Introducing intersex wellbeing and rights and the INIA programme

Background

Intersex people are exposed to human rights violations all over the world. Ongoing practices of sex-normalising surgery and other medical interventions on minors too young to give informed consent encroach on their bodily autonomy. Little is known about the public health implications of bodies with variations of sex characteristics (VSC). What key issues do VSCs raise?

Methods

In 2020 the INIA international consortium began work on a large research programme to address intersex people's wellbeing and human rights from a variety of new and innovative perspectives. The programme will train a cohort of 10 early-stage researchers working collaboratively to develop knowledge that will inform policy making and practice across a range of key sectors. Drawing on critical intersex studies, the research projects are relevant to stakeholders who are concerned with supporting the wellbeing and rights of intersex people through knowledge sharing and development. The project received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 859869. Please see https://www.intersexnew.co.uk/.

Results

Indicative findings show that VSC could be an important area of public health work concerning diversity and equality. Early-stage results show a dearth of intersex visibility in key areas including social policy, education, and elder care. Intersex people and those with VSC face major health challenges and discrimination. There is a pressing need for appropriate healthcare.

Conclusions

The interdisciplinary INIA programme surfaces multiple discourses about intersex people and those with variations of sex characteristics. Projects of particular interest to public health practitioners and policy makers include those concerning multi-disciplinary healthcare, ethics, social policy, education, aging, and service user participation.

Blood Stem Cell Collection: Factors Influencing the Recovery of Granulocyte-Macrophage Colony Forming Cells

We evaluated data from all blood cell (BC) collections performed in our institution between 1989 and 1995 to determine factors influencing the outcome of collection. One hundred and thirty-three collections were performed on 106 patients. Malignant diagnoses were: non-Hodgkins lymphoma (NHL) in 35%, multiple myeloma in 31%, breast cancer in 26%, and Hodgkin's disease in 8%. Collections were obtained routinely in myeloma and breast cancer and due to bone marrow involvement with malignancy or inaspirable bone marrow in lymphoma patients. Collections were obtained on a Cobe Spectra or Baxter-Fenwall CS3000+. Engraftment potential was determined by methylcellulose colony assay (CFU-GM), with a target of >10 × 104 CFU-GM/kg. Apheresis nucleated cell count correlated significantly, albeit weakly (r = 0.26), with CFU-GM with a cell count of >5 × 10s/kg resulting in an adequate number of CFU-GM in 78% of patients. In univariant analysis outcome of collection was significantly influenced by the patients age (p = 0.01), malignant diagnosis (p < 0.001), reason for collection (p = 0.002), and the mobilization regimen (p = 0.01). The nature of the apheresis device used did not influence outcome. Only malignant diagnosis was significant (p < 0.001) in multivariate analysis. We conclude that the outcome of BC is most strongly influenced by patient factors such as malignant diagnosis. These factors must be considered when comparing the outcome of different mobilization regimens and when planning collection strategies.

Bone Marrow Mononuclear Cell Count does not Predict Neutrophil and Platelet Recovery following Autologous Bone Marrow Transplant: Value of the Colony-Forming Unit Granulocyte-Macrophage (CFU-GM) Assay

The common use of the marrow autograft mononuclear cell (MNC) count derives from positive correlative studies following allogeneic transplantation and from earlier conflicting data regarding the value of the bone marrow autograft colony-forming unit granulocyte-macrophage (CFU-GM) assay for predicting hematologic recovery after ABMT. We conducted a retrospective analysis at our institution to determine whether autograft CFU-GM levels predict engraftment of neutrophils and platelets after ABMT in heavily pretreated patients with hematologic malignancies. Between 1 January 1993 and 1 March 1995, 58 heavily pretreated patients received only marrow cells as the autograft product. Patients with Hodgkin's disease (n = 25), acute myeloid leukemia (n = 19), and non-Hodgkin's lymphoma (n = 14) underwent intensive therapy with etoposide and melphalan. Unpurged marrow containing a minimum of 1.5 × 108/kg (range: 1.5-4.8) was infused. Median time to an absolute neutrophil count ≥0.5 × 109/L was 21 days (range 10-270) and median time to a platelet count ≥20 × 109/L independent of transfusions was 44 days (range 13-317). There was no correlation between autograft MNC count and neutrophil or platelet engraftment. However, a correlation between autograft CFU-GM and both platelet and neutrophil recovery was demonstrated with a threshold CFU-GM of 3 × 104/kg; delayed neutrophil recovery was observed in 79% of patients below this threshold compared to only 9% in those with an autograft CFU-GM level of more than 3 × 104/kg (p = 0.0001). Similarly, platelet recovery was delayed in 76% of patients below, and 20% of those above this threshold (p = 0.003). We conclude that marrow autograft CFU-GM is predictive of engraftment of both platelets and neutrophils in heavily pretreated patients after ABMT for hematological malignancies.

