after SCT appear warranted.

Systemic sclerosis (SSc) is a multisystem disease of presumed autoimmune pathogenesis for which no proven effective treatment exists. High-dose immunosuppressive therapy (HDIT) has been proposed as an investigational treatment for severe autoimmune diseases. Nineteen patients with poor-prognosis SSc underwent HDIT. The median age was 40 years (range, 23-61 years), the median modified Rodnan skin score (a measure of dermal sclerosis) was 31, and the median DLCO was 57%. Conditioning therapy involved 800 cGy total body irradiation (TBI) (± lung shielding to approximately 200 cGy), 120 mg/kg cyclophosphamide, and 90 mg/kg equine antithymocyte globulin. CD34-selected granulocyte–colony-stimulating factor–mobilized autologous blood stem cells provided hematopoietic rescue. With median follow-up at 14.7 months, the Kaplan-Meier estimated 2-year survival rate was 79%. Three patients died of treatment complications and one of disease progression. Two of the first 8 patients had fatal regimen-related pulmonary injury, a complication not found among 11 subsequent patients who received lung shielding for TBI. Overall, internal organ functions were stable to slightly worse after HDIT, and 4 patients had progressive or nonresponsive disease. As measured by modified Rodnan skin scores and modified health assessment questionnaire disability index (mHAQ-DI) scores, significant disease responses occurred in 12 of 12 patients evaluated at 1 year after HDIT. In conclusion, though important treatment-related toxicities occurred after HDIT for SSc, modifications of initial approaches appear to reduce treatment risks. Responses in skin and mHAQ-DI scores exceed those reported with other therapies, suggesting that HDIT is a promising new therapy for SSc that should be evaluated in prospective randomized studies.

Fatigue is a common problem among multiple myeloma (MM) patients. Armodafinil is a drug known to promote wakefulness, which is related to modafinil, a compound that improves fatigue in some cancer patients treated with chemotherapeutic agents. We investigated whether armodafinil could reduce cancer-related fatigue in MM patients. This double-blind, placebo-controlled phase 3 trial evaluated the efficacy of armodafinil in MM patients with evidence of moderate fatigue. Patients were randomized to one of two arms: treatment-only, with armodafinil given at 150 mg/daily for 56 days, or placebo-first, with placebo given on days 1–28, followed by armodafinil administered at 150 mg daily on days 29–56. Fatigue was measured on days 1 (pre-dose: baseline), 15, 28, 43, and 56 using seven separate assessments, including four patient-reported outcomes of fatigue and related quality of life measures, as well as three objective measures of cognitive function. Overall toxicities were similar between treatment groups. No significant differences were observed between the placebo-first and the treatment-only arms after 28 days. Treatment with armodafinil for 28 additional days did not produce responses. Both placebo-first and treatment-only patients showed similar significant improvements in three patient-reported measures and one objective task at day 28 compared to baseline. Placebo-first patients improved on eight additional measures (one patient-reported measure, six subscales, and one objective task), suggesting a strong placebo effect in this patient population. Evaluation and treatment of cancer-related fatigue continues to be challenging; a clear definition of this symptom and better assessment tools are needed.

Background Circulating progenitor cells (CPC) especially endothelial progenitor cell (EPC) levels and functions are attenuated in diabetic patients. This may explain the poorer outcome of diabetics undergoing percutaneous coronary intervention (PCI). We aim to study the dynamic changes of these cells in these patients. Methods Blood of 8 diabetics with stable coronary artery disease who underwent elective PCI, were obtained at baseline, 1, 4 and 24 h after PCI. Fluorescence activated cell sorting (FACS) analysis was performed to quantitate CD34+ and CD34+/ KDR+ cells. Patients with recent acute coronary syndrome were excluded. Results After PCI, decreases in CPC from baseline were detected in 7 out of the 8 patients. In these 7 patients, mean CD34+ and CD34+/KDR+ cells were 182±99/1×10 5 and 18±16/1×10 5 cells respectively. Maximal decrease of CD34+ and CD34+/KDR+ cells were 47.8% and 53.3% at 1 h and 4 h respectively. At 24 h, CPC levels returned to baseline but were not elevated. The only patient with raised cardiac enzymes has instead, 2 to 3 fold increase in CPCs at 1 and 4 h. Conclusions We found a transient dip in circulating progenitors early during PCI. This suggests incorporation of the cells into the sites of vascular denudation. The absence of subsequent CPC elevation post-PCI in diabetes may be associated with known poorer outcome of these patients. With myocardial injury, more progenitors may be mobilized from the bone marrow into the circulation and abolish the hyperacute reduction in circulating levels.

Summary This non-comparative phase II study (ClinicalTrials.gov: NCT00715208) evaluated bortezomib in place of vincristine in established rituximab-chemotherapy regimens in relapsed/refractory follicular (FL) or marginal zone lymphoma (MZL). Patients were allocated (physician/patient preference) to receive six 21-d cycles of: bortezomib 1·6 mg/m2 (days 1, 8), rituximab 375 mg/m2 (day 1), cyclophosphamide 1000 mg/m2 (day 1) and prednisone 100 mg (days 1–5; VR-CP; 47 FL, 1 MZL patients); or bortezomib, rituximab, prednisone per VR-CP, cyclophosphamide 750 mg/m2 and doxorubicin 50 mg/m2 (day 1; VR-CAP; 4 FL, 2 MZL, 1 chronic lymphocytic leukaemia patients). With VR-CP, the response rate was 77%, with a 27% complete response rate. After a median follow-up of 10·9 months, 40% of patients had relapsed/progressed or died. Median duration of response and progression-free survival was 21·9 and 14·9 months, respectively. Common drug-related grade ≥3 adverse events were neutropenia (25%), thrombocytopenia (6%) and lymphopenia (6%). Thirteen (27%) patients reported peripheral neuropathy (one grade 3). With VR-CAP, one FL patient achieved complete response and three FL and two MZL patients achieved partial responses. Three patients reported drug-related grade 1/2 peripheral neuropathy. Weekly bortezomib and rituximab represents an active, feasible treatment platform in FL. VR-CP was active and well tolerated in patients with relapsed/refractory FL.

