Glofitamab stimulates immune cell infiltration of CNS tumors and induces clinical responses in secondary CNS lymphoma

Although CD20xCD3 bispecific antibodies are effective against systemic B-cell lymphomas, their efficacy in CNS lymphoma is unknown. Here, we report the CD20xCD3 bispecific, glofitamab, penetrates the blood-brain barrier, stimulates immune-cell infiltration of CNS tumors, and induces responses in CNS lymphoma.

Bendamustine lymphodepletion is a well-tolerated alternative to fludarabine and cyclophosphamide lymphodepletion for axicabtagene ciloleucel therapy for aggressive B-cell lymphoma

Fludarabine/cyclophosphamide (Flu/Cy) is established for lymphodepletion (LD) prior to standard-of-care CAR T-cell therapy for lymphoma. There is ongoing need to test alternative LD regimens to preserve efficacy, improve safety, and address challenges including the recent national fludarabine shortage. We retrospectively evaluated outcomes among patients with relapsed/refractory aggressive B-cell lymphoma who received bendamustine (n = 27) or Flu/Cy (n = 42) LD before axicabtagene ciloleucel (axi-cel) at our institution. The median change in absolute lymphocyte count from pre-LD to time of axi-cel infusion was -0.6×109 /L in bendamustine cohort and -0.7×109 /L in Flu/Cy cohort. The best overall response/complete response rates were 77.8% (95% CI: 57.7%-91.4%)/48.1% (95% CI: 28.7%-68.1%) among bendamustine cohort and 81.0% (95% CI: 65.9%-91.4%)/50.0% (95% CI: 34.2%-65.8%) among Flu/Cy cohort. Six-month progression-free survival were 43.8% (95% CI: 24.7%-61.3%) and 55.6% (95% CI: 39.0%-69.3%) in bendamustine and Flu/Cy cohorts, while 6-month overall survival were 81.5% (95% CI: 61.1%-91.8%) and 90.4% (95% CI: 76.4%-96.3%), respectively. Relative to Flu/Cy-treated patients, bendamustine-treated patients did not show an increase in hazards associated with experiencing progression/relapse/death (aHR:1.4 [95% CI: 0.7-2.8]; p = .32) or death (aHR:1.6 [95% CI: 0.5-5.6]; p = .46), after adjusting for baseline number of prior therapies and refractory disease. Any grade/grade ≥3 CRS were observed in 89%/3.7% and 86%/4.8% among bendamustine and Flu/Cy cohorts, while any grade ICANS/grade ≥3 ICANS were observed in 30%/19% and 55%/31% respectively. While more Flu/Cy-treated patients experienced grade ≥3 neutropenia compared with bendamustine-treated patients (100% vs. 68%), grade ≥3 infectious complications were comparable (24% vs. 19% respectively). More patients received bendamustine LD and axi-cel as outpatient than Flu/Cy cohort, without increased toxicities and with shorter median inpatient stays. In conclusion, we observed comparable efficacy and lower any grade ICANS among patients receiving bendamustine relative to Flu/Cy LD, followed by axi-cel.

Cost-effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated diffuse large B-cell lymphoma

In patients with treatment-naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study (A Study Comparing the Efficacy and Safety of Polatuzumab Vedotin With Rituximab-Cyclophosphamide, Doxorubicin, and Prednisone [R-CHP] Versus Rituximab-Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone [R-CHOP] in Participants With Diffuse Large B-Cell Lymphoma) reported a 6.5% improvement in the 2-year progression-free survival (PFS), with no difference in overall survival (OS) or safety using polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) compared with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). We evaluated the cost-effectiveness of pola-R-CHP for DLBCL. We modeled a hypothetical cohort of US adults (mean age, 65 years) with treatment-naive DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of pola-R-CHP and R-CHOP using a range of plausible long-term outcomes. Progression rates and OS were estimated from POLARIX. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150 000 per quality-adjusted life-year (QALY). Assuming a 5-year PFS of 69.6% with pola-R-CHP and 62.7% with R-CHOP, pola-R-CHP was cost-effective at a WTP of $150 000 (incremental cost-effectiveness ratio, $84 308/QALY). pola-R-CHP was no longer cost-effective if its 5-year PFS was 66.1% or lower. One-way sensitivity analysis revealed that pola-R-CHP is cost-effective up to a cost of $276 312 at a WTP of $150 000. pola-R-CHP was the cost-effective strategy in 56.6% of the 10 000 Monte Carlo iterations at a WTP of $150 000. If the absolute benefit in PFS is maintained over time, pola-R-CHP is cost-effective compared with R-CHOP at a WTP of $150 000/QALY. However, its cost-effectiveness is highly dependent on its long-term outcomes and costs of chimeric antigen receptor T-cell therapy. Routine usage of pola-R-CHP would add significantly to health care expenditures. Price reductions or identification of subgroups that have maximal benefit would improve cost-effectiveness.