Dosing free nitrous acid for sulfide control in sewers: results of field trials in Australia

Intermittent dosing of free nitrous acid (FNA), with or without the simultaneous dosing of hydrogen peroxide, is a new strategy developed recently for the control of sulfide production in sewers. Six-month field trials have been carried out in a rising main sewer in Australia (150 mm in diameter and 1080 m in length) to evaluate the performance of the strategy that was previously demonstrated in laboratory studies. In each trial, FNA was dosed at a pumping station for a period of 8 or 24 h, some with simultaneous hydrogen peroxide dosing. The sulfide control effectiveness was monitored by measuring, on-line, the dissolved sulfide concentration at a downstream location of the pipeline (828 m from the pumping station) and the gaseous H2S concentration at the discharge manhole. Effective sulfide control was achieved in all nine consecutive trials, with sulfide production reduced by more than 80% in 10 days following each dose. Later trials achieved better control efficiency than the first few trials possibly due to the disrupting effects of FNA on sewer biofilms. This suggests that an initial strong dose (more chemical consumption) followed by maintenance dosing (less chemical consumption) could be a very cost-effective way to achieve consistent control efficiency. It was also found that heavy rainfall slowed the recovery of sulfide production after dosing, likely due to the dilution effects and reduced retention time. Overall, intermittent dose of FNA or FNA in combination with H2O2 was successfully demonstrated to be a cost-effective method for sulfide control in rising main sewers.

A phase I/II study of sepantronium bromide (YM155, survivin suppressor) with paclitaxel and carboplatin in patients with advanced non-small-cell lung cancer

BACKGROUND

This phase I/II study examined the safety and efficacy of Sepantronium Bromide (S), a small-molecule selective survivin suppressant, administered in combination with carboplatin (C) and paclitaxel (P).

PATIENTS AND METHODS

Forty-one patients were treated on study. Twenty-two patients received escalating doses of S (3.6-12 mg/m(2)) and 19 with untreated stage IV non-small-cell lung cancer (NSCLC) were treated with the maximum tolerated dose of 10 mg/m(2) in combination with standard doses of C (AUC6) and P (200 mg/m(2)) for six cycles. S was administered as a continuous intravenous infusion (CIVI) over 72 h in 21-day treatment cycles. Study end points included safety and toxic effect, response rate, progression-free and overall survival (PFS and OS), as well as exploratory pharmacodynamic correlates.

RESULTS

Treatment with S was well tolerated, and toxic effects were mostly hematological in the phase II study. Two (11%) partial responses were observed with a median PFS of 5.7 months and median OS 16.1 months. Pharmacodynamic analysis did not demonstrate an association with response.

CONCLUSION

The combination of S (10 mg/m(2)/day 72-h CIVI) administered with C and P every 3 weeks exhibited a favorable safety profile but failed to demonstrate an improvement in response rate in advanced NSCLC.

CLINICAL TRIAL NUMBER

NCT01100931.

Modeling the effects of low-LET cosmic rays on electronic components

The effects of cosmic radiation in single cells, organic tissues and electronics are a major concern for space exploration and manned missions. Standard heavy ions radiation tests employ ion cocktails with energy of the order of 10 MeV per nucleon and with a linear energy transfer ranging from a few MeV cm(2) mg(-1) to hundreds of MeV cm(2) mg(-1). In space, cosmic rays show significant fluxes at energies up to the order of GeV per nucleon. The present work aims at investigating single event damage due to low-, high- and very-high-energy ions. The European Space Agency reference single event upset monitor data are used to support the discussion. Finally, the effect of ionization induced directly by primary particles and ionization induced by recoils produced in an electronic device is investigated for different types of devices.

