ALBERT

Description: Postmenopausal women have an increased risk of cardiovascular disease, and heart disease is the leading cause of death in postmenopausal American women. Conventional hormone replacement therapy has been shown to result in an increase in thrombotic events in large prospective clinical trials including HERS I, and the recently halted Women’s Health Initiative. One possible mechanism for this observed increase is the unfavorable net effects of conjugated equine estrogens and medroxyprogesterone acetate on the hemostatic balance and inflammatory factors. An estimated 50 million American women are peri or postmenopausal and clinical therapies for menopausal symptoms remain a significant challenge in light of the known thrombotic risks. In this prospective blinded study, we examined the short-term effect of topical progesterone cream on menopausal symptom relief in 30 healthy postmenopausal women. Potential adverse effects of topical progesterone on hemostatic and inflammatory factors and cortisol levels were also examined. Subjects were randomized to first receive either 20 mg of topical progesterone cream or placebo cream for 4 weeks. Following a subsequent 4-week washout period, subjects were crossed over to either placebo cream or active drug for an additional 4-week period. In each case, progesterone and cortisol levels were monitored by salivary sampling. Baseline values, 4-week follow-up values and end-of-study values were also obtained for the Greene Climacteric Scale, total factor VII:C, factor VIIa, factor V, fibrinogen, antithrombin, PAI-1, CRP, TNFα, and IL-6. For subjects receiving 20 mg of topical progesterone cream for 4 weeks, Greene Climacteric Scale scores were consistently and significantly improved (decreased) over baseline, demonstrating significant relief from menopausal symptoms. In addition, in a subpopulation of hypercortisolemic women, topical progesterone was associated with a favorable decrease in nocturnal cortisol. Surprisingly, and in sharp contrast to earlier studies with conventional hormone replacement therapy, topical progesterone had no effect on any of the hemostatic components examined: total factor VII:C, factor VIIa, factor V, fibrinogen, antithrombin, and PAI-1 levels were all unchanged. Levels of CRP, TNFα and IL-6 also remained unchanged. From this study we conclude that administration of topical progesterone cream at a daily dose of 20 mg significantly relieves menopausal symptoms in postmenopausal women without adversely altering prothrombotic potential. Since the thrombotic complications that are typically observed with conventional hormone replacement therapy do not seem to occur with topical progesterone, this treatment should be seriously considered as an effective and safe alternative clinical therapy for women suffering from menopausal symptoms.

Description: Shear-wave velocity ( V S ) and time-averaged shear-wave velocity to 30 m depth ( V S 30 ) are the key parameters used in seismic site response modeling and earthquake engineering design. Where V S data are limited, available data are often used to develop and refine map-based proxy models of V S 30 for predicting ground-motion intensities. In this paper, we present shallow V S data from 27 sites in Puerto Rico. These data were acquired using a multimethod acquisition approach consisting of noninvasive, collocated, active-source body-wave (refraction/reflection), active-source surface wave at nine sites, and passive-source surface-wave refraction microtremor (ReMi) techniques. V S -versus-depth models are constructed and used to calculate spectral response plots for each site. Factors affecting method reliability are analyzed with respect to site-specific differences in bedrock V S and spectral response. At many but not all sites, body- and surface-wave methods generally determine similar depths to bedrock, and it is the difference in bedrock V S that influences site amplification. The predicted resonant frequencies for the majority of the sites are observed to be within a relatively narrow bandwidth of 1–3.5 Hz. For a first-order comparison of peak frequency position, predictive spectral response plots from eight sites are plotted along with seismograph instrument spectra derived from the time series of the 16 May 2010 Puerto Rico earthquake. We show how a multimethod acquisition approach using collocated arrays compliments and corroborates V S results, thus adding confidence that reliable site characterization information has been obtained.

