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  • American Society of Hematology  (35,108)
  • Hindawi
  • Copernicus
  • Krefeld : Geologischer Dienst Nordhein-Westfalen
  • Irkutsk : Ross. Akad. Nauk, Sibirskoe Otd., Inst. Zemnoj Kory
  • 2005-2009  (53,269)
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  • 1
    Publication Date: 2009
    Description: 〈b〉Paleomagnetic determination of paleolatitude and rotation of Bering Island (Komandorsky Islands) Russia: comparison with rotations in the Aleutian Islands and Kamchatka〈/b〉〈br〉 P. S. Minyuk and D. B. Stone〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 329-348, https://doi.org/10.5194/smsps-4-329-2009, 2009〈br〉 A paleomagnetic study was carried out on Paleogene sedimentary rocks from Bering Island, Komandorsky islands, located at the far western end of the Aleutian Island Arc. The age of these sediments has been debated at length, but the combination of magnetostratigraphy with the fossil record indicates that the base of the section is of early Eocene (approximately 55 Ma) and the top latest Eocene age. Paleomagnetic data were obtained from 260 samples from 60 individual bedding units. The combined data show a clockwise rotation 〈i〉R〈/i〉=26.3°±8.5°, 〈i〉F〈/i〉=8.1°±2.5° with respect to the North American Plate and 〈i〉R〈/i〉=38°±8.8°, 〈i〉F〈/i〉=8.7°±2.7° with respect to the Eurasian Plate. They also show a shallowing of the inclination which yields a paleolatitude of 53°, 12° south of its expected latitude. The shallowing may have a component due to compaction, but the wide variation in sampled lithologies, combined with internal consistency of the data set, would argue against the shallowing being significant. To compare these data with other Aleutian Arc data we compiled a comprehensive survey of all available data sets. Out of these we selected four islands for which the data passed basic reliability criteria, namely Umnak, Amlia, Amchitka and Medny islands. All four showed significant clockwise rotation with respect to both North American and Eurasian polar wander paths. Several mechanisms can generate the observed rotation, ranging from block rotation driven by oblique relative motion of the Pacific plate, through lateral transport along the curve of the arc, to whole-arc rotation about its eastern end. The distribution and age spread of the rotation data are insufficient to discriminate between mechanisms, but it seems likely that different mechanism may have operated at different times and in different locations.
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  • 2
    Publication Date: 2009
    Description: 〈b〉Paleomagnetism of the Cretaceous rocks from Cape Kronotskiy, East Kamchatka and reconstruction of terrane trajectories in the NE Pacific area〈/b〉〈br〉 W. Harbert, N. V. Tsukanov, D. V. Alexeiev, C. Gaedicke, R. Freitag, B. V. Baranov, S. G. Skolotnev, W. Kramer, and W. Seifert〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 313-327, https://doi.org/10.5194/smsps-4-313-2009, 2009〈br〉 The Kamchatka Peninsula of northeastern Russia is located along the northwestern margin of the Bering Sea and consists of zones of complexly deformed accreted terranes. Paleomagnetic samples were collected for study from a Late Cretaceous aged locality at Cape Kronotskiy (λ=54°44.8´ N, φ=162°1.29´ E). Two components of magnetization were observed. During stepwise thermal demagnetization, the B-magnetic component was observed up to 600°C having a direction and associated uncertainty in stratigraphic coordinates of 〈i〉D〈sub〉s〈/sub〉〈/i〉=300.7°, 〈i〉I〈sub〉s〈/sub〉〈/i〉=48.7°, α〈sub〉95〈/sub〉=10.9°, k-value=11.8, n=17. The B component paleolatitude calculated from the Fisher mean in stratigraphic coordinates and associated statistics are λ〈sub〉obs〈/sub〉=30.4° N or S, λ〈sub〉95〈/sub〉=8.9°, n=17 (sites), k-value=11. Our overall study paleolatitude result is similar to a previously reported paleomagnetic study completed within this unit. Terrane trajectories calculated using the finite rotation poles of Engebretson et al. (1985), which are corrected for either Pacific-hotspot drift or True Polar Wander hotspot-spin axis relative motion, show that the sampled unit represents a far traveled tectonostratigraphic terrane and support a model in which accretion (docking) events of this composite or superterrane with the North America plate occur at approximately 40 Ma.
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  • 3
    Publication Date: 2009
    Description: 〈b〉Comparison of Cretaceous granitoids of the Chaun tectonic zone to those of the Taigonos Peninsula, NE Asia: rock chemistry, composition of rock forming minerals, and conditions of formation〈/b〉〈br〉 P. L. Tikhomirov, M. V. Luchitskaya, and I. R. Kravchenko-Berezhnoy〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 289-311, https://doi.org/10.5194/smsps-4-289-2009, 2009〈br〉 The Cretaceous granitoid complexes of the Eastern Taigonos and the Prybrezhny Taigonos belts (southern part of the Taigonos Peninsula), Tanyurer pluton of the Okhotsk-Chukotka volcanic belt, and the Peekiney, Moltykan, and Telekay plutons of the Chaun tectonic zone are discussed in relation to their structural position, petrography, rock and mineral chemistry and physicochemical conditions of melt crystallization. These granitoid plutons were generated through melting of a compositionally heterogeneous crustal source, with direct contribution from mafic melts produced in the mantle wedge above active or extinct Benioff zones. Variations of the trace-element composition of granitoids are controlled to a greater extent by local compositional peculiarities of the source regions than by the geodynamic regime as such. The final crystallization of these plutons occurred at comparatively shallow depths, between 1–2 and 6–7 km, in a temperature interval of 700–770°C. The depth of emplacement of the bodies decreases with increasing distance from the areas with oceanic and transitional type crust, as does the degree of incompatible element enrichment of the mantle and crustal sources of melts. Variations in fo〈sub〉2〈/sub〉 values at the late stages of crystallization of the plutons reach 3–4 orders of magnitude, exceeding the limits of the quartz-fayalite-magnetite (QFM) and nickel-nickel oxide (NNO) buffer equilibria, which likely results from local variations of the source composition.
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  • 4
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    Copernicus
    In: eEarth
    Publication Date: 2009
    Description: 〈b〉Thermogeodynamic manifestations in the Caucasus and their genesis〈/b〉〈br〉 G. E. Gugunava, J. K. Kiria, and T. B. Bochorishvili〈br〉 eEarth Discuss., 4, 77-89, doi:10.5194/eed-4-77-2009, 2009〈br〉 〈b〉Publication in eE not foreseen〈/b〉 (discussion: closed, 2 comments)〈br〉 In the work two aspects of thermal character are considered: first of all this is the connection of subduction phenomena with thermal life of the Caucasus on the basis of over interpreted data of magnetotelluric sounding, and secondly, origin of thermostressed condition of the Caucasus and its geological aspects which is manifested in the following: 〈br〉〈br〉 1. in the zones of anomalous thermodisplacements thermofaults should occur (Le Pishon et al., 1977). These thermofaults are in good correlation with deep faults which are distinguished by geological and seismic methods, these thermofaults may be earthquake sources (Spitak, Racha, etc. earthquakes), also may be channels through which magma derivates (giving mineral deposits) may penetrate on surface (Gugunava and Gijeishvili, 1989); 〈br〉〈br〉 2. in the body of sedimentary complex thermostressed seals and seal failures occur, which are apparently traps for oil-gas fluids. Good correlation of thermodense anomalies with oil deposits of the Caucasus is shown (Alexidze et al., 1985; Gugunava, 1980). 〈br〉〈br〉 Everything above mentioned was carried out within frames of stationary thermal model which did not allow us to reveal time characteristics of interconnection of geological medium and thermal field. 〈br〉〈br〉 Now investigations are being carried out within the frames of stationary thermal model and its interconnection with geological environment.
    Print ISSN: 1815-381X
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  • 5
    Publication Date: 2009
    Description: 〈b〉Thermogeodynamic manifestations in the Caucasus and their genesis〈/b〉〈br〉 G. E. Gugunava, J. K. Kiria, and T. B. Bochorishvili〈br〉 eEarth Discuss., 4, 77-89, doi:10.5194/eed-4-77-2009, 2009〈br〉 〈b〉Publication in eE not foreseen〈/b〉 (discussion: closed, 2 comments)〈br〉 In the work two aspects of thermal character are considered: first of all this is the connection of subduction phenomena with thermal life of the Caucasus on the basis of over interpreted data of magnetotelluric sounding, and secondly, origin of thermostressed condition of the Caucasus and its geological aspects which is manifested in the following: 〈br〉〈br〉 1. in the zones of anomalous thermodisplacements thermofaults should occur (Le Pishon et al., 1977). These thermofaults are in good correlation with deep faults which are distinguished by geological and seismic methods, these thermofaults may be earthquake sources (Spitak, Racha, etc. earthquakes), also may be channels through which magma derivates (giving mineral deposits) may penetrate on surface (Gugunava and Gijeishvili, 1989); 〈br〉〈br〉 2. in the body of sedimentary complex thermostressed seals and seal failures occur, which are apparently traps for oil-gas fluids. Good correlation of thermodense anomalies with oil deposits of the Caucasus is shown (Alexidze et al., 1985; Gugunava, 1980). 〈br〉〈br〉 Everything above mentioned was carried out within frames of stationary thermal model which did not allow us to reveal time characteristics of interconnection of geological medium and thermal field. 〈br〉〈br〉 Now investigations are being carried out within the frames of stationary thermal model and its interconnection with geological environment.
    Print ISSN: 1815-3836
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  • 6
    Publication Date: 2009
    Description: 〈b〉Holocene evolution and sedimentation rate of Alikes Lagoon, Zakynthos island, Western Greece: preliminary results〈/b〉〈br〉 P. Avramidis and N. Kontopoulos〈br〉 eEarth, 4, 23-29, doi:10.5194/ee-4-23-2009, 2009〈br〉 In the present study we present preliminary results from Alikes lagoon in Zakynthos island, an area that is one of the most seismically active regions of Greece. In order to estimate – interpret the Holocene evolution of the area and to reconstruct the palaeoenvironmental changes, we based on data derived from a 21 m sediment core. Sediment types, structure, colour, as well as contact depths and bed characteristics were recorded in the field. Standarised sedimentological analysis was carried out, on 46 samples including grain size analysis, calculation of moment measures, and micro- and molluscan fossils of 17 selected samples. Moreover, radiocarbon age determinations have been made on individual 〈i〉Cardium〈/i〉 shells from two horizons and whole – core Magnetic Susceptibility (MS) measurements were taken. The interpretation of depositional environments suggests a coastal environment (restricted-shallow) with reduced salinity such as a lagoon margin and in a tidal flat and/or marsh particularly. The maximum age of the studied sediments is about 8500 BP. The rate of sedimentation between 8280 BP while 5590 BP was 5.3 mm/yr and between 5590 BP and modern times is on the order of 1.03 mm/yr. These sedimentation rates results are similar to other coastal areas of western Greece.
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  • 7
    Publication Date: 2009
    Description: 〈b〉Morphology of the pore space in claystones – evidence from BIB/FIB ion beam sectioning and cryo-SEM observations〈/b〉〈br〉 G. Desbois, J. L. Urai, and P. A. Kukla〈br〉 eEarth, 4, 15-22, doi:10.5194/ee-4-15-2009, 2009〈br〉 The morphology of pore space has a strong effect on mechanical and transport properties of mudrocks and clay-rich fault gouge, but its characterization has been mostly indirect. We report on a study of Boom clay from a proposed disposal site of radioactive waste (Mol site, Belgium) using high resolution SEM at cryogenic temperature, with ion beam cross-sectioning to prepare smooth, damage free surfaces. Pores commonly have crack-like tips, preferred orientation parallel to bedding and power law size distribution. We define a number of pore types depending on shape and location in the microstructure: large jagged pores in strain shadows of clastic grains, high aspect ratio pores between similarly oriented phyllosilicate grains and crescent-shaped pores in saddle reefs of folded phyllosilicates. 3-D reconstruction by serial cross-sectioning shows 3-D connectivity of the pore space. These findings offer a new insight into the morphology of pores down to nano-scale in comparison to traditional pore size distributions calculated from mercury Injection experiments, explain slaking of clays by successive wetting and drying and provide the basis for microstructure-based models of transport in clays.
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  • 8
    Publication Date: 2009
    Description: 〈b〉Holocene evolution and sedimentation rate of Alikes Lagoon, Zakynthos island, Western Greece: preliminary results〈/b〉〈br〉 P. Avramidis and N. Kontopoulos〈br〉 eEarth, 4, 23-29, doi:10.5194/ee-4-23-2009, 2009〈br〉 In the present study we present preliminary results from Alikes lagoon in Zakynthos island, an area that is one of the most seismically active regions of Greece. In order to estimate – interpret the Holocene evolution of the area and to reconstruct the palaeoenvironmental changes, we based on data derived from a 21 m sediment core. Sediment types, structure, colour, as well as contact depths and bed characteristics were recorded in the field. Standarised sedimentological analysis was carried out, on 46 samples including grain size analysis, calculation of moment measures, and micro- and molluscan fossils of 17 selected samples. Moreover, radiocarbon age determinations have been made on individual 〈i〉Cardium〈/i〉 shells from two horizons and whole – core Magnetic Susceptibility (MS) measurements were taken. The interpretation of depositional environments suggests a coastal environment (restricted-shallow) with reduced salinity such as a lagoon margin and in a tidal flat and/or marsh particularly. The maximum age of the studied sediments is about 8500 BP. The rate of sedimentation between 8280 BP while 5590 BP was 5.3 mm/yr and between 5590 BP and modern times is on the order of 1.03 mm/yr. These sedimentation rates results are similar to other coastal areas of western Greece.
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  • 9
    Publication Date: 2009
    Description: 〈b〉Map – geographic locations related to the manuscript sequence〈/b〉〈br〉 〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 3-3, https://doi.org/10.5194/smsps-4-3-2009, 2009〈br〉
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  • 10
    Publication Date: 2009
    Description: 〈b〉Age and paleomagnetism of the Okhotsk-Chukotka Volcanic Belt (OCVB) near Lake El'gygytgyn, Chukotka, Russia〈/b〉〈br〉 D. B. Stone, P. W. Layer, and M. I. Raikevich〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 243-260, https://doi.org/10.5194/smsps-4-243-2009, 2009〈br〉 Paleomagnetic results from the upper two thirds of the whole section of the Okhotsk-Chukotka Volcanic Belt (OCVB) volcanics exposed in the area around Lake El'gygytgyn, Chukotka yield stable, consistent magnetic vectors and well-preserved reversed directions. The magnetostratigraphy and 〈sup〉40〈/sup〉Ar/〈sup〉39〈/sup〉Ar geochronologic data reported here indicate that the sampled OCVB volcanics were erupted between about 90 and 67 Ma, and show no significant change in the apparent pole position over that time. The OCVB extends from northeast China, across Northeast Russia to the Bering Straight. This belt is made up of both extrusive and intrusive rocks, with the extrusive rocks and their associated sediments being dominant. The whole belt important in interpreting the paleogeography of the region because it overlies many of the accreted terranes of Northeast Russia. Most importantly, it overlies parts of the Chukotka-Alaska block which is thought to have moved out of the Arctic Ocean region, as well as terranes accreted from the south. These latter terranes have been rafted northwards on the paleo-plates of the Pacific, implying that the present relative paleogeography of all of the terranes overlain by the OCVB were essentially in place by 67 Ma, and possibly as early as 90 Ma. However, comparing our paleomagnetic pole position for the OCVB with those for North America and Eurasia (a proxy for Siberia) shows a statistically significant displacement of the OCVB pole to the south west. This implies that not only the OCVB, but the underlying terranes of northeast Russia, experienced southerly displacement with respect to the Siberian and North American platforms since the Late Cretaceous.
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  • 11
    Publication Date: 2009
    Description: 〈b〉Tectonic reconstruction of Uda-Murgal arc and the Late Jurassic and Early Cretaceous convergent margin of Northeast Asia–Northwest Pacific〈/b〉〈br〉 S. D. Sokolov, G. Ye. Bondarenko, A. K. Khudoley, O. L. Morozov, M. V. Luchitskaya, M. I. Tuchkova, and P. W. Layer〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 273-288, https://doi.org/10.5194/smsps-4-273-2009, 2009〈br〉 A long tectonic zone composed of Upper Jurassic to Lower Cretaceous volcanic and sedimentary rocks is recognized along the Asian continent margin from the Mongol-Okhotsk fold and thrust belt on the south to the Chukotka Peninsula on the north. This belt represents the Uda-Murgal arc, which was developed along the convergent margin between Northeast Asia and Northwest Meso-Pacific. Several segments are identified in this arc based upon the volcanic and sedimentary rock assemblages, their respective compositions and basement structures. The southern and central parts of the Uda-Murgal arc were a continental margin belt with heterogeneous basement represented by metamorphic rocks of the Siberian craton, the Verkhoyansk terrigenous complex of Siberian passive margin and the Koni-Taigonos Late Paleozoic to Early Mesozoic island arc with accreted oceanic terranes. At the present day latitude of the Pekulney and Chukotka segments there was an ensimatic island arc with relicts of the South Anyui oceanic basin in a backarc basin. Accretionary prisms of the Uda-Murgal arc and accreted terranes contain fragments of Permian, Triassic to Jurassic and Jurassic to Cretaceous (Tithonian–Valanginian) oceanic crust and Jurassic ensimatic island arcs. Paleomagnetic and faunal data show significant displacement of these oceanic complexes and the terranes of the Taigonos Peninsula were originally parts of the Izanagi oceanic plate.
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  • 12
    Publication Date: 2009
    Description: 〈b〉Provenance analysis and tectonic setting of the Triassic clastic deposits in Western Chukotka, Northeast Russia〈/b〉〈br〉 M. I. Tuchkova, S. Sokolov, and I. R. Kravchenko-Berezhnoy〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 177-200, https://doi.org/10.5194/smsps-4-177-2009, 2009〈br〉 The study area is part of the Anyui subterrane of the Chukotka microplate, a key element in the evolution of the Amerasia Basin, located in Western Chukotka, Northeast Russia. The subterrane contains variably deformed, folded and cleaved rhythmic Triassic terrigenous deposits which represent the youngest stage of widespread marine deposition which form three different complexes: Lower-Middle Triassic, Upper Triassic (Carnian) and Upper Triassic (Norian). All of the complexes are represented by rhythmic interbeds of sandstone, siltstone and mudstone. Macrofaunas are not numerous, and in some cases deposits are dated by analogy to, or by their relationship with, other units dated with macrofaunas. The deposits are composed of pelagic sediments, low-density flows, high-density flows, and shelf facies associations suggesting that sedimentation was controlled by deltaic progradation on a continental shelf and subsequent submarine fan sedimentation at the base of the continental slope. Petrographic study of the mineral composition indicates that the sandstones are lithic arenites. Although the Triassic sandstones appear similar in outcrop and by classification, the constituent rock fragments are of diverse lithologies, and change in composition from lower grade metamorphic rocks in the Lower-Middle Triassic to higher grade metamorphic rocks in the Upper Triassic. This change suggests that the Triassic deposits represent an unroofing sequence as the source of the clastic material came from more deeply buried rocks with time.
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  • 13
    Publication Date: 2009
    Description: 〈b〉Multi-phase tectonic structures in the collision zone of the Kolyma-Omolon microcontinent and the eastern margin of the North Asian craton, Northeastern Russia〈/b〉〈br〉 A. V. Prokopiev and V. S. Oxman〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 65-70, https://doi.org/10.5194/smsps-4-65-2009, 2009〈br〉 The sequence of formation of structures is established in the zone of junction of the eastern margin of the North Asian craton and the northeastern flank of the Kolyma-Omolon microcontinent, in the area of bend of the Kolyma structural loop. Detailed structural studies revealed two phases in the formation of Mesozoic structures – an early thrust phase and a late strike-slip phase. Structures formed during each of the phases are described. Thrust structures are represented by the Setakchan nappe on which the minimum amount of horizontal displacement is estimated at 13–15 km. Later superposed left-lateral strike-slip faults have a north strike. Formation of these latter structures occurred during the second phase of collision between the Kolyma-Omolon microcontinent and the eastern margin of the North Asian craton.
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  • 14
    Publication Date: 2009
    Description: 〈b〉Geology of the Shelves surrounding the New Siberian Islands, Russian Arctic〈/b〉〈br〉 D. Franke and K. Hinz〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 35-44, https://doi.org/10.5194/smsps-4-35-2009, 2009〈br〉 A total of 11 700 km of multichannel seismic reflection data were acquired during recent reconnaissance surveys of the wide, shallow shelves of the Laptev and western East Siberian Seas around the New Siberian Islands. To the north of the Laptev Sea, the Gakkel Ridge, an active mid-ocean ridge which separates the North American and Eurasian Plates, meets abruptly the steep slope of the continental shelf. Extension has affected the Laptev Shelf since at least the Early Tertiary and has resulted in the formation of three major, generally north-south trending rift basins: the Ust' Lena Rift, the Anisin Basin, and the New Siberian Basin. Our data indicate that the rift basins on the Laptev Shelf are not continuous with those on the East Siberian Shelf. The latter shelf can best be described as an epicontinental platform which has undergone continuous subsidence since the Late Cretaceous. The greatest subsidence occurred in the NE, manifested by a major depocentre filled with inferred (?)Late Cretaceous to Tertiary sediments up to 5 s (twt) thick. On the basis of deep reflection data we revise and adjust Mesozoic domain boundaries around the New Siberian Islands.
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  • 15
    Publication Date: 2009
    Description: 〈b〉A seismic swarm near Neshkan, Chukotka, northeastern Russia, and implications for the boundary of the Bering plate〈/b〉〈br〉 K. G. Mackey, K. Fujita, B. M. Sedov, L. V. Gounbina, and S. Kurtkin〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 261-271, https://doi.org/10.5194/smsps-4-261-2009, 2009〈br〉 A seismic swarm lasting over two years occurred near the village of Neshkan, Chukotka, far northeastern Russia, beginning with a 〈i〉M〈sub〉L〈/sub〉〈/i〉, 4.2 (4.1 〈i〉m〈sub〉b〈/sub〉〈/i〉) earthquake on 9 December 2002. The swarm generated considerable anxiety among the local populace and authorities. Two temporary seismic stations were deployed during the latter part of September 2003, and recorded over 150 events with magnitudes up to 3.0. Eighteen locatable events appear to form a northeast striking linear trend, parallel to other seismicity trends in Chukotka, extending 20 km to the southwest from the village. We interpret this trend as a previously unknown fault. A small pond located ~1 km west of the village drained and some apparent surface deformation was observed over the course of the earthquake sequence. Relocation of historic seismicity in the region shows that a magnitude 6.0 in 1996 may have ruptured an adjacent fault segment. Other, less well located but larger, teleseismic events earlier in the 20th century may also have occurred on or near this fault. The seismicity is consistent a proposed region of transtension along the northern boundary of a Bering plate.
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  • 16
    Publication Date: 2009
    Description: 〈b〉South Anyui suture: tectono-stratigraphy, deformations, and principal tectonic events〈/b〉〈br〉 S. D. Sokolov, G. Ye. Bondarenko, P. W. Layer, and I. R. Kravchenko-Berezhnoy〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 201-221, https://doi.org/10.5194/smsps-4-201-2009, 2009〈br〉 Geochronologic and structural data from the terranes of the South Anyui suture zone record a protracted deformational history before, during and after an Early Cretaceous collision of the passive margin of the Chukotka-Arctic Alaska continental block with the active continental margin of the North Asian continent. Preceding this collision, the island arc complexes of the Yarakvaam terrane on the northern margin of the North Asian craton record Early Carboniferous to Neocomian ages in ophiolite, sedimentary, and volcanic rocks. Triassic to Jurassic amphibolites constrain the timing of subduction and intraoceanic deformation along this margin. The protracted (Neocomian to Aptian) collision of the Chukotka passive margin with the North Asian continent is preserved in a range of structural styles including first north verging folding, then south verging folding, and finally late collisional dextral strike slip motions which likely record a change from orthogonal collision to oblique collision. Due to this collision, the southern passive margin of Chukotka was overthrust by tectonic nappes composed of tectono-stratigraphic complexes of the South Anyui terrane. Greenschists with ages of 115–119 Ma are related to the last stages of this collision. The postcollisional orogenic stage (Albian to Cenomanian) is characterized by sinistral strike slip faults and an extensional environment.
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  • 17
    Publication Date: 2009
    Description: 〈b〉Deformation of the Northwestern Okhotsk Plate: How is it happening?〈/b〉〈br〉 D. Hindle, K. Fujita, and K. Mackey〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 147-156, https://doi.org/10.5194/smsps-4-147-2009, 2009〈br〉 The Eurasia (EU) – North America (NA) plate boundary zone across Northeast Asia still presents many open questions within the plate tectonic paradigm. Constraining the geometry and number of plates or microplates present in the plate boundary zone is especially difficult because of the location of the EU-NA euler pole close to or even upon the EU-NA boundary. One of the major challenges remains the geometry of the Okhotsk plate (OK). whose northwestern portion terminates on the EU-OK-NA triple junction and is thus caught and compressed between converging EU and NA. We suggest that this leads to a coherent and understandable large scale deformation pattern of mostly northwest-southeast trending strike-slip faults which split Northwest OK into several extruding slivers. When the fault geometry is analysed together with space geodetic and focal mechanism data it suggests a central block which is extruding faster bordered east and west by progressively slower extruding blocks until the OK plate boundary faults are encountered. Taking into account elastic loading from both the intra-OK faults and the OK-Pacific (PA) boundary reconciles geodetic motions with geologic slip rates on at least the OK-NA boundary which corresponds to the Ulakhan fault.