Intrathecal transplantation of stem cells by lumbar puncture for thoracic spinal cord injury in the rat

STUDY DESIGN

Experimental investigation of intrathecal transplantation of stem cells by lumbar puncture (LP) in a rat model that simulates human thoracic spinal cord injury (SCI).

OBJECTIVES

To examine the distribution and phenotype of spinal cord-derived neural stem/progenitor cells (NSPCs) and bone marrow-derived mesenchymal stromal cells (BMSCs) following LP transplantation in SCI rats.

SETTING

Toronto Western Research Institute, Toronto, Ontario, Canada.

METHODS

NSPCs or BMSCs were transplanted via LP at level L3-5 1 week after compression SCI at T8. Rats were killed at 3, 17 and 27 days after LP transplantation and the relative distribution of cells at C4, T8 and L3-5 was quantitated. The phenotype of the NSPC and BMSC was assessed with immunocytochemistry in vitro and following LP transplantation.

RESULTS

By 4 weeks, more NSPC migrated to the lesion site relative to BMSC and uninjured animals. However, there was no preferential homing of either of these types of cells into the parenchyma of the injury site, and most of the transplanted cells remained in the intrathecal space. In vitro, spinal cord-derived NSPC proliferated and expressed nestin, but after LP transplantation, NSPC became post-mitotic and primarily expressed oligodendrocyte markers. In contrast, BMSC did not express any neural antigens in vivo.

CONCLUSION

LP is a minimally invasive method of cell transplantation that produces wide dissemination of cells in the subarachnoid space of the spinal cord. This is the first study to report and quantify the phenotype and spatial distribution of LP transplanted NSPC and BMSC in the intact and injured spinal cord.

High-dose chemotherapy and auto-SCT in elderly patients with Hodgkin's lymphoma

Our purpose was to assess efficacy and toxicity of high-dose chemotherapy (HDCT) and ASCT in patients with relapsed and refractory Hodgkin's lymphoma (HL) aged 60 years and older and compare the results with a group of younger HL patients treated in a similar manner. We identified 15 consecutive patients, with HL aged 60 years and older who underwent HDCT (etoposide 60 mg/kg+ melphalan 160 mg/m(2)) and ASCT at our institution from May 2001 to March 2008. The results were compared with a cohort of 157 younger HL patients treated in a similar manner from January 1999 to December 2006. After a median follow-up of 2.5 years, PFS at 3 years after ASCT was 73% (95% confidence interval (CI) 37-90) for the older group and 56% (95% CI 46-64) for the younger group (P=0.45); OS after ASCT was 88% (95% CI 39-98) for the older group and 84% (95% CI 75-90) for the younger group (P=0.80). No transplant-related deaths were seen. Our study suggests that ASCT is feasible for selected elderly patients with HL, giving similar results to younger patients in terms of survival and toxicity.

Subdural Hematomas during CML Therapy with Imatinib Mesylate

Seven of one hundred twenty-one patients with chronic myeloid leukemia (CML) treated with imatinib mesylate developed subdural hematomas. All had advanced disease and were treated initially at a dose of 600 mg per day. Three patients had thrombocytopenia (platelet < 10 x 10(9)/l), one had leukocytosis (white blood cell count > 150 x 10(9)/l) and three had neither around the time of diagnosis of the subdural hematomas. Four patients required surgical evacuation. One patient, in blast crisis, died as a consequence of the subdural hematoma. Three patients survived but died of progressive CML. The remaining three patients having recommenced imatinib, are alive and well, and one has achieved a major cytogenetic response. Subdural hematomas must be considered even in mildly symptomatic patients receiving imatinib regardless of their peripheral blood counts. Patients who survive can be cautiously restarted on imatinib. Further studies are required to study the potential relationship between imatinib mesylate and subdural hematomas.

Irradiated KHYG-1 retains cytotoxicity: Potential for adoptive immunotherapy with a natural killer cell line

PURPOSE

To evaluate gamma-irradiation on KHYG-1, a highly cytotoxic natural killer (NK) cell line and potential candidate for cancer immunotherapy.

METHODS AND MATERIALS

The NK cell line KHYG-1 was irradiated at 1 gray (Gy) to 50 Gy with gamma-irradiation, and evaluated for cell proliferation, cell survival, and cytotoxicity against tumor targets.