Cost effectiveness of polatuzumab vedotin in combination with chemoimmunotherapy (Pola-R-CHP) in previously untreated diffuse large B-cell lymphoma

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Background: In patients with treatment naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study demonstrated a 6.5% improvement in the 2-year (yr) progression-free survival (PFS) with no difference in overall survival or safety using polatuzumab vedotin + R-CHP compared to standard RCHOP. We evaluated the cost effectiveness of pola-R-CHP for DLBCL. Methods: We modeled a hypothetical cohort of US adults (mean age, 58 yrs) with treatment naïve DLBCL by developing a Markov model with a 1-month cycle and 20-yr horizon. The cost-effectiveness of two strategies were directly compared (pola-R-CHP, RCHOP) using a range of plausible long-term outcomes. A patient with DLBCL in remission after treatment could develop subsequent progression or relapse, death, or alternative toxicity. Progression rates and overall survival were estimated from POLARIX study. Outcome measures were reported in incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life-yr (QALY). Results: Assuming a 5-yr PFS of 69.6% with pola-R-CHP and 62.6% with RCHOP, pola-R-CHP was more effective (0.81 incremental QALYs) but more costly ($66,218) and was cost-effective at a WTP of 150,000 (ICER $82,220/QALY). Its cost effectiveness was highly dependent on the 5-yr PFS of pola-R-CHP with it no longer being cost effective if the 5-yr PFS was < 65%. One way sensitivity analysis demonstrated that pola-R-CHP is cost effective up to a cost of $270,506 at a WTP of $150,000. Probabilistic sensitivity analysis was derived from performing 10,000 Monte-Carlo model iterations and demonstrated that pola-R-CHP was the cost-effective strategy in 61.3% of iterations with RCHOP being cost-effective in 38.6% of iterations at a WTP of $150,000. Conclusions: If the absolute benefit in PFS is maintained over time, frontline pola-R-CHP for treatment of DLBCL would be cost effective at its current cost when compared to RCHOP at a WTP of $150,000/QALY. However, its cost effectiveness is highly sensitive to changes in long-term PFS and the cost of pola-R-CHP. If pola-R-CHP is adopted as frontline therapy for the 29,108 incident cases of DLBCL annually in the US, this will lead to an additional 1.8 billion dollars in healthcare expenditures. This highlights the importance of decreasing the cost of pola-R-CHP and identifying sub-populations that derive the highest benefit from it.[Table: see text]

Progress in ITER ECE Diagnostic Design and Integration

The ITER Electron Cyclotron Emission (ECE) diagnostic is progressing towards its Preliminary Design Review (PDR). In parallel, the diagnostic integration in the Equatorial Port is ongoing. Port Integration has to address the structural integrity to withstand various loads, maintenance and the safety aspects of ECE diagnostic. The ITER ECE system includes radial and oblique lines-of-sight. Recently, a successful peer-review of the in-port plug Hot Calibration Source has taken place and its performance and integration feasibility has been demonstrated. Four 45-meter long low-loss transmission lines are designed to transmit mm-wave power in the frequency range of 70- 1000 GHz in both X- and O-mode polarization from the port plug to the ECE instrumentation room in the diagnostic building. Prototype transmission lines are being tested [1]. A prototype polarizing Martin-Puplett type Fourier Transform Spectrometer (FTS) operating in the frequency range 70-1000 GHz, has a fast scanning mechanism and a cryo-cooled dual-channel THz detector system. Its performance has been tested as per ITER requirements. Assessment of the instrumentation and control requirements, functional and non-functional requirements, operation procedures, plant automation are ongoing for the PDR. The current status of the diagnostic, together with integration activities, is presented.

VUV spectroscopy in impurity injection experiments at KSTAR using prototype ITER VUV spectrometer

The ITER vacuum ultra-violet (VUV) core survey spectrometer has been designed as a 5-channel spectral system so that the high spectral resolving power of 200-500 could be achieved in the wavelength range of 2.4-160 nm. To verify the design of the ITER VUV core survey spectrometer, a two-channel prototype spectrometer was developed. As a subsequent step of the prototype test, the prototype VUV spectrometer has been operated at KSTAR since the 2012 experimental campaign. From impurity injection experiments in the years 2015 and 2016, strong emission lines, such as Kr xxv 15.8 nm, Kr xxvi 17.9 nm, Ne vii 46.5 nm, Ne vi 40.2 nm, and an array of largely unresolved tungsten lines (14-32 nm) could be measured successfully, showing the typical photon number of 10¹³-10¹⁵ photons/cm² s.

Test of prototype ITER vacuum ultraviolet spectrometer and its application to impurity study in KSTAR plasmas

To optimize the design of ITER vacuum ultraviolet (VUV) spectrometer, a prototype VUV spectrometer was developed. The sensitivity calibration curve of the spectrometer was calculated from the mirror reflectivity, the grating efficiency, and the detector efficiency. The calibration curve was consistent with the calibration points derived in the experiment using the calibrated hollow cathode lamp. For the application