Durable benefit of rituximab maintenance post-autograft in patients with relapsed follicular lymphoma: 12-year follow-up of the EBMT lymphoma working party Lym1 trial

We report the 12-year follow-up of the prospective randomized EBMT LYM1 trial to determine whether the benefit of brief duration rituximab maintenance (RM) on progression-free survival (PFS) in patients with relapsed follicular lymphoma (FL) receiving an autologous stem cell transplant (ASCT) is sustained. One hundred and thirty-eight patients received RM with or without purging. The median follow-up after random assignment is 12 years (range 10-13) for the whole series. The 10-year PFS after ASCT is 47% (95% CI 40-54) with only 4 patients relapsing after 7.5 years. RM continues to significantly improve 10-year PFS after ASCT in comparison with NM [P = 0.002; HR 0.548 (95% CI 0.38-0.80)]. Ten-year non-relapse mortality (NRM) was not significantly different between treatment groups (7% overall). 10-year overall survival (OS) after ASCT was 75% (69-81) for the whole series, with no significant differences according to treatment sub-groups. 10-year OS for patients who progressed within 24 months (POD24T) was 60%, in comparison with 85% for patients without progression. Thus the benefit of rituximab maintenance after ASCT on relapse prevention is sustained at 12 years, suggesting that RM adds to ASCT-mediated disease eradication and may enhance the curative potential of ASCT.

Parental and peer supports are associated with an active lifestyle of adolescents: evidence from a population-based survey

OBJECTIVES

Parental and peer support can foster adolescents' activity behaviours; however, little is known about how such support are linked with adolescents' active lifestyle in non-Western settings. The study aimed to explore associations of parental and peer support with an active lifestyle of adolescents in Malaysia.

STUDY DESIGN

This is a cross-sectional study.

METHODS

We used data from the 2012 Malaysian Global School-based Student Health Survey, which covered adolescents aged 11-17 years (51% girls). Adolescents were asked about their physical activity, sitting time, and levels of parental and peer support. Participants with ≥60 min of moderate to vigorous physical activity per day and ≤2 h of sitting time per day were categorised as having an 'active lifestyle'. Binary logistic regression was used to examine the relationships by gender and age group (11-14 and 15-17 years).

RESULTS

Of the participating adolescents (n = 12,081), 15.3% reported to have an active lifestyle (boys: 22.0%; girls: 8.8%). About 31% reported to have higher levels of parental support, whereas 47% reported higher levels of peer support. Higher parental and peer support were significantly associated with an active lifestyle of boys across both age groups. Girls with higher parental support had higher odds of reporting an active lifestyle in both age groups, whereas higher peer support was significantly associated with an active lifestyle among girls aged 11-14 years.

CONCLUSIONS

This study uniquely extends the current evidence by examining the associations of parental and peer support with physical activity and sitting time combined. More research is needed to understand how different types of social support can influence adolescents' active lifestyle.

Physical activity and sedentary behaviour in Bangladesh: a systematic scoping review

OBJECTIVES

Lack of physical activity (PA) contributes to increasing prevalence of non-communicable diseases (NCDs) globally. However, little is known about PA and sedentary behaviour (SB) among populations in low- and middle-income countries (LMICs). This systematic review examined prevalence of PA and SB in Bangladesh.

STUDY DESIGN

Systematic review of the literature.

METHODS

A systematic electronic search in eight databases and a manual search of retrieved articles' references were conducted. Original research conducted in Bangladesh with PA- and/or SB-related outcome(s) were included.

RESULTS

Out of 1,162 retrieved titles, 33 articles (32 cross-sectional and one case-control study) met the inclusion criteria. Twenty-nine studies were with healthy populations: adults (n = 19); children and adolescents (n = 7); and children, adolescents and adults (n = 3). Five studies used nationally representative samples of adults and one of adolescents. Most studies (n = 26) assessed PA only; three only SB, and four both PA and SB. All studies used self-reported measures. Among healthy adults, prevalence of insufficient PA ranged from 5% to 83%. Occupational and transport-related PA contributed the most towards total PA with negligible contribution of recreational PA. Among children and adolescents, the prevalence of insufficient PA ranged between 20% and 67%. Females engaged in less PA compared to males. Limited evidence currently exists about the prevalence of SB, especially among adults.

CONCLUSIONS

PA and SB research has received little attention in Bangladesh. Critical knowledge gaps identified in this review should be taken into account when designing new research and programmes in Bangladesh and other LMICs with similar socio-economic and cultural settings.

Molecular High-Grade B-Cell Lymphoma: Defining a Poor-Risk Group That Requires Different Approaches to Therapy

PURPOSE

Biologic heterogeneity is a feature of diffuse large B-cell lymphoma (DLBCL), and the existence of a subgroup with poor prognosis and phenotypic proximity to Burkitt lymphoma is well known. Conventional cytogenetics identifies some patients with rearrangements of MYC and BCL2 and/or BCL6 (double-hit lymphomas) who are increasingly treated with more intensive chemotherapy, but a more biologically coherent and clinically useful definition of this group is required.

PATIENTS AND METHODS

We defined a molecular high-grade (MHG) group by applying a gene expression-based classifier to 928 patients with DLBCL from a clinical trial that investigated the addition of bortezomib to standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The prognostic significance of MHG was compared with existing biomarkers. We performed targeted sequencing of 70 genes in 400 patients and explored molecular pathology using gene expression signature databases. Findings were validated in an independent data set.