RESULTS

We showed that a dose of at least 10 Gy was sufficient to inhibit proliferation of KHYG-1 within the first day but not its cytolytic activity. While 50 Gy had an apoptotic effect in the first hours after irradiation, the killing of K562 and HL60 targets was not different from non-irradiated cells but was reduced for the Ph + myeloid leukemia lines, EM-2 and EM-3.

CONCLUSIONS

gamma-irradiation (at least 10 Gy) of KHYG-1 inhibits cell proliferation but does not diminish its enhanced cytolytic activity against several tumor targets. This study suggests that KHYG-1 may be a feasible immunotherapeutic agent in the treatment of cancers.

Utility of subsequent conventional dose chemotherapy in relapsed/refractory transplant-eligible patients with diffuse large B-cell lymphoma failing platinum-based salvage chemotherapy

Up to 60% of patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) do not respond to second-line (salvage) chemotherapy and hence are not offered autologous hematopoietic cell transplantation (AHCT). The utility of further salvage chemotherapy in an attempt to proceed with AHCT remains undefined. The authors reviewed 201 patients with DLBCL relapsed/refractory to anthracycline-based chemotherapy who received first-line salvage chemotherapy containing cis-platinum. Of the 120 non-responders to first-line platinum-based salvage chemotherapy, 73 received second-line salvage chemotherapy. The response rate to second-line salvage chemotherapy was 14%. Factors predicting lack of response were progression on primary therapy (p = 0.007), abnormal lactate dehydrogenase findings (p = 0.0027) and tumor bulk (p = 0.013) at second progression. Eight patients who responded received AHCT and appeared to have comparable survival to those transplanted after one salvage regimen. The authors conclude that the utility of second-line salvage chemotherapy is low, and that it is best reserved for patients demonstrating initial anthracycline sensitivity and low tumor burden.

The relationship between absolute lymphocyte count with PFS in patients with Hodgkin's lymphoma undergoing autologous hematopoietic cell transplant

Previous reports in Hodgkin's lymphoma (HL) patients undergoing autologous hematopoietic cell transplantation (AHCT) have demonstrated a significant association between the absolute lymphocyte count at day 15 (ALC-15) with survival. To evaluate this finding further, we analyzed 146 patients with relapsed/refractory HL who underwent AHCT to evaluate the relationship between lymphocyte counts at apheresis and at two time points (days 15 and 90) after AHCT with PFS. We found no association between the ALC-15 and the ALC-90 with PFS. We found lymphocyte counts at apheresis and disease sensitive to salvage chemotherapy were predictive of PFS. In conclusion, our study does provide some support for the theory that the immune system may be important in disease control but further and more detailed studies in this area are required.

Bone marrow-derived mesenchymal stromal cells for the repair of central nervous system injury

Transplantation of bone marrow-derived mesenchymal stromal cells (MSCs) into the injured brain or spinal cord may provide therapeutic benefit. Several models of central nervous system (CNS) injury have been examined, including that of ischemic stroke, traumatic brain injury and traumatic spinal cord injury in rodent, primate and, more recently, human trials. Although it has been suggested that differentiation of MSCs into cells of neural lineage may occur both in vitro and in vivo, this is unlikely to be a major factor in functional recovery after brain or spinal cord injury. Other mechanisms of recovery that may play a role include neuroprotection, creation of a favorable environment for regeneration, expression of growth factors or cytokines, vascular effects or remyelination. These mechanisms are not mutually exclusive, and it is likely that more than one contribute to functional recovery. In light of the uncertainty surrounding the fate and mechanism of action of MSCs transplanted into the CNS, further preclinical studies with appropriate animal models are urgently needed to better inform the design of new clinical trials.

Outcome following multiple lines of salvage chemotherapy prior to autologous stem cell transplant for relapsed or refractory diffuse large B-cell lymphoma (DLBCL)