Description: We characterize shallow subsurface faulting and basin structure along a transect through heavily urbanized Reno, Nevada, with high-resolution seismic reflection imaging. The 6.8 km of P -wave data image the subsurface to approximately 800 m depth and delineate two subbasins and basin uplift that are consistent with structure previously inferred from gravity modeling in this region of the northern Walker Lane. We interpret two primary faults that bound the uplift and deform Quaternary deposits. The dip of Quaternary and Tertiary strata in the western subbasin increases with greater depth to the east, suggesting recurrent fault motion across the westernmost of these faults. Deformation in the Quaternary section of the western subbasin is likely evidence of extensional growth folding at the edge of the Truckee River through Reno. This deformation is north of, and on trend with, previously mapped Quaternary fault strands of the Mt. Rose fault zone. In addition to corroborating the existence of previously inferred intrabasin structure, these data provide evidence for an active extensional Quaternary fault at a previously unknown location within the Truckee Meadows basin that furthers our understanding of both the seismotectonic framework and earthquake hazards in this urbanized region.

Description: We conducted active and passive seismic imaging investigations along a 5.6-km-long, east–west transect ending at the mapped trace of the Wasatch fault in southern Utah Valley. Using two-dimensional (2D) P-wave seismic reflection data, we imaged basin deformation and faulting to a depth of 1.4 km and developed a detailed interval velocity model for prestack depth migration and 2D ground-motion simulations. Passive-source microtremor data acquired at two sites along the seismic reflection transect resolve S-wave velocities of approximately 200??m/s at the surface to about 900??m/s at 160 m depth and confirm a substantial thickening of low-velocity material westward into the valley. From the P-wave reflection profile, we interpret shallow (100–600 m) bedrock deformation extending from the surface trace of the Wasatch fault to roughly 1.5 km west into the valley. The bedrock deformation is caused by multiple interpreted fault splays displacing fault blocks downward to the west of the range front. Further west in the valley, the P-wave data reveal subhorizontal horizons from approximately 90 to 900 m depth that vary in thickness and whose dip increases with depth eastward toward the Wasatch fault. Another inferred fault about 4 km west of the mapped Wasatch fault displaces horizons within the valley to as shallow as 100 m depth. The overall deformational pattern imaged in our data is consistent with the Wasatch fault migrating eastward through time and with the abandonment of earlier synextensional faults, as part of the evolution of an inferred 20-km-wide half-graben structure within Utah Valley. Finite-difference 2D modeling suggests the imaged subsurface basin geometry can cause fourfold variation in peak ground velocity over distances of 300 m.

Description: The postorogenic collapse of the early Paleozoic Caledonian orogeny is well documented; however, several different plate tectonic models exist for the convergent phase involving closure of the Iapetus Ocean and the collision of Laurentia and Baltica. Receiver function analysis of 11 broadband seismometers along a 270 km transect in the East Greenland Caledonides reveals the existence of an east-dipping high velocity slab. Numerical modeling demonstrates that relict subducted and eclogitized crust is a plausible explanation. Thus, eastward subduction preceded subsequent west-dipping subduction during the formation of the East Greenland and Scandinavian Caledonides. This is a key constraint for understanding the Caledonian and continental margin evolution in the North Atlantic realm.

Description: We ran finite-difference earthquake simulations for great subduction zone earthquakes in Cascadia to model the effects of source and path heterogeneity for the purpose of improving strong-motion predictions. We developed a rupture model for large subduction zone earthquakes based on a k –2 slip spectrum and scale-dependent rise times by representing the slip distribution as the sum of normal modes of a vibrating membrane. Finite source and path effects were important in determining the distribution of strong motions through the locations of the hypocenter, subevents, and crustal structures like sedimentary basins. Some regions in Cascadia appear to be at greater risk than others during an event due to the geometry of the Cascadia fault zone relative to the coast and populated regions. The southern Oregon coast appears to have increased risk because it is closer to the locked zone of the Cascadia fault than other coastal areas and is also in the path of directivity amplification from any rupture propagating north to south in that part of the subduction zone, and the basins in the Puget Sound area are efficiently amplified by both north and south propagating ruptures off the coast of western Washington. We find that the median spectral accelerations at 5 s period from the simulations are similar to that of the Zhao et al. (2006) ground-motion prediction equation, although our simulations predict higher amplitudes near the region of greatest slip and in the sedimentary basins, such as the Seattle basin.