Studies have shown a high prevalence (40–83%) of complementary and alternative medicine (CAM) use among cancer patients in the U.S.A cross-sectional, mixed-methods pilot study was completed. This paper focuses on the quantitative analysis conducted on demographic predictors of complementary medicine (CM) use, reasons to use CM, and disclosure to healthcare provider data. Surveys were interview-administered at the Loma Linda University Medical Center Cancer Center. Participants, 18 years or older, were selected from a convenient sample. Eighty-seven percent (87.9%) of participants reported to have used CM as a cancer treatment and most reported to have used it “to help fight the cancer.” Women were eight-times more likely to use prayer. All non-Caucasian and Hispanic participants reported to use CM as a cancer therapy and none reported to use a CM provider. More women (72%) disclosed their CM use than men (53.3%). Different prevalences and predictors exist when differentiating CM modalities, reasons to use CM vary by gender, and disclosure proportions vary by gender.

There is a need for efficacious therapies for metastatic castration-resistant prostate cancer (mCRPC) after disease progression on docetaxel. The SRC tyrosine kinase and its related family members may be important drivers of prostate cancer and can be inhibited by dasatinib. mCRPC patients, after one previous chemotherapy, started dasatinib at 70 mg twice daily, amended to 100 mg daily. The primary endpoint was the disease control (DC) rate, defined as complete response (CR), partial response (PR), or stable disease (SD) in prostate specific antigen (PSA), RECIST, bone scan, and FACT-P score. Up to 41 patients were to be accrued (two-stage design, 21+20) to rule out a null-hypothesized effect of 5 versus 20% (α=0.05, β=0.1). Secondary endpoints included progression-free survival, toxicity, and pharmacokinetic and pharmacodynamic correlatives. Of 38 patients, 27 were evaluable for response or toxicity. The median duration of therapy was 55 days (6-284). Five patients showed DC after 8 weeks of therapy (18.5% DC, 95% CI: 6.3-38.1%). One PR (3.7% response rate, 95% CI: 0.1-19.0%) was observed in a patient treated for 284 days. Twelve patients (43%) discontinued treatment for toxicity. Dasatinib induced a decrease in phytohemagglutinin-stimulated CSF2, CD40L, GZMB, and IL-2 mRNAs in blood cells, indicating target engagement. Decreases in plasma IL-6 and bone alkaline phosphatase, and in urinary N-telopeptide, were associated with DC. Dasatinib has definite but limited activity in advanced mCRPC, and was poorly tolerated. The observation of a patient with prolonged, objective, clinically significant benefit warrants molecular profiling to select the appropriate patient population.

7030Background: B cell acute lymphoblastic leukemia with overexpression of CRLF2 (CRLF2 B-ALL) is a Ph-like leukemia with poor outcome in children, as well as in adults. Activation of the CRLF2 rec...

Introduction. The high prevalence of complementary and alternative medicine (CAM) use among cancer patients (40%-83%) receiving conventional treatment and the complex relationship between the psychosocial factors that may contribute to or result from CAM use requires further understanding. The authors conducted a descriptive mixed-methods pilot study to understand CAM practices, attitudes, and beliefs among cancer patients at the Loma Linda University Medical Center. Methods. This was the qualitative phase of the study, and no hypotheses were set. A total of 23 face-to-face interviews were conducted, and thematic coding was used to analyze 22 interview transcriptions. There were 14 CAM users (64%) and 8 nonusers (36%). Findings. The themes present among those who used CAM were the following: physicians viewed as one aspect of health care options, a holistic view on well-being, satisfaction with CAM use, and 3 key coping methods (confrontive, supportive, and optimistic) to confront cancer. Themes were not independent of each other. Two themes were present among nonusers; nonusers trusted their physician and were more likely to express evasive coping methods. Discussion. Perceptions and behavioral patterns are complex predictors of CAM use. A better understanding of CAM, medical pluralism, and the perceptions of patients would help health care providers deliver a better quality of care. The promotion of integrative care may help health care providers better identify medical pluralism and would shift focus to patient-centered care.

A single arm phase II trial of single-agent bortezomib (BZM) alone or combined with hormone blockade was conducted in patients with early PSA recurrence after definitive local therapy. The primary endpoint of this study was to determine the time to PSA relapse after BZM therapy alone or when BZM was combined with hormone blockade. The secondary endpoint was to determine the safety of combination therapy. Part A of the treatment schedule consisted of three cycles of BZM 1.3 mg/m2 IV given on days 1,4,8,11. If patients progressed on Part A, they were entered on Part B which consisted of a single dose of LH-RH antagonist, daily oral antiandrogen, and weekly BZM 1.3 mg/m2 for three out of four weeks for a total of three months. BZM treatment significantly decreased the slope of the log PSA (p=0.024) demonstrating that this agent alone was capable of slowing the rise of the PSA. Of eight patients treated with BZM alone five had stable disease, two progressed and 1 went off study secondary to toxicity. The major toxicity was neurotoxicity requiring discontinuation of therapy in three patients and treatment interruption in nine patients. Of those receiving Parts A and B or B only, there were 11 of 15 CRs with the average time to progression of 5.5 months. BZM treatment can change the slope of PSA rise and can be combined with hormone deprivation therapy without significant additional side effects; these agents are associated with a median time to CR of 42 days.