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Background: The standard of care for chemosensitive relapsed or refractory DLBCL is autologous stem cell transplant (ASCT). There is no standard approach for patients (pts) whose disease fails to respond to platinum-based salvage chemotherapy (pSC) although pts who undergo further salvage chemotherapy to demonstrate chemosensitivity may benefit from ASCT (Chen, et al, BMT 2002). We analyzed the overall response rate (ORR) to each line of salvage therapy for pts with relapsed or refractory DLBCL and the impact of the number of salvage regimens necessary to demonstrate chemosensitivity on overall and progression-free survival (OS and PFS) post-ASCT. Methods: We retrospectively reviewed our computerized database and charts between Jan 1/99 - Dec 31/05 and identified 203 pts relapsed after or refractory to anthracycline-based chemo treated with pSC. Pts typically received 2–3 cycles of pSC to assess chemotherapy sensitivity. Responding patients received etoposide 60 mg/kg and melphalan 160 mg/m2 supported by autologous PBSCs. Pts with stable or progressive disease following first line salvage chemotherapy (SC1) were offered alternate non-cross resistant second-line salvage chemotherapy (SC2) and proceeded to ASCT if chemosensitive. Results: Pt characteristics: Median age at time of salvage chemotherapy: 52 years (range 21–65); primary refractory: 48%; advanced stage disease at salvage: 50%; prior rituximab: 17%; prior radiation 26%. 119/203 pts did not respond to SC1, 81 pts received SC2 and 10 pts received 3 salvage regimens (SC3). ORRs to salvage were: SC1: 40%, SC2: 14%, SC3: 10%. Pts able to proceed to ASCT were: SC1: 37%, SC2: 14%, SC3: 0. With a median follow-up of 1.8 years, the 2-year OS post ASCT for the SC1 and SC2 groups was 69% and 56% respectively. The 2-year PFS post ASCT for the SC1 and SC2 groups were 58% and 40%. Conclusions: The ORR to platinum-based SC is low in this cohort of primary refractory/relapsed patients (40%), and only 14% of pts who received SC2 after pSC responded. Although some have prolonged PFS following SC2 and ASCT, additional strategies should be investigated in these patients.

No significant financial relationships to disclose.

Late treatment mortality and secondary cancers after autologous stem cell transplant for relapsed or refractory Hodgkin lymphoma (HL)

8016

Background: Late treatment-related mortality and second cancers have an important influence on the long-term outcome of patients (pts) with HL. The incidence of treatment failure and causes of death were evaluated in pts with advanced HL receiving high-dose therapy and ASCT, to understand the impact of late events on overall survival (OS). Methods: From Dec 1986 to Nov 2005, 323 pts with relapsed/refractory HL after primary chemotherapy (plus radiation [RT]: 32%) received salvage chemotherapy to best response, followed by etoposide 60 mg/kg day -4 and melphalan 160–180 mg/m2 day -3 supported by autologous bone marrow (46%), mobilized peripheral blood stem cells (49%) or both (5%)on day 0; 24% received involved field RT post-ASCT. Risk of treatment failure and second cancer was estimated using competing risks methods. Results: Patient Characteristics: male: 61%; median age 33 years (range16–67). Number of salvage regimens pre-ASCT: 1: 72%; 2: 25%. Disease status post-salvage chemotherapy: CR 28%, PR 66%. After a median follow-up of 4.7 years post-ASCT (range 1–17), 174 pts (54%) have experienced treatment failure (relapse or treatment related death) and 154 pts (48%) have died, 75% following relapse and 20% from toxicity without relapse. Of the 30 deaths without relapse, 30% occured >5 years post-ASCT. Failure free survival at 3 and 10 years is 50% (95% CI, 44–55%) and 40% (33–46), and overall survival is 68% (63–73) and 39% (33- 46), respectively. There have been 29 second cancers (17 AML/MDS, 12 solid tumors) in pts alive without relapsed HL. The probability of a second cancer is 4.9% (2.8–7.8) at 3 years and 12% (8–17%) at 10 years. The hazard rates for second malignancy, leukemia and solid tumors for each 10-year age increment are 1.9 (p=0.0001), 1.9 (0.001) and 1.8 (0.03), respectively. Only 4 pts have relapsed beyond 5 years post- ASCT but the cumulative incidence of treatment-related death (from toxicity or second cancers) continues to increase from 9% (6–13) at 3 years to 15% (11–20) 10 yrs post-ASCT. Conclusions: In this single-institution series of uniformly treated patients with relapsed/refractory HL, late relapse of disease is uncommon, but late toxicities have a significant and ongoing impact on failure-free survival.

No significant financial relationships to disclose.