Description: Introduction: Interphase FISH on CD138-selected bone marrow cells enables genetic risk stratification in newly diagnosed multiple myeloma (MM), however as MM remains incurable, most centres still treat newly diagnosed MM uniformly, utilising the most active regimens available. At relapse an increasing choice of regimens, coupled with co-morbidities and treatment-emergent toxicities, means no uniform approach is possible. Instead, therapy is tailored to disease and patient related risk factors. In this setting, FISH testing may be particularly useful if not done at diagnosis and to identify progression events that may alter prognosis. Aim: To evaluate the outcome of FISH analysis in consecutive patients with relapsed MM undertaken at our centre: success rate, frequency of abnormalities, incidence of progression events and correlation of FISH abnormalities with treatment outcomes. Methods: FISH analysis was performed on 192 samples from 154 relapsed patients (2012-13). Plasma cells were selected using magnetic CD138 MicroBeads and interphase FISH carried out using probes as recommended by the EMN (Ross et al, 2012). If patients had no prior results, a full FISH MM panel was performed, using probes for t(4;14), t(14;16), t(11;14), deletion 17p (17p-), Chr 1 abnormalities (1p-/1q+) and deletion 13q (13q-). If patients had been previously tested for an IgH translocation (Tx), a progression event panel was used: 1p-/1q+, 17p- and 13q-. Patients underwent FISH testing prior to starting the next line of therapy. Results: 79% of samples were successfully analysed, with analysis limited in 16% and failed in 5%. Common reasons for failure were poor quality/aged slides, insufficient material and poor hybridisation. 17% of patients had no cytogenetic abnormality. The most common abnormality was 13q- (43.1%), followed by 1q+ (41.4%), t(11;14) (18.3%), t(4;14) (12.4%), 17p- (12.0%) 1p- (8.9%), and t(14;16) (5.6%) Progression events were more common in t(14;16) and t(4;14) groups. All patients with t(14;16) and 82% with t(4;14) had an additional genetic lesion. Only 21% of patients with t(11;14) and 54% with no IgH Tx had an additional event. 80 patients (51.3%) had prior FISH results and 13 (16.3%) had developed a new abnormality on the later test. In 9 cases the progression event was 17p-, in 2 it was 1q+ and 2 cases developed 17p- and 1q+. The patients developing 1q+ were previously standard risk, so repeat testing altered risk group. Acquisition of 17p- indicates especially poor outcome, thus in all 13 cases repeat FISH analysis altered risk. Among patients with progression events none harboured t(11;14), 8 (64%) had no IgH Tx, 3 had t(14;16) and 2 had t(4;14). FISH results were correlated with clinical outcome. Patients were stratified as having high risk genetics [t(4;14), t(14,16), 17p- in ≥50% cells, 1p-/1q+] or standard risk [t(11;14), normal cytogenetics]. 63 (41%) patients were high risk, 83 (54%) standard risk, with no information available for 8 (5%). Both groups had received a median of 2 prior lines of therapy. Response rates (≥PR) to the next line of therapy were similar (60.4% standard risk vs 56.0% high risk). PFS from time of FISH was significantly longer in the standard risk group (9.8 months vs 5.9, p

Description: Abstract 2187 Plasma cells, the terminal effectors of the B-cell lineage include both short- and long-lived cells. The latter persist for extended periods in the absence of cell division, supported in niche environments. No model system has successfully recapitulated the function of the niche to allow the in vitro generation of long-lived plasma cells. This limits investigation into the factors controlling and targeting plasma cell populations. Here we describe the generation of mature human plasma cells with extended lifespan from peripheral blood B-cells. Cell division accompanies phenotypic maturation between plasmablasts and plasma cells. These cells then persist in the absence of cell division, remaining functional and viable in extended culture, currently limited solely by elective termination. Extended survival is accompanied by maturation to a phenotype consistent with human bone marrow plasma cells. By establishing a set of conditions sufficient to allow the development and persistence of mature human plasma cells in vitro, we recapitulate the essential function of the plasma cell niche. We definitively link phenotypic maturation to lifespan and provide the first platform with which to explore and manipulate the full trajectory of human plasma cell differentiation. Disclosures: No relevant conflicts of interest to declare.