The history of ascorbic acid (AA) and cancer has been marked with controversy. Clinical studies evaluating AA in cancer outcome continue to the present day. However, the wealth of data suggesting that AA may be highly beneficial in addressing cancer-associated inflammation, particularly progression to systemic inflammatory response syndrome (SIRS) and multi organ failure (MOF), has been largely overlooked. Patients with advanced cancer are generally deficient in AA. Once these patients develop septic symptoms, a further decrease in ascorbic acid levels occurs. Given the known role of ascorbate in: a) maintaining endothelial and suppression of inflammatory markers; b) protection from sepsis in animal models; and c) direct antineoplastic effects, we propose the use of ascorbate as an adjuvant to existing modalities in the treatment and prevention of cancer-associated sepsis.

WT1 (Wilms' tumor gene 1) overexpression is implicated in the prognosis of acute leukemia. The purpose of this study was to investigate WT1 expression and its clinical implication in childhood acute leukemia (AL) in Chinese population. Bone marrow specimen from 200 children at different stages of acute leukemia and from 21 children without leukemia were studied. The WT1 expression at diagnostic marrow specimen in both acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL) was higher than control group, whereas WT1 expression in AML was higher than in ALL, and WT1 expression level in relapse in ALL increased more significantly than in AML. The WT1 expression level showed positive correlation with the hypodiploidy and BCR-ABL fusion gene in acute leukemia. A rapidly decrease of WT1 expression level predicted a good response to the induction therapy and low expression of WT1 correlates with remission status. This study suggested that WT1 expression levels in acute leukemia can potentially be a marker for evaluating therapeutic efficacy, correlating with monitoring minimal residue disease, and predicting hematological relapse in children acute leukemia.

Background Oxaliplatin is a platinum compound used in the treatment of gastrointestinal malignancies, including colorectal cancer. The incidence of hypersensitivity reaction in patients receiving oxaliplatin is approximately 15%, with severe reaction (grade 3 and 4) occurring in 2% of patients. Case presentation We report two patients with metastatic colorectal cancer who developed de novo hypersensitivity reaction and acute thrombocytopenia after oxaliplatin infusion. Both patients had oxaliplatin treatment several years before and exhibited hypersensitivity on the third dose of oxaliplatin in recent treatment. Oxaliplatin was discontinued when clinical reaction was identified. Both patients were confirmed to have strong oxaliplatin-induced IgG platelet-reactive antibodies. Both patients' thrombocytopenia resolved within two weeks after discontinuation of oxaliplatin. One patient had disease stabilization lasting for three months without chemotherapy. Both patients subsequently received other chemotherapeutic agents without evidence of hypersensitivity reaction or immune-mediated thrombocytopenia. Conclusion We recommend vigilant monitoring of complete blood count and signs and symptoms of bleeding after the occurrence of oxaliplatin-induced hypersensitivity to avoid serious complications of immune-mediated thrombocytopenia.

The authors report a case of orbital plasmacytoma in a 48-year-old man with known multiple myeloma. He presented with proptosis, diplopia, and decreased vision of the left eye for several weeks. He had been previously treated for IgA lambda multiple myeloma with chemotherapy, radiation, and autologous stem cell transplant. After a left orbitotomy, flow cytometry revealed a tumor rich in plasma cells expressing CD138 with equivocal lambda light chain expression. The patient underwent orbital radiation, with improvement of vision and disc edema OS. The patient is currently undergoing salvage chemotherapy for relapse of multiple myeloma. This is the third reported case of IgA myeloma involving the orbit.

More effective therapeutic strategies are required for patients with poor-prognosis systemic sclerosis (SSc). A phase 2 single-arm study of high-dose immunosuppressive therapy (HDIT) and autologous CD34-selected hematopoietic cell transplantation (HCT) was conducted in 34 patients with diffuse cutaneous SSc. HDIT included total body irradiation (800 cGy) with lung shielding, cyclophosphamide (120 mg/kg), and equine antithymocyte globulin (90 mg/kg). Neutrophil and platelet counts were recovered by 9 (range, 7 to 13) and 11 (range, 7 to 25) days after HCT, respectively. Seventeen of 27 (63%) evaluable patients who survived at least 1 year after HDIT had sustained responses at a median follow-up of 4 (range, 1 to 8) years. There was a major improvement in skin (modified Rodnan skin score, −22.08; P < .001) and overall function (modified Health Assessment Questionnaire Disability Index, −1.03; P < .001) at final evaluation. Importantly, for the first time, biopsies confirmed a statistically significant decrease of dermal fibrosis compared with baseline (P < .001). Lung, heart, and kidney function, in general, remained clinically stable. There were 12 deaths during the study (transplantation-related, 8; SSc-related, 4). The estimated progression-free survival was 64% at 5 years. Sustained responses including a decrease in dermal fibrosis were observed exceeding those previously reported with other therapies. HDIT and autologous HCT for SSc should be evaluated in a randomized clinical trial.