Pleural effusions in patients treated with dasatinib: Results from two institutions, risk factors and management

17503

Background: Dasatinib (SPRYCEL, formerly BMS354825) is a multi-targeted kinase inhibitor that has been shown to be very effective in the therapy of imatinib-resistant and -intolerant Ph-positive CML/ALL patients, frequently resulting in hematologic and cytogenetic remissions. Therapy with kinase inhibitors has been limited to some extent by fluid retention, the type of which is dependent on the individual drug. Pleural effusions have been relatively more common with dasatinib. We report on the experience at two large teaching hospitals - incidence, risk factors and management. Methods: 27 patients were treated on 5 BMS Phase 2 Studies (2CP, 1AP, 1BP-M, 1BP-L, 1ALL) - 17 CP, 5 AP, 3 BP-M, 2 BP-L/ALL. All patients started on a dose of 70mg BID of dasatinib. Results: In all 13 patients developed effusions. All but 1 were Grade 2; grades 2–4 are symptomatic and require intervention. Of the 14 who did not, 9 were either withdrawn from study because of CML progression (3) or dose-reduced because of hematological toxicity (6). The development of effusions was more common in patients with more advanced disease (BC>AP>CP), in those with previous lung problems (smoking, infections), and in those maintained on starting doses of dasatinib. Effusions could develop even 1–2 years (1>100d, 2>200, 2>300d, 1>500d) after starting therapy often triggered by a lung infection. Effective management included ongoing combinations of diuretics, temporary drug discontinuation, dose reduction, and more recently a once daily drug dosing schedule (Hochhaus et al , Blood 2006, 108: 166a). One patient required thoracentesis and chest tube. Conclusions: Dose monitoring and adjustments and management of the effusions have permitted continuation of the therapy in 10 of the 13 patients with good hematological outcomes. A change in dose schedule will be most effective.

No significant financial relationships to disclose.

Phase II monotherapy study of YM155, a novel survivin suppressant, administered by 168-hour continuous infusion in previously treated hormone refractory prostate cancer (HRPC)

5135

Background: In a PC-3 tumor cell model YM155 inhibited survivin mRNA transcription and survivin protein expression and showed potent (nM) anti-proliferation activity with strong signs of tumor regression. In a phase I study, two highly refractory HRPC patients exhibited a > 50% reduction of PSA from baseline. Methods: Patients with metastatic HRPC who received prior taxane chemotherapy were eligible. The primary endpoint is PSA response rate (decline by ≥ 50%). Other endpoints include objective tumor response by RECIST and evaluation of toxicity. A two stage Simon study design required one response in stage I (N=13) and 3 responses in stage II (N=14). If 4 responses are achieved then an additional 33 pts (N=60) will be enrolled to further characterize the efficacy and safety. Patients are considered evaluable if they complete 2 cycles. YM155 is given as a 168 hour continuous infusion every three weeks (1 cycle) at a dose of 4.8 mg/m2/day. Results: First two stages are enrolled with treatment ongoing. Data on 32 pts is provided. Median age is 67 y/o (range 53 - 81) with ECOG PS of 0 - 2. All but one patient received at least one prior taxane containing regimen. Two patients are PSA responders to date. One achieved response at cycle 2 (currently at cycle 3) and one at cycle 6 (currently at cycle 10). The median number of cycles is 3 (range 1 - 10). Two patients discontinued due to adverse events; in only one patient was the event (fever) considered related to study drug. Five/32 patients reported grade 3, 4, or 5 AE considered related to drug (coagulopathy secondary to coumadin therapy followed by intracranial hemorrhage, fatigue, URI, decreased Hgb, thrombocytopenia). Seven/32 patients remain on drug including the two responders. Conclusions: The preliminary data of YM155 in HRPC demonstrates activity and has an acceptable toxicity profile.

No significant financial relationships to disclose.

Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement

The considerable therapeutic potential of human multipotent mesenchymal stromal cells (MSC) has generated markedly increasing interest in a wide variety of biomedical disciplines. However, investigators report studies of MSC using different methods of isolation and expansion, and different approaches to characterizing the cells. Thus it is increasingly difficult to compare and contrast study outcomes, which hinders progress in the field. To begin to address this issue, the Mesenchymal and Tissue Stem Cell Committee of the International Society for Cellular Therapy proposes minimal criteria to define human MSC. First, MSC must be plastic-adherent when maintained in standard culture conditions. Second, MSC must express CD105, CD73 and CD90, and lack expression of CD45, CD34, CD14 or CD11b, CD79alpha or CD19 and HLA-DR surface molecules. Third, MSC must differentiate to osteoblasts, adipocytes and chondroblasts in vitro. While these criteria will probably require modification as new knowledge unfolds, we believe this minimal set of standard criteria will foster a more uniform characterization of MSC and facilitate the exchange of data among investigators.