RESULTS

The MHG group comprised 83 patients (9%), with 75 in the cell-of-origin germinal center B-cell-like group. MYC rearranged and double-hit groups were strongly over-represented in MHG but comprised only one half of the total. Gene expression analysis revealed a proliferative phenotype with a relationship to centroblasts. Progression-free survival rate at 36 months after R-CHOP in the MHG group was 37% (95% CI, 24% to 55%) compared with 72% (95% CI, 68% to 77%) for others, and an analysis of treatment effects suggested a possible positive effect of bortezomib. Double-hit lymphomas lacking the MHG signature showed no evidence of worse outcome than other germinal center B-cell-like cases.

CONCLUSION

MHG defines a biologically coherent high-grade B-cell lymphoma group with distinct molecular features and clinical outcomes that effectively doubles the size of the poor-prognosis, double-hit group. Patients with MHG may benefit from intensified chemotherapy or novel targeted therapies.

Pithedulosides A-G, oleanane glycosides from Pithecellobium dulce

Seven saponins named pithedulosides A-G were isolated from the seeds of Pithecellobium dulce. Their structures were established through spectral analyses as echinocystic acid 3-O-alpha-L-arabinopyranosyl-(1-->6)-beta-D-glucopyranoside, echinocystic acid and oleanolic acid 3-O-alpha-L-arabinopyranosyl- (1-->2)-alpha-L-arabinopyranosyl-(1-->6)-beta-D-glucopyranosides and 3-O-beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl -(1-->6)-beta-D-glucopyranosides, oleanolic acid 3-O-alpha-L-arabinopyranosy-(1-->2)-alpha-L- arabinopyranosyl-(1-->6)-[beta-D-glucopyranosyl-(1-->2)]-beta- D-glucopyranoside, and 3-O-beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl-(1-->6) -[beta-D-glucopyranosyl-(1-->2)]--beta-D-glucopyranoside.

Quality of drinking water in the Aligarh Muslim University Campus, Aligarh, U.P. (India) with respect to heavy metals

The physico-chemical characteristics of the drinking water in nine residential halls of the Aligarh Muslim University, Aligarh, U.P. (India), were studied. Nine samples each of running and standing water were taken four times over a period of one month at weekly intervals from all of the residential halls and were analysed for physico-chemical characteristics and heavy metal contents. The temperature, pH and electrical conductivity of water samples ranged between 20.0-26.0°C; 7.00-8.00 and 116.00-199.04 micromhos cm(-1) respectively whereas the values of total alkalinity, total hardness, Cl(-), SO 4 (-) , F(-), NH3-N, NO2-N; NO3-N were found between 261.00-396.00; 128.00-200.00; 8.00-69.00; 12.00-46.00; 0.90-1.35; 0.20-0.44; ND; 1.60-6.50 mg l(-1) respectively. The ranges of heavy metal concentrations in the running water samples were as follows: Cd (0.70-3.75); Cr (ND-5.00); Co (9.50-18.75); Cu (0.75-15.00); Fe (ND-13.50); Mn (3.50-51.00); Ni (7.00-17.50); Pb (0.50-2.50) and Zn (10.00-176.50) μg l(-1). The heavy metal concentrations in standing water samples were found to be: Cd (1.20-4.90); Cr (ND-10.00); Co (10.25-19.00); Cu (1.75-20.00); Fe (ND-18.00); Mn (5.00-66.50); Ni (8.75-19.75); Pb (0.75-5.50) and Zn (28.60-364.00) μg l(-1). The concentrations of heavy metals in drinking water supplies of the Aligarh Muslim University campus were well below the guidelines for drinking water quality as prescribed by World Health Organisation (1984). It is evident from the results that the drinking water may not cause any significant health hazard to water consumers due to heavy metals but these may be hazardous if they get accumulated in the body due to continuous consumption of water.

Studies on heavy metals in the ground waters of the city of Aligarh U.P. (India)

A study was conducted to determine the levels of heavy metals Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn along with physico-chemical parameters in ground waters of Aligarh city, U.P. (India). Twenty seven samples of hand pump water and twenty three samples of municipal water supply were collected from different localities of the Aligarh city, five times during the period of two months at intervals of 12 days. The samples were analysed for physico-chemical characteristics (pH, electrical conductivity, chlorides, sulphates, total hardness, total alkalinity, nitrate-nitrogen, fluoride, calcium and magnesium) and heavy metal contents. The concentrations of heavy metals in the hand pump water samples were found in the ranges of Cd (ND-5.00); Cr (ND-30.00); Cu (ND-82.50); Fe (16.80-460.00); Mn (ND-425.00); Ni (ND-25.00); Pb (ND-25.00) and Zn (28.60-775.00) μg l(-1). The heavy metal concentrations in the municipal water supply samples were found to be Cd (ND-5.00); Cr (ND-25.00); Cu (ND-37.50); Fe (8.00-37.50); Mn (ND-320.00); Ni (ND-25.00); Pb (ND-25.00) and Zn (2.00-271.87) μg l(-1).It appears from the results of these studies the concentrations of Cd, Cr, Cu, Ni, Pb, and Zn in the ground waters of the Aligarh City were found to be lower than the prescribed limits of World Health Organisation (1984), whereas the values of Fe and Mn were found above the prescribed limits in some localities. The chloride total hardness and nitrate-nitrogen were comparatively higher in the hand pump water than the municipal supply water. The reason of higher values of these parameters may be ascribed to the surface disposal of sewage wastes, wastes from metal processing industries and other house hold refuses.