Myelodysplastic syndromes (MDSs) and myeloproliferative neoplasms (MPNs) are subgroups of myeloid neoplasms with chronic clinical courses. MDSs are characterized by simultaneous proliferation and apoptosis of hematopoietic cells and peripheral blood cytopenias. MDS with isolated del(5q) is a specific subtype of MDS that occurs primarily in older women, and is characterized by macrocytic anemia, increased platelet count, micromegakaryocytes, and favorable clinical course. …

High-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated for the control of severe autoimmune diseases. The addition of antithymocyte globulin (ATG) to high-dose chemoradiotherapy in the high-dose immunosuppressive therapy regimen and CD34 selection of the autologous graft may induce a higher degree of immunosuppression compared with conventional autologous HSCT for malignant diseases. Patients may be at higher risk of transplant-related complications secondary to the immunosuppressed state, including Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD), but this is an unusual complication after autologous HSCT. Fifty-six patients (median age, 42 years; range, 23–61 years) with either multiple sclerosis (n = 26) or systemic sclerosis (n = 30) have been treated. The median follow-up has been 24 months (range, 2–60 months). Two patients (multiple sclerosis, n = 1; systemic sclerosis, n = 1) had significant reactivations of herpesvirus infections early after HSCT and then developed aggressive EBV-PTLD and died on days +53 and +64. Multiorgan clonal B-cell infiltrates that were EBV positive by molecular studies or immunohistology were identified at both autopsies. Both patients had positive screening skin tests for equine ATG (Atgam) and had been converted to rabbit ATG (Thymoglobulin) from the first dose. Of the other 54 patients, 2 of whom had partial courses of rabbit ATG because of a reaction to the intravenous infusion of equine ATG, only 1 patient had a significant clinical reactivation of a herpesvirus infection (herpes simplex virus 2) early after HSCT, and none developed EBV-PTLD. The T-cell count in the peripheral blood on day 28 was 0/μL in all 4 patients who received rabbit ATG; this was significantly less than in patients who received equine ATG (median, 174/μL; P = .001; Mann-Whitney ranked sum test). Although the numbers are limited, the time course and similarity of the 2 cases of EBV-PTLD and the effect on day 28 T-cell counts support a relationship between the development of EBV-PTLD and the administration of rabbit ATG. The differences between equine and rabbit ATG are not yet clearly defined, and they should not be considered interchangeable in this regimen without further study.

Advancements in rheumatoid arthritis (RA) treatment protocols and introduction of targeted biological therapies have markedly improved patient outcomes, despite this, up to 50% of patients still fail to achieve a significant clinical response. In veterinary medicine, stem cell therapy in the form of autologous stromal vascular fraction (SVF) is an accepted therapeutic modality for degenerative conditions with 80% improvement and no serious treatment associated adverse events reported. Clinical translation of SVF therapy relies on confirmation of veterinary findings in targeted patient populations. Here we describe the rationale and preclinical data supporting the use of autologous SVF in treatment of RA, as well as provide 1, 3, 6, and 13 month safety outcomes in 13 RA patients treated with this approach.

Abstract 1435 Abstract ABT-737 is a small molecule antagonist of BCL-2, BCL-XL, and BCL-w currently under evaluation in clinical trials in the oral form of ABT-263 (Navitoclax). Acquired resistance to BCL-2 inhibitors will inevitably emerge. Published pre-clinical data showed increased levels of BFL-1 and/or MCL-1 proteins in lymphoma, and concurrent up-regulation of BCL-XL and BCL2A1 in chronic lymphocytic leukemia, which are not targeted by ABT-737. To investigate potential mechanisms of resistance to BCL-2 inhibitors in acute myeloid leukemia, we developed resistant cell lines by long-term culture of HL-60 and MV4-11 cells with ABT-737, designated as HL-60R and MV4-11R. Parental lines, HL-60 and MV4-11 which were highly sensitive to ABT-737 with IC50 values of 30 nM and 90nM respectively, whereas those for HL-60R and MV4-11R were 10μM and 4.7μM respectively. Annexin V binding assay revealed that both resistant lines were resistant to ABT-737 induced apoptosis as compared to the parental HL-60 and MV4-11 cells. To explore the common pathway mediating acquired resistance to ABT-737, genes differentially expressed 2-fold or greater between parental and resistant lines on HL-60 and MV4-11 were studied. Interestingly, significant changes for BCL-2 family members were not found, suggesting that non-BCL2 family genes could play important roles in mediating the drug resistance to ABT-737. Among them, C3aR1 [Complement component 3a receptor 1] was significantly over-expressed in both resistant cell lines when compared to parental lines and verified with real-time RT-PCR. C3aR1 inhibitor, SB 290157, showed preferential cytotoxicity to both HL-60R and MV4-11R in a dose-dependent way and spared parental cells during 48 hrs in vitro MTT assay. Our findings suggest C3aR1 plays a key role in the resistance phenotype to Bcl-2 inhibitor and blocking C3aR1 revert the resistance. C3aR1 encodes a G-protein coupled seven trans-membrane receptor for C3a, an important inflammatory mediator. The C3a-C3aR axis modulated SDF-1–CXCR4 axis-dependent responses and regulated the homing of hematopoietic stem/progenitor cells into bone marrow. C3aR1 over expression has been associated with FLT3 and D835/I836 mutation cytogenetically normal acute myeloid leukemia, renal cancer and melanoma. We further investigate the role of C3aR1 in 138 cases of AML including 50 cases in initial diagnosis, 68 cases in remission and 20 cases in relapse with real-time RT-PCR. The result showed that C3aR1 expression is highest in initial stage and lowest in remission (p=0.006), there was no significant difference between initial and relapse stages (p=0.384). [Table 1] For newly diagnosed AML patients, high C3aR1 is statistically associated with younger age [median: 34 vs 43 years old], higher presenting WBC [median: 39K vs 27K], higher marrow % blasts [70 vs 55%], but not related to efficacy of first induction treatment, FAB classification or conventional chromosome risk groups.Table 1C3aR1 expression in AML clinical casesAML casesAge (year)C3AR1malefemalemedianrangeM-estimatorrangepInitial2822367-79199.777.49-2514.6P1 = 0.006Remission37313412-7092.2523.45-2286P2 = 0.046Relapse11944.513-54142.7512.4-2372.04P3 = 0.384Note: M-estimator was used for evaluating the differential expression of AML samples and the value was amplified by 104p1: initial vs remission; p2: relapse vs remission; p3 initial vs relapse The biological significant of C3a-C3aR axis in AML and resistance phenotype is intriguing and may suggest a novel mechanism of evading the apoptotic regulation by Bcl-2 gene family as suggested by our current study. Ongoing studies will further elucidate relationship of C3a-C3aR axis in AML. Disclosures: No relevant conflicts of interest to declare.