Feasibility and safety of autotransplants with noncryopreserved marrow or peripheral blood stem cells: a systematic review

The objective of this systematic review is to examine the feasibility and safety of autologous noncryopreserved stem-cell transplants. This technique avoids the cost of establishing and maintaining a cryopreservation facility and may be of value for transplant centers in regions with limited economic resources. The primary outcome was the graft failure rate. In addition, a detailed description of the high-dose therapy regimens employed was undertaken. Secondary outcomes were transplant-related mortality and neutrophil and platelet engraftments times. Sixteen well-conducted nonrandomized studies met the eligibility criteria. Only two cases of graft failure (0.36%) occurred among 560 assessable patients receiving high-dose therapy and autotransplant for non-Hodgkin's lymphoma, Hodgkin's lymphoma, multiple myeloma, germ-cell tumors and acute leukemias. The most traditional high-dose schedules were used, although often modified to shorter regimens. High-dose melphalan appeared especially useful given its short half-life and was used to treat multiple myeloma by most groups. Secondary outcomes were comparable to those reported in the most relevant studies addressing standard (cryopreserved) autotransplant. According to this study, the use of autologous noncryopreserved hematopoietic progenitors to support patients undergoing high-dose therapy is feasible and safe.

Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement

The considerable therapeutic potential of human multipotent mesenchymal stromal cells (MSC) has generated markedly increasing interest in a wide variety of biomedical disciplines. However, investigators report studies of MSC using different methods of isolation and expansion, and different approaches to characterizing the cells. Thus it is increasingly difficult to compare and contrast study outcomes, which hinders progress in the field. To begin to address this issue, the Mesenchymal and Tissue Stem Cell Committee of the International Society for Cellular Therapy proposes minimal criteria to define human MSC. First, MSC must be plastic-adherent when maintained in standard culture conditions. Second, MSC must express CD105, CD73 and CD90, and lack expression of CD45, CD34, CD14 or CD11b, CD79alpha or CD19 and HLA-DR surface molecules. Third, MSC must differentiate to osteoblasts, adipocytes and chondroblasts in vitro. While these criteria will probably require modification as new knowledge unfolds, we believe this minimal set of standard criteria will foster a more uniform characterization of MSC and facilitate the exchange of data among investigators.

Outcome of salvage therapy for relapsed or refractory peripheral T-cell lymphoma (PTCL), anaplastic large cell lymphoma (ALCL), and diffuse large B-cell lymphoma (DLBCL)

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Background: Compared to patients with ALCL and DLBCL, PTCL patients have a lower response and higher relapse rate following anthracycline-based chemotherapy. However, in the case of relapsed or primary refractory disease, it is unclear if response to salvage treatment and survival are similarly inferior. Methods: Between 01/01/1995 and 12/30/2004, 45 patients with PTCL, 21 with ALCL, and 171 with DLBCL were referred to our institution for consideration of ASCT. The majority of patients (70%) received a platinum-based salvage regimen. Responding patients then received high-dose etoposide and melphalan followed by autologous stem cell transplant (ASCT). Results: The three groups were similar in age (median 53, range: 19–66), but PTCL patients had more advanced stage disease (III or IV) at salvage than ALCL and DLBCL (71 vs. 61 vs. 48%, p=0.03). Response rates to salvage chemotherapy were similar: 53% for PTCL, 57% for ALCL, and 53% for DLBCL (p=0.94). For T-cell (PTCL and ALCL) patients, there was a trend to better response if a platinum-based regimen was given (61 vs. 35%, p=0.06). Post-transplant, 9/21 PTCL, 3/11 ALCL, and 41/88 DLBCL patients relapsed (43 vs. 27 vs. 46%, p=0.47). Two-year event-free survival (EFS) rates were 28% (95% CI: 14–42%) for PTCL, 45% (23–67%) for ALCL, and 45% (37–53%) for DLBCL (p=0.068). Event-free and overall survival for all patients, and for those who proceeded to ASCT, are shown in the table . Conclusions: Two-year EFS is inferior for patients with relapsed/refractory PTCL treated with the intention of proceeding to ASCT, compared to ALCL and DLBCL, as is 2-year OS rate. However, PTCL patients had similar response to primarily platinum-based salvage chemotherapy, and achieved similar outcome post-ASCT. These findings suggest that strategies to improve the outcome of PTCL patients may include changes to first-line treatment and salvage regimens.

[Table: see text]

No significant financial relationships to disclose.

Clarification of the nomenclature for MSC: The International Society for Cellular Therapy position statement

The plastic-adherent cells isolated from BM and other sources have come to be widely known as mesenchymal stem cells (MSC). However, the recognized biologic properties of the unfractionated population of cells do not seem to meet generally accepted criteria for stem cell activity, rendering the name scientifically inaccurate and potentially misleading to the lay public. Nonetheless, a bona fide MSC most certainly exists. To address this inconsistency between nomenclature and biologic properties, and to clarify the terminology, we suggest that the fibroblast-like plastic-adherent cells, regardless of the tissue from which they are isolated, be termed multipotent mesenchymal stromal cells, while the term mesenchymal stem cells is used only for cells that meet specified stem cell criteria. The widely recognized acronym, MSC, may be used for both cell populations, as is the current practice; thus, investigators must clearly define the more scientifically correct designation in their reports. The International Society for Cellular Therapy (ISCT) encourages the scientific community to adopt this uniform nomenclature in all written and oral communications.

Short-wavelength infrared tuneable filters on HgCdTe photoconductors

The design, micro-fabrication, and electronic and optical performance of a tuneable short-wavelength infrared Fabry-Pérot microresonator on a mercury cadmium telluride photoconductor is presented. The maximum processing temperature of 125 degrees C has negligible effect on the electronic and optical performance of photoconductor test structures. Maximum responsivity, effective carrier lifetime and detectivity are 60x103 VW-1, 2x10-5 s and 8x1010 cmHz1/2W-1, respectively. The maximum effective carrier lifetime and specific detectivity are in good agreement with the theoretical maxima. Uncooled device operation is possible since responsivity is observed not to improve with thermo-electric cooling. Spectral tuning of the micro-filters is demonstrated over the wavelength range 1.7 to 2.2 mum using drive voltages up to 8 V, with the full-width-half-maximum of the resonance approximately 100 nm. Membrane deflection can be up to 40% of the cavity width.

Autologous stem cell transplantation in multiple myeloma patients <60 vs >/=60 years of age

The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Using data from the Autologous Blood and Marrow Transplant Registry, we compared the outcome of 110 patients >/=the age of 60 (median 63; range 60-73) years, undergoing AuSCT with that of 382 patients <60 (median 52; range 30-59) years. The two groups were similar except that older patients had a higher beta(2)-microglobulin level at diagnosis (P=0.016) and fewer had lytic lesions (P=0.007). Day 100 mortality was 6% (95% confidence interval 4-9) and 1-year treatment-related mortality (TRM) was 9% (6-13) in patients <60 years, compared with 5% (2-10) and 8% (4-14), respectively, in patients >/=60 years. The relapse rate, progression-free survival (PFS) and overall survival (OS) in the two groups were also similar. Multivariate analysis of all patients identified only an interval from diagnosis to AuSCT >12 months and the use of two prior chemotherapy regimens within 6 months of AuSCT as adverse prognostic factors. Our results indicate that AuSCT can be safely performed in selected older patients: the best results were observed in patients undergoing AuSCT relatively early in their disease course.

Myeloablative conditioning regimens for AML allografts: 30 years later

During the last three decades, several myeloablative conditioning regimens have been used for AML allografts. In this review, we systematically examine the data from studies reporting on myeloablative conditioning regimens for AML allografts. High-dose busulfan combined with cyclophosphamide (BuCy) and cyclophosphamide in combination with total body irradiation (CyTBI) are the two most commonly used conditioning regimens for AML allografts. From the available data, there are no significant differences in survival with these two regimens. A small benefit of decreased relapse rate with CyTBI is counterbalanced by a nonsignificant increase in treatment-related mortality. The incidence of veno-occlusive disease is significantly higher in patients treated with BuCy. Therapeutic monitoring of busulfan was not reported in any of the studies comparing the regimens. Either of the regimens can be used for AML allografts, and the choice may ultimately depend on local availability and expertise. Further improvements may be possible from modifications of the standard regimens. Data from these latter studies seem to be encouraging, but are not based on comparative randomized trials.