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  • 18
    Publication Date: 2009
    Description: 〈b〉The Tommot pluton: a Middle Paleozoic rift-related alkaline gabbro and syenite complex, Yakutia, northeast Russia〈/b〉〈br〉 V. A. Trunilina, P. W. Layer, L. M. Parfenov, A. I. Zaitsev, and Y. S. Orlov〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 97-109, https://doi.org/10.5194/smsps-4-97-2009, 2009〈br〉 The Tommot pluton is located within the continental Omulevka terrane of the inner zone of the Verkhoyansk-Kolyma Mesozoic orogen. It is a small complex (~12 km〈sup〉2〈/sup〉) composed of alkaline-ultramafic rocks, alkaline and subalkaline gabbroids, and alkaline and quartz syenites. The pluton is unique both in the composition and age of its constituent rocks. Mineralogical-petrographical and geochemical studies of the rocks indicate that the alkaline rocks resulted from the melting of depleted mantle horizons. K-Ar, Rb-Sr, and 〈sup〉40〈/sup〉Ar/〈sup〉39〈/sup〉Ar age determinations confirm a Paleozoic age of the rocks. Formation of the alkaline rocks is related to Middle Paleozoic rifting which occurred as two discrete events: a Late Devonian event, which affected the marginal part of the Siberian continent, and a Late Carboniferous event that reflects internal deformation of the Omulevka terrane or late-stage extension. A spatially associated alkali granite, the Somnitel'nyy pluton, is Late Jurassic–Early Cretaceous in age and is synchronous with accretion of the Kolyma-Omolon Superterrane to Siberia in the Mesozoic.
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  • 19
    Publication Date: 2009
    Description: 〈b〉Biography – Leonid M. Parfenov (1937–2002)〈/b〉〈br〉 K. Fujita, A. V. Prokopiev, and D. B. Stone〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 5-9, https://doi.org/10.5194/smsps-4-5-2009, 2009〈br〉
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  • 20
    Publication Date: 2009
    Description: 〈b〉Geochronology and thermochronology of Cretaceous plutons and metamorphic country rocks, Anyui-Chukotka fold belt, North East Arctic Russia〈/b〉〈br〉 E. L. Miller, S. M. Katkov, A. Strickland, J. Toro, V. V. Akinin, and T. A. Dumitru〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 157-175, https://doi.org/10.5194/smsps-4-157-2009, 2009〈br〉 U-Pb isotopic dating of seven granitoid plutons and associated intrusions from the Bilibino region (Arctic Chukotka, Russia) was carried out using the SHRIMP-RG. The crystallization ages of these granitoids, which range from approximately 116.9±2.5 to 108.5±2.7 Ma, bracket two regionally significant deformational events. The plutons cut folds, steep foliations and thrust-related structures related to sub-horizontal shortening at lower greenschist facies conditions (〈i〉D〈/i〉〈sub〉1〈/sub〉), believed to be the result of the collision of the Arctic Alaska-Chukotka microplate with Eurasia along the South Anyui Zone (SAZ). Deformation began in the Late Jurassic, based on fossil ages of syn-orogenic clastic strata, and involves strata as young as early Cretaceous (Valanginian) north of Bilibino and as young as Hauterivian-Barremian, in the SAZ. The second phase of deformation (〈i〉D〈/i〉〈sub〉2〈/sub〉) is developed across a broad region around and to the east of the Lupveem batholith of the Alarmaut massif and is interpreted to be coeval with magmatism. 〈i〉D〈/i〉〈sub〉2〈/sub〉 formed gently-dipping, high-strain foliations (〈i〉S〈/i〉〈sub〉2〈/sub〉). Growth of biotite, muscovite and actinolite define 〈i〉S〈/i〉〈sub〉2〈/sub〉 adjacent to the batholith, while chlorite and white mica define 〈i〉S〈/i〉〈sub〉2〈/sub〉 away from the batholith. Sillimanite (± andalusite) at the southeastern edge the Lupveem batholith represent the highest grade metamorphic minerals associated with 〈i〉D〈/i〉〈sub〉2〈/sub〉. 〈i〉D〈/i〉〈sub〉2〈/sub〉 is interpreted to have developed during regional extension and crustal thinning. Extension directions as measured by stretching lineations, quartz veins, boudinaged quartz veins is NE-SW to NW-SE. Mapped dikes associated with the plutons trend mostly NW-SE and indicate NE-SW directed extension. 〈sup〉40〈/sup〉Ar/〈sup〉39〈/sup〉Ar ages from 〈i〉S〈/i〉〈sub〉2〈/sub〉 micas range from 109.3±1.2 to 103.0±1.8 Ma and are interpreted as post-crystallization cooling ages following a protracted period of magmatism and high heat flow. Regional uplift and erosion of many kilometers of cover produced a subdued erosional surface prior to the eruption of volcanic rocks of the Okhotsk-Chukotka volcanic belt (OCVB) whose basal units (~87 Ma) overlie this profound regional unconformity. A single fission track age on apatite from granite in the Alarmaut massif yielded an age of 90±11 Ma, in good agreement with this inference.
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  • 21
    Publication Date: 2009
    Description: 〈b〉Summary of Northeast Asia geodynamics and tectonics*〈/b〉〈br〉 L. M. Parfenov, G. Badarch, N. A. Berzin, A. I. Khanchuk, M. I. Kuzmin, W. J. Nokleberg, A. V. Prokopiev, M. Ogasawara, and H. Yan〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 11-33, https://doi.org/10.5194/smsps-4-11-2009, 2009〈br〉 The compilation, synthesis, description, and interpretation of regional geology and tectonics of major regions, such as Northeast Asia (Eastern Russia, Mongolia, Northern China, South Korea, and Japan) and the Circum-North Pacific (the Russian Far East, Alaska, and Canadian Cordillera), requires a complex methodology that includes: (1) definitions of key terms; (2) compilation of a regional geodynamics map that can be constructed according to modern tectonic concepts and definitions; and (3) formulation of a comprehensive tectonic model. This article presents a summary of the regional dynamics and tectonics of Northeast Asia as developed for a new summary geodynamics map of the region. This article also describes how a high-quality summary geodynamics map and companion tectonic analysis substantially aids in the understanding of the origin of major rock units, major structures, and contained mineral and fuel resources, and provides important guidelines for new research. 〈br〉〈br〉 * Prepared in memory of Leonid M. Parfenov, the leader of the geodynamics map team for the International collaborative project on NE Asia tectonics and metallogenesis.
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  • 22
    Publication Date: 2009
    Description: 〈b〉Detrital zircon geochronologic tests of the SE Siberia-SW Laurentia paleocontinental connection〈/b〉〈br〉 J. S. MacLean, J. W. Sears, K. R. Chamberlain, A. K. Khudoley, A. V. Prokopiev, A. P. Kropachev, and G. G. Serkina〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 111-116, https://doi.org/10.5194/smsps-4-111-2009, 2009〈br〉 Strikingly similar Late Mesoproterozoic stratigraphic sequences and correlative U-Pb detrital-zircon ages may indicate that the Sette Daban region of southeastern Siberia and the Death Valley region of southwestern North America were formerly contiguous parts of a Grenville foreland basin. The Siberian section contains large numbers of detrital zircons that correlate with Grenville, Granite-Rhyolite, and Yavapai basement provinces of North America. The sections in both Siberia and Death Valley exhibit west-directed thrust faults that may represent remnants of a Grenville foreland thrust belt. North American detrital-zircon components do not occur in Siberian samples above a ~600 Ma breakup unconformity, suggesting that rifting and continental separation blocked transfer of clastic sediment between the cratons by 600 Ma. Faunal similarities suggest, however, that the two cratons remained within the breeding ranges of Early Cambrian trilobites and archeocyathans.
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  • 23
    Publication Date: 2009
    Description: 〈b〉Seismotectonics of the Chersky Seismic Belt, eastern Sakha Republic (Yakutia) and Magadan District, Russia〈/b〉〈br〉 K. Fujita, B. M. Koz'min, K. G. Mackey, S. A. Riegel, M. S. McLean, and V. S. Imaev〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 117-145, https://doi.org/10.5194/smsps-4-117-2009, 2009〈br〉 The Chersky seismic belt represents a zone of deformation between the North American and Eurasian plates in northeast Russia. The belt extends from the Laptev Sea into the Chersky Range where it splits into two branches. One branch extends to Kamchatka and the Aleutian-Kurile Junction, while the other branch extends south towards Sakhalin Island. Focal mechanisms indicate a change from extension to transpression in the northern Verkhoyansk Range and generally left-lateral transpression in the Chersky Range extending to northern Kamchatka. The few focal mechanisms on the second branch suggest right-lateral transpression. A large number of faults, sub-parallel to the seismicity and presumed to be strike-slip, are visible in satellite imagery and topographic maps and are also associated with seismically generated landslides. 〈br〉〈br〉 These data support a model in which the Sea of Okhotsk forms the core of a separate Okhotsk microplate surrounded by diffuse boundaries on the north and west. Microseismicity in continental northeast Russia is most heavily concentrated within and between the fault systems along the northern boundary of the proposed Okhotsk plate and indicates a high level of deformation. The sense of slip on the faults (both from focal mechanisms and geology) are also generally consistent with the extrusion of the Okhotsk plate to the southeast as it is compressed between its larger neighbors. The northernmost part of the Okhotsk plate may be decoupled to some degree from the more stable central Sea of Okhotsk.
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  • 24
    Publication Date: 2009
    Description: 〈b〉Review of geology of the New Siberian Islands between the Laptev and the East Siberian Seas, North East Russia〈/b〉〈br〉 M. Kos'ko and E. Korago〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 45-64, https://doi.org/10.5194/smsps-4-45-2009, 2009〈br〉 The New Siberian Islands comprise De Long Islands, Anjou Islands, and Lyakhov Islands. Early Paleozoic, Mesozoic and Cenozoic sediments and igneous rocks are known on the De Long Islands. Cambrian slate, siltstone, mudstone and silicified limestone occur on Bennett Island. Ordovician volcanogenic turbidites, lavas, and small intrusions of andesite-basalt, basalt, dolerite, and porphyritic diorite were mapped on Henrietta Island. The igneous rocks are of calc-alkaline island arc series. The Ordovician age of the sequence was defined radiometrically. Early Paleozoic strata were faulted and folded presumably in the Caledonian time. Early Cretaceous sandstone and mudstone are known on Bennett Island. They are overlain by a 106–124 Ma basalt unit. Cenozoic volcanics are widespread on the De Long Islands. Zhokhov Island is an eroded stratovolcano. The volcanics are mostly of picrite-olivine type and limburgite. Radiometric dating indicates Miocene to Recent ages for Cenozoic volcanism. 〈br〉〈br〉 On the Anjou islands Lower-Middle Paleozoic strata consist of carbonates, siliciclastics, and clay. A Northwest-southeast syn-sedimentary facies zonation has been reconstructed. Upper Paleozoic strata are marine carbonate, clay and siliciclastic facies. Mudstone and clay predominate in the Triassic to Upper Jurassic section. Aptian-Albian coal bearing deposits uconformably overlap lower strata indicating Early Cretaceous tectonism. Upper Cretaceous units are mostly clay and siltstone with brown coal strata resting on Early Cretaceous weathered rhyolite. Cenozoic marine and nonmarine silisiclastics and clay rest upon the older units with a transgressive unconformity including a weathering profile in the older rocks. 〈br〉〈br〉 Manifestations of Paleozoic and Triassic mafic and Cretaceous acidic magmatism are also found on these islands. The pre-Cretaceous structure of the Anjou islands is of a block and fold type Late Cimmerian in age followed by faulting in Cenozoic time. 〈br〉〈br〉 The Lyakhov islands are located at the western end of the Late Cimmerian South Anyui suture. Sequences of variable age, composition, and structural styles are known on the Lyakhov Islands. These include an ancient metamorphic sequence, Late Paleozoic ophiolitic sequence, Late Mesozoic turbidite sequence, Cretaceous granites, and Cenozoic sediments. Fold and thrust imbricate structures have been mapped on southern Bol'shoi Lyakhov Island. North-northwestern vergent thrusts transect the Island and project offshore. Open folds of Jurassic–Early Cretaceous strata are characteristic of Stolbovoi and Malyi Lyakhov islands. 〈br〉〈br〉 Geology of the New Siberian Islands supports the concept of a circum Arctic Phanerozoic fold belt. The belt is comprised of Caledonian, Ellesmerian, Early Cimmerian and Late Cimmerian fold systems, manifested in many places on the mainland and on islands around the Arctic Ocean. Knowledge of the geology of the New Siberian Islands has been used to interpret anomalous gravity and magnetic field maps and Multi Channel Seismic (MCS) lines. Two distinguishing structural stages are universally recognized within the offshore sedimentary cover which correlate with the onshore geology of the New Siberian Islands. Dating of the upper structural stage and constituent seismic units is based on structural and stratigraphic relationships between Late Mesozoic and Cenozoic units in the archipelago. The Laptev Sea–western East Siberian Sea seismostratigraphic model for the upper structural stage has much in common with the seismostratigraphic model in the American Chukchi Sea.
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  • 25
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    Copernicus
    Publication Date: 2009
    Description: 〈b〉Editors and Acknowledgement〈/b〉〈br〉 〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 1-1, https://doi.org/10.5194/smsps-4-1-2009, 2009〈br〉
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  • 26
    Publication Date: 2009
    Description: 〈b〉Morphology of the pore space in claystones – evidence from BIB/FIB ion beam sectioning and cryo-SEM observations〈/b〉〈br〉 G. Desbois, J. L. Urai, and P. A. Kukla〈br〉 eEarth, 4, 15-22, doi:10.5194/ee-4-15-2009, 2009〈br〉 The morphology of pore space has a strong effect on mechanical and transport properties of mudrocks and clay-rich fault gouge, but its characterization has been mostly indirect. We report on a study of Boom clay from a proposed disposal site of radioactive waste (Mol site, Belgium) using high resolution SEM at cryogenic temperature, with ion beam cross-sectioning to prepare smooth, damage free surfaces. Pores commonly have crack-like tips, preferred orientation parallel to bedding and power law size distribution. We define a number of pore types depending on shape and location in the microstructure: large jagged pores in strain shadows of clastic grains, high aspect ratio pores between similarly oriented phyllosilicate grains and crescent-shaped pores in saddle reefs of folded phyllosilicates. 3-D reconstruction by serial cross-sectioning shows 3-D connectivity of the pore space. These findings offer a new insight into the morphology of pores down to nano-scale in comparison to traditional pore size distributions calculated from mercury Injection experiments, explain slaking of clays by successive wetting and drying and provide the basis for microstructure-based models of transport in clays.
    Print ISSN: 1815-381X
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  • 27
    Publication Date: 2009
    Description: 〈b〉Late Pleistocene palaeoproductivity patterns during the last climatic cycle in the Guyana Basin as revealed by calcareous nannoplankton〈/b〉〈br〉 G.-E. López-Otálvaro, J. A. Flores, F. J. Sierro, I. Cacho, J.-O. Grimalt, E. Michel, E. Cortijo, and L. Labeyrie〈br〉 eEarth, 4, 1-13, doi:10.5194/ee-4-1-2009, 2009〈br〉 Variations in the assemblage and abundance of coccoliths reveal changes in oceanic and atmospheric dynamics in the Guyana Basin over the last climatic cycle, mainly linked to latitudinal variations in the ITCZ (Intertropical Convergence Zone). Records of the N ratio (a palaeoproductivity index of coccolithophores) allowed us to monitor nutri-thermocline fluctuations. Nannofossil accumulation rates (NAR) vary closely with the N ratio, indicating a strong correlation between these two palaeoproductivity proxies. Decreases in the N ratio and NAR values suggest lower palaeoproductivity during glacial substages, indicating a deep nutri-thermocline (deep stratification of the mixed layer) as a consequence of the piling up of warm water dragged by the NEC. This setting was favoured by the southern shift of the ITCZ and Trade winds which blew perpendicular to the Guyana coast. By contrast, increases in the N ratio and NAR values revealed higher palaeoproductivity during interglacial substages, suggesting a shoaling of the nutri-thermocline. This scenario is favoured by a northward displacement of the ITCZ with the southeast Trade winds blowing alongshore. Additionally, palaeoproductivity changes during substages of Marine Isotope Stage (MIS) 6-5 are of much higher amplitude than those recorded in substages of MIS 4-2 and the early Holocene. Similarities between the palaeoproductivity and the 65° N summer insolation records, suggest a link between the depth of nutri-thermocline, the latitudinal migration of the ITCZ and ice-sheet changes in the Northern Hemisphere.
    Print ISSN: 1815-3836
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  • 28
    Publication Date: 2009
    Description: 〈b〉Late Pleistocene palaeoproductivity patterns during the last climatic cycle in the Guyana Basin as revealed by calcareous nannoplankton〈/b〉〈br〉 G.-E. López-Otálvaro, J. A. Flores, F. J. Sierro, I. Cacho, J.-O. Grimalt, E. Michel, E. Cortijo, and L. Labeyrie〈br〉 eEarth, 4, 1-13, doi:10.5194/ee-4-1-2009, 2009〈br〉 Variations in the assemblage and abundance of coccoliths reveal changes in oceanic and atmospheric dynamics in the Guyana Basin over the last climatic cycle, mainly linked to latitudinal variations in the ITCZ (Intertropical Convergence Zone). Records of the N ratio (a palaeoproductivity index of coccolithophores) allowed us to monitor nutri-thermocline fluctuations. Nannofossil accumulation rates (NAR) vary closely with the N ratio, indicating a strong correlation between these two palaeoproductivity proxies. Decreases in the N ratio and NAR values suggest lower palaeoproductivity during glacial substages, indicating a deep nutri-thermocline (deep stratification of the mixed layer) as a consequence of the piling up of warm water dragged by the NEC. This setting was favoured by the southern shift of the ITCZ and Trade winds which blew perpendicular to the Guyana coast. By contrast, increases in the N ratio and NAR values revealed higher palaeoproductivity during interglacial substages, suggesting a shoaling of the nutri-thermocline. This scenario is favoured by a northward displacement of the ITCZ with the southeast Trade winds blowing alongshore. Additionally, palaeoproductivity changes during substages of Marine Isotope Stage (MIS) 6-5 are of much higher amplitude than those recorded in substages of MIS 4-2 and the early Holocene. Similarities between the palaeoproductivity and the 65° N summer insolation records, suggest a link between the depth of nutri-thermocline, the latitudinal migration of the ITCZ and ice-sheet changes in the Northern Hemisphere.
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  • 29
    Publication Date: 2009
    Description: 〈b〉Geotectonic setting of the Tertiary Uyandina and Indigirka-Zyryanka basins, Republic Sakha (Yakutia), Northeast Russia, using coal rank data〈/b〉〈br〉 H.-J. Paech〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 85-96, https://doi.org/10.5194/smsps-4-85-2009, 2009〈br〉 Outcrops along the Inach River in the Uyandina basin and those along the Myatis' River in the Indigirka-Zyryanka basin were studied in detail and sampled for coal rank determinations. The Uyandina basin is an intramontane pull-apart basin characterized by extensional structures within the Moma rift system. The coal rank is below 0.3% vitrinite reflectance (〈i〉R〈sub〉r〈/sub〉〈/i〉), which indicates shallow, immature conditions of basin formation and very low subsidence. The Myatis' River coal-bearing outcrops in the Indigirka-Zyryanka basin reveal compression induced by continent collision. The compressive deformation includes also lowermost Pliocene strata. Due to the position in the Verkhoyansk-Chersky fold belt adjacent to the Kolyma-Omolon microcontinent the Indigirka-Zyryanka basin has much in common with a foredeep, i.e. the asymmetry in thickness and tectonic structure. The vitrinite reflectance data (〈i〉R〈sub〉r〈/sub〉〈/i〉) which range from 0.25% to more than 5% reinforce the accepted models that describe basin subsidence and geothermal history and the tectonic deformation.
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  • 30
    Publication Date: 2009
    Description: 〈b〉Structural studies near Pevek, Russia: implications for formation of the East Siberian Shelf and Makarov Basin of the Arctic Ocean〈/b〉〈br〉 E. L. Miller and V. E. Verzhbitsky〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 223-241, https://doi.org/10.5194/smsps-4-223-2009, 2009〈br〉 The Pevek region of Arctic Russia provides excellent beach cliff exposure of sedimentary and igneous rocks that yield detailed information on the nature, progression and timing of structural events in this region. Regional folding and thrust faulting, with the development of a south-dipping axial plane cleavage/foliation developed during N-S to NE-SW directed shortening and formation of the Chukotka-Anyui fold belt. This deformation involves strata as young as Valanginian (136–140 Ma, Gradstein et al., 2004). Fold-related structures are cut by intermediate to silicic batholiths, plutons and dikes of Cretaceous age. Reported K-Ar whole rock and mineral ages on the granitoids range from 144 to 85 Ma, but to the south, more reliable U-Pb zircon ages on compositionally similar plutons yield a much narrower age range of ~120–105 Ma (Miller et al., this volume) and a pluton in Pevek yields a U-Pb age on zircon of 108.1±1.1 Ma with evidence for inheritance of slightly older 115 Ma zircons. Magmas were intruded during an episode of E-W to ENE-WSW directed regional extension based on the consistent N-S to NNW-SSE orientation of over 800 mapped dikes and quartz veins. Analysis of small-offset faults and slickensides yield results compatible with those inferred from the dikes. Younger tectonic activity across this region is minor and the locus of magmatic activity moved southward towards the Pacific margin as represented by the 〈90 Ma Okhotsk-Chukotsk volcanic belt (OCVB). A lengthy period of uplift and erosion occurred after emplacement of Cretaceous plutons and produced the peneplain beneath the younger OCVB. 〈br〉〈br〉 Based on our studies, we speculate that ~120–105 Ma magmatism, which heralds a change in tectonic regime from compression to extension, could represent one of the consequences of the inception of rifting in the Amerasian Basin of the Arctic, forming the Makarov Basin north of the Siberian shelf at this longitude. A synthesis of available seismic reflection, gravity and magnetic data for the offshore Siberian Shelf reveals a widespread, seismically mappable basement-sedimentary cover contact that deepens northward towards the edge of the shelf with few other significant basins. Various ages have been assigned to the oldest strata above the unconformity, ranging from Cretaceous (Albian – 112–100 Ma) to Tertiary (Paleocene–Eocene – ~60–50 Ma). The period of uplift and erosion documented along the Arctic coast of Russia at this longitude could represent the landward equivalent of the (yet undrilled) offshore basement-sedimentary cover contact, thus overlying sedimentary sequences could be as old as early Late Cretaceous. Although quite speculative, these conclusions suggest that land-based geologic, structural, petrologic and geochronologic studies could provide useful constraints to help resolve the plate tectonic history of the Arctic Ocean.
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  • 31
    Publication Date: 2009
    Description: 〈b〉Middle Paleozoic-Mesozoic boundary of the North Asian craton and the Okhotsk terrane: new geochemical and geochronological data and their geodynamic interpretation〈/b〉〈br〉 A. V. Prokopiev, J. Toro, J. K. Hourigan, A. G. Bakharev, and E. L. Miller〈br〉 Stephan Mueller Spec. Publ. Ser., 4, 71-84, https://doi.org/10.5194/smsps-4-71-2009, 2009〈br〉 The Okhotsk terrane, located east of the South Verkhoyansk sector of the Verkhoyansk fold-and-thrust belt, has Archean crystalline basement and Riphean to Early Paleozoic sedimentary cover similar to that of the adjacent the North Asian craton. However, 2.6 Ga biotite orthogneisses of the Upper Maya uplift of the Okhotsk terrane yielded Early Devonian 〈sup〉40〈/sup〉Ar/〈sup〉39〈/sup〉Ar cooling ages, evidence of a Mid-Paleozoic metamorphic event not previously known. These gneisses are also intruded by 375±2 Ma (Late Devonian) calc-alkaline granodiorite plutons that we interpret as part of a continental margin volcanic arc. Therefore, Late Devonian rifting, which affected the entire eastern margin of North Asia separating the Okhotsk terrane from the North Asian craton, was probably a back-arc event. 〈br〉〈br〉 Our limited 〈sup〉40〈/sup〉Ar/〈sup〉39〈/sup〉Ar data from the South Verkhoyansk metamorphic belt suggests that low grade metamorphism and deformation started in the Late Jurassic due to accretion of the Okhotsk terrane to the North Asia margin along the Bilyakchan fault. Shortening and ductile strain continued in the core of the South Verkhoyansk metamorphic belt until about 120 Ma due to paleo-Pacific subduction along the Uda-Murgal continental margin arc.