4575 Background: The efficacy of therapies for prostate cancer following failure of androgen deprivation and docetaxel is limited. SRC dysregulation may be important in prostate cancer progression....

Abstract 2798 Background: Non-Hodgkin's lymphoma is the most common hematologic malignancy, with an estimated >65,000 new cases in the US in 2010. The indolent follicular lymphoma (FL) and marginal zone lymphoma (MZL) subtypes account for approximately 22% and 10% of cases, respectively. Rituximab, cyclophosphamide, vincristine, and prednisone, with doxorubicin (R-CHOP) or without (R-CVP) are the most common regimens used for frontline and relapsed/refractory FL. Bortezomib (VELCADE®) has shown activity alone and with rituximab in relapsed/refractory FL/MZL, and also in combination with chemo-immunotherapy regimens such as R-CHOP. However, overlapping peripheral neuropathy (PN) with vincristine may limit bortezomib dosing. Thus, the aim of this phase 2, two-arm, non-randomized, multicenter study was to evaluate the safety and efficacy of administering bortezomib in place of vincristine in the R-CHOP and R-CVP regimens. Methods: Patients aged ≥18 years with relapsed or refractory FL (including transformed FL) or MZL following ≥1 prior chemotherapy, ≥1 measurable tumor mass, ECOG performance status ≤2, no grade ≥2 residual toxicity from previous therapy/surgery, no grade ≥2 PN, and adequate hematologic, renal, and hepatic function were eligible. Based on investigator preference, patients received up to six 21-day cycles of bortezomib 1.6 mg/m2 IV on days 1 and 8, rituximab 375 mg/m2 IV on day 1, and prednisone 100 mg PO on days 1–5, plus either cyclophosphamide 1000 mg/m2 IV (VR-CP arm), or cyclophosphamide 750 mg/m2 IV and doxorubicin 50 mg/m2 IV (VR-CAP arm) on day 1. All patients then received rituximab 375 mg/m2 IV every 3 months for ≤2 years as maintenance. The primary endpoint was complete response (CR) rate, determined after all patients completed the 12-week follow-up visit. Secondary endpoints included overall response rate (ORR; CR + partial response [PR]), duration of response (DOR), progression-free survival (PFS), and safety/tolerability. Response was assessed by investigators using modified International Workshop Response Criteria. Toxicities were graded using National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: A total of 55 patients have been enrolled, 48 to VR-CP and 7 to VR-CAP; reasons for selecting VR-CP included extent of prior anthracycline therapy (56%), study center preference (25%), response to prior R-CVP (13%), and age (10%). Of the 48 VR-CP patients, 50% were male, 88% were white, median age was 63.5 years (range 40–85), 47 had FL (52/33/15% grade 1/2/3; 19/43/38% low/intermediate/high risk by FL International Prognostic Index [FLIPI]), and 1 had MZL. Median number of prior lines of therapy was 2 (range 1–10), which included R-CHOP in 27 (56%), rituximab in 19 (40%), and R-CVP in 7 (15%) patients. Of 47 evaluable patients, 14 (30%) achieved CR and 23 (49%; including 1 MZL) PR (ORR 79%). Median DOR and PFS have not been reached. Patients received a median of 6 (range 2–6) cycles of VR-CP; 40 (83%) received all 6 cycles, and 28 (58%) have continued into the rituximab maintenance phase. All patients reported ≥1 adverse event (AE), including 65% with grade ≥3 AEs, and 25% with serious AEs. Most common AEs included diarrhea (52%), nausea (46%), fatigue (44%), neutropenia (31%), constipation, and vomiting (each 23%); grade ≥3 AEs included neutropenia (27%), lymphopenia (10%), and thrombocytopenia (6%). The incidence of PN was 21% (2% grade ≥3). Four (8%) patients discontinued due to AEs. Of 7 VR-CAP patients (2 male, 7 white, median age 57 years [range 55–73]), 4 had FL (3 grade 1, 1 unknown; all FLIPI high-risk), 2 MZL, and 1 chronic lymphocytic leukemia. Median number of prior lines of therapy was 1 (range 1–8). Of 6 response-evaluable patients, 0/4 achieved CR/PR (3 FL, 1 MZL; ORR 67%). Five patients received all 6 cycles; 4 have continued into rituximab maintenance. AEs included fatigue (n=5), alopecia, neutropenia (each n=4), anemia, constipation, nausea, rigors, and thrombocytopenia (each n=3). Neutropenia (n=4) was the only grade ≥3 AE reported in >1 patient. PN was seen in 2 patients (no grade 3). Two patients had serious AEs. There have been no on-study deaths in either arm. Conclusion: These results indicate that VR-CP is active, with a 30% CR rate, in patients with relapsed or refractory FL/MZL, including those who had received prior chemo-immunotherapy. Prolonged follow-up is required to evaluate DOR and PFS; updated results will be presented. Disclosures: Craig: Genentech: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Off Label Use: Use of bortezomib in combination in follicular lymphoma and marginal zone lymphoma. Cabanillas:Celgene: Consultancy, Research Funding; Bayer: Research Funding; Pfizer: Research Funding. Parasuraman:Millennium Pharmaceuticals, Inc.: Employment, Equity Ownership. Neuwirth:Millennium Pharmaceuticals, Inc.: Employment. O'Connor:Millennium Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding.