Description: Background: Talabostat (PT-100), an orally available inhibitor of dipeptidyl peptidases, is in Phase 2 studies for B-cell malignancies and solid tumors. Talabostat increases production of cytokines and chemokines in lymph nodes and spleen, stimulating both adaptive and innate immune responses (Adams S, Cancer Research, 2004;64:5471). Talabostat may thus enhance the antibody-dependent cytotoxicity of MAbs such as rituximab. Methods: This is a Phase 1 study to evaluate the safety and activity of talabostat and rituximab in patients with indolent NHL who did not respond or progressed following rituximab. Rituximab 375mg/m2 was administered weekly x 4. Total daily doses of talabostat 400μg (n=6), 600μg (n=3), or 800μg (n=6) were administered BID for 6 days following each dose of rituximab. Cytokines and chemokines were assessed pre-, 2, and 6 hours post-talabostat on Days 1, 6, 13, 20, and 27. Flow cytometry was performed at baseline and Day 28. Clinical and laboratory evaluations were performed at specified times. Adverse events (AEs) were graded per NCI-CTC and recorded throughout the study. Disease assessments were performed on Days 28 and 84. Results: 11 men and 4 women aged 48–82 with NHL (n=10) or SLL/CLL (n=5) have been treated. 9 patients completed the 28-day study: 4 at 400μg, 1 at 600μg, and 4 at 800μg. Enrollment continues at 400μg/day. The most frequent AEs have been edema (67%), nausea (47%), dizziness (40%), hypotension (33%), fatigue (33%), vomiting (33%), constipation (33%), thrombocytopenia (27%), and weight gain (27%). Grade 3 toxicities include: dizziness, myopathy (400μg/day), and 2 events of thrombocytopenia (600μg/day). Grade 3 peripheral edema, myalgia, dehydration, electrolyte imbalance, hypereosinophilia, elevated CPK (primarily CK-MM), and rhabdomyolysis were seen in 2/6 patients at 800μg/day; these events were DLTs. One partial response (PR) lasting 7 months was seen in one patient (800μg/day). A PR was seen in a second patient at 800μg/day but did not meet the strict NCI-WG criteria for response. Elevations in cytokines 〉ULN were reported across all doses following talabostat: G-CSF (13/15), IL-1β (10/15), IL-2 (7/15), IL-6 (8/15), IL-8 (8/15), IL-10 (11/15), TNF-α (11/15), and IFN-γ (3/15). At Day 28 or early termination, CD20 was decreased in most (12/15) patients. Increases were seen in the percentage of CD3 (12/15), CD3/4 (11/15) and CD3/8 (9/15). In all 5 patients with SLL/CLL, CD5+/CD20+ was

Description: Background: T cells can be activated and expanded ex vivo using the Xcellerate™ Process, in which peripheral blood mononuclear cells (PBMC) are incubated with anti-CD3 and anti-CD28 antibody-coated magnetic beads (Xcyte™-Dynabeads®). In an ongoing trial of Xcellerated T Cells in subjects with chronic lymphocytic leukemia, marked and sustained reductions in lymphadenopathy and splenomegaly were observed (Wierda et al., ASCO 2004). Increases in neutrophil, platelet and NK cell counts were also documented. This study is designed to determine if similar effects can be observed in subjects with indolent non-Hodgkin’s lymphoma (NHL). Methods: Subjects must have indolent NHL (follicular, small lymphocytic, marginal zone, or mantle cell lymphoma), have relapsed or refractory disease, and have received at least 1 but not more than 4 prior treatment regimens. PBMC are collected by leukapheresis for the Xcellerate Process, and subjects subsequently receive two infusions of 20–60 x 109 Xcellerated T Cells separated by 6–8 weeks. Approximately 40 subjects will be treated. Results: Seven subjects have been enrolled and Xcellerated T Cells have been manufactured in 5 subjects to date. T cells expanded 181.8 ± 88.5 fold and the final product was 〉99.0 ± 0.0% T cells (mean + SD). One subject with small lymphocytic lymphoma has been treated with two infusions of 38.6 x 109 Xcellerated T Cells. There have been no serious adverse events to date. Following the first treatment, the lymphocyte count increased from 1.8 x 109/L to 2.9 x 109/L on Day 28. The neutrophil count also increased from 2.9 x 109/L to 5.5 x 109/L six weeks following infusion. The subject had a significant reduction in cervical lymphadenopathy and a slight decrease in bulky mesenteric lymphadenopathy six weeks following the first infusion. Conclusions: Xcellerated T Cells can be manufactured in subjects with indolent NHL. Treatment leads to significant increases in T cell and neutrophil counts. Preliminary data suggest a reduction in peripheral lymphadenopathy. Data on additional subjects will be presented.