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  • 32
    Publication Date: 2009-01-08
    Description: The past decade has shown a marked increase in the use of high-throughput assays in clinical research into human cancer, including acute myeloid leukemia (AML). In particular, genome-wide gene expression profiling (GEP) using DNA microarrays has been extensively used for improved understanding of the diagnosis, prognosis, and pathobiology of this heterogeneous disease. This review discusses the progress that has been made, places the technologic limitations in perspective, and highlights promising future avenues
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  • 33
    Publication Date: 2009-11-20
    Description: Abstract 1689 Poster Board I-715 Introduction The use of the proteasome inhibitor bortezomib has demonstrated activity in multiple myeloma and lymphomas. The HDAC inhibitor romidepsin is being evaluated in CTCL and PTCL, though its activity in B-cell lymphomas is less clear. We hypothesized that the combination of bortezomib and romidepsin would result in synergistic apoptosis in different B-cell NHL cell lines based upon the observed activity of this combination in more mature B-cell malignancies such as myeloma. Experimental Design Daudi, HT, Ramos and SUDHL-4 cell lines were exposed to different concentrations of bortezomib and romidepsin, separately, concurrently, and sequentially. Cell viability was assessed using MTT-assay, induced apoptosis was evaluated using Annexin V and PI staining from 24-48 hours. Apoptosis was also evaluated using western blot analysis of caspases and PARP cleavage. LC3 and HDAC6 level expressions were performed to determine if the effect of the combination was a result of the aggresome or autophagy pathway. Cell cycle studies were also performed to study if there were any changes after treating cells with the combination. Results The combination of bortezomib and romidepsin resulted in synergistic B-cell apoptosis as measured by MTT-assay with combination indices of 〈 0.5. This was associated with increased caspases and PARP cleavage as early as 24 hours after exposure. Order of addition experiments demonstrated definite sequence specificity. When romidepsin was added first, and 6 hours later followed by bortezomib, apoptosis was enhanced, compared to both agents being given concurrently or when bortezomib was administered first. Cell cycle analysis studies demonstrated that pretreatment of cells with romidepsin for 6 hours followed by the addition of bortezomib arrested the cells in G2M phase. HDAC6 expression was significantly reduced following combination therapy, and LC3-I was cleaved to LC3-II in treated cells suggesting that the combination affected aggresome formation and autophagy. Conclusion The combination of romidepsin and bortezomib at low nanomolar concentrations suggests that this may be an important clinical combination to test in patients with relapsed or refractory B-cell malignancies. Sequence of administration data is currently being tested to determine if the effect is a result of autophagy inhibition as is seen in myeloma cell lines. Additional mechanistic studies will be presented with the goals of identifying predictors of response that can then be validated in prospective clinical trials. Disclosures Lechowicz: Gloucester: Consultancy. Kaufman:Millennium: Consultancy; Genzyme: Consultancy; Celgene: Consultancy; Merck: Research Funding; Celgene: Research Funding. Lonial:Gloucester: Research Funding; Novartis: Consultancy; BMS: Consultancy; Millennium: Consultancy, Research Funding; Celgene: Consultancy. Flowers:Millennium: Research Funding.
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  • 34
    Publication Date: 2009-11-20
    Description: Abstract 3701 Poster Board III-637 Background Romidepsin is an anti-neoplastic agent that has been identified as a novel pan-HDAC inhibitor with single-agent activity in T-cell lymphoma. In a combined analysis of 167 patients (pts) with cutaneous T-cell lymphoma (CTCL) from 2 clinical studies (GPI and NCI studies), the overall response rate was 35%, including 10 pts with a complete clinical response (CCR). Median duration of response was 13.8 months and 42% of pts with advanced disease (stage ≥IIB) responded [Demierre et al. J Clin Oncol 27:15s, 2009 (suppl; abstr 8546)]. The most common hematologic abnormalities in these pts included anemia (41%), thrombocytopenia (34%), neutropenia (27%), and lymphopenia (26%). Most hematologic toxicities were Grade 1 or 2, although 'Grade 3 events were observed. These events were reversible and a small portion of the patients discontinued the study drug because of these events (2%). This report details an analysis of platelet counts in pts receiving romidepsin and an investigation into the mechanism of thrombocytopenia in nonclinical studies. Methods Pts with CTCL who received ≥1 prior systemic therapy failure and had an ECOG PS of 0-2 were enrolled in 2 single-arm, open-label, multicenter and international clinical studies. Treatment with QTc prolonging therapies or CYP34A inhibitors was prohibited and pts with significant cardiovascular abnormalities were excluded. Romidepsin at 14 mg/m2 was administered as a 4-hr IV infusion on days 1, 8, and 15 of a 28 day cycle. Nonclinical studies were conducted in mice to investigate the mechanism of romidepsin effects on platelets. Romidepsin was administered to female BALB/c mice at doses of 1 or 4 mg/kg by tail-vein injection on days 1, 5 and 9. Blood samples were collected every 2 days from alternating groups of mice to minimize effects of bleeding on platelet counts. Results In clinical studies, there is a mean decrease in platelet counts during the treatment period of each cycle, and a return to baseline levels or above between cycles observed in both clinical studies as described in the table below. No clinically meaningful change has been observed in the central tendency over 4 cycles of treatment in both studies. In the mouse studies, dose-dependent effects were seen on both WBC and platelet counts. Day 2 WBC counts dropped to 45% and 10% of normal at the 1 and 4 mg/kg doses, respectively. WBC counts remained low until after the dosing period in the 1 mg/kg romidepsin group, but recovered more quickly in the 4 mg/kg group. Day 2 platelet counts were 70% of normal at the 1 mg/kg dose and remained near this level until day 10, followed by recovery to normal at day 15. At the 4 mg/kg dose, profound thrombycytopenia was induced, with platelet counts only 20% of normal on days 4-6. Platelet counts slowly recovered to 70% of normal by day 15. Plasma thrombopoietin levels were normal throughout the experiment for the 1 mg/kg group, and showed a large increase to 275% of normal on day 6 in the 4 mg/kg group, which is the expected response to thrombocytopenia as a signal to increase platelet production and indicates that platelet reduction is not attributable to defective TPO production. Bone marrow megakaryocyte populations are being examined to determine the effects of romidepsin on these platelet-producing cells. Conclusions Following romidepsin administration, a saw tooth pattern is observed in the reduction and recovery of platelets. Recovery of platelets appears to occur more rapidly in humans than in mice; however, the effects are reversible after dosing in clinical studies and in murine models. In the clinical data the recovery pattern suggests that the transient effects are direct and are not effects on bone marrow. Disclosures: Whittaker: Gloucester Pharmaceuticals: Research Funding. Prince:Gloucester Pharmaceuticals: Consultancy. Demierre:Gloucester Pharmaceuticals: Consultancy, Honoraria. Lonial:Gloucester Pharmaceuticals: Honoraria. Kim:Gloucester Pharmaceuticals: Consultancy, Honoraria. Nichols:Gloucester Pharmaceuticals: Employment, Equity Ownership. Nix:Gloucester Pharmaceuticals: Employment.
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  • 35
    Publication Date: 2009-07-30
    Description: Precursor T-cell acute lymphoblastic leukemia (T-ALL) in children represents a clinical challenge, because relapses are usually fatal. It is thus necessary to identify high-risk patients as early as possible to effectively individualize treatment. We aimed to define novel molecular risk markers in T-ALL and performed array-based comparative genomic hybridization (array-CGH) and expression analyses in 73 patients. We show that DNA copy-number changes are common in T-ALL and affect 70 of 73 (96%) patients. Notably, genomic imbalances predicted to down-regulate the TGF-β or up-regulate the PI3K-AKT pathways are identified in 25 of 73 (34%) and 21 of 73 (29%) patients, suggesting that these pathways play key roles in T-ALL leukemogenesis. Furthermore, we identified a deletion at 6q15-16.1 in 9 of 73 (12%) of the patients, which predicts poor early treatment response. This deletion includes the CASP8AP2 gene, whose expression is shown to be down-regulated. The interaction of CASP8AP2 with CASP8 plays a crucial role in apoptotic regulation, suggesting a functional link between the clinical effect of the deletion and the molecular mode of action. The data presented here implicate the TGF-β and PI3K-AKT pathways in T-ALL leukemogenesis and identify a subgroup of patients with CASP8AP2 deletions and poor early treatment response.
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  • 36
    Publication Date: 2009-11-20
    Description: Abstract 1955 Poster Board I-978 The detection of chromosome abnormalities in mature B-cell neoplasms by conventional cytogenetics remains difficult, mainly due to the low proliferative rate of mature lymphoid cells. The current FISH panel for chronic lymphocytic leukemia (CLL) is designed to detect some of the more common abnormalities of prognostic significance in CLL [i.e., del(6q), del(11q), +12, del(13q), del(17p)]. This CLL FISH panel has improved the detection rate of these markers by making it possible to obtain cytogenetic information from interphase cells; however, as it is limited to only these 5 markers, it cannot detect all abnormalities associated with CLL. More importantly, the impact of other chromosome abnormalities on prognosis and disease progression, with and without the presence of these 5 prognostic markers, is not known. CpG-oligodeoxynucleotides (ODNs) such as DSP30 activate cells of the immune system in a sequence-dependent manner and promote proliferation of CLL cells in vitro [Decker et al. Blood 2000;95:999-1006]. They also upregulate costimulatory molecules and potential target antigens during immunotherapy. The use of DSP30 in combination with interleukin 2 (IL2) has proven effective in increasing the detection of chromosome abnormalities in CLL [Dicker et al. Blood 2006;108:3152-60] and other mature B-cell lymphoid malignancies by conventional cytogenetics [Struski et al. Leukemia 2009;23:617-9], when compared to the well-established B-cell mitogens. In our extensive clinical experience of incorporating DSP30/IL2 into our culture media, this cocktail has significantly increased the detection of chromosome abnormalities in CLL by conventional cytogenetics, from 55% to greater than 80%. We thus decided to investigate if various other lymphoid malignancies would respond to the mitogen activity of DSP30/IL2 as well as or better than CLL. Specifically, we evaluated 812 cases of mature B-cell lymphoid malignancies that were abnormal by flow cytometry, morphology, or cytogenetic analysis. All samples (bone marrow or blood) were cultured for approximately 72 hours using the DSP30/IL2 mitogen cocktail. Of these 812 cases, 746 (91%) provided sufficient mitotic index and quality for a complete cytogenetic analysis and interpretation. Of the CLL cases (n=509), 79 were initially interpreted as normal by conventional cytogenetic analysis, but were later interpreted as abnormal by FISH for deletion 13q only. In view of the known cryptic nature of this deletion in CLL, these cases were not included in the study, leaving a total of 430 CLL cases, and thus bringing the total number of cytogenetically successful study cases to 667. In addition to the 430 CLL cases, there were 14 variant CLLs; 36 diffuse large B-cell lymphomas (DLBCLs); 35 follicular lymphomas; 34 non-Hodgkin lymphomas (not further specified); 29 marginal zone B-cell lymphomas of splenic type (sMZBCL); 27 mantle cell lymphomas (MCLs), of which 8 were blastoid; 16 MZBCL of MALT type; 13 hairy cell leukemias (HCLs); 12 lymphoproliferative disorders (not further specified); 10 lymphoplasmacytic lymphomas (LPLs); 6 Burkitt lymphomas; 3 Hodgkin lymphomas; and 2 B-cell prolymphocytic leukemias (PLLs). Of particular interest is the fact that we detected clonal abnormalities in 100% of HCLs, blastoid MCLs, variant CLLs, and B-cell PLL, as well as in 97% of sMZBCLs, 89% of DLBCLs, and 80% of LPLs This is of great importance since HCLs and LPLs are rarely abnormal by conventional cytogenetics using the more traditional combinations of mitogens making it difficult to identify markers of prognostic significance. In conclusion, our findings demonstrate that the DSP30/IL2 cocktail induces proliferation of various B-cell mature lymphoid disorders and that its mitogenic action is not limited to CLL. We are continuing to develop our understanding of the considerable response of specific lymphoid malignancies to the DSP30/IL2 cocktail by correlating additional clinical data, and hope that the end result will open new avenues in regards to prognostic outcome and therapeutic approaches. Disclosures: No relevant conflicts of interest to declare.
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  • 37
    Publication Date: 2009-10-01
    Description: Higher levels of procoagulant factors and factor XII deficiency may be risk factors for first venous thromboembolism (VTE). We studied associations of coagulation factors IX through XIII with risk of future VTE in 2 general population samples. Using a nested case-control study combining the 21 860 participants of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study, we determined antigenic levels of these coagulation factors in primarily pre-event blood samples from 462 participants who subsequently developed VTE and 1047 participants who remained free of VTE. Only elevated levels of factors IX and XI were associated with increased risk of VTE after adjustment for age, sex, race, and study. For factor IX, the odds ratio (OR) was 1.4 (95% confidence interval [CI], 1.0-2.0) comparing the top to bottom quintile. The OR for factor XI was higher: 2.0 (95% CI, 1.4-2.9). With further adjustment for body mass index and diabetes, only elevated factor XI remained associated with VTE risk: OR 1.8 (95% CI, 1.3-2.7). Associations were similar by study and whether the thrombosis was idiopathic or secondary. Factor XII deficiency was not related to VTE risk. Among these procoagulant factors, only elevated factor XI was a risk factor for VTE.
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  • 38
    Publication Date: 2009-07-16
    Description: The concept of endothelial progenitor cells (EPCs) has attracted considerable interest in cardiovascular research, but despite a decade of research there are still no specific markers for EPCs and results from clinical trials remain controversial. Using liquid chromatography–tandem mass spectrometry, we analyzed the protein composition of microparticles (MPs) originating from the cell surface of EPC cultures. Our data revealed that the conventional methods for isolating mononuclear cells lead to a contamination with platelet proteins. Notably, platelets readily disintegrate into platelet MPs. These platelet MPs are taken up by the mononuclear cell population, which acquires “endothelial” characteristics (CD31, von Willebrand factor [VWF], lectin-binding), and angiogenic properties. In a large population-based study (n = 526), platelets emerged as a positive predictor for the number of colony-forming units and early outgrowth EPCs. Our study provides the first evidence that the cell type consistent with current definitions of an EPC phenotype may arise from an uptake of platelet MPs by mononuclear cells resulting in a gross misinterpretation of their cellular progeny. These findings demonstrate the advantage of using an unbiased proteomic approach to assess cellular phenotypes and advise caution in attributing the benefits in clinical trials using unselected bone marrow mononuclear cells (BMCs) to stem cell-mediated repair.
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  • 39
    Publication Date: 2009-11-20
    Description: Abstract 18 Introduction: Long-term survival in pediatric relapsed AML is only 20-30%. Optimal reinduction therapy is unknown, and there is a concern about cardiotoxicity with repeated anthracycline use at relapse. Preclinical in vitro and animal studies, and limited clinical data suggest that liposomal daunorubicin (DaunoXome®, DNX) is less cardiotoxic. These considerations lead to a phase III study, in the setting of the International BFM Study Group. Materials and methods: FLAG was randomised against FLAG/DNX in the 1st reinduction course. The conventional 5-days FLAG only was recommended as the 2nd course. DNX was dosed at 60 mg/m2/day on days 1, 3 and 5. After induction, allogeneic stem cell transplantation was generally recommended, but time-to-transplant could be bridged by high- or low-intensive consolidation therapy. Primary endpoint of the study was early treatment response, based on bone marrow examination shortly before reinduction course 2, and defined as either good (≤20% leukemic blasts) or poor (〉20% leukemic blasts). This endpoint was chosen because of its prognostic value in earlier relapsed AML BFM-trials, and because compliance with an extended protocol guideline was likely to be suboptimal within the context of a highly multinational and multicenter AML Relapse protocol. However, secondary endpoints were defined, including the CR2 rate determined after 2 courses, long-term survival, and toxicity. Patients with AML M3 and those 〉18 years of age at initial diagnosis were ineligible. The study opened in most countries in 2002/2003. The study closed for accrual on April 1, 2009 when the required 360 fully eligible and evaluable patients had been randomized. Early and late relapsed AML was defined as a relapse within or after 1 year from initial diagnosis, but this only influenced treatment in that early relapsed AML patients were eligible for haploidentical SCT, while late relapsed AML patients were eligible for autologous SCT, if a matched or partly mismatched transplant was not possible. Thirteen groups from 20 countries and 〉100 centers have enrolled patients, with informed consent and after approval of the study by regulatory authorities. Data are presented according to intention-to-treat, with a median follow-up of 2.7 years for patients at risk. Results: Overall 4-year probability of survival (pOS) was 35% SE 2%, the overall CR2 rate 62%. The good early responders had a 4-year pOS of 45% SE 3% versus 10% SE 3% for poor responders (p
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  • 40
    Publication Date: 2009-11-20
    Description: Abstract 634 FLT3, a transmembrane receptor tyrosine kinase constitutively activated via mutation in blasts of patients (pts) with AML, is an important therapeutic target. Blasts from approximately 25% of pts have a length or internal tandem duplication (ITD) mutation in the juxtamembrane region or tyrosine kinase domain (TKD1) of FLT3, which is associated with reduced disease-free survival and overall survival (OS), particularly in pts with normal cytogenetics. Blasts from 5–10% of pts have a point mutation (typically D835Y) in the tyrosine kinase domain (TKD); the effect of this mutation on prognosis is uncertain. Midostaurin (PKC412) is a multi-targeted kinase inhibitor with demonstrated clinical activity in FLT3-mutant (FLT3–mut) and FLT3-wild-type (FLT3–wt) AML (peripheral blood blast reduction in 70% and 30% of pts, respectively) but rarely produces complete remissions). Preclinical studies demonstrated synergy between FLT3 inhibitors and chemotherapy. We conducted a Phase 1b trial to investigate the feasibility of administering daunorubicin (60 mg/m2 IV, days 1–3) and cytarabine (100 mg/m2 IVCI, days 1–7) induction and high-dose cytarabine post-remission therapy (3 gm/m2 over 3h every 12h, days 1, 3, and 5 for 3 cycles) plus oral midostaurin at 100 mg or 50 mg each twice daily on days 8–21 (sequentially) or days 1–7, 15–21 (concomitantly) with all chemo cycles in newly diagnosed pts under age 61 with de novo AML. Whereas 100 mg of midostaurin plus induction chemotherapy was poorly tolerated due to nausea and vomiting, the 40 pts who received 50 mg of midostaurin orally twice daily ( 20 each on the sequential and concomitant schedules; 27 FLT3–wt; 13 FLT3–mut [9 with an ITD]), tolerated the combination well. Median midostaurin exposure was 133 days (range 21–975) for the FLT3–mut pts and 90 days (range 7–1016) for FLT3–wt pts. Maintenance therapy with midostaurin was allowed with investigator discretion and was received by 5 pts (3 FLT3–mut, 2 FLT–wt). The median ages for the FLT3–wt and FLT3–mut pts were 50 years (range 25–60) and 46 years (range 20–65), respectively. 77% of the FLT3–mut pts displayed normal, 15% adverse and 8% other intermediate cytogenetics compared with 18.5%, 26%, and 26%, respectively, for FLT3-wt (also 18.5% favorable; 11% unknown). Complete response occurred in 32/40 (80%) of all pts (20/27 [74%] of FLT3–wt patients, 12/13 [92%] of FLT3–mut pts). Patients were censored at the last date they were known to be alive with a median post treatment follow-up for FLT3-mut pts of 1059 days and 1086 days for FLT3-wt. Even accounting for their differing cytogenetics and ages, the OS of the FLT3–mut subgroup was expected to be inferior to that of the FLT3–wt subgroup. However, we report that the 1 and 2 year OS for the pts with FLT3–mut AML was 85% and 62%, respectively, and was comparable to that of the FLT3–wt subgroup (81% and 59%, respectively). Although based on small numbers and not stratified for type of FLT3 mutation (TKD, ITD, ITD length, location, or allelic ratio), these long-term results suggest that combination therapy with a FLT3 inhibitor and chemotherapy might be effective enough to obviate the perceived need for allogeneic stem cell transplantation for FLT3–mut AML pts in first complete remission. Moreover, these data support the rationale for the ongoing international phase 3 study of induction, post-remission intensification, and maintenance with midostaurin (50 mg po bid) or placebo. Disclosures: Stone: Novartis: Research Funding, ad hoc consultancy; Cephalon: ad hoc consultancy. Off Label Use: midostaurin with chemothereapy for AML. Paquette:Novartis: Honoraria, Research Funding, Speakers Bureau. Schiller:Novartis: Research Funding, Speakers Bureau; Millenium: Research Funding, Speakers Bureau; Genzyme: Research Funding; Vion: Research Funding; Centocor: Research Funding; Eli Lilly: Research Funding; Celgene: Research Funding. Schiffer:Novartis: Consultancy, Research Funding; Genzyme: Consultancy. Ehninger:Novartis: Honoraria, Research Funding. Cortes:Novartis: Research Funding; Bristol-Myers Squibb: Research Funding; Wyeth: Research Funding. Kantarjian:Novartis: Research Funding. DeAngelo:Bristol-Myers Squibb: Speakers Bureau; Celgene: Speakers Bureau; Enzon: Speakers Bureau; Novartis: Speakers Bureau. Huntsman-Labed:Novartis: Employment, Equity Ownership. Dutreix:Novartis: Employment, Equity Ownership. Rai:Novartis: Employment, Equity Ownership. Giles:Novartis: Research Funding; Merck: Research Funding; Bristol-Myers Squibb: Research Funding; Vion: Research Funding.
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  • 41
    Publication Date: 2009-11-20
    Description: Abstract 2168 Poster Board II-145 The deregulated tyrosine kinase associated with t(9;22) fusion protein BCR-ABL is efficiently targeted by tyrosine kinase inhibitors (Imatinib, Nilotinib and Dasatinib). It is generally believed that most patients have residual disease. The inability to eliminate the refractory leukemia stem cell in chronic myeloid leukemia (CML) is not well understood. The refractory stem cell is present despite effective inhibition of the BCR-ABL kinase in these cells, and dissociation between kinase inhibition and cell death implies lack of dependency on BCR-ABL aberrant kinase activity, unlike the one seen in more mature CML cells. Thus the oncogene addictive dependency of these leukemia stem cells may be overcome by intrinsic and/or extrinsic factors/pathways. One such pathway involved in hematopoeitic stem cell maintenance is the Wnt/β-catenin signaling pathway. BCR-ABL signaling is known to directly activate the Wnt/β-catenin pathway. The loss of function of a negative regulator of the Wnt/β-catenin pathway, known as GSK3β is associated with CML progression from chronic phase to the blast phase. Lastly, the loss of β-catenin in murine models impairs the self renewal capacity of both the normal and the BCR-ABL+ leukemia stem cell. Thus this pathway is important during various stages of the disease. We explored the effect of Wnt inhibition using a novel Wnt pathway inhibitor (AG-214, University of Michigan). AG-214 is structurally related to a previously reported Wnt-inhibitor. AG-214 is able to antagonize β-catenin/TCF in luciferase reporter assays, and expression of Wnt targets in colon cancer cell lines. We utilized a serum free culture system with 5 added cytokines and treated both CML blast crisis CD34+ as well as chronic phase CD34+ cells with AG-214. Our in vitro experiments show that primary blast crisis CD34+ cells are induced to undergo apoptosis at an IC-50 of approximately 2 μM. Furthermore, combination of 1.25 μM of AG-214 with 2 μM Imatinib achieved greater than 50% apoptosis. Analysis of chronic phase CML CD34+ cells showed that targeting of Wnt/β-catenin pathway requires higher concentration of the Wnt-inhibitor (〉2.5 μM), and that the addition of Imatinib can cooperate to enhance the apoptotic response. Furthermore, chronic phase progenitors (Lin-CD38+/CD34+) are more sensitive to lower concentrations of AG-214 whereas 5 μM is required to induce significant apoptosis of ∼70% in the primitive leukemia stem cell (Lin-/CD38-/CD34+) population, and addition of 2 μM Imatinib increased their apoptotic response to ∼84%. Normal CD34+ cells do not undergo significant apoptosis with 5 μM of AG-214 (∼10%) even when combined with 2 μM Imatinib (∼20%). Targeting of the Wnt/β-catenin pathway enhances apoptosis in both blast crisis and chronic phase CML progenitors and leukemia stem cells. Disclosures: No relevant conflicts of interest to declare.
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  • 42
    Publication Date: 2009-03-26
    Description: Although well characterized in the mouse, the role of Notch signaling in the human T-cell receptor αβ (TCR-αβ) versus TCR-γδ lineage decision is still unclear. Although it is clear in the mouse that TCR-γδ development is less Notch dependent compared with TCR-αβ differentiation, retroviral overexpression studies in human have suggested an opposing role for Notch during human T-cell development. Using the OP9-coculture system, we demonstrate that changes in Notch activation are differentially required during human T-cell development. High Notch activation promotes the generation of T-lineage precursors and γδ T cells but inhibits differentiation toward the αβ lineage. Reducing the amount of Notch activation rescues αβ-lineage differentiation, also at the single-cell level. Gene expression analysis suggests that this is mediated by differential sensitivities of Notch target genes in response to changes in Notch activation. High Notch activity increases DTX1, NRARP, and RUNX3 expression, genes that are down-regulated during αβ-lineage differentiation. Furthermore, increased interleukin-7 levels cannot compensate for the Notch dependent TCR-γδ development. Our results reveal stage-dependent molecular changes in Notch signaling that are critical for normal human T-cell development and reveal fundamental molecular differences between mouse and human.
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  • 43
    Publication Date: 2009-07-09
    Description: During surface-initiated blood coagulation in vitro, activated factor XII (fXIIa) converts factor XI (fXI) to fXIa. Whereas fXI deficiency is associated with a hemorrhagic disorder, factor XII deficiency is not, suggesting that fXI can be activated by other mechanisms in vivo. Thrombin activates fXI, and several studies suggest that fXI promotes coagulation independent of fXII. However, a recent study failed to find evidence for fXII-independent activation of fXI in plasma. Using plasma in which fXII is either inhibited or absent, we show that fXI contributes to plasma thrombin generation when coagulation is initiated with low concentrations of tissue factor, factor Xa, or α-thrombin. The results could not be accounted for by fXIa contamination of the plasma systems. Replacing fXI with recombinant fXI that activates factor IX poorly, or fXI that is activated poorly by thrombin, reduced thrombin generation. An antibody that blocks fXIa activation of factor IX reduced thrombin generation; however, an antibody that specifically interferes with fXI activation by fXIIa did not. The results support a model in which fXI is activated by thrombin or another protease generated early in coagulation, with the resulting fXIa contributing to sustained thrombin generation through activation of factor IX.
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  • 44
    Publication Date: 2009-09-10
    Description: The ability of CD8+ T cells to engage a diverse range of peptide–major histocompatibility complex (MHC) complexes can also lead to cross-recognition of self and nonself peptide-MHC complexes and thus directly contribute toward allograft rejection or autoimmunity. Here we present a novel form of cross-recognition by herpes virus–specific CD8+ cytotoxic T cells that challenges the current paradigm of self/non-self recognition. Functional characterization of a human leukocyte antigen (HLA) Cw*0602-restricted cytomegalovirus-specific CD8+ T-cell response revealed an unusual dual specificity toward a pp65 epitope and the alloantigen HLA DR4. This cross-recognition of HLA DR4 alloantigen was critically dependent on the coexpression of HLA DM and was preferentially directed toward the B-cell lineage. Furthermore, allostimulation of peripheral blood lymphocytes with HLA DRB*0401-expressing cells rapidly expanded CD8+ T cells, which recognized the pp65 epitope in the context of HLA Cw*0602. T-cell repertoire analysis revealed 2 dominant populations expressing T-cell receptor beta variable (TRBV)4-3 or TRBV13, with cross-reactivity exclusively mediated by the TRBV13+ clonotypes. More importantly, cross-reactive TRBV13+ clonotypes displayed markedly lower T-cell receptor binding affinity and a distinct pattern of peptide recognition, presumably mimicking a structure presented on the HLA DR4 allotype. These results illustrate a novel mechanism whereby virus-specific CD8+ T cells can cross-recognize HLA class II molecules and may contribute toward allograft rejection and/or autoimmunity.
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  • 45
    Publication Date: 2009-05-28
    Description: Recent studies suggested that JAK2V617F mutation is frequent in patients with splanchnic vein thrombosis (SVT) but not in patients with other venous thromboembolic events (VTE). However, whether screening for the JAK2V617F mutation in VTE patients is justified remains unclear. Therefore, we performed a systematic review to assess the frequency of JAK2 mutation in VTE patients and the role of JAK2V617F mutation in the diagnosis of myeloproliferative neoplasms. MEDLINE and EMBASE databases were searched. Two reviewers independently performed study selection and extracted study characteristics. Pooled odds ratios of case-control studies and weighted mean proportion of the prevalence of JAK2V617F mutation of uncontrolled series were calculated. Twenty-four studies involving 3123 patients were included. Mean prevalence of JAK2 mutation was 32.7% (95% confidence interval, 25.5%-35.9%) in SVT patients. JAK2 mutation was associated with increased risk of SVT (odds ratio, 53.98; 95% confidence interval, 13.10-222.45). Mean prevalence of JAK2 mutation in other VTE patients was low (range, 0.88%-2.57%). Presence of JAK2V617F mutation in SVT patients was associated with a subsequent diagnosis of myeloproliferative neoplasm in many patients. JAK2 mutation is strongly associated with SVT, and routine screening of JAK2 mutation appears to be indicated in these patients.
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  • 46
    Publication Date: 2009-11-20
    Description: Abstract 3441 Poster Board III-329 Background CLL is characterized by the progressive accumulation of monoclonal B lymphocytes. One theory to explain how CLL cells avoid elimination through immune surveillance mechanisms is through a defect in the ability of T-cells to form immunological synapses with antigen-presenting tumor B-cells (Ramsay et al JCI 2008). Lenalidomide is an immunomodulatory agent with clinical activity in the treatment of B-cell malignancies. Recent laboratory studies showed that lenalidomide not only stimulates T- and natural killer (NK)-cell-mediated ADCC, it also restores the T-cell-mediated ability to form immunological synapses with CLL tumor cells. Since NK cells also exert cytotoxicity through immune synapse formation, here we explore how lenalidomide affects NK-cell-mediated cytotoxicity mechanisms and whether this activity is altered in the presence of rituximab since published studies showed that lenalidomide-pretreated B-cells have a down-regulated surface CD20 expression. Further, we investigated the molecular events associated with immune synapse formation and the effect of lenalidomide. Methods Immune synapse formation was assessed in NK cells (from healthy donors PBMCs) co-cultured with either B-CLL cells derived from pts or with K562 cells (positive control). Cells were fixed and the ability to form synapses was assessed via immunohistochemisty co-staining for either F-actin and CD2, or F-actin and perforin (a cytolytic protein found in NK cells). Synapse formation was visualized by microscopy and measured via relative mean fluorescent intensity. Activity of RhoA, Rac1, Cdc42 were measured using Rho GTPases assay kits. Inhibition of lenalidomide-mediated immune synapse activity was assayed using the cell permeable Rho inhibitor C3 (0.5 mM). Flow cytometry was used to measure changes in surface CD20 and CD54 (ICAM-1) expression in B-CLL samples from 3 pts after treatment with lenalidomide. Results Lenalidomide induced the formation of immunological synapses between NK cells and primary B-CLL cells (p
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  • 47
    Publication Date: 2009-01-29
    Description: The antiphospholipid syndrome (APS) is an acquired thrombophilia, characterized by the occurrence of venous and arterial events. This article examines the laboratory and key clinical aspects of APS. Particular focus is given to anti–beta 2-glycoprotein I (β2GPI) antibodies in view of their recent inclusion in the APS classification criteria. The clinical utility of using the β2GPI enzyme-linked immunosorbent assay, in conjunction with the established lupus anticoagulant assays and cardiolipin enzyme-linked immunosorbent assay, for diagnosing and risk stratifying patients suspected of having APS is discussed. The relative importance of the various assays in diagnosing obstetric APS (early and late gestation miscarriages) is explored. The implications of recent epidemiologic findings for possibly understanding the underlying pathophysiologic mechanisms of obstetric APS are highlighted. Insights into which patients with obstetric APS may be at most risk of thrombotic complications are presented.
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  • 48
    Publication Date: 2009-12-03
    Description: To study B-cell development from bone marrow (BM), we generated recombination-activating gene 1 (Rag1)–targeted mice lacking mature lymphocytes. B-cell development can be induced in such mice by B cell–specific restoration of a functional Rag1 transcription unit. Follicular and marginal zone B cells populated the spleen when Rag1 expression was permitted. Notably, the peritoneal cavity was dominated by bona fide B-1a cells, as judged by surface markers and functional properties. These BM-derived B-1a cells exhibited a polyclonal VDJ repertoire with substantial N nucleotide insertions. Nevertheless, physiologic frequencies of phosphatidylcholine-specific B cells were detected. Importantly, the BM of young and 5-month-old mice was indistinguishable with regard to the potential to generate B-1a cells.
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  • 49
    Publication Date: 2009-07-16
    Description: Historically, graft-versus-host disease (GVHD) beyond 100 days after hematopoietic cell transplantation (HCT) was called chronic GVHD, even if the clinical manifestations were indistinguishable from acute GVHD. In 2005, the National Institutes of Health (NIH) sponsored a consensus conference that proposed new criteria for diagnosis and classification of chronic GVHD for clinical trials. According to the consensus criteria, clinical manifestations rather than time after transplantation should be used in clinical trials to distinguish chronic GVHD from late acute GVHD, which includes persistent, recurrent, or late-onset acute GVHD. We evaluated major outcomes according to the presence or absence of NIH criteria for chronic GVHD in a retrospective study of 740 patients diagnosed with historically defined chronic GVHD after allogeneic HCT between 1994 and 2000. The presence or absence of NIH criteria for chronic GVHD showed no statistically significant association with survival, risks of nonrelapse mortality or recurrent malignancy, or duration of systemic treatment. Antecedent late acute GVHD was associated with an increased risk of nonrelapse mortality and prolonged treatment among patients with NIH chronic GVHD. Our results support the consensus recommendation that, with appropriate stratification, clinical trials can include patients with late acute GVHD as well as those with NIH chronic GVHD.
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  • 50
    Publication Date: 2009-01-08
    Description: Chronic immune activation is a major cause for progressive immunodeficiency in human immunodeficiency virus type-1 (HIV) infection. The underlying trigger, however, remains largely unknown. HIV single-stranded RNA is a potent immune activator by triggering Toll-like receptor (TLR) 7/8. Thus, we hypothesized that sustained TLR7 triggering induces chronic immune activation and thereby contributes to progressive immunodeficiency. We used the synthetic compound R848 or a mixture of uridine-rich HIV single-stranded (ss) RNA oligonucleotides—both are potent TLR7/8 agonists—to explore the effects of sustained TLR7 triggering on the murine lymphoid system. Sustained TLR7 triggering induced an immunopathology reminiscent of progressive lymphoid destruction in HIV disease; we observed lymphopenia, elevated proinflammatory cytokines, splenomegaly, contracted lymphoid subsets, and lymphoid microarchitecture alteration with reduced marginal zone B-lymphocytes. Upon exposure to inactivated vesiculo-stomatitis virus, antibody production was abolished, although splenic lymphocytes were activated and total IgG was elevated. Our data imply that HIV itself may directly contribute to immune activation and dysfunction by stimulating TLR7. Thus, manipulation of TLR7 signaling may be a potential strategy to reduce chronic hyper-immune activation and, thereby, disease progression in HIV infection.
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  • 51
    Publication Date: 2009-03-05
    Description: Polymorphisms in folate pathway genes may influence the susceptibility to acute lymphoblastic leukemia (ALL). DNA was isolated from 245 pediatric ALL patients (cases) and from 500 blood bank donors (controls). Polymorphisms in methylene-tetrahydrofolate reductase (MTHFR 677C〉T, 1298A〉C), methionine synthase (MTR 2756A〉G), methionine synthase reductase (MTRR 66A〉G), methylenetetrahydrofolate dehydrogenase (MTHFD1 1958G〉A), nicotinamide N-methyltransferase (NNMT IVS −151C〉T), serine hydroxymethyl transferase (SHMT1 1420C〉T), thymidylate synthase (TS 2R3R), and the reduced folate carrier (RFC1 80G〉A) were detected. In ALL patients, an increased occurrence was observed of the RFC1 80AA variant (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.2; P = .002) and the RFC1 80A allele (OR = 1.5; 95% CI, 1.1-2.1; P = .02). Likewise, the NNMT IVS −151TT genotype showed a 2.2-fold increased ALL risk (OR = 2.2; 95% CI, 1.1-4.6; P = .04). A 1.4-fold reduction in ALL risk was observed for (heterozygous or homozygous) carriers of the TS 2R allele and the MTHFR 677T allele (OR = 0.7; 95% CI, 0.5-1.0; P 〈 .05). Furthermore, interactions between NNMT and MTHFR 677C〉T and RFC1 were observed. NNMT IVS −151CC/MTHFR 677CT + TT patients exhibited a 2-fold reduction in ALL risk whereas RFC1 80AA/NNMT IVS −151CT + TT subjects had a 4.2-fold increase in ALL risk (P = .001). For the first time, we associate the RFC1 80G〉A and NNMT IVS −151C〉T variants to an increased ALL susceptibility.
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  • 52
    Publication Date: 2009-11-20
    Description: Abstract 4311 Objectives Oral mucositis is a common complication of high-dose chemotherapy and radiotherapy followed by hematopoietic stem-cell support (HSCT). We evaluated the efficacy and safety of calcium phosphate mouth rinse (Caphosol) for prevention and reduction of severity and duration of oral mucositis in patients treated with HSCT. Methods In 2009 23 patients were treated. Three received allogeneic stem cells (ALLO): 2- Hodgkin disease (HD), 1-myeloma multiplex (MM) and twenty autologous transplantation (AUTO): 8-non-Hodgkin lymphomas (NHL); 7- HD; 3-MM. For ALLO conditioning regimens were composed of: fludarabine 150mg/m 2 and melphalan 140mg/m 2. AUTO were treated with: BEAM: carmustine, etoposide, cytarabine and melphalan (HD and NHL) and melphalan 200mg/m 2 (MM). The source of hematopoietic stem cells was peripheral blood. Caphosol was prepared according to the manufacturer‘s instructions and administered 4 times daily, starting from the day before the beginning of chemotherapy till the end of hospitalization. Control group was composed of patients, who had been treated with HSCT previously, before “palifermin and caphosol era”. The groups were comparable according to number of patients, their age, type of disease, transplant and conditioning regimen. Oral mucositis was assessed with the use of the five-grade World Health Organization (WHO) oral-toxicity scale. Oral mucositis was evaluated daily after the beginning of transplantation procedure until discharge from the BMT Unit. The number of days with painkillers or antibiotics were estimated. Total parenteral nutrition was given according to the standards [Martin-Salces M, De Paz R, Canales MA et al (2008) Nutritional recommendations in hematopoietic stem cell transplantation. Nutrition 24: 769-775]. Treatment with antibiotics was started when neutropenic fever occurred. Safety was assessed on the basis of the incidence of adverse events. Statistical analysis was performed using Wilcoxon‘ test for analysis of differences between groups. Results Oral mucositis grade 2-4 was not observed. In patients treated with calcium phosphate mouth rinse oral mucositis grade 2-4 was not observed. Nobody had to receive opioid analgesics or total parenteral nutrition. 30% patients developed the first degree of oral mucositis 4-5 days' duration. In the control group OM was observed in all cases, 50% patients had III- IV degree. Median duration of OM was 10 and 12 days (range 5- 20) for auto- and allogeneic patients, respectively. As compared with control group, treatment with calcium phosphate mouth rinse was associated with significant reduction of the incidence of oral mucositis in II- IV degrees (0 percent versus 50 percent, p 〈 0.001), duration of oral mucositis (4/ 5 days vs. 10/12 days, p 〈 0.001), duration of pain-killers‘ treatment (0- 22 days vs. 0- 3 days, p 〈 0.001) and number of days with antibiotics‘ treatment (0- 7 days vs. 7- 20 days, p= 0.002). These differences were observed in both types of transplantation. No side effects of calcium/phosphate oral rinse were observed. Conclusion In comparison with control group, treatment with Caphosol was associated with the significant reduction of the incidence of oral mucositis in II- IV degrees, duration of oral mucositis, pain-killers‘ treatment and number of days with antibiotics‘ treatment. Calcium phosphate mouth rinse is a very promising medicine for prevention of oral mucositis for patients treated with high dose chemotherapy supported with hematopoietic stem cell transplantation. Disclosures: No relevant conflicts of interest to declare.
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  • 53
    Publication Date: 2009-10-29
    Description: Acute lymphoblastic leukemia (ALL) diagnosed in the first month of life (congenital ALL) is very rare. Although congenital ALL is often assumed to be fatal, no studies have been published on outcome except for case reports. The present study reports the outcome of 30 patients with congenital ALL treated with the uniform Interfant-99 protocol, a hybrid regimen combining ALL treatment with elements designed for treatment of acute myeloid leukemia. Congenital ALL was characterized by a higher white blood cell count and a strong trend for higher incidence of MLL rearrangements and CD10-negative B-lineage ALL compared with older infants. Induction failure rate was 13% and not significantly different from that in older infants (7%, P = .14), but relapse rate was significantly higher in congenital ALL patients (2-year cumulative incidence [SE] was 60.0 [9.3] vs 34.2 [2.3], P 〈 .001). Two-year event-free survival and survival of congenital ALL patients treated with this protocol was 20% (SE 9.1%). Early death in complete remission and treatment delays resulting from toxicity were not different. The survival of 17% after last follow-up, combined with a toxicity profile comparable with that in older infants, justifies treating congenital ALL with curative intent. This trial was registered at www.clinicaltrials.gov as no. NCT 00015873, and at www.controlled-trials.com as no. ISRCTN24251487.
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  • 54
    Publication Date: 2009-09-03
    Description: The role of hematopoietic cytokines in lineage commitment remains uncertain. To gain insight into the contribution of cytokine signaling to myeloid lineage specification, we compared granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) signaling in Ba/F3 cells expressing both the G-CSF and M-CSF receptors and in lineage-negative murine marrow cells. G-CSF and M-CSF serve as prototypes for additional cytokines that also influence immature myeloid cells. G-CSF specifically activated signal transducer and activator of transcription 3 and induced Src homology region 2 domain-containing phosphatase 2 (SHP2) phosphorylation, whereas M-CSF preferentially activated phospholipase Cγ2, and thereby extracellular signal-regulated kinase (ERK), to stabilize c-Fos and stimulate CCAAT/enhancer-binding protein (C/EBP)α(S21) phosphorylation. In contrast, activation of Jun kinase or c-Jun was similar in response to either cytokine. Inhibition of ERK prevented induction of c-Fos by M-CSF and reduced C/EBPα phosphorylation and formation of colony-forming unit–monocytes. SHP2 inhibition reduced ERK activation in G-CSF, but not M-CSF, and reduced colony-forming unit–granulocytes, underscoring divergent pathways to ERK activation. Phorbol ester mimicked the effect of M-CSF, activating ERK independent of SHP2. In summary, M-CSF activates ERK more potently than G-CSF, and thereby induces higher levels of c-Fos and phospho-C/EBPα(S21), which may directly interact to favor monopoiesis, whereas G-CSF activates signal transducer and activator of transcription 3 and SHP2, potentially shifting the balance to granulopoiesis via gene induction by C/EBPα homodimers and via effects of SHP2 on regulators besides ERK.
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  • 55
    Publication Date: 2009-04-09
    Description: To investigate the cell of origin linking follicular (FL) and transformed (t-FL) lymphomas, we analyzed the somatic hypermutation (SHM) pattern of the variable region of the immunoglobulin heavy gene (IgH-VH) in 18 sequential FL/t-FL samples and a father (donor) and son (recipient), who developed FL and t-FL, after transplantation. Genealogic trees showed a pattern compatible with a common progenitor cell (CPC) origin in 13 cases. The identification of the t-FL clonotype in the previous FL sample and of the putative CPC sequence in both the FL/t-FL biopsies showed that the intraclonal diversity of FL and t-FL germinal centers (GCs) is more intricate than previously described, and all 3 clonotypes (CPC, FL, t-FL) may occur simultaneously within the same lymph node. On the basis of the father/son model, this CPC must be long-lived, providing a possible explanation for the incurable nature of this disease.
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  • 56
    Publication Date: 2009-11-12
    Description: Hematogenous metastasis is promoted by interactions of tumor cells with leukocytes, platelets, and the endothelium in the local intravascular microenvironment. Here we show that the activation of the microvascular endothelium results in recruitment of monocytes to metastatic tumor cells and promotes the establishment of the metastatic microenvironment. This inflammatory-like endothelial response was observed in microvascular endothelial cells only. Microarray analysis of microvascular endothelial cells cocultured with tumor cells in the presence of leukocytes and platelets revealed a specific gene expression profile. Selectin-mediated interactions of tumor cells with platelets and leukocytes activated endothelial cells and induced production of C-C chemokine ligand 5 (CCL5). Inhibition of CCL5-dependent monocyte recruitment during the early phase of metastasis by a CCL5 receptor antagonist strongly reduced tumor cell survival and attenuated metastasis. Collectively, these findings demonstrate that the endothelial expression of CCL5 contributes to the formation of a permissive metastatic microenvironment.
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  • 57
    Publication Date: 2009-08-13
    Description: Platelet response to activation varies widely between individuals but shows interindividual consistency and strong heritability. The genetic basis of this variation has not been properly explored. We therefore systematically measured the effect on function of sequence variation in 97 candidate genes in the collagen and adenosine-diphosphate (ADP) signaling pathways. Resequencing of the genes in 48 European DNA samples nearly doubled the number of known single nucleotide polymorphisms (SNPs) and informed the selection of 1327 SNPs for genotyping in 500 healthy Northern European subjects with known platelet responses to collagen-related peptide (CRP-XL) and ADP. This identified 17 novel associations with platelet function (P 〈 .005) accounting for approximately 46% of the variation in response. Further investigations with platelets of known genotype explored the mechanisms behind some of the associations. SNPs in PEAR1 associated with increased platelet response to CRP-XL and increased PEAR1 protein expression after platelet degranulation. The minor allele of a 3′ untranslated region (UTR) SNP (rs2769668) in VAV3 was associated with higher protein expression (P = .03) and increased P-selectin exposure after ADP activation (P = .004). Furthermore the minor allele of the intronic SNP rs17786144 in ITPR1 modified Ca2+ levels after activation with ADP (P 〈 .004). These data provide novel insights into key hubs within platelet signaling networks.
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  • 58
    Publication Date: 2009-11-20
    Description: Abstract 3453 Poster Board III-341 Introduction Increasing insight into the biology of CLL suggests a relevant interplay between tumor cells and the microenvironment. Preclinical data point to the potency of Lenalidomide to favourably modulate such interactions and remarkable clinical activity has been demonstrated in monotherapy trials in pretreated and also in previously untreated CLL patients. However, tumor flare and tumor lysis have been observed as problems and the optimal dose and schedule is still under investigation. In addition, the potential for interaction with effective standard treatment for CLL is unknown. We used a combination of Fludarabine and Rituximab as a backbone to establish a tolerable Lenalidomide dose in a dose escalation design. Study design The study treatment follows two phases: In the induction phase the maximal tolerated dose (MTD) of Lenalidomide in combination with FR should be determined. The protocol combines 6 cycles of Fludarabine (40mg/m2 po d1-3) and Rituximab (375mg/m2 iv day 4 on cycle 1 and 500mg/m2 iv day 1 on cycles 2-6), both in a 28 day cycle. Lenalidomide is given at a starting dose of 2,5 mg daily (day 7-21 of cycle 1) and with dose escalation steps to 5, 10, 15, 20 and 25mg of Lenalidomide from day 1-21 of the following cycles, if toxicity of the combination permits. In a second phase, Rituximab (375mg/m2 iv) at 2, 4 and 6 months after the last cycle is combined with Lenalidomide (day 1-28 of 28 day cycles) at the last tolerated dose for 6 months of maintenance. 40 patients are planned for this study. We herewith present the planned interim analysis for dose finding and safety endpoints for the induction phase of the first 10 patients recruited into the study. Results Mean age of patients was 70 years (range 59-76). Six of 10 patients had stage Rai III/IV and mean WBC count was 159 G/L. Seven of 10 patients had at least one high risk feature from CD38 and FISH analysis or by mutation status. Of the 60 planned cycles 46 (77%) are currently evaluable for this analysis. No systematic toxicity determining MTD was found. 50% of patients proceeded through dose escalation steps as planned. Two patients have already tolerated 25mg of Lenalidomide with their FR cycles. Regarding toxicities, grade 3 and 4 neutropenia was expected in this combination and observed in 7/10 patients. However it was not used as a dose limiting toxicity per se. Still, one 75 year old patient was dose reduced because of febrile neutropenia in the previous cycle. Overall three infectious episodes were observed on treatment. Two patients experienced thrombotic events one of which was then taken off study because of Richter transformation, which might in hindsight have been present from study onset. Surprisingly, 5/10 patients experienced significant skin toxicity, mostly in the form of skin rashes, which was deemed dose limiting in two patients. It was, however, clearly associated with Pneumocystis prophylaxis in one patient, who then went on to receive the full Lenalidomide dose without further rashes. No tumor lysis or flare reaction was observed in the 10 patients reported. Preliminary efficacy data show that all patients achieved at least a PR after 3 cycles of therapy (except for the patient with the Richter transformation). Of the 3 patients currently evaluable after 6 cycles of treatment one CR and two very good PRs were observed before starting the maintenance phase of the study. Conclusions The combination of Lenalidomide with Fludarabine and Rituximab seems clinically feasible and no tumor lysis or flare reaction have been observed, possibly due to the Lenalidomide step up design, as well as the initial tumor load reduction by the chemo-immunotherapy backbone. No clear dose dependent toxicity has emerged as dose limiting for Lenalidomide escalation in this combination. However, 50% of patients had to be dose-limited due to not clearly dose-dependent skin and vascular toxicities. A regime of thromboprophylaxis as well as a delayed start of prophylaxis against pneumocystis have since been amended to improve the management of the patients. In addition, and remarkably, the regimen shows clinical efficacy despite controversial in vitro reports, suggesting a potential negative interaction between Lenalidomide and Rituximab. This might be due to the Lenalidomide pause before each Rituximab cycle or may reflect a difference between in vitro and in vivo. Disclosures Egle: Roche: Research Funding, Speakers Bureau. Off Label Use: Lenalidomide treatment in CLL, Rituximab maintenance in CLL. Greil:Roche: Honoraria, Research Funding; Celgene: Research Funding.
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  • 59
    Publication Date: 2009-11-01
    Description: Abstract LBA-2 Background: In a large proportion of patients that have completed 6 to 12 months of treatment with a vitamin K antagonist (VKA) for their acute episode of venous thromboembolism (VTE) the question arises whether to stop or continue this treatment. Continuation implies the need for regular laboratory control and subsequent dose adjustments. Furthermore, the risk of bleeding persists. New oral anticoagulants hold the promise of simple fixed-dose regimens without the need for monitoring and could make continuation of therapy more attractive. The Einstein-Extension study was therefore designed to assess the relative efficacy and safety of rivaroxaban, a direct oral factor Xa inhibitor, versus placebo in patients who had completed 6 to 12 months of anticoagulant treatment for their acute episode of VTE. Patients in whom there was a clear indication for continued anticoagulant treatment were not eligible. Study Design: This randomized, double-blind, placebo-controlled, superiority study evaluated therapy with rivaroxaban 20 mg once-daily for an additional 6 or 12 months. The primary efficacy outcome was symptomatic recurrent VTE (i.e., the composite of recurrent DVT, non-fatal PE, and fatal PE). The principal safety outcome was major bleeding. Also the occurrence of clinically relevant non-major bleeding (e.g. nose bleeds, large skin hematomas, and macroscopic hematuria) was recorded. The study was event-driven requiring a minimum of 30 confirmed recurrent events. All outcomes were adjudicated by an independent blinded committee. Results: A total of 1197 patients were randomized between February 2007 and May 2009 by 280 study sites in 28 countries. The intention-to-treat population consisted of 602 rivaroxaban and 594 placebo patients. Baseline characteristics and risk factors for VTE were comparable between the two groups. The mean duration of study treatment was 190 days in both groups. During the treatment period, symptomatic recurrent VTE events occurred in 42 (7.1%) of the placebo treated patients and in 8 (1.3%) of the rivaroxaban recipients (hazard ratio, 0.18; 95 % CI, 0.09 – 0.39; p〈 0.0001). After the stop of study medication, 6 symptomatic recurrent VTE events occurred in each group during the one month observational period. Major bleeding did not occur in placebo patients and was observed in 4 (0.7%) rivaroxaban recipients (p=0.106). None of these bleeding events were fatal or in a critical site. Clinically relevant non-major bleeding was noted in 7 (1.2%) and 32 (5.4%) of the placebo and rivaroxaban recipients, respectively. Two (0.3%) patients in the placebo group died versus 1 (0.2%) in the rivaroxaban group. No patients were observed to have an alanine aminotransferase (ALT) rise above 3 times the upper limit of normal (xULN) combined with a total bilirubin above 2 xULN. Conclusion: A fixed dose of 20 mg of rivaroxaban once-daily is associated with an 82% relative risk reduction in the recurrence of VTE in patients who had completed a 6 to 12 month course of anticoagulant therapy for their index event. Based on the estimated cumulative incidence rates, approximately, 15 patients need to be treated to prevent one recurrent VTE event. This clinically relevant reduction in recurrence was associated with a low incidence of major bleeding (0.7%). This oral once-daily regimen provides the clinician with a simple option for patients in whom continued anticoagulant treatment is indicated. Disclosures: Buller: Bayer Healthcare: Research Funding.
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  • 60
    Publication Date: 2009-05-07
    Description: BLyS and its major receptor BAFF-R have been shown to be critical for development and homeostasis of normal B lymphocytes, and for cell growth and survival of neoplastic B lymphocytes, but the biologic mechanisms of this ligand/receptor-derived intracellular signaling pathway(s) have not been completely defined. We have discovered that the BAFF-R protein was present in the cell nucleus, in addition to its integral presence in the plasma membrane and cytoplasm, in both normal and neoplastic B cells. BAFF-R interacted with histone H3 and IKKβ in the cell nucleus, enhancing histone H3 phosphorylation through IKKβ. Nuclear BAFF-R was also associated with NF-κB/c-Rel and bound to NF-κB targeted promoters including BLyS, CD154, Bcl-xL, IL-8, and Bfl-1/A1, promoting the transcription of these genes. These observations suggested that in addition to activating NF-κB pathways in the plasma membrane, BAFF-R also promotes normal B-cell and B-cell non-Hodgkin lymphoma (NHL-B) survival and proliferation by functioning as a transcriptional regulator through a chromatin remodeling mechanism(s) and NF-κB association. Our studies provide an expanded conceptual view of the BAFF-R signaling, which should contribute a better understanding of the physiologic mechanisms involved in normal B-cell survival and growth, as well as in the pathophysiology of aggressive B-cell malignancies and autoimmune diseases.
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  • 61
    Publication Date: 2009-11-20
    Description: Abstract 432 Elotuzumab is a humanized monoclonal IgG1 antibody directed against CS1, a cell surface glycoprotein, which is highly and uniformly expressed in multiple myeloma (MM). Elotuzumab induces significant antibody-dependant cytotoxicity (ADCC) against primary myeloma cells in the presence of either autologous or allogeneic peripheral lymphocytes (PBMC), which is significantly enhanced when PBMC effector cells were pretreated with lenalidomide (Tai et al., Blood 112:1329, 2008). The primary objective of the phase 1 portion of the study is to evaluate the maximum tolerated dose (MTD) of elotuzumab in combination with lenalidomide and low dose dexamethasone in patients with relapsed MM. The study is also evaluating safety, pharmacokinetics (PK) and clinical response. Lenalidomide (25 mg PO) is given on Days 1-21 of a 28-day cycle. Elotuzumab in three escalating dose cohorts (5, 10 and 20 mg/kg) is administered by IV infusion on Days 1, 8, 15 and 22 of the 28-day cycle in the first two cycles and then on Days 1 and 15 of each subsequent cycle. Dexamethasone is given weekly at 40 mg PO. Initially, patients received 6 cycles of treatment unless withdrawn earlier due to disease progression or unacceptable. toxicity. The protocol was amended to allow for patients in the 10 and 20 mg/kg cohorts to receive treatment for up to 12 months following enrollment of the last patient. Key entry criteria: age ≥ 18 years; MM with at least one relapse; measurable disease M-protein component in serum and/or in urine; and prior lenalidomide treatment, if any, more than 6 weeks of first dose. To date, 24 patients with a median age of 60 years have been enrolled in the study and 23 patients have received study drug. The median time from initial diagnosis of MM was 5 years and patients had received a median of 3 prior MM treatments. Patients had been previously treated with thalidomide (58%), bortezomib (67%) or lenalidomide (21%) and 42% were refractory to their most recent MM therapy. Patients have been treated in the 3 cohorts; 3 patients each in the first two cohorts (5 and 10 mg/kg elotuzumab) and 17 patients (7 in dose-escalation phase and 10 in the expansion phase) in the third cohort (20 mg/kg). No dose limiting toxicities were identified during the dose-escalation phase of the study and no MTD was established. One patient discontinued in the first cycle due to grade 4 allergic reaction resulting from elotuzumab infusion in the expansion phase of the study. Additional SAEs (1 of each) included grade 2 atrial fibrillation (related to lenalidomide/dexamethasone) and unrelated grade 4 ruptured diverticulum, grade 3 neutropenic fever and grade 3 diarrhea.. Other common grade 3 or 4 AEs included neutropenia (25%) and thrombocytopenia (25%), which were managed by dose withholding or dose reduction of lenalidomide. Approximately 25% of patients experienced grade 1 or 2 chills and/or pyrexia associated with elotuzumab infusion. The best clinical response (IMWG criteria) in the 13 patients who have received at least two cycles of treatment is shown in the table below. Preliminary PK analysis of elotuzumab suggests a serum half-life of 10-11 days at 10 and 20 mg/kg. Elotuzumab at all three doses resulted in near complete saturation of CS1 sites on plasma cells and NK cells in bone marrow and NK cells in the peripheral compartment. In conclusion, the combination of elotuzumab with lenalidomide and low-dose dexamethasone has a manageable adverse event profile and compared to historical data for lenalidomide and high-dose dexamethasone, the preliminary efficacy data (≥ PR of 92%) are very encouraging. Additional safety, efficacy and PK/PD data will be presented at the meeting. Disclosures: Lonial: Celgene: Consultancy; Millennium: Consultancy, Research Funding; BMS: Consultancy; Novartis: Consultancy; Gloucester: Research Funding. Off Label Use: Lenalidomide/dexamethasone in combination with elotuzumab in patients with relapsed/refractory multiple myeloma. Vij:Celgene: Research Funding, Speakers Bureau. Harousseau:Celgene France: Advisory Board; Janssen Cilag France: Advisory Board; Celgene: Honoraria; Janssen Cilag: Honoraria; Novartis: Honoraria; Amgen: Honoraria. Facon:Celgene: Membership on an entity's Board of Directors or advisory committees; Janssen Cilag: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees. Kaufman:Celgene: Consultancy, Research Funding; Millennium: Consultancy; Genzyme: Consultancy; Merck: Research Funding. Mazumder:Celgene: Speakers Bureau; Millennium: Speakers Bureau. Leleu:Celgene: Research Funding, Speakers Bureau. Fry:Facet Biotech: Employment. Singhal:Facet Biotech: Employment. Jagannath:Millennium: Advisory Board; Merck: Advisory Board.
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  • 62
    Publication Date: 2009-09-17
    Description: This phase 3 prospective randomized trial evaluated the efficacy and long-term safety of erythropoietin (EPO) with or without granulocyte colony-stimulating factor plus supportive care (SC; n = 53) versus SC alone (n = 57) for the treatment of anemic patients with lower-risk myelodysplastic syndromes. The response rates in the EPO versus SC alone arms were 36% versus 9.6%, respectively, at the initial treatment step, 47% in the EPO arm, including subsequent steps. Responding patients had significantly lower serum EPO levels (45% vs 5% responses for levels 〈 200 mU/mL vs ≥ 200 mU/mL) and improvement in multiple quality-of-life domains. With prolonged follow-up (median, 5.8 years), no differences were found in overall survival of patients in the EPO versus SC arms (median, 3.1 vs 2.6 years) or in the incidence of transformation to acute myeloid leukemia (7.5% and 10.5% patients, respectively). Increased survival was demonstrated for erythroid responders versus nonresponders (median, 5.5 vs 2.3 years). Flow cytometric analysis showed that the percentage of P-glycoprotein+ CD34+ marrow blasts was positively correlated with longer overall survival. In comparison with SC alone, patients receiving EPO with or without granulocyte colony-stimulating factor plus SC had improved erythroid responses, similar survival, and incidence of acute myeloid leukemia transformation.
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  • 63
    Publication Date: 2009-04-09
    Description: AML1-ETO is the chimeric protein product of the t(8;21) in acute myeloid leukemia. The ETO portion of the fusion protein includes the eTAFH domain, which is homologous to several TATA binding protein–associated factors (TAFs) and interacts with E proteins (E2A and HEB). It has been proposed that AML1-ETO–mediated silencing of E protein function might be important for t(8;21) leukemogenesis. Here, we determined the solution structure of a complex between the AML1-ETO eTAFH domain and an interacting peptide from HEB. On the basis of the structure, key residues in AML1-ETO for HEB association were mutated. These mutations do not impair the ability of AML1-ETO to enhance the clonogenic capacity of primary mouse bone marrow cells and do not eliminate its ability to repress proliferation or granulocyte differentiation. Therefore, the eTAFH-E protein interaction appears to contribute relatively little to the activity of AML1-ETO.
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  • 64
    Publication Date: 2009-07-16
    Description: Endothelial sialomucin CD34 functions as an L-selectin ligand mediating lymphocyte extravasation only when properly glycosylated to express a sulfated carbohydrate epitope, 6-sulfo sialyl Lewis x (6-sulfo SLex). It is thought that multivalent 6-sulfo SLex expression promotes high-affinity binding to L-selectin by enhancing avidity. However, the reported low amount of 6-sulfo SLex in total human CD34 is inconsistent with this model and prompted us to re-evaluate CD34 glycosylation. We separated CD34 into 2 glycoforms, the L-selectin–binding and nonbinding glycoforms, L-B-CD34 and L-NB-CD34, respectively, and analyzed released O- and N-glycans from both forms. L-B-CD34 is relatively minor compared with L-NB-CD34 and represented less than 10% of total tonsillar CD34. MECA-79, a mAb to sulfated core-1 O-glycans, bound exclusively to L-B-CD34 and this form contained all sulfated and fucosylated O-glycans. 6-Sulfo SLex epitopes occur on core-2 and extended core-1 O-glycans with approximately 20% of total L-B-CD34 O-glycans expressing 6-sulfo SLex. N-glycans containing potential 6-sulfo SLex epitopes were also present in L-B-CD34, but their removal did not abolish binding to L-selectin. Thus, a minor glycoform of CD34 carries relatively abundant 6-sulfo SLex epitopes on O-glycans that are important for its recognition by L-selectin.
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  • 65
    Publication Date: 2009-11-20
    Description: Abstract 3619 Poster Board III-555 Granulocyte colony-stimulating factor (G-CSF) controls neutrophil production in the bone marrow under steady state conditions and during demand-driven hematopoiesis occurring in response to infection. STAT3 is a principal signaling molecule activated by the G-CSF receptor (G-CSFR). We previously reported that STAT3 has an important role in demand-driven granulopoiesis, although its cellular and molecular mechanisms have been unclear. To address this, we investigated STAT3 function in emergency granulopoiesis stimulated by G-CSF administration or infection with Listeria monocytogenes, which is restrained by the G-CSF response pathway in vivo. Our results show that STAT3-deficiency renders hematopoietic stem cells and myeloid progenitors refractory to the proliferation-inducing effects of G-CSF or Listeria monocytogenes infection. STAT3-deficient myeloid progenitors have a cell autonomous defect in G-CSF-responsive cell cycle progression and undergo delayed granulocyte maturation relative to wild type cells. To define STAT3 target pathways in granulocytic progenitors, we investigated the expression of CCAAT enhancer binding protein (C/EBP) beta, a transcription factor that is necessary for G-CSF-driven emergency granulopoiesis. We found that STAT3 directly regulates G-CSF-responsive C/EBPbeta expression by binding to Cebpb promoter. Moreover, we show that STAT3 and C/EBPbeta co-regulate c-Myc during emergency granulopoiesis. These results place STAT3 as a crucial G-CSF-responsive signal transducer during demand-driven granulopoiesis, through its regulation of critical transcription factors in developing granulocytes. Disclosures: Zhang: Amgen: Research Funding. Nguyen-Jackson:Amgen: Research Funding. Watowich:Amgen, Inc: Research Funding.
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  • 66
    Publication Date: 2009-12-24
    Description: Extracellular matrix metalloproteinase inducer (EMMPRIN/CD147) is thought to promote tumor angiogenesis mostly through its protease-inducing function and more recently by its ability to increase tumor cell expression of vascular endothelial growth factor (VEGF). In this study, we present evidence that EMMPRIN can promote angiogenesis by a direct effect on endothelial cells through a paracrine regulation of the VEGF/VEGF-receptor (VEGFR) system. Using human microvascular endothelial cell line–1 endothelial cells, we show that EMMPRIN selectively increased the soluble VEGF isoforms (121 and 165), but not the matrix-bound VEGF 189 form. In addition, EMMPRIN up-regulated the expression of VEGFR-2 without an effect on VEGFR-1. This increase in VEGFR-2 was responsible for the observed EMMPRIN stimulation of the migratory and tube formation capacity of endothelial cells. EMMPRIN′s effects, which were matrix metalloproteinase and urokinase-type plasminogen activator independent, were mediated primarily through hypoxia-inducible factor-2α expression, also up-regulated by EMMPRIN. VEGFR-2 increase was also observed in vivo in a mouse model of xenograph tumors overexpressing EMMPRIN. These results suggest that in addition to increasing protease production, EMMPRIN may contribute to the formation of a reactive stroma also through the up-regulation of hypoxia-inducible factor-2α, VEGFR-2, and the soluble forms of VEGF in endothelial cells, thus directly regulating the angiogenic process.
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  • 67
    Publication Date: 2009-11-20
    Description: Abstract 286 It is well established that deregulation of the PI3K signaling pathway plays an important role in the etiology of human malignancies including those of hematologic origin. In 30–50% of solid tumors, oncogenic activation of the PI3K pathway is the result of gain-of-function mutations in the PI3K p110α isoform or due to the loss-of-function of the PTEN phosphatase that is responsible for PI3K downregulation. In B cell malignancies these mutations are rarely observed in spite of the fact that PI3K pathway activation is commonly observed and often essential for tumor cell growth and survival. In this case, PI3K pathway activation has been shown to result from constitutive B cell receptor (BCR) activation and/or from exposure to survival factors present in the microenvironment. The activation of the PI3K pathway by cell surface receptors is directly mediated by the Class I isoforms (α, β, δ, and γ), however, their relative contribution in B cell tumors is unknown. Interestingly, genetic and pharmacological approaches that specifically inactivate the p110δ isoform have demonstrated its important role in normal B cell signaling in response to multiple factors including antigen, CD40L, BAFF, SDF-1 and CXCR13 making it an attractive target for therapeutic intervention in B cell malignancies. CAL-101 is an oral p110δ specific inhibitor which is currently being evaluated in a phase I clinical trial for the treatment of patients with select hematologic malignancies. This compound is a novel potent p110δ inhibitor with an IC50 of 2.5 nM against purified p110δ and EC50 of 65 nM in p110δ-mediated basophil activation in whole blood. CAL-101 demonstrates 300-, 200-, and 40-fold selectivity over the other class I family members (α, β, and, γ respectively) and no activity against class II and III PI3K family members or other PI3K-related proteins including mTOR and DNA-PK. Furthermore, a kinome-wide screen failed to detect activity against any additional kinases. To investigate the potential role of p110δ in B cell hematologic tumors we screened a wide range of leukemia and lymphoma cell lines for constitutive PI3K pathway activation. The expression of p110δ was observed in 〉90% of these cell lines and in many cases was accompanied by constitutive Akt phosphorylation. In this context, CAL-101 was able to reduce p-Akt levels and block additional downstream effectors such as p-S6, and GSK-3β in cells that represent a range of tumor types including follicular lymphoma, acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma, and mantle cell lymphoma (MCL). Furthermore, treatment with CAL-101 resulted in growth suppression and induction of apoptosis which was accompanied by PARP and caspase-3 cleavage. Growing evidence suggests that signals from the microenviroment are essential for the expansion, homing, and survival of malignant B cells, in addition to promoting resistance to conventional drug therapy. To investigate the potential role p110δ plays during B cell signaling via interactions with the microenvironment, we examined invoked stimulation of leukemia and lymphoma cell lines with CXCL12, CXCL13, BAFF, or BCR crosslinking in the presence or absence of CAL-101. Stimulation with either chemokines or growth factors resulted in the phosphorylation of Akt which was inhibited by CAL-101 in a dose dependent manner. Moreover, p110δ inhibition with CAL-101 inhibits the chemotaxis of ALL and MCL cell lines to CXCL12. These studies have now been extended to the analysis of primary patient B-ALL and MCL cells to further establish preclinical proof of concept for therapeutic application of CAL-101. In summary, CAL-101 is a potent and selective p110δ kinase inhibitor with broad anti-tumor activity against cancer cells of hematologic origin. Our results demonstrate that selective inhibition of p110δ with CAL-101 inhibits malignant B cell growth, survival, and migration. Furthermore, p110δ inhibition may enhance the effect of cytotoxic drugs or overcome cell mediated drug resistance by inhibiting the protective signals of the microenviroment, providing a rational for combination therapy. These data suggest that p110δ may play an important role in regulating signals between malignant B cells and their microenvironment thereby providing the preclinical rationale for clinical evaluation of CAL-101 alone or in combination with cytotoxics or biologics in patients with hematologic malignancies. Disclosures: Lannutti: Calistoga Pharmaceuticals: Employment. Meadows:Calistoga Pharmaceuticals: Employment. Kashishian:Calistoga Pharmaceuticals: Employment. Steiner:Calistoga Pharmaceuticals: Employment. Johnson:Calistoga Pharmaceuticals: Research Funding. Giese:Calistoga Pharmaceuticals: Employment.
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  • 68
    Publication Date: 2009-06-04
    Description: Radioimmunotherapy (RIT) options for T-cell non-Hodgkin lymphomas (T-NHLs) are limited. We evaluated anti-CD45-RIT in human (h) and murine (m) T-NHL. CD45 was highly expressed on hT-NHL patient samples (median, 2.3 × 105 antigen-binding capacity units/cell) and hT-NHL cell lines (3.4 × 105 CD45 antigen-binding capacity units/cell). Biodistribution studies in hTNHL xenografts showed that 131I-labeled BC8 (anti-hCD45) delivered 154% (P = .01) and 237% (P = .002) more radioiodine to tumor sites over control antibodies at 24 hours and 48 hours, respectively. Importantly, tumor sites targeted with 131I-BC8 exhibited 2.5-fold (P = .05), 3.0-fold (P = .007), and 3.6-fold (P = .07) higher 131I retention over the nontarget organs of lungs, liver, and kidneys, respectively (24 hours). Because the clinical use of anti-hCD45 would target both T-NHL and other hematolymphoid tissues, we evaluated the ability of anti-mCD45 to target mT-NHL. mT-NHL grafts targeted with anti-mCD45 correspondingly retained 5.3 (P 〈 .001), 5.4 (P 〈 .001), and 8.7 (P 〈 .001) times the radioactivity in tumor sites compared with nontarget organs of lung, liver, and kidney. 131I-labeled BC8 therapy yielded improved complete remission rates (75% vs 0%, P 〈 .001) and progression-free survivals (median, 23 days vs 4.5 days, P 〈 .001) compared with controls. These data indicate that the high CD45 expression of T-NHL allows reliable tumor targeting and disease control supporting anti-CD45 RIT for T-NHL patients.
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  • 69
    Publication Date: 2009-08-13
    Description: The importance of donor-recipient human leukocyte antigen (HLA)-DPB1 matching for the clinical outcome of unrelated hematopoietic stem cell transplantation (HSCT) is controversial. We have previously described an algorithm for nonpermissive HLA-DPB1 disparities involving HLA-DPB1*0901,*1001,*1701,*0301,*1401,*4501, based on T-cell alloreactivity patterns. By revisiting the immunogenicity of HLA-DPB1*02, a modified algorithm was developed and retrospectively tested in 621 unrelated HSCTs facilitated through the Italian Registry for oncohematologic adult patients. The modified algorithm proved to be markedly more predictive of outcome than the original one, with significantly higher Kaplan-Meier probabilities of 2-year survival in permissive compared with nonpermissive transplantations (55% vs 39%, P = .005). This was the result of increased adjusted hazards of nonrelapse mortality (hazard ratio [HR] = 1.74; confidence interval [CI], 1.19-2.53; P = .004) but not of relapse (HR = 1.02; CI, 0.73-1.42; P = .92). The increase in the hazards of overall mortality by nonpermissive HLA-DPB1 disparity was similar in 10 of 10 (HR = 2.12; CI, 1.23-3.64; P = .006) and 9 of 10 allele-matched transplantations (HR = 2.21; CI, 1.28-3.80; P = .004), both in early-stage and in advanced-stage disease. These data call for revisiting current HLA matching strategies for unrelated HSCT, suggesting that searches should be directed up-front toward identification of HLA-DPB1 permissive, 10 of 10 or 9 of 10 matched donors.
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  • 70
    Publication Date: 2009-11-20
    Description: Abstract 3727 Poster Board III-663 Deacetylases (DACs) are enzymes that remove the acetyl groups from target proteins, leading to regulation of gene transcription and other cellular processes. Entinostat (SNDX-275) is a novel and potent DAC inhibitor that is selective for class I DACs and is currently undergoing pre-clinical and clinical testing in Hodgkin lymphoma (HL). Potent synergistic anti-tumor activity has been observed by combining less potent DAC inhibitors with bortezomib in pre-clinical models. In our efforts to develop more therapeutic options for refractory/resistant B-cell lymphoma, we evaluated the effects of Eentinostat as a single agent and in combination with bortezomib against B-cell non-Hodgkin's lymphoma (NHL) cell lines and primary NHL cells. Studies were conducted in a panel of 12 NHL cell lines representing various subtypes of B-cell lymphoma (i.e. DLBCL/ABC, DLBCL/GCB, Burkitt's, transformed and MCL), which included: rituximab-[chemotherapy]-sensitive cell lines (RSCL, Raji, RL and DHL-4), rituximab-[chemotherapy]-resistant cell lines (RRCL, Raji-4RH, Raji-2R, RL-4RH, and DHL-4 4RH), and primary lymphoma cells isolated from patients with various subtypes of NHL and HL. Patient-derived tumor cells were isolated from fresh specimens by negative selection using magnetic beads. NHL cells and patient-derived primary cells were exposed to entinostat at different doses (0.01 to 100uM) either alone or in combination with CDDP (1 to 100μM), doxorubicin (4 to 16μM), vincristine (1 to 5μM), or bortezomib (1 to 10nM). Anti-tumor activity was measured after a 24 or 48 hr incubation. In cell lines, changes in mitochondrial potential and cell proliferation were determined by alamar blue reduction using a kinetic assay measuring activity at 4 hr intervals for 24 and 48 hrs. For patient-derived primary NHL cells, changes in ATP content (apoptosis) was determined using the cell titer glow assay. Entinostat was highly active in all the cell lines tested including rituximab-[chemotherapy]-resistant cell lines. The IC50 of Entinostat in the majority of the cells tested was 0.5 to 5uM at 48 hrs. Similar findings were observed in primary tumor cells derived from lymphoma patients. In addition, synergistic activity was observed by combining entinostat and bortezomib in both NHL cell lines, as well as in primary NHL/HL tumor specimens. A lesser degree of augmented anti-tumor activity was also observed when entinostat was combined with cisplatin or doxorubicin (but not vincristine). In summary, our data suggests that entinostat is a novel and potent DAC inhibitor with a wide therapeutic spectrum. Entinostat is capable of inducing cell death against various subtypes of B-cell lymphoma cell lines including RSCL, RRCL, as well as patient-derived primary tumor cells and augments the anti-tumor effects of bortezomib and other chemotherapeutic agents. Given the isoform selectivity of entinostat, the results indicate that HDAC1 and 2 may be the key targets of DAC inhibitors in HL and NHL cells. Ongoing studies are evaluating the mechanisms responsible for the synergistic effects of entinostat plus chemotherapy and will be updated at the annual meeting. Current findings strongly suggest that entinostat added to bortezomib and/or other chemo agents may become a novel and potent strategy in the treatment of aggressive and indolent NHL and HL in the future. Disclosures: No relevant conflicts of interest to declare.
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  • 71
    Publication Date: 2009-11-20
    Description: Abstract 4919 Waldenstrom's macroglobulinemia (WM) is characterized by the presence of lymphoplasmacytic cells in the bone marrow and the secretion of IgM monoclonal antibody in the serum. Several conventional therapies are available but the disease remains incurable. Recently, bortezomib (a proteasomal inhibitor) has shown promising anti-WM activity with enhanced responses when combined with traditional therapies. Resistance to bortezomib therapy is an important event that is associated with continued treatment. In order to understand the mechanism of bortezomib resistance in WM we exposed BCWM.1 (a known WM cell line) in vitro to increasing concentrations of bortezomib over prolonged periods of time and isolated the bortezomib resistant clone (BCWM.1/BR). This clone was compared with its parent wild type cell line (BCWM.1/WT). Investigation to understand the susceptibility of BCWM.1/Br cells to various therapeutic agents showed that these cells are resistant to many of the agents such as melaphalan, fludarabine or doxorubicin. Interestingly, verapamil, a broad spectrum inhibitor of multidrug resistance, failed to reverse the resistance induced by bortezomib indicating that bortezomib resistance is not because of an activation of multidrug resistance in these cells. While BCWM.1/WT cells showed an IC50 of 7.8nM when treated for 72h with bortezomib, the BCWM.1/BR cells were not inhibited at any concentration of the compound up to 100nM. Furthermore, the cells with the acquired resistance showed a 4 fold increase in the proteasomal activity as measured by the release of a fluorescent product (7-Amino-4-methylcoumarin (AMC)) from its peptide substrate, suc-LLVY-AMC. Biochemical analysis further revealed that many of the proteasomal components are altered in BCWM.1/BR cells as compared to their parental control cells. Interestingly, protein levels of two of the proteasomal catalytic subunits, PSMB5 and PSMB9 are upregulated in resistant cells suggesting a reason for the enhanced proteasomal activity of these cells. The resistant cells showed an altered gene expression profile that indicates a transformation of the parental wild type cell line to acquire resistance. A comparative analysis of the signal transduction pathways operated in these cells showed that many of the activation and cell survival pathways that are present in BCWM.1 cells are inhibited in the resistant cells. For example, BCWM.1 cells show a constitutive activation of AKT and ERK1/2 which are inhibited in the resistant cells thus making them insensitive to the inhibitors of these pathways. Similarly, HSP27 which was earlier shown to contribute to bortezomib induced resistance was completely inhibited in BCWM.1 resistant cells. Interestingly, there is an increase in Bcl-2 protein in BCWM.1/BR cells as compared to WT cells indicating that the resistant cells might be dependent on Bcl-2 family for their survival. Inhibition of Bcl-2 induced potent apoptosis in BCWM.1/BR cells. Thus the results presented here indicate that acquired bortezomib resistance in BCWM.1 cells alters their proteasomal activity, cellular signaling pathways to make them resistant to many of the known therapies but these cells retain the Bcl-2 mediated pathway for targeting thus inhibitors of Bcl-2 may be used in therapy against bortezomib-resistant WM. Disclosures Chanan-Khan: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Immunogen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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  • 72
    Publication Date: 2009-11-20
    Description: Abstract 4848 Background Myelodysplastic syndrome(MDS) belong to the most common hematological diseases however epidemiological data on MDS are sparse. Until 2008 there were no data about epidemiology of MDS in Poland. Methods From 03.2008-05.2009 we have registered 966 patients in Polish MDS Registry. We have included only alive patients of various time of diagnosis. Patients from 22 centers were diagnosed according to WHO 2001 criteria. Results There were 508(53%)males and 458(47%) females. Median age at diagnosis was 70(range 19-99). Under 50 were 83(9%) cases with preponderance of females- 51 cases( males 32cases), between 50-70 there were 353(41%) cases, half of the patients-432(50%) were above 70( 247 males and 185 females).Prior chemotherapy and/or radiotherapy had 37((3,8%) patients. Distribution of MDS subtypes was as follows: RA-170(20%) cases, RARS-58(7%), RCMD-244(28%), RCMD-RS-18(2%), RAEB-1-120(14%), RAEB-2-169(19,5%), 5q- -40(4,6%), MDS-U-44(5%).In 103(10%) subtype was not done. Karyotype was available in 276(28%) cases. Cytogenetic risk groups were: low risk-182(68%), intermediate-52(20%) and high risk-33(12%). The most frequent cytogenetic results were: normal karyotype 44%, isolated 5q deletion 19%, complex karyotype 6%, 5q deletion + another one change 3% and 5q deletion with at least 2 changes 3%. According to IPSS risk groups low risk was found in 61( 22%) of cases, intermediate-1 -130(48%), intermediate-2-47(17%) and high risk in 31(11,5%). Median values of Hb was 9,1 g/dL, plts 129 G/L, ANC 1,7 G/L. RBC transfusion dependent were 429(44%) patients and platelet transfusion dependent were 100( 11%) pts. At least 2 U/month RBC transfusion requirement was 140(14%) patients. Serum ferritin level was assessed in 530 cases-171 of them( 32%) had higher than 1000μg/L level. Conclusions We have observed predominance of females among MDS patients under 50. Half of the patients had RA or RCMD subtype. Isolated 5 q deletion was the most frequent cytogenetic abnormality. Forty four percentage of patients was RBC transfusion dependant. Serum ferritin level was significantly elevated in 32% of assessed patients at the moment of MDS diagnosis. Disclosures No relevant conflicts of interest to declare.
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  • 73
    Publication Date: 2009-11-20
    Description: Abstract 4915 Multiple studies have highlighted the critical role of mutation and loss of p53 function in multiple myeloma (MM) when acquiring a more aggressive phenotype and refractoriness to treatment. Therefore, agents capable of overcoming p53 mutational status are important in the context of MM therapeutics. We have previously reported the in vitro and in vivo anti-MM activity of the multi-targeted small molecule inhibitor RGB-286638. Using a human MM cell xenograft model in SCID mice we demonstrated that RGB-286638 inhibited tumor growth and prolonged survival. Our data confirmed suppression of CDK1/cyclin B, CDK4, 6/Cyclin D1, D3, and CDK2/Cyclin E complexes in MM.1S MM cells containing wt-p53, which was correlated with rapid downregulation of Rb phosphorylation, resulting in effective G2/M cell cycle blockage and increased sub-G1phase. RGB-286638 induced dose and time-dependent inhibition of RNA pol II phosphorylation as an early event promptly followed by p53 induction. Moreover, RGB-286638 treatment was associated with p53 phosphorylation at ser 15, indicative of DNA damage followed by apoptosis, evidenced by caspases 8, 9 and 3 cleavage and confirmed by Annexin V/PI staining. All together these data suggested that RGB-286638-induced RNA pol II inhibition triggers cytotoxicity in MM cells via p53-dependent apoptosis. Interestingly, RGB-286638 demonstrated cytotoxic activity even in p53-deficient conventional drug-resistant RPMI 8226/Dox 40 MM cells. RGB-286638 treatment of RPMI 8226/Dox40 MM cells showed increased PARP response associated with enhanced NAD depletion followed by increased ATP consumption. Furthermore, concomitant assessment of RGB-286638-induced ATP depletion versus cytotoxicity demonstrated more than 60% ATP loss preceded cell death in RPMI 8226/Dox40 but not in MM.1S. This data suggests the role of either p53-mediated apoptosis (when active) or PARP-induced NAD/ATP depletion and bioenergetic crisis (when absent). Interestingly, the knockdown of p53 did not rescue MM.1S cells from RGB 286638-induced death, suggesting the existence of alternative p53-independent pathways through which RGB-286638 exerts its cytotoxic activity. Ongoing studies are addressing the molecular effects of p53 silencing in MM cells. In addition, dissecting the mechanism of RGB-286638 p53-independent cytotoxicity in MM cells will provide insights for future therapeutic strategies in patients with aggressive MM and associated mutated/deleted-p53. Disclosures Loferer: GPC Biotech AG: Employment. Munshi:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Millennium: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis : Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Anderson:Millenium: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Raje:Celgene: Research Funding; Novartis: Research Funding; AstraZeneca: Research Funding.
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  • 74
    Publication Date: 2009-11-20
    Description: Abstract 4886 Detection of high molecular weight light chain oligomers in urinary exosomes of patients with AL amyloidosis. Background Exosomes are microvesicles that are part of the multivesicular body (MVB) pathway. They are created by the inward budding of the cell surface membrane and contain both surface bound membrane proteins and cytosolic proteins which can be used to identify the cell of origin. Immunoglobulin light chain amyloidosis (AL) occurs as the result of amyloid formation by the misfolding of monoclonal light chains (LC) and deposition of these amyloid fibrils in various soft tissues. This reaction requires the organization of the monoclonal LC's into protofibrils which are then weave into amyloid fibrils. This study was undertaken to determine whether urinary exosomes of glomerular origin contain intermediate species of amyloid formation. Method Urine samples from patients with AL, light chain deposition disease (LCDD), multiple myeloma (MM) and monoclonal clonal gammopathy of undetermined significance (MGUS) were collected. Urinary exosomes were isolated and separated into fractions by gradient centrifugation. Western blots were performed on the urinary exosome fractions using anti-kappa or anti-lambda antibodies. Glomerular fractions were identified using antibodies directed toward podocin. Results Urine samples were collected from 5 patients with AL, 2 from LCDD, 1 from MM and 1 MGUS. On the Western blot, immunoglobulin LC were seen in all exosomal fractions in patients with AL amyloidosis, LCDD, MM but not MGUS which is similar to normal controls (not shown). In patients with AL, oligomeric species were found in the highest concentrations in fraction 4 and 5 (Figure 1). Fraction 4 and 5 were also stained for podocin, a glomerular protein (not shown). The highest molecular weight species was ∼250 kd which corresponds to a LC decamer. High molecular weight species were also identified in 1 of 2 LCDD patients corresponding to a tetramer. The band was identified in fraction 10 which had polycystin-1 expression suggesting a tubular origin. No high molecular weight LC species was found in patients with MM or MGUS. Conclusion Our study found high molecular weight LC species corresponding to the intermediates involved in protofibril formation in urinary exosomes of patients with AL. Smaller (tetramer) high molecular weight LC species were also found in a patient with LCDD but not in patients with MM and MGUS. Not only were the high molecular weight LC species found exclusively in the diseases characterized by deposition of LC aggregates, they were also found in the segments of the nephron where the deposits were expected: glomerulus for AL and tubular epithelium for LCDD. This is consistent with our current understanding of the pathogenic mechanisms of these diseases. We believe urinary exosomes are a powerful tool in the study of diseases involving self-aggregation of monoclonal proteins. It has tremendous potential in both diagnostic and scientific research in this area. Disclosures Gertz: celgene: Honoraria; millenium: Honoraria, Membership on an entity's Board of Directors or advisory committees.
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  • 75
    Publication Date: 2009-11-20
    Description: Abstract 4902 Introduction Cytogenetics and fluorescent-in situ hybridization (FISH) are important outcome predictors in multiple myeloma (MM). There were only few small studies that investigated prognostic implication of FISH and/or conventional karyotyping in Korean MM patients. We investigated the incidences and prognostic significances of chromosomal abnormalities detected by FISH and/or conventional karyotyping among Korean MM patients. Patients and Methods We collected data of patients from Korean Myeloma Registry and performed retrospective analysis. We compared the survival of patients with chromosomal abnormalities and other clinical findings. Results From 2000 to 2009, total of 801 newly diagnosed myeloma patients were enrolled in this study. Median age of patients was 62 years. Median overall survival was 82 months, and median follow up of time was 92 months. Among the patients who had conventional karyotype analysis, 17.1% were complex karyotype, followed by del13q (7.4%), hyperdiploidy (7.6%), hypodiploidy (3.0%), and t(11;14) (3.9%). Among the patients who had FISH analysis, 22.8% were del 13q, followed by t(11;14) (18.2%), t(4;14) (13.7%), del17p (11.8%) and t(14;16) (5.9%). Univariate analyses revealed that complex karyotype (p
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  • 76
    Publication Date: 2009-11-20
    Description: Abstract 4873 Angiogenesis plays a significant role in the biology of multiple myeloma (MM). Erythropoiesis stimulating agents (ESAs) have been recently associated with reduced survival in a subset of cancer patients who receive ESAs, including MM but the etiology for this correlation has not been sufficiently explored. It is known that the endothelial cells produce angiogenic factors, promote the growth and survival of MM cells and carry erythropoietin receptors which in hypoxic conditions they transport the signal for their own proliferation and expansion under the influence of the endogenous erythropoietin. The aim of this study was to investigate the possible impact of ESAs administration on post-therapy angiogenesis. We studied 84 newly diagnosed MM patients (47M/37F; median age: 65 years, range: 39-82 years) who underwent conventional anti-myeloma therapy: 62 patients received VAD (53 of whom within the context of the randomized study VAD vs. TVAD, conducted by the Greek Myeloma Study Group) and 22 patients received MP. Fifty-two patients received ESAs for at least 8 weeks (ESA group), while 32 did not receive ESA (non-ESA group). MVD was assessed in bone marrow biopsies at baseline and at the time of best response by using monoclonal antibodies targeting CD34. The number of microvessels expressing the CD34 antibody was counted by two experienced pathologists through a grid at a magnification of 400x and was finally divided to the number of the high power fields used for screening the whole marrow surface. The counts were finally expressed as number of vessels per mm2 area of the involved marrow. Fifteen individuals with normal findings in the bone marrow were used as controls. Furthermore, the following cytokines that are involved in the angiogenesis process in MM were measured in the serum of both patients and controls on the day of the trephine biopsy performance: VEGF, bFGF, TGF-b, IL-6, soluble IL-6R (sIL-6R), IL-1b and TNF-α, using an ELISA methodology (R&D, Minneapolis, MN, USA). Patients characteristics between the ESA and non-ESA groups at baseline were well balanced except of Hb which was, as expected, significantly lower in the ESA-group (p
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  • 77
    Publication Date: 2009-11-20
    Description: Abstract 4815 Algae preparations are commonly used in complementary and alternative medicine for presumed anti-oxidant, anti-inflammatory, and anti-cancer properties. In this study, we have examined the effects of extracts from algae and algae components on the proliferation of normal hematopoietic and leukemia cells. To prepare extracts, 1 gram of Dunaliella salina (Dun), Astaxanthin (Ast), Spirulina (C-phycocyanin) (Spir), or Aphanizomenon flos-aquae (AFA) were added to 10 ml of 70% ethanol and incubated at 4°C on a shaker for 24 hours. The slurry was centrifuged at 400 g for 10 minutes at 4°C, and the supernatant was filtered through 413-grade filter paper. Leukemia cell lines were purchased from ATCC and blood or marrow aspirates from normal subjects or patients with leukemia were subjected to Ficoll-Hypaque density gradient centrifugation. CD34+ cells were isolated using Miltenyi Biotec MiniMACS magnetic bead cell separation columns. To determine effects on cell proliferation, increasing concentrations of algae extracts were added in fresh medium to plated cells, and MTT reagent was added followed by detergent and absorbance readings were recorded at 570 nm. Leukemic cell lines such as HL60 and MV4-11 were significantly inhibited by Ast and AFA at concentration of 0.8 mg/mL of extract (p
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  • 78
    Publication Date: 2009-11-20
    Description: Abstract 4877 Introduction The CD138negCD20+ cell population has been suggested as the putative multiple myeloma (MM) cancer stem cells, both in MM cell lines and in patient specimens. CD200 is an immunosuppressive membrane glycoprotein reported to be co-expressed with other stem-cell markers in prostate, breast, brain, and colon cancers. Also, CD200 is a negative prognostic factor for MM. It remains unknown whether CD200 is expressed in the CD138negCD20+ MM cell population, the putative MM cancer stem cells. Here we addressed this question by assessing CD200 expression in different subpopulations of MM cells according to their CD138 expression levels. Methods Two MM cell lines (RPMI8226 and NCI-H929) were co-stained with FITC-labeled anti-CD200, PE-labeled anti-CD20, and APC-labeled anti-CD138 antibodies for multicolor flow cytometry analysis. The cells were gated into 4 subpopulations (h1〉h2〉h3〉h4 corresponding to CD138 expression levels: high〉dim〉low〉negative). In each gated cell population, CD200 expression was assessed, and the CD200+ and CD200neg cell subpopulations were further gated for analysis of their CD20 expression levels. Results In the RPMI 8226 cell line, the distribution of gated h1, h2, h3, and h4 populations was 87.51%, 5.86%, 5.26%, and 1.29%, respectively. In the h2 (CD138dim) population, 22.88% of the cells were CD200+. In contrast, CD200 was expressed at much lower levels in the other three populations, ranging from 7.28% (h1), 6.65% (h3), to 0.48% (h4). In CD200+ cells from the gated h1, h2, h3, and h4 population, CD20+ cells were 19.50%, 23.03%, 27.67%, and 18.75%, respectively, while in the CD200neg cells, CD20+ cells were 20.79%, 22.50%, 25.08%, and 28.02%, respectively. In the NCI-H929 cell line, 18.59% of the cells in the h2 population were CD200+, whereas only 1.61%, 1.69%, and 0.47% of the cells in the h1, h3, and h4 populations were CD200+. In each population, there were more CD20+ cells in CD200+ cells than in CD200neg cells, which were 24.52% vs 0.04% (h1), 41.94% vs 11.34% (h2), 11.11% vs 3.06% (h3), and 50.00% vs 2.25% (h4), respectively. Conclusions These results demonstrate that the immunosuppressive molecule CD200 is preferentially expressed in a CD138dim subpopulation of multiple myeloma cells. Depending on cell line, the putative myeloma stem cell marker CD20 is either preferentially, or not preferentially, expressed in the CD200+ cells, suggesting that an immune-resistant subpopulation of MM stem cells might exist, which may have important implications for designing immunotherapeutic approaches to treat this disease. Disclosures Goldenberg: Immunomedics, Inc.: Employment, Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties.
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  • 79
    Publication Date: 2009-11-20
    Description: Abstract 4841 Myelodysplastic syndromes (MDS) are a group of acquired clonal stem cell disorders that mainly affect the elderly population, characterized by ineffective hematopoiesis and high risk of leukemic transformation. MDS are heterogeneous in terms of morphology, clinical features and survival. An increasing body of work reveals that there might be differences in clinical features between Asian and Western cases. Japanese patients seem to be younger, have a lower frequency of refractory anemia (RA) with ringed sideroblast (RARS) and a higher frequency of RA, according to FAB classification, as well as different prognostic factors such as the frequency of cytogenetic abnormalities. Incidence rates for MDS in Brazil are unavailable. The purpose of the study was to obtain epidemiological data of MDS adult patients who presented from January 2003 to December 2007 in 10 Brazilian tertiary-care hematology centers from different regions of the country. Patient data collected by participating physicians were entered and stored with the use of an internet-based, data collection tool. Blood counts, bone marrow aspiration, trephine biopsy and chromosomal study were recorded. Survival was estimated through Kaplan-Meier method and the difference between survival curves was assessed by means of Log-Rank Test. Death incidence rates were estimated and compared. Statistical analyses of relevant variables were performed. Three hundred and forty three patients with diagnosis of MDS according to FAB/WHO classification were included in this retrospective analysis. The mean age at presentation was 68 years (range 17 to 98). Fifty percent of cases were male. Cigarette smoking, alcohol abuse and pesticide/herbicide exposure were reported in 33.5%, 13.4% and 14.3% respectively. Median hemoglobin was 8.7 g/dL, median neutrophils count was 1,575/mm3 and median platelets count was 97,000/mm3. There was no excess of blasts in 68.4% of cases. Bone marrow biopsy was performed in 78.5% of patients. Lymphoid nodules were seen in 11.3% and any degree of fibrosis in 28.6%. Cytogenetic analysis was performed in 67.8% of cases and showed chromosomal abnormalities in 50.5%. The del(5q) isolated or combined with other alterations were observed in 6.0%. Flow cytometry analysis for CD55 and CD59 was performed in 11,3% and was normal in 97,4%. Near 8% of cases were classified as secondary MDS. The distribution of disease subtypes according to FAB classification was: RA 42,3%, RARS 9,0%, RA with excess of blasts (RAEB) 20,7%, RAEB-t 4,2% and chronic myelomonocytic leukemia (CMML) 3,9%. According to IPSS patients were stratified as low-risk (low risk plus intermediate I) 55,9% and high risk (intermediate II and high risk) 13,1%. In 30,1% no stratification was possible. In 26,5% of cases iron overload was diagnosed although only 28,3% of cases had performed serum ferritin. The follow-up time ranged from 1 to 78 months (mean: 28 months). Thirty-six percent of patients died and the death was MDS-related in 68.3% of cases. The high and low risk survival curves were significantly different (p
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  • 80
    Publication Date: 2009-11-20
    Description: Abstract 2496 Poster Board II-473 Background: HMG-CoA reductase inhibitors (statins) have been used to treat hypercholesterolemia and hyperlipidemia for over 20 years. Statins competitively inhibit HMG-CoA reductase thereby blocking the synthesis of mevalonate. They directly inhibit synthesis of steroid hormones and cholesterol but also indirectly inhibit prenylation and ubiqitination. As all currently marketed statins are lipophillic, with the exception of Pravachol (pravastatin), several therapeutic trials have attempted to exploit these indirect actions to treat both neoplastic (glioblastoma, anaplastic astrocytoma) and degenerative (Alzheimer's, Parkinson's) neurologic disease. We studied the impact of incidentally prescribed statins on high-risk patients with primary central nervous system diffuse large B cell lymphoma (PCNSL). Methods: We used an IRB-approved clinicopathologic database, derived from comprehensive tumor registry data at the Massachusetts General Hospital, to identify all patients diagnosed with primary central nervous system lymphoma (PCNSL) between 1991 and 2007 (n=118). We excluded pediatric patients, patients who did not receive curative treatment and patients who failed to achieve a CR with initial therapy. Automated analysis of billing and medication administration records was used to identify the administration of statins to these patients. We compared the outcome of patients who were receiving statins to controls with PCNSL who did not receive statins. We excluded patients who did not receive statins within the time interval from 6 months prior to 2 years after their PCNSL diagnosis. As only a single statin pt was less than 50 we excluded all pts below this age from the cases and controls. All patients received high dose MTX based therapy. Overall survival (OS) was calculated from the date of first methotrexate. Results: Median age of statin patients was 66 yrs (range 52 – 76); median age of controls was 66 years (range 50 - 86). Nine patients were on atorvastatin, 9 were on simvastatin, 1 each were on pravastatin, rosuvastatin and fluvastatin. At a median follow-up of 47.5 months, concurrent statin therapy was associated with improved OS (62% vs. 37%)(p=0.04 Log-rank test). The median OS for all statin patients 〉 50 years old (n=21) was 60 months versus 37 months for all other patients 〉 50 years old (n=67) (p=
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  • 81
    Publication Date: 2009-11-20
    Description: Abstract 2475 Poster Board II-452 Introduction: Non-Hodgkin Lymphoma (NHL) is the fifth most common type of malignancy in Canada. The most common subtype of NHL is diffuse large B-cell lymphoma (DLBCL). Initial standard treatment for DLBCL includes combination immuno-chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). This regimen is typically administered every 21 days for a total of 6 cycles. Febrile neutropenia (FN) is a serious toxicity of lymphoma chemotherapy and patients with this condition must be treated aggressively as it could lead to complications such as prolonged hospitalization and death. Granulocyte-colony stimulating factors such as filgrastim and pegfilgrastim are efficacious in preventing FN, yet their cost-effectiveness has not been evaluated in the publicly funded Canadian healthcare system. Methods: A Markov model was constructed to evaluate the cost-effectiveness (cost-utility) of filgrastim and pegfilgrastim as primary prophylaxis versus no primary prophylaxis against FN in DLBCL patients receiving induction chemotherapy. Health states included in the model were hospitalization for FN, and receiving chemotherapy with no FN. It was assumed that patients in the no primary prophylaxis arm of the model who experienced a FN episode would receive secondary prophylaxis with filgrastim for all subsequent chemotherapy cycles. The time horizon of the model was 18 weeks, the time period over which the six cycles of chemotherapy are administered. The analysis was conducted from the hospital perspective. Costs are reported in 2009 Canadian dollars and outcomes in quality-adjusted life years (QALY). One-way sensitivity analyses were done on model parameters. A probabilistic sensitivity analysis was done to evaluate overall uncertainty in the model. Results: In the base case analysis costs associated with the no primary prophylaxis, filgrastim and pegfilgrastim interventions were $6044, $9450 and $15899, respectively. Quality-adjusted life years associated with the three interventions were 0.198, 0.200, and 0.202 respectively (over the 18-week model time horizon). The incremental cost-effectiveness ratio (ICER) of filgrastim compared to no primary prophylaxis was estimated to be $1.7 million (M)/QALY [95% confidence interval: -14M/QALY (dominated) to $15M/QALY]; for pegfilgrastim compared to filgrastim the ICER was estimated to be $4.4M/QALY [95% confidence interval: -25M/QALY (dominated) to $22.7M/QALY]. All one-way sensitivity analyses yielded ICERs of greater than $1M/QALY. Conclusions: The ICERs for filgrastim and pegfilgrastim when used as primary prophylaxis against FN in DLBCL patients receiving induction chemotherapy are well above the usually accepted cost-effectiveness threshold of $50,000/QALY. Disclosures: Mittmann: Amgen Canada: Unrestriced educational grant.
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  • 82
    Publication Date: 2009-11-20
    Description: Abstract 2484 Poster Board II-461 Background: Hematologic (HM) and solid tumor malignancy (STM) patients may be immunocompromised (IC) due to their underlying diseases and the immunosuppressive therapies they received. Availability of a practical and robust algorithm to classify HM and STM patients into IC levels using data from healthcare databases could be valuable for a variety of epidemiologic, health service or outcome research in the field of oncology. Classification of the IC status of patients also permits accurate prediction of the types of supportive care that such patients may need to prevent infectious complications that often accompany treatments for the underlying malignancy. Methods: An expert panel mainly comprised of hematologists and oncologists developed an algorithm to classify HM and STM patients' level of IC into either none/low, medium, or high, using data available in electronic databases. The algorithm was based on the following factors: (1) the type of chemotherapy agents and/or corticosteroids, (2) time since last chemotherapy/corticosteroid treatment, and (3) specific type of HM (for HM patients). Chemotherapy agents were classified into levels of IC, irrespective of dose used. Corticosteroid therapy was classified into levels of IC based on dose and duration of treatment. IC levels were allowed to change monthly to reflect what chemotherapy agents were used, dose and duration of corticosteroid if any, and time since the last IC treatment. In the base case scenario, the patient's IC level (based on treatment) stayed at an assigned level for 6 months after the last treatment and then moved to the next lower level for an additional 6 months. In alternative scenarios, sensitivity analyses were also performed using the 1, 3, 9, and 12 month cutoffs. If the patient received multiple chemotherapy agents/corticosteroid regimens, the most immunocompromising agent determined the IC level during that time period. We applied and tested this algorithm in a study of HM and STM patients diagnosed in 2001-2005 at Kaiser Permanente Northern California (KPNC). Herpes zoster (HZ), a viral disease caused by the reactivation of varicella zoster virus, is associated with impairment of cell-mediated immunity. Therefore, we used incidence of HZ as a proxy for true IC status. The KPNC cancer registry was used to identify cancer diagnoses and the type, stage and grade of the underlying HM. Data on specific chemotherapy agents and/or dose and duration of corticosteroids as well as time since last IC treatment were obtained from KPNC pharmacy databases. Potential episodes of HZ in 2001-2006 were identified from HZ diagnosis codes and antiviral use in various KPNC databases. HZ diagnosis was confirmed by clinical review of patient's medical records. We measured HZ incidence rates in HM and STM patients and examined whether they were correlated with IC level based on our algorithm. Results: In the base case scenario, among the 4,465 patient-years (py) of follow-up in HM patients, 25.3%, 34.4%, and 40.3% of follow-up time was categorized as none/low, medium, or high IC, respectively. The corresponding rates of HZ were 13, 25, and 48/1000 py. Among the 23,072 py of follow-up in STM patients, 74.9%, 8.0%, and 17.1% of follow-up time was categorized as none/low, medium, or high IC, respectively. The corresponding rates of HZ were 10, 20, and 19/1000 py, respectively. The algorithm was not sensitive to changes from 3 to 12 months, but was sensitive to the 1 month cutoff, in the assumption of duration of IC since the last IC treatment. Conclusions: It is feasible and practical to categorize cancer patients into IC levels using electronic pharmacy and cancer registry databases. The correlation between incidence of HZ and levels of IC in both HM and STM patients suggested that the proposed algorithm may appropriately assign IC levels in these patients. Additional testing in other cancer populations may be needed to further validate this algorithm. Disclosures: Tran: Merck & Co., Inc.: Employment. Ray:Merck & Co., Inc.: Investigative. Saddier:Merck & Co., Inc.: Employment. Trigg:Merck & Co., Inc.: Employment. Hayes:Merck & Co., Inc.: Consultancy. Li:Merck & Co., Inc.: Investigative. Rizzieri:Merck & Co., Inc.: Consultancy. Stein:Merck & Co., Inc.: Consultancy. Weber:Merck & Co., Inc.: Consultancy. Serody:Merck & Co., Inc.: Consultancy. Raasch:Merck & Co., Inc.: Consultancy. Habel:Merck & Co., Inc.: Investigative.
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  • 83
    Publication Date: 2009-11-20
    Description: Abstract 2456 Poster Board II-433 Murine T cells exposed to rapamycin maintain flexibility towards Th1/Tc1 differentiation; the degree to which rapamycin might inhibit human Th1/Tc1 differentiation has not been fully evaluated. In the presence of rapamycin, T cell co-stimulation and polarization with IL-12 or IFN-α permitted human CD4+ and CD8+ T cell differentiation towards a Th1/Tc1 phenotype: by intracellular flow, median percentage expression of Foxp3, IFN-γ, and T-bet was 4%, 20%, and 72%, respectively. Phospho-flow cytometry revealed that such Th1/Tc1 cells expressed activated STAT1 and STAT4 in spite of mTOR blockade; STAT activation was abrogated by PI3 kinase inhibition. Rapamycin-resistant human Th1/Tc1 cells (Th1/Tc1.R cells): (1) had increased expression of the autophagy-related gene LC3BII by gene array and protein analysis; (2) preferentially expressed anti-apoptotic bcl-2 family members (reduced Bax, Bak; increased phospho-Bad); (3) maintained mitochondrial membrane potentials; and (4) had reduced apoptosis relative to control Th1/Tc1 cells not generated in rapamycin (p=0.04). The anti-apoptotic phenotype of Th1/Tc1.R cells was abrogated by co-incubation with the autophagy inhibitor, 3-methyl adenine. The in vivo effect of the Th1/Tc1.R cells was evaluated using two xenogeneic GVHD (x-GVHD) models. First, in an LPS-induced x-GVHD model, Th1/Tc1.R cells resulted in lethality in 75% recipients; soluble TNF-α receptor therapy with etanercept reduced the frequency of lethality to 15%. Second, using a non-LPS natural history model of x-GVHD, recipients of Th1/Tc1.R cells (relative to recipients of control Th1/Tc1 cells) had increased human T cell engraftment (day 30 post-BMT, p=0.001), increased human T cell cytokine levels, increased human T cell expression of the cytotoxic degranulation molecule CD107 (p=0.05), and increased human T cell infiltration of skin, gut, and liver. In this model, lethality due to x-GVHD was also increased in Th1/Tc1.R cell recipients (lethality increased from 20% to 70%, p=0.04). We conclude that rapamycin therefore does not impair human T cell capacity for type I differentiation. Rather, by promoting autophagy rapamycin permits stable expression of T-bet and generates an anti-apoptotic Th1/Tc1 effector phenotype, thereby yielding increased x-GVHD. Disclosures: No relevant conflicts of interest to declare.
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  • 84
    Publication Date: 2009-11-20
    Description: Abstract 2437 Poster Board II-414 Introduction: BK virus (BKV) is a polyomavirus that is ubiquitous in humans, infecting over 85% of normal individuals. After initial infection it persists in a latent state in the urothelium from whence it can reactivate causing disease in immunocompromised patients. BKV is a cause of haemorrhagic cystitis after allogeneic SCT and is emerging as one of the major causes of graft loss after renal transplant. Current treatment is limited to reduction of immunosuppression as possible. Aim: To develop a method for production of a T cell product with BKV specificity from normal donors for use in adoptive immunotherapy post hemopoietic stem cell transplantation. Methods: Peripheral blood mononuclear cells (PBMC) or monocyte derived dendritic cells (mo-DC) were pulsed with mixes of overlapping peptides covering the 5 BKV proteins (VP1, VP2, VP2 isoform 3, large T antigen (LTA) and small T antigen (sTA)). Mo-DC were produced by isolating monocytes by adherence to plastic and culturing for 7 days in GM-CSF and IL-4 containing media. On day 6 mo-DC were matured by the addition of TNF. T cells were stimulated on day 1 and 7 with peptide pulsed PBMC or mo-DC and cultured for 21 days with increasing doses of IL-2 from day 7. The cellular product was then analysed for phenotype, BKV specificity and functionality by examining cytokine production and cytotoxicity. Results: Cellular proliferation was seen in all of 10 normal donors with a mean increase of 6.4 fold in total cell number. All cellular products were 〉84% CD3 positive (Mean 96%, SEM 1.3) with CD4 and CD8 ratio varying significantly between individual donors (CD4 range 9.7 to 97.5%, mean 70.79; CD8 range 0.8 to 77.0%, mean 23.3). Cells were of memory phenotype, being CD28+ (mean 86.1%, SEM 6.5), CD45RO+ (mean 84.1%, SEM 5.9) and a variable proportion were of central memory phenotype (CD62L+ mean 21.6%, range 6.9 to 55.0). Cytokine responses to stimulation with BKV peptides could be elicited in 5 of 6 evaluable donors. Multiple cytokines were produced by the responding cells: IFN-γ (mean 29.9% of CD3 cells, range 4.5 to 78.8), TNF (mean 19.9%, range 2.7 to 63) and IL-2 (mean 12.8%, range 1.2 to 37.8). Cytokine responses were seen in both CD4 and CD8 cells and showed significant individual variation. VP1 and LTA specific cells dominated most cultures while a smaller percentage of the cells were specific for VP2, VP2 isoform 3 and sTA. CD8 specificity was mainly confined to a single protein whereas CD4 responses tended to be of lower magnitude but broader specificity. Cultures exhibited cytotoxic activity with the lysis of BKV antigen coated target cells in a pattern that correlated with the presence of CD8 positive cytokine producing cells (up to 78.9% specific lysis at effector to target ratio of 20:1). Discussion: The clinical utility of this product remains to be determined. Potential uses include prophylaxis and therapy of reactivation of BK virus after hemopoietic stem cell or renal transplantation. This method for large-scale expansion of BKV specific CTL could be utilised for analysis of BKV targeted immune responses and epitope identification. Disclosures: No relevant conflicts of interest to declare.
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  • 85
    Publication Date: 2009-11-20
    Description: Abstract 2444 Poster Board II-421 Alloreactive effector T cells are the central to graft-versus-host disease (GVHD), a life-threatening complication after allogeneic hematopoietic stem cell transplantation (HSCT). In GVHD host antigens are never cleared and alloreactive effector T cells are continuously generated over a period of several months or longer, but their suppression and control have proven to be difficult in practice. Using mouse models of GVHD directed against minor histocompatibility antigens (miHAs), we demonstrate that alloreactive effector T cells proliferate and persist upon chronic exposure to alloantigens via reactivation of stem cell transcriptional programs normally expressed in embryonic stem cells and neural stem cells. Many activated stem cell genes in effector T cells were distinct from those in memory T cells and were maintained at high levels upon T cell receptor activation, suggesting a specific role in chronically activated effector T cells. One of these genes, Ezh2, encodes a chromatin modifying enzyme essential to the proliferation, survival and differentiation of stem cells, was upregulated in CD8+ effector T cells upon antigenic stimulation and downregulated when the antigen was withdrawn. Pharmacologically inactivation of EZH2 with 3-Deazaneplanocin A inhibited effector T cell proliferation and survival. Silencing Ezh2 independently validated that Ezh2 was important for regulating effector T cell proliferation and expression of many stem cell genes. To further evaluate whether alloreactive CD8+ effector T cells obtained stem cell-like properties, e.g. the ability to self-renew to continually generate effector cells, we adoptively transferred highly purified miHA H60-specific (H60+) CD8+ effector T cells into secondary allogeneic and congenic recipients, respectively. As compared to congenic recipients, allogeneic recipients had 80-fold more proliferating H60+CD8+ effector T cells. These donor H60+CD8+ effector T cells expressed high levels of CD122, CD69, CXCR3, PD1, IFNγ and Granzyme B, required miHA H60 stimulation to sustain their replication with effector function and expression of stem cell genes, and caused severe GVHD in secondary allogeneic recipients. These results indicate that stem cell transcriptional programs expressed in embryonic and neural stem cells may play important roles in effector T cells. Among these stem cell genes, Ezh2 emerges as an important therapeutic target in modulating alloreactive T cell-mediated GVHD. Disclosures: Zhang: University of Michigan Comprehensive Cancer Center: Research Funding; Damon Runyon Cancer Research Foundation: Research Funding.
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  • 86
    Publication Date: 2009-11-20
    Description: Abstract 2436 Poster Board II-413 Sensitive in vivo imaging methods have advanced the fields of stem cell transplantation, graft-versus–host disease (GVHD) and graft-versus-tumor responses (GVT). Near-infrared (NIF) fluorescent proteins (FP) appear advantageous for deeper tissue penetration due to minimized absorbance by hemoglobin, water and lipids. Therefore we tested whether a recently published NIF FP (FP635, “Katushka”) could serve as a single reporter for whole body and single cell imaging. To compare signal intensities of eGFP and FP635 we generated fluorescent MOSEC cell lines (mouse ovarian cancer), titrated them in vitro and subcutaneously (s.c.) in vivo in Balb/c nu/nu mice. MOSEC FP635 showed twice the signal intensities compared to MOSEC eGFP in vitro by spectral fluorescence imaging (FLI). In vivo the eGFP signal was attenuated 〉60% in contrast to only 20% for FP635 from subcutaneous sites. However, FP635 signals from deep tissue layers were quenched. To address whether reduced signal attenuation of FP635 may allow sensitive visualization of immune processes by FLI and multiphoton-laser-scanning-microscopy (MPM) we generated transgenic mice in the genetic C57Bl/6 (B6) background, expressing FP635 under the ubiquitin promoter. Transgenic founders were selected upon signal intensities of leukocyte populations measured by flow cytometry in the PerCP channel. Combination of FP635 with colors other than red were possible for multiparameter flow cytometry. Next, eGFP, DsRed and FP635 splenocytes from transgenic donors were titrated as described above. In vitro signal intensities of FP635 splenocytes were 〉5 times lower compared to the other two FPs. FP635 signal absorption in vivo was low (30%) which is consistent with MOSEC titration results. In vivo DsRed detection was most sensitive and signals were similarly attenuated as FP635 in contrast to eGFP (60%). Subsequently, we aimed to visualize FP635 in a model of GVHD, where alloreactive T cells undergo massive expansion. Balb/c nu/nu mice were lethally irradiated and transplanted with 5×106 B6.WT bone marrow cells plus either 2×107 B6.DsRed+Luciferase+ or 2×107 B6.FP635 splenocytes. Sensitivity for DsRed cell detection was superior over FP635 cells. FP635 signal was only weakly detectable in lymph nodes (LN) by ex vivo FLI, where DsRed signals were detectable at earlier timepoints and LNs were even visualized by in vivo FLI. DsRed+ Luciferase+ double transgenic splenocytes allowed direct comparison of bioluminescence imaging (BLI) to FLI. Timely in vivo visualization of immune cells in deep tissues was feasible only by BLI. After whole body imaging the suitability of FP635 for MPM was checked by co-injecting eGFP B cells and either DsRed or FP635 T cells intravenously into RAG-/- mice. As FP635 is a NIF FP we expected to achieve deeper tissue penetration in hemoglobin rich organs, such as the spleen, in single cell microscopy. After 6 weeks of adoptive cell transfer we imaged spleens by MPM. Tissue penetration depths of DsRed or FP635 T cells were compared to eGFP B cells. No advantage in penetration depth of FP635 over DsRed was measured. Photobleaching is an important factor for microscopy, especially if cells are to be tracked over long time. FP635 transfected 293T cells bleached faster (t1/2=108 sec) than 293T cells transfected with eGFP (t1/2〉900 sec) or DsRed (t1/2=411 sec). These experiments indicate that very high expression levels of FP635 need to be achieved for imaging. The signal attenuation of FP635 is low which may increase the sensitivity but in our hands DsRed showed comparable characteristics. Yet, the fast photobleaching of FP635 compared to the broadly established FPs DsRed and eGFP may be disadvantageous for long term microscopic tracking of cells. Our data indicate that BLI is by far superior over FLI in sensitivity and tissue penetration for whole body imaging of immune cells. However, FLI of red or near-infrared clonally selectable tumor cell lines may provide a welcome color addition to study immune cell-tumor interactions in combined models of BLI and FLI. Disclosures: No relevant conflicts of interest to declare.
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  • 87
    Publication Date: 2009-11-20
    Description: Abstract 2430 Poster Board II-407 After transplantation, hematopoietic stem/progenitor cells (HSPCs) home to the marrow, where they engraft and self-renew. To explore the mechanism of this multi-step and dynamic repopulation process, we performed the first in vivo adult vertebrate chemical screen aimed at identifying novel chemical modulators of HSPC repopulation using a novel competitive marrow transplantation assay in zebrafish. To distinguish between the donors, we used ubiquitous GFP or DsRed2 transgenic fish, Tg(β-actin:GFP) and Red GloFish®, for marrow cell isolation. 20,000 GFP+ cells were treated with a chemical and mixed with 80,000 untreated DsRed2+ marrows. This pool of cells was injected retro-orbitally into a transparent adult zebrafish. After a recovery period, the fish was then anesthetized and the region of the kidney (the adult site of hematopoiesis) was examined by fluorescence microscopy. The competition between the two donors was determined by analyzing the ratios of GFP and DsRed2 fluorescence intensity with ImageJ software. Using this assay, we demonstrated that dmPGE2 and/or GSK-3β inhibitor treatment of GFP+ marrows for 3 hrs could dramatically increase repopulation in fish. A chemical library of 480 chemicals with known bioactivities was screened using this in vivo assay. GFP+ marrows were incubated with different chemicals for 3 hrs and ten recipient fish were transplanted for each chemical. By examining engraftment at 4 weeks, we found 10 chemicals that improved HSPC repopulation. Based on the known bioactivity, these chemicals were categorized into several signaling pathways, including prostaglandin metabolism and retinoic acid pathways. Several of the compounds also increased HSC formation in zebrafish embryos, indicating that some pathways might be shared by different developmental stages. To examine whether the bioactivities of these hits are conserved in mammals, CD45.1 mouse whole bone marrow cells were treated with hit compounds for 3 hrs and competitively transplanted into CD45.2 recipients. Peripheral blood was sampled at 3, 6, 12, and 20 week post transplant. Several hits were confirmed to increase long-term chimerism in mice. The retinoic acid pathway has been shown to play an important role in hematopoiesis. Among the six retinoic acid receptor (RAR) agonists in the chemical library, which includes all-trans retinoic acid (ATRA), only two structurally highly related compounds, AM-580 and TTNPB scored positive in the screen. These two compounds have distinctive chemical moieties from ATRA. This structural difference likely leads to stronger agonistic effects on RAR than ATRA and resists degradation. In conclusion, the in vivo chemical screening using zebrafish competitive marrow transplantation provides a successful example of phenotypic screening in whole adult vertebrates. The discovery of novel repopulation modulators should provide a better understanding of signaling events that regulate homing and self-renewal, and may have clinical application in marrow or cord blood transplantation. Disclosures: Zon: FATE Inc: Consultancy, Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Stemgent: Consultancy.
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  • 88
    Publication Date: 2009-11-20
    Description: Abstract 2398 Poster Board II-375 B-catenin is the central effector molecule of the canonical wnt signaling pathway which governs cell fate and differentiation during embryogenesis as well as self-renewal of hematopoietic stem cells. Deregulation of the pathway has been observed in various malignancies including myeloid leukemias where over-expression of β-catenin is an independent adverse prognostic factor. In the present study we examined the functional outcome of stable β-catenin down-regulation through lentivirus-mediated expression of short hairpin RNA (shRNA). Reduction of the β-catenin levels in AML cell lines and patient samples diminished their in vitro proliferation ability without significantly affecting cell viability. In order to study the role of β-catenin in vivo, we transplanted leukemic cell lines with control or reduced levels of β-catenin in NOD/SCID animals and analyzed the engraftment levels in the bone marrow. We observed that while the immediate homing of the cells was not affected by the β-catenin levels, the bone marrow engraftment was directly dependent on its levels. Subsequent examination of bone marrow sections revealed that the reduced engraftment was partly due to the inability of the cells with lower β-catenin levels to dock to the endosteal niches, a finding that was confirmed in competitive repopulation assays with untransduced cells. When we examined the expression levels of adhesion molecules and integrins in engrafted cells in vivo, we observed a significant down-regulation of CD44 expression, a molecule that participates in the interaction of HSCs with the niche. Gene expression analysis of the components of the wnt signaling pathway showed that the pathway is subject to tight transcriptional regulation with minor expression deviations. We did, however, observe an up-regulation in components that participate in the non-canonical wnt signaling pathways such as the WNT5B ligand. Ongoing experiments in normal cord blood CD34+ cells will determine the in vivo role of β-catenin signaling in normal hematopoietic progenitors. In conclusion, our study showed that β-catenin comprises an integral part in the development and progression of AML in vivo, indicating that manipulation of the wnt pathway may hold a therapeutic potential in the management of AML. Disclosures: No relevant conflicts of interest to declare.
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  • 89
    Publication Date: 2009-11-20
    Description: Abstract 245 Background: The incidence of MDS in Canada is not known. Diagnosis of MDS is often challenging as dysplastic features on bone marrow may be non-specific, requiring exclusion of other disorders. The province of Manitoba, with a population of 1.2 million, has a cancer registry which has included patients with MDS since 2001. In this province, hematology diagnostic services are centralized at two teaching hospitals and the few bone marrows performed outside are reviewed centrally. This provided us with the opportunity to use registry data and bone marrow records to determine the incidence of MDS. We hypothesized that for an accurate estimate, a proportion of MDS cases would require follow-up data. Methods: Retrospective study to examine all cases of MDS, which included chronic myelomonocytic leukemia (CMML) diagnosed in Manitoba. All adult Manitobans diagnosed with MDS and CMML (excluding RAEB-T), from 01/2006 to 12/2007 were identified from the cancer registry using ICD-O-3 topography code C42.1 and morphology codes 9980/3, 9982/3, 9983/3, 9985/3, 9986/3, 9987/3, 9989/3 and 9945/3. Bone marrow records for the same period were reviewed to identify all cases that had features of MDS. The clinical charts of all these patients were reviewed centrally to exclude those whose clinical course or repeat investigations suggested an alternative diagnosis. Results: A total of 80 patients with newly diagnosed MDS were identified. The age adjusted incidence of MDS was 3.26/100,000. Incidence was higher in men (4.05/100,000) as against women (2.57/100,000). Incidence varied significantly with age at diagnosis: 80yr: 21.93. Eleven cases (13.75%) were not known to the cancer registry but were detected on reviewing the bone marrow data. From the registry, nine cases (11.25%) were excluded as the chart review and follow-up revealed alternative diagnoses. Conclusions: The incidence of MDS for Manitoba is similar to published rates in Europe and the USA. This may be an underestimation of the actual incidence, as elderly patients may not undergo bone marrow examination if the therapeutic intervention is only supportive. Cancer registries that include MDS based on one-time bone marrow reports should include a review process of confirming or excluding the diagnosis of MDS based on follow up investigations and course of illness. Disclosures: No relevant conflicts of interest to declare.
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  • 90
    Publication Date: 2009-11-20
    Description: Abstract 2447 Poster Board II-424 Allogeneic bone marrow transplantation (BMT) represents the most effective treatment for patients with high risk and relapsed hematologic malignancies. One of the major complications of allogeneic BMT is graft-versus-host disease (GvHD), which is caused by donor T cells reacting against host antigens. These same alloreactive donor T cells can provide a beneficial ¡°graft-versus-leukemia¡± (GvL) effect as well resulting in reduction in leukemia relapse. Because regulatory T cells (Tregs) have been shown to suppress GvHD while preserving GvL, their use in the allogeneic transplant setting provides a promising strategy to treat GvHD. However, three major obstacles prevent their routine use in human clinical trials: 1) the low circulating numbers of Tregs in peripheral blood, 2) loss of suppressor activity following ex vivo expansion and 3) the lack of Treg-specific markers to purify ex vivo expanded Tregs. Foxp3 is a forkhead transcription factor which is both exclusively expressed in Tregs and, when overexpressed in conventional effector T cells (Teff), can convert these Teff into functionally suppressive Treg-like T cells. The Foxp3 locus is unmethylated in Tregs while highly methylated and silenced in all other T cells. Several groups have shown that the hypomethylating agent azacitidine (AzaC) induces FOXP3 expression in non-Tregs. Furthermore, we have shown that treatment of anti-CD3/CD28 antibody-coated bead-activated CD4+CD25- T cells with AzaC results in robust and prolonged (〉7 days) expression of FOXP3. AzaC-induced FOXP3 expression is also associated with a potent Treg-like suppressive phenotype in vitro. Thus, we hypothesize that AzaC treatment of mice after allogeneic BMT will dramatically mitigate GvHD while preserving GvL via transcriptional regulation of Foxp3 in alloreactive Tconv. In murine T-cell depleted BMT model (B6¡æBalb/c; 900 cGy TBI) with delayed infusion of conventional T cells (Tconv) (2 ×106) at day 11 post BMT, followed by subcutaneous treatment of AzaC (2 mg/kg at days 15, 17, 19, and 21 post BMT), we found that AzaC dramatically suppressed GvHD caused by allogeneic donor T cells while maintaining donor (H2Kb) engraftment of all lineages. We found that the AzaC group had significantly higher FOXP3+ Tregs than in PBS control group and that these Tregs were derived from donor T cells, suggesting that the suppression of GvHD was mediated by AzaC-induced Tregs. We further tested whether AzaC treatment of mice transplanted with allogeneic T cells preserve GvL while mitigating GvHD. Using the same murine allogeneic BMT model, Click Beetle Red luciferase-expressing A20 leukemia cells (BALB/C derived) were injected with T-cell depleted BM and 10 × 106 Tconv and in vivo bioluminescence imaging was performed to assess tumor burden in vivo post transplant. We found that AzaC treatment mitigated GvHD without abrogating GvL (Fig. 1) or donor engraftment. Thus, the adminstration of hypomethlating agents like AzaC in vivo after allogeneic stem cell transplant dramatically reduces GvHD while maintaining both donor engraftment and a potent GvL effect providing the foundations for future clinical trials. Disclosures: DiPersio: Genzyme Corporation: Honoraria.
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  • 91
    Publication Date: 2009-11-20
    Description: Abstract 2383 Poster Board II-360 Elevated expression of CXCR4, a receptor for SDF1, with Internal Tandem Duplication of Flt3 (ITD-Flt3) is an indicator of poor prognosis in patients with acute myeloid leukemia. We previously showed that ITD-Flt3 enhances migration of hematopoietic cells to SDF1, suggesting that ITD-Flt3 may facilitate dissemination of leukemia cells by modulating SDF1/CXCR4 signaling and that blocking this functional cross-talk between ITD-Flt3 and CXCR4 pathways may have therapeutic benefit. While identification of selective pathways in cells transformed by ITD-Flt3, which are distinct from normal cells is crucial to develop therapeutic agents without hematopoietic toxicity, the mechanisms responsible for aberrant migration induced by ITD-Flt3 are not known. We now demonstrate the existence of CXCR4 signaling pathways regulated by ITD-Flt3 that are distinct from normal CXCR4 signaling using genome wide transcription analysis. Ectopic expression of ITD-Flt3 in Ba/F3 cells enhances random cell migration and modulates expression of 1,675 genes out of 41,174 genes (4.1%) examined compared to control cells lacking ITD-Flt3. ITD-Flt3 down-regulated CXCR4 mRNA by 55% compared to control and modulated 36 additional transcripts implicated in cell migration and localization (0.09%, P
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  • 92
    Publication Date: 2009-11-20
    Description: Abstract 2381 Poster Board II-358 The natural history of patients (pts) who fail or relapse after chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) has not been established. Three hundred pts received FCR as initial therapy for progressive or advanced chronic lymphocytic leukemia (CLL) (Tam CS; Blood 112(4):975-980, 2008). Fifteen (5%) pts failed to respond, 72% achieved a CR and 22% a PR. Treatment failure occurred in 18 pts because of the development of AML, MDS or Richter's transformation and there were 15 deaths in remission (infection (7), cancer (6), or cardiac events (2)). Fourteen relapsed pts have not received therapy and are considered to be “watch and wait.” One hundred and twelve pts have received therapy. A large variety of treatment programs were administered at time of relapse during the ten years of the study. The most commonly used were FCR-like regimens (33) with or without lumiliximab or bevacizumab, FCR + alemtuzumab (CFAR) 9 pts, rituximab-based regimens (28) +/- GMCSF or steroids, Campath-based regimens (16) +/- rituximab, and a variety of other phase I and miscellaneous salvage treatments. 79 pts received salvage therapy at M. D. Anderson Cancer Center (MDACC) and the 33 others in their local community. 17 patients (16%) achieved a CR and 46 a PR (4%). CR rates were 15% for FCR, 56% for CFAR, 4% for rituximab regimens, 31% for alemtuzumab regimens and 4% for other regimens. While higher CR rates were noted in alemtuzumab regimens, no difference in time-to-treatment failure or survival was noted. The median overall survival was 33 months with a 40% five-year survival rate. A number of characteristics shown in Table 1 associated with complete remission and overall response rate. Outcome of 1st Salvage – FCR Relapsed/Refractory (112 pts) Characteristic Value Patients %CR %OR Med Surv (Mths) Age / years
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  • 93
    Publication Date: 2009-11-20
    Description: Abstract 2377 Poster Board II-354 Fludarabine containing regimens has become the gold standard for first-line treatment of CLL. The prognosis for the response is usually done by mutation analysis and cytogenetics. These types of analyses are time consuming and could not be available in general practice. Staging is very easy tool for predicting the response, although it is not a matter of individual prognosis. The aim of the study was to find clinical data predicting the response. As a model, we have evaluated the response after 3 fludarabine containing regimens. Patients and methods 75 patients treated by fludarabin containing regimens (FC and FCR) were included (2002-2008). Staging was performed according to Binet (1977). Stage B and C patients were included. Lymph nodes were evaluated by CT and ultrasound. CD38 was done by CytoFlow (cut off 30%). Mutation analysis was studied by PCR and sequencing with cut off 98%. Early response(ER) was defined as PR and CR after 3 cycles of therapy, others were considered as nER. CR was defined according to NCI criteria. The patients were treated and followed-up by the single team of physicians, there were no losses of follow-us.SPSS - 17 statistical program was used for analysis. Results. In the whole group, median PFS was 25 mons . There were 40 ER pts(33 - PR and 7 - CR).Median PFS in ER patients was 38mons, in other patients (nER) – 17mons (p= 0.0001). After 6 cycles of therapy, the overall response was 100%; CR was 83% and 7% PR I ER pts, in nER- resp- 67%, 23% and 41% ( p 〈 0,001). Differences of median PFS according to standard prognostic factors is presented in table 1: Thus, ER patients with standard adverse prognostic factors did better than nER with similar prognostic factors. ER patients in comparison to nER had higher median PFS on both FC (28 mons vs 14 mons, p=0.001) and FCR (58 mons vs 18 mons, p=0.018) regimens. Conclusion. The early response (PR and CR) after three fluadarabine containing regimens is a good predictor for PFS. More intensive treatment should be considered for patients without early response. Disclosures: No relevant conflicts of interest to declare.
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  • 94
    Publication Date: 2009-11-20
    Description: Abstract 2284 Poster Board II-261 Background: To evaluate the role of autologous and allogeneic SCT in the treatment of PTCLs, Japan Study Group for Cell Therapy and Transplantation conducted a multicenter retrospective survey in Japan and Korea. Methods: After excluding patients with adult T-cell leukemia/lymphoma and NK-cell tumors, patient data were newly collected from 330 patients (222 male and 108 female) with a median age of 49 years (range, 13–71) who underwent SCT between 9/1991 and 12/2008 (196 autologous and 134 allogeneic including 31 patients with previous autograft). Allogeneic SCT (53 BM, 54 PB, 1 BM+PB, 26 CB) was performed using a reduced-intensity conditioning (RIC) in 84 patients (63%). While a pathologic central review will be performed, currently there were 159 (48%) patients with PTCL, not otherwise specified, 63 (19%) with angioimmunoblastic T-cell lymphoma, 47(14%) with anaplastic large cell lymphoma (23 ALK-negative, 14 ALK-positive and 10 unknown), 12 (4%) with enteropathy-associated T-cell lymphoma, and others. The disease status at transplant in the allo-group was significantly worse than that in the auto-group (Table 1). The median number of chemotherapy regimens was 2 (range, 1–7), and the median duration between diagnosis and transplant was 267 days (range, 120-4889 days). Results: The median follow-up for surviving patients was 45 mo (range, 2.3–141 mo). There was no significant difference in overall survival among different groups, including histological subtypes, RIC and myeloablative conditioning in the allo-group and high-dose chemotherapy regimens in the auto-group. Early survival rate after transplant was significantly better for auto-group than allo-group (Wilcoxon P=0.001), but the difference was marginal in the total course (Logrank P=0.06) (Figure). The non-relapse mortality (NRM) in the auto-group was significantly lower than that in the allo-group (P1), cell source (CB/BM+PB), and performance status (PS; 〉1), stage, chemorefractory disease, international prognostic index (IPI; H-I/H risk) and prognostic index for PTCL, unspecified (PIT; group 3/4) at transplant. The risk factors in the allo-group were bulky mass at diagnosis, age (〉50 years), cell source, and PS, stage, IPI and PIT at transplant, while those in the auto-group were age (〉40 years), recurrence after frontline therapy, number of chemotherapy regimens, and stage, chemorefractory disease, IPI and PIT at transplant. Conclusions: Despite a worse disease status at transplant in the allo-group, the overall survival was comparable to that in the auto-group. This supports the notion that early allogeneic SCT is a valuable treatment option for PTCLs, although a large-scale randomized trial to identify a suitable upfront-transplant type for chemosensitive patients with PTCLs is warranted. Disclosures: No relevant conflicts of interest to declare.
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  • 95
    Publication Date: 2009-11-20
    Description: Abstract 230 Allogeneic hematopoietic stem cell transplantation (HSCT) provides powerful therapeutic activity through elimination of cancer cells by donor T cells. However, its success is limited by life-threatening graft-versus-host disease (GVHD). Novel immunomodulatory approaches are needed to effectively control GVHD. Notch signaling is a highly conserved cell-cell communication that plays an essential role in T cell development and can influence differentiation and function of mature T cells in a context-dependent fashion. Using several mouse models of allogeneic HSCT, we report that inactivation of Notch signaling in donor T cells inhibits the induction of severe GVHD while preserving significant graft-versus-leukemia (GVL) activity. To block canonical Notch signaling in mature T cells without interfering with T cell development, we used conditional expression of the pan-Notch inhibitor DNMAML (ROSADNMAMLf × Cd4-Cre mice). DNMAML CD4+ T cells derived from donor C57BL/6 (B6) mice had normal initial activation, proliferation and expansion, but failed to differentiate into effector T cells mediating severe GVHD in lethally irradiated major histocompatibility complex-mismatched BALB/c recipient mice. Notably, Notch-deprived alloreactive T cells retained potent GVL activity, leading to improved overall survival of the recipients. Alloreactive DNMAML T cells showed impaired production of IL-2 and multiple inflammatory cytokines (e.g. TNFα, IFNγ and IL-17), as well as defective induction of selected effector molecules (e.g. granzyme B and perforin). The specificity of these findings was independently validated using donor CD4+ T cells with conditional inactivation of Rbpj, encoding CSL/RBP-Jk, a transcription factor that is absolutely required for Notch-mediated transcriptional activation. To further evaluate the effects of Notch signaling in both CD4+ and CD8+ alloreactive T cells, we infused control B6 or DNMAML B6 T cells into unirradiated haploidentical B6xDBA/2 F1 and irradiated minor histocompatibility antigen (miHA)-mismatched BALB/b recipients. Donor DNMAML CD4+ and CD8+ T cells both showed significantly reduced ability to induce severe GVHD in these CD4+ help-dependent CD8+ T cell-mediated GVHD mouse models. These results indicate that Notch is a novel critical signaling pathway regulating CD4+ and CD8+ T cell responses in multiple mouse models of allogeneic HSCT. Given the beneficial immunomodulatory effects of Notch inhibition in alloreactive donor T cells, Notch signaling appears as a promising therapeutic target to limit the harmful effects of GVHD while preserving beneficial GVL activity after allogeneic HSCT. Disclosures: Zhang: University of Michigan Comprehensive Cancer Center: Research Funding; Damon Runyon Cancer Research Foundation: Research Funding. Maillard:University of Michigan Comprehensive Cancer Center: Research Funding; Damon Runyon Cancer Foundation: Research Funding; ASH Scholar Awards : Research Funding.
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  • 96
    Publication Date: 2009-11-20
    Description: Abstract 2291 Poster Board II-268 Haploidentical bone marrow transplantation (BMT) is an alternative treatment to patients with high-risk hematologic malignancy lacking a HLA-matched donor and those urgently need transplantation. We used a haploidentical-BMT protocol without ex vivo T cell depleted based on the knowledge that marrow grafts have 10 times fewer lymphocytes compared to peripheral blood stem cell grafts and granulocyte colony-stimulating factor (G-CSF) donor priming reduce the incidence of acute GvHD. Materials and Methods: 40 patients (median age of 32, 12-63) with advanced disease or leukemia with poor prognostic features underwent unmanipulated haplo-BMT: 22 with AML, 9 with ALL, 3 with CML, 3 with Hodgkin lymphoma and 3 with plasmacell leukemia. Status at disease: 22 early (first or second comple! te remission), 18 advanced (progressive or refractory disease). All pairs of donors and recipients were identical for one HLA haplotype and incompatible at 2 or 3 loci.The myeloablative conditioning regimens used were different; antithymocyte globuline, cyclosporine, metotrexate, mycophenolate mofetil and basiliximab were used for GvHD prophylaxis. Donors were primed with filgrastim at 4 micrograms/Kg/d for 7 consecutive days. Bone marrow cells were harvest on the 8 day and were infused unmanipulated. Results: the median dose of total nucleated, CD34+ and CD3+cells was 7×10e8/Kg (1.01-28.7), 2.3×10e6/Kg (1.17-6.0) and 23.3×10e6/Kg (9.7-66.6) respectively. 1 patients had a primary graft failure and 5 patients died early prior to engraftment. In the remaining 34 patients, engraftment was seen with median time to granulocyte and platelet recovery of 22 and 27 days respectively; acute GvHD was grade 0 in 17 patients (50%), grade I in 9 (26%), grade II in 7 (20%) and grade IV in 1 (3%). In 29 evaluable patients, chronic GvHD was limited in 3 (10%) and extensive in 1 (3%). Transplant-related mortality at 6 months for early and advantage stage was 22% and 35% respectively. After a median follow up of 18 (3-42) months, 8 patients relapsed; 11 patients (50%) in the early stage and 4 (22%) in advanced phase are now living in haematological remission. The 1-year Kaplan-Meyer probability of disease-free survival is 45% for all patients. Conclusion: the high engraftment rate, low incidence of grade II-IV acute GvHD and an acceptable TRM suggest that G-CSF-primed marrow grafting along with sequential immunosuppression could provide an excellent alternative for patients who lack matched donors. Disclosures: No relevant conflicts of interest to declare.
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  • 97
    Publication Date: 2009-11-20
    Description: Abstract 2341 Poster Board II-318 Background. The clinical heterogeneity of chronic lymphocytic leukemia (CLL) requires parameters to stratify patients into prognostic subgroups to adapt treatment ranging from ‘watch and wait’ to allogeneic stem cell transplantation. To this end, several parameters such as lymphocyte doubling time, β-2 microglobulin, CD38 and ZAP-70 expression, immunoglobulin variable heavy chain (IgVH) mutation status and genetic abnormalities, as assessed by fluorescence in situ hybridization (FISH), have been integrated in clinical practice. Aims. In the present study, we investigated by FISH the incidence of the known major cytogenetic alterations (+12 and 13q14, 17p13, 11q23 deletions) in a series of Binet A B-CLL patients included in the prospective O-CLL1 GISL study started in April 2007. Methods. Molecular markers characterization and FISH analyses were performed as previously reported (Cutrona et al. Haematologica, 2008; Fabris et al. GCC, 2008). A cut-off value of 2% was used to distinguish mutated and unmutated patients. CD38 and ZAP-70 were determined by flow-cytometry and a 30% cut-off was used to distinguish between positive or negative cases. Results. Up to date, 326 patients have been enrolled in the trial and FISH data concerning trisomy 12 and 13q14, 17p13, 11q23 deletions were available in 305 patients. At least one abnormality was found in 197 (64%) cases. The most frequent was del(13)(q14) (150/305, 49%), followed by +12 (40/303, 13%) (in one and three cases accompanied by 17p13 and 13q14 deletions, respectively), del(17)(p13) (7/305, 2%) and del(11)(q23) (17/305, 5%). 13q14 deletion was found as a sole abnormality in 134 patients; in the remaining cases, it was combined with +12 (3 pts) and 17p13 (3 pts) or 11q23 (10 pts) deletions. Among patients with 13q14 deletions, 99 were monoallelic, 12 biallelic and 39 showed a combination of the two patterns. Biomarkers data were available in all of the patients: 95/305 (31%) cases had unmutated IgVH genes; ZAP-70 and CD38 were positive in 117/305 (38%) and 72/305 (23%) cases, respectively. Concerning the distribution of cytogenetic aberrations, the unmutated IgVH group included 29/150 (19%) 13q14 deleted cases, 23/40 (57%) cases with trisomy 12 and 4/7 (57%) and 16/17 (94%) with 17p13 and 11q23 deletions, respectively. ZAP-70-positive groups included 43/150 (28%) 13q14 deleted cases, 26/40 (65%) cases showing trisomy 12 and 5/7 (71%) and 12/17 (70%) with 17p13 and 11q23 deletions, respectively. Finally, CD38-positive cases included 18/150 (12%) 13q14 deleted cases, 26/40 (65%) cases carrying trisomy 12 and 5/7 (71%) and 7/17 (41%) with 17p13 and 11q23 deletions, respectively. The percentages of IgVH mutations significantly correlated with cytogenetic alterations; namely, 5.8±0.3 for cases with del(13)(q14), 4.6±0.4 for normal karyotype, 2.6±0.5 in +12, 0.3±0.2 in del(11)(q23), and 1.7±0.9 in del(17)(p13) cases (p for trend
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  • 98
    Publication Date: 2009-11-20
    Description: Abstract 2281 Poster Board II-258 Background: A decision analysis using the Markov process is a flexible and convenient analytical method that tracks the clinical events that occur after a certain decision with different probabilities and utilities over time. To address the role of allogeneic hematopoietic cell transplantation (allo-HCT) for acute myeloid leukemia (AML) in CR1, we performed a Markov decision analysis using newly collected clinical data from 2029 patients. Methods: Probabilities and other outcome data were derived from a database of adult AML patients that was constructed from case report files collected for this study. We included patients who were diagnosed with AML other than M3 between 1999 and 2006, aged 16 to 70 years, and who had achieved CR1 after 1 or 2 courses of induction chemotherapy. Using the software package TreeAge Pro 2009, we constructed a Markov decision model that compared 2 strategies: allo-HCT in CR1 (HCT group) and no allo-HCT in CR1 (CTx group). Possible health states considered in each decision included, for the HCT group, 1) no relapse without chronic GVHD, 2) no relapse with chronic GVHD, 3) relapse, and 4) dead, and, for the CTx group, 1) no relapse, 2) relapse, 3) second remission, 4) after salvage allo-HCT, and 5) dead. Quality-of-life (QOL) adjustments were made by incorporating time trade-off utilities that were derived from a questionnaire to 12 physicians who were familiar with the treatment of AML. The cycle length between state transitions was set at 3 months. Results: A total of 2029 patients were eligible for this analysis. The median age was 50 years, and the median follow-up of the surviving patients was 4.10 years. The proportions of patients with favorable, intermediate, unfavorable and unknown cytogenetic risk by SWOG criteria were 20%, 54%, 17% and 9%, respectively. Therapies performed at CR1 were allo-HCT in 494 patients (24%) and chemotherapy in 1535 patients (76%). Among 1076 patients whose HLA typing was performed for allo-HCT in CR1, 431 had HLA-matched or 1-antigen-mismatched related donors. Life expectancy and quality-adjusted life expectancy for the HCT and CTx groups in each risk category are summarized in Table 1. Life expectancy of the HCT group was longer than that of the CTx group (4.96 years vs. 4.44 years). However, quality-adjusted life expectancy of the HCT group was comparable to that of the CTx group (4.06 years vs. 3.98 years) due to a larger reduction of expected life length in the HCT group after QOL adjustment. In a subset analysis of the CTx group, patients with more favorable cytogenetic risk had a longer life expectancy. Whereas allo-HCT in CR1 was associated with a shorter life expectancy in patients with favorable-risk AML, allo-HCT in CR1 was associated with a longer life expectancy in those with intermediate-risk or unfavorable-risk AML. Adjustment for QOL did not change the preferred decision in the intermediate- and unfavorable-risk groups, although the survival advantages for allo-HCT in CR1 were less than those without QOL adjustment. In a subset of patients who had related donors, both life expectancy and quality-adjusted life expectancy were longer in the HCT group. Conclusion: The results of our decision analysis using the Markov process indicated that patients with intermediate- or unfavorable-risk AML have a longer life expectancy and quality-adjusted life expectancy with a decision of allo-HCT in CR1. Our results also showed that a Markov decision analysis that incorporates QOL may be useful as a decision-making tool for patients who might be candidates for allo-HCT. Disclosures: No relevant conflicts of interest to declare.
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  • 99
    Publication Date: 2009-11-20
    Description: Abstract 2276 Poster Board II-253 Introduction: Mycophenolate Mofetil (MMF) controls the rate of synthesis of guanine monophosphate in the de novo pathway of purine synthesis thus suppressing the proliferation of B and T lymphocytes and preventing allograft rejection. Methods: 27 patients (pts) with age ( 21-66 yrs), diagnosed with acute myeloid leukemia (AML,n = 16), acute lymphoblastic leukemia (ALL,n=3), chronic myeloid leukemia (CML,n=2), aplastic anemia (AA,n=1), Hodgkins lymphoma (n=2), Non- Hodgkins Lymphoma (n=2), Myeloproliferative disorder (MPD, n=1) received GvHD prophylaxis with tacrolimus, methotrexate and MMF. Post BMT and before engrafment patients received MMF doses as shown in figure 1 to determine which MMF dosing strategy best targets the therapeutic Area Under the Curve (AUC) which is between 30 and 60 h*mcg/ml. Patients had normal bilirubin levels at the time of drug testing. Other factors including age, gender, disease, conditioning regimen intensity (Myeloablative (MAC) vs Reduced Intensity Conditioning (RIC), disease, organ function and concomitant medications were analyzed. We found the intravenous (iv) dose of 1.5 gm Q 6 to be optimal based on observed pharmacokinetics.We used a cohort of six patients (AML=4, CML=1, MPD=1). MPA and MPAG levels for a dose of 1.5 gm iv q 6 hrly and oral MMF at 1 gm q 8 hrly, were collected at pre-defined time points before engraftment, analyzed using liquid chromatography mass spectrometry. AUC0-8 (for q 8 hr oral dosing) and AUC0-6 (for q 6 hr intravenous dosing frequency) were calculated using a non-compartmental pharmacokinetic (PK) model with PK software (WinNonlin Professional 5.2). Oral dosing beyond 1 gm q 8 hours was not attempted due to GI intolerance. Results: The Cmax of MPA at an iv dose of 1.5 gm q 6hr ranged from 2-16.70 mcg/ml with a median Cmax of 9.40 mcg/ml and a median AUC 0-6* hr of 26.14 mcg/ml. The Cmax MPA for oral dosing of 1 gm q 8 hr ranged from 3.70- 9.40 mcg/ml with a median Cmax of 4.45 ug/ml at 3 hrs and a median AUC 0-8* hr of 18.40 ug/ml. The box and whisker plot of MPA concentration (mcg/ml) vs Dose/regimen reveals the median concentration achieved by dosing intravenously q 6 hr and through oral at q 8 hr are similar, the box representing 25th -75th quartile and the error bars representing 10th -90th quartile. In data not shown, MPAG levels increased linearly while MPA levels increased less than proportionally with dose, suggesting that the nonlinear PK relationship of MPA levels is not due to the influence of glucuronidation but may be an indicator of a saturable distribution process to tissues or erythrocytes”. Conclusion: The conditioning intensity, GVHD prophylaxis did not affect MPA levels in this cohort of six pts with normal hepatic function. The maximum IV dose at 1.5 gm q 6 hrs generated similar levels to those with 1 gm orally q 8 hrs. Further dose escalation does not result in higher MPA levels. Disclosures: No relevant conflicts of interest to declare.
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  • 100
    Publication Date: 2009-11-20
    Description: Abstract 1843 Poster Board I-869 Introduction: The mammalian target of rapamycin (mToR) plays a crucial role in cell growth due to its role as nutrient dependent regulator of important cytokine signaling pathways. In multiple myeloma, mToR is involved in the phosphoinositide-3-kinase (PI3K)-AKT pathway which can be activated by the loss of the tumor suppressor phosphatase and tensin homolog (PTEN) or by stimulation with growth and survival factors such as interleukin-6 (IL-6) and insulin-like growth factor-1 (IGF-1). Inhibitors of the mToR pathway (sirolimus/rapamycin, everolimus and temsirolimus) are approved for immunosuppression and/or cancer treatment. However, the clinical activity of mToR inhibitors may be limited by the fact that, after inhibition of the rapamycin-sensitive mToR-Raptor complex, AKT is activated by the rapamycin-insensitive mToR-Rictor complex. In this regard, the inhibitory effect of mToR inhibitors was evaluated in combination with PI3K inhibitors in vitro and in vivo. Results: Rapamycin and everolimus induced a dose-dependent growth inhibition in six human malignant plasma cell lines. Growth inhibition was mediated by G1 cell cycle arrest and in a subset of cell lines by induction of apoptosis. Overexpression of Bcl-XL or Mcl-1 proteins did not prevent from apoptosis induction by mToR inhibitors, nor did sensitivity to rapamycin-induced apoptosis correlate with the p53 mutation status. In the INA-6 SCID mouse xenograft model, treatment with rapamycin resulted in a significant survival benefit compared to untreated mice. Six out of 14 rapamycin treated mice did not develop plasmacytomas during the observation period of 149 days. Remarkably, short term treatment of plasmacytoma bearing mice led to a significant shrinkage of the plasma cell tumor. Explanted tissue showed apoptotic plasma cells, a finding confirmed by immunohistological staining using an antibody specific for the human cleaved form of poly (ADP-ribose) polymerase (PARP). The combination of rapamycin and the PI3K inhibitor Ly294002 led to an increase of growth inhibition in all tested plasma cell lines. The additional growth inhibition by Ly294002 appeared to be due to AKT activation upon mToR inhibition by the rapamycin-insensitive Rictor complex, indicated by increased AKT phosphorylation at Ser473 as determined by Western blot analysis. Conclusion: Clinical trials currently evaluate mToR inhibitors for their potential to expand treatment options for myeloma patients. The data presented here suggest that a combination of mToR inhibitors with PI3K inhibitors may lead to additive therapeutic chances. Disclosures: Guenther: Novartis: Consultancy, Research Funding. Gramatzki:Novartis: Consultancy, Research Funding, Speakers Bureau.
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