8134 Background: PLD and bortezomib (BORT) are FDA-approved for MM patients who have received one prior therapy. We have previously demonstrated in laboratory studies that lower doses of PLD administered more frequently are better tolerated than higher doses given less often. The combination of BORT and dexamethasone (DEX) is effective for previously untreated MM patients. Prior studies by our group have shown that intravenous administration of DEX 40 mg, BORT 1.0 mg/m2 and PLD 5 mg/m2 (DVD) on days 1, 4, 8, and 11 of a 28-day cycle is effective for relapsed/refractory MM patients and well tolerated. Methods: We conducted a single-arm multi-center phase II study for previously untreated MM patients to evaluate the DVD regimen. Patients were treated to a maximum response plus two additional cycles or completed a maximum of eight cycles of therapy without disease progression. Results: Thirty-five patients were enrolled with a median age of 65 years (range, 42-82 years). Thirty and 33 patients are currently ...

Abstract 4936 Despite recent advances in the treatment of MM, the disease remains incurable and many of the most effective, newer combination therapies are accompanied by significant side effects that have a major negative impact on the patient's quality of life. Pegylated liposomal doxorubicin (PLD) and bortezomib have shown anti-MM efficacy in the laboratory and for the treatment of previously treated MM patients, leading to FDA approval for patients who have failed one prior therapy. Using our severe combined immunodeficiency-hu murine models of human MM, we have previously demonstrated that lower doses of PLD administered daily are more effective and better tolerated than higher amounts given weekly. Moreover, the combination of bortezomib and dexamethasone has been shown to be effective for previously untreated MM patients. Prior studies by our group have shown that combining chemotherapy including PLD with bortezomib administered at 1.0 mg/m2 on days 1, 4, 8, and 11 of a 28-day cycle rather than the standard 1.3 mg/m2 on the same days of a 21-day schedule is effective for MM patients with relapsed or refractory disease and associated with a reduction in the incidence and severity of peripheral neuropathy. Thus, we conducted a single-arm multi-center phase II study for previously untreated MM patients to evaluate the combination of intravenously administered dexamethasone, bortezomib and PLD (DVD). The treatment consisted of intravenous administration of 40 mg dexamethasone followed by 1.0 mg/m2 bortezomib and finally 5.0 mg/m2 PLD on days 1, 4, 8, and 11 of a 28-day cycle. Patients were treated to a maximum response plus two additional cycles or completed a maximum of eight cycles of therapy without disease progression. To date, 22 (of 35 planned) patients have been enrolled with a median age of 64 years (range, 42-79 years). The majority of those on study (68 %) were diagnosed with International Staging System II or III MM. Four patients are too early to assess for response. To date, among the 18 evaluable patients, 16 (89%) have shown objective responses to the DVD regimen, including 2 complete responses (11%), 8 partial responses (44%) and 6 minimal responses (33%). The other 2 patients (11%) had stable disease, with one of these subjects showing a continuing reduction in M-protein after 2 cycles of therapy to date. Thus, disease control was achieved in all patients. To date, no patient has shown progressive disease after 2+ - 12+ months of follow-up. Six patients experienced grade 3 adverse events and one patient with a prior history of pulmonary interstitial fibrosis developed a grade 4 toxicity (shortness of breath). Grade 3 adverse events in three of the six patients were judged not to be related to the study treatment. The most common grade 3 adverse event was reversible neutropenia (n=2). To date, only 2 patients (9%) have developed peripheral neuropathy (grade 1). Notably, there have been no cases of stomatitis or hand-foot syndrome. Thus, these results suggest that the DVD regimen using a modified schedule and doses of the combination of intravenous dexamethasone, bortezomib and PLD is a well tolerated treatment that produces high response rates for previously untreated patients with multiple myeloma. Disclosures Berenson: Millennium Pharmaceuticals: Consultancy, Research Funding, Speakers Bureau; Centocor Ortho Biotech: Consultancy, Speakers Bureau. Hilger:Millennium Pharmaceutcals: Employment.

e16053 Background: We conducted a single arm, phase II trial of single-agent bortezomib, a proteasome inhibitor, in patients with prostate cancer with biochemical recurrence (PSA relapse) after definitive local therapy. Eligible patients had previous radical prostatectomy and/or radiation therapy (including brachytherapy), and a rising PSA over 1 ng/mL without bone scan evidence of metastasis. The primary goal of this study was to determine the PSA response to single agent bortezomib. Secondary goal was to identify the time to PSA relapse after bortezomib therapy defined as time from nadir to PSA >1ng/ml. Methods: Treatment was composed of bortezomib 1.3mg/m2 IV on days 1,4,8,11 then 10 days off for the first two cycles. The third cycle was comprised of weekly bortezomib therapy for three out of four weeks. Sixteen patients were enrolled and treated at 4 sites with13 evaluable patients. Results: Median baseline PSA was 12.0 ng/ml. 3 of 13 patients (23%) achieved complete responses and 1 a partial response (PR) for a response rate of 30% (95% CI: 0.09 –0.61). Median time to PSA relapse in these 3 patients was 6.0 months. Linear longitudinal modeling was used to compare the rate of increase in PSA prior to treatment versus during treatment with bortezomib and found that treatment significantly decreased the slope of log PSA during treatment, slowing PSA rise (p = 0.003). The major toxicity associated with bortezomib therapy was peripheral neuropathy (7 pts, grade 3 in 3 pts) requiring dose reductions in 3 cases and discontinuation of therapy in 4 patients. Other toxicities included non-neutropenic infections (shingles in 2 pts), 1 small bowel ileus (grade 3), and 1 case of thrombocytopenia (grade 3). Conclusions: In a small number of patients there was a 30% PSA response rate to single agent bortezomib therapy. Further investigations using bortezomib as a single-agent or in combination are warranted in this patient population. No significant financial relationships to disclose.

We develop a standardized, fully automated, quantification system for liver fibrosis assessment using second harmonic generation microscopy and a morphology-based quantification algorithm. Liver fibrosis is associated with an abnormal increase in collagen as a result of chronic liver diseases. Histopathological scoring is the most commonly used method for liver fibrosis assessment, where a liver biopsy is stained and scored by experienced pathologists. Due to the intrinsic limited sensitivity and operator-dependent variations, there exist high inter- and intraobserver discrepancies. We validate our quantification system, Fibro-C-Index, with a comprehensive animal study and demonstrate its potential application in clinical diagnosis to reduce inter- and intraobserver discrepancies.

14535 Background: ABT-869, an orally administered, potent small molecule inhibitor of VEGF receptors 1–3 and platelet derived growth factor, is active in solid malignancies. Consistent with similar...

Histone deacetylases (HDACs) are emerging new molecular targets for cancer therapy. Small-molecule HDAC inhibitors have been developed and shown to induce tumor cell cytostasis, differentiation and apoptosis in experimental models and efficacy in clinical trials in various hematological malignancies following intravenous and/or oral administration. SB939 is a novel HDAC inhibitor with improved metabolic, pharmacokinetic and pharmacological properties compared to other HDAC inhibitors currently in clinical trials1. The objective of this study was to characterize the anti-tumor efficacy of SB939 in preclinical models of hematological malignancies. SB939 selectively inhibits HDAC class I and II isozymes, with Ki values ranging from 16 to 247 nM. It inhibited the proliferation of cell lines from various haematological malignancies, including leukemia, lymphoma and multiple myeloma with IC50 values ranging from 80 nM to 200 nM. It induced cell cycle arrest leading to apoptotic cell death in tumor cell lines as well as primary cells isolated from patients with acute myeloid leukemia (AML) or chronic myeloid leukemia (CML). SB939 has excellent pharmacokinetic properties and tolerability after oral administration in mice1. The oral anti-tumor efficacy of SB939 was evaluated in models of AML (MV4-11) and lymphoma (Ramos) with the tumors grown subcutaneously in nude mice. After daily oral treatment at 50mg/kg (21 days for MV4-11; 14 days for Ramos), SB939 significantly reduced tumor growth in both models (%TGI values were 116% and 100% respectively in MV4-11 and Ramos). In the MV4-11 model, SB939 induced complete tumor regression, in 6/10 mice. In conclusion, our data demonstrate that SB939 is a potent, orally active anti-tumor drug with potential for the treatment of various types of hematological malignancies. 1Kanda Sangthongpitag, Haishang Wang, Pauline Yeo, Liu Xin, Evelyn Goh, Lee Sun New, Peizi Zeng, Xiaofeng Wu, Changyong Hu, Tony Ng and Kantharaj Ethirajulu. ADME attributes of SB939, a best-in-class HDAC Inhibitor, and its PK/PD correlation in the Pharmacological Species. EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics Prague Congress Centre, 2006, Nov 7–10; Prague, Czech Republic, Abstract number 166

13064 Background: Internal tandem duplications (ITDs) of fms-like tyrosine kinase 3 (FLT3) receptor are identified in 20–25% of adult AML patients associated with poor prognosis. ABT-869 is active in FLT3-AML and is currently under clinical investigaton. We hypothesize that the combination of ABT-869 with chemotherapy can improve the therapeutic index in FLT3-AML. Methods: Using Calcusyn software, the additive, synergistic or antagonistic effect of ABT-869 with concurrent or sequential cytosine arabinoside (Ara-C) or doxorubicin (Dox) was measured in MV4–11 and MOLM-14 cells. The synergistic combination sequence was further tested in a MV4–11 xenograft model in four groups (10 mice/group) including control, Ara-C, ABT-869, and combination (Ara-C first for 4 days, then daily ABT-869). Cell cycle analysis and apoptosis and signal pathway assays were performed in vitro and in vivo. Results: ABT-869 induced dose- and time-dependent apoptosis on FLT3-AML cells resulting in down regulation of p-FLT3, p-STAT5, Bcl-XL and up regulation of p53 and BID. ABT-869 caused G1-phase arrest and the removal of cells in the S- and G2/M-phase mediated by reduction of cyclins D and E. We observed significant synergistic effect with Ara-C or Dox first, followed by ABT-869, as well as in concurrent treatment with ABT-869 and Dox. Simultaneous treatment with ABT-869 and Ara-C only achieved additive effect. Conversely, we found an antagonistic effect in the sequence of pretreatment of ABT-869 followed by chemotherapy. In a MV4–11 xenograft model, all mice succumbed to leukemia in the control and Ara-C groups (median survival = 53 and 55.5 days respectively). Combination therapy gave a faster reduction of tumor volume compared to ABT-869 treatment alone (p=0.03) without recurrence of leukemia in either group by day 67. In vivo immunohistochemistry (IHC) analysis revealed ABT-869 potently inhibited VEGF and phosphor-ERK. Conclusions: ABT-869 can be given after Ara-C or Dox to act synergistically. Our study suggests that combinations of RTKIs with chemotherapy should be carefully tested prior to clinical protocol development. A clinical trial of such combination therapy in FLT3-AML is warranted. No significant financial relationships to disclose.

Most patients or donors undergoing leukapheresis (LP) for autologous or allogeneic PBSC transplantation requires multiple collections to achieve a sufficient CD34+ cell dose. LP is usually initiated when peripheral blood (PB) CD34+ reached a certain level, such as 20/μl. The aim of this retrospective analysis is to summarize our institutional experience of initiating LP at a low PB CD34+ cell level of 5/μl and investigate the merit of the practice. All patients or donors underwent LP (using Cobe Spectra or Baxter Amicus) processing 3 times the blood volume. A total of 170 LP procedures (118 autologous and 52 allogeneic) was performed in 74 adult patients or donors (> 40 kg) between Jan 2004 and May 2005. Autologous patients were mobilized with chemotherapy and G-CSF while allogeneic donors with G-CSF alone. A “good” LP product is defined as one having ≥ 1 x 106 CD34+ cells/kg so that a minimum dose of 3 x 106/kg can be achieved in 3 collections. Our result showed that each PBSC product contained 6.07 x 108 WBC/kg (median, range: 0.13–17.5) and 1.59 x 106 CD34+ cells/kg (0.14–24.9). Total CD34+ cells in PBSC products were correlated to PB CD34+ cell counts (r = 0.79, data not shown). As shown in Table 1, initiating LP at higher levels of PB CD34+ cell increased the proportion of good LP. Nevertheless, 76% of collections initiated at > 5 CD34+ cells/μl achieved good LP criterion. It is possible that the level of PB CD34+ cells was still increasing in many patients or donors after initiation of LP at the low level. However, some patients /donors still achieved minimim CD34+ cell dose when second LP day (Day 2) PB CD34+ cell level was lower than that of first LP day (Day 1) (Table 2). These patients /donors would likely NOT have been collected if higher levels of PB CD34+ cells were used as guideline for start of LP. Eleven patients /donors whose Day 2 CD34+ cell count was below that of Day 1 achieved minimum CD34+ cell dose when LP was initiated at < 20/μl. When LP was initiated at < 10/μl, four individuals achieved minimum dose. All 4 were autologous patients mobilized with chemotherapy and G-CSF (3 AML and 1 NHL). In conclusion, our results showed that initiating LP at low PB CD34+ cells can be helpful to some individuals. The guideline may be especially useful in those patients that can only be mobilized marginally. Table 1: Initiating LP at Different Levels of PB CD34+ Cells PB CD34+ Cells # LP % Good LP > 5/μl 156 75.9 > 10/μl 119 87.4 > 20/μl 65 95.4 Table 2: Patient /Donor Achieving Dose and Levels of PB CD34+ Cells PB CD34+ Cells # Patients & Donors # Patients & Donors Achieving Dose # Patients & Donors that achieved dose when Day 2 PB CD34+ cells were lower than that of Day 1 < 20/μ l 46 35 (82.6%) 11 < 10/μ l 14 10 (71.4%) 4

Objective To evaluate long-term outcomes after HDIT and transplantation of autologous CD34+ hematopoietic progenitor cells in severe SSc. Methods: Eligibility required early ( 15) together with involvement of lungs, heart or kidneys (estimated median 5 year survival Results: Of 33 pts (median mRSS = 30) follow-up includes 25 patients at one year, 19 pts at two years, 13 pts at three years and 5 pts at four years. Progression was defined as further loss of organ function or use of immunosuppressive therapy after HDIT. Ten pts died of which 5 were due to disease progression and 5 to transplant complications. Estimated 3-year overall and progression-free survivals are 79% (95% CI 65–93%) and 52% (95% CI 33–72%), respectively. Three late deaths from progression occurred at 1343, 1511 and 1801 days after HDIT. Four pts are alive with progressive disease. At 1 and 3 years after HDIT there were significant improvements in skin score and function (Table) with lung function indices overall remaining stable. Small increases in serum creatinine and decreases in the left ventricular ejection fraction were found. Five pts developed renal insufficiency and 2 required dialysis. Conclusions: HDIT appears to be a promising therapy for high-risk SSc pts but limitations include transplant toxicities and disease progression in some pts. To more clearly define the role of HDIT in severe SSc, a NIH-supported randomized multicenter study has been initiated in North America to compare HDIT against 12 doses of monthly intravenous cyclophosphamide at 750 mg/m2. Changes at 1 and 3 years after HDIT* Baseline 1 year p value 3 years p value *Values are means and mean changes from baseline. HAQ - health assessment questionnaire; DLCO- carbon monoxide diffusing capacity; FVC-forced vital capacity Skin (mRSS) 30.3 (n=33) −14.8 (n=24) p

Tyrosine Kinase Inhibitors (TKI) have significantly changed the landscape of current cancer therapy. Understanding of mechanisms of aberrant TK signaling and strategies to inhibit TKs in cancer, further promote the development of novel agents. ABT-869, a novel ATP-competitive receptor tyrosine kinase inhibitor is a potent inhibitor of members of the vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) receptor families. ABT-869 showed potent antiproliferative and apoptotic properties in vitro and in animal cancer xenograft models using tumor cell lines that were "addicted" to signaling of kinases targeted by ABT-869. When given together with chemotherapy or mTOR inhibitors, ABT-869 showed at least additive therapeutic effects. The phase I trial for ABT-869 was recently completed and it demonstrated respectable efficacy in solid tumors including lung and hepatocellular carcinoma with manageable side effects. Tumor cavitation and reduction of contrast enhancement after ABT-869 treatment supported the antiangiogenic activity. The correlative laboratory studies conducted with the trial also highlight potential biomarkers for future patient selection and treatment outcome. Parallel to the clinical development, in vitro studies on ABT-869 resistance phenotype identified novel resistance mechanism that may be applicable to other TKIs. The future therapeutic roles of ABT-869 are currently been tested in phase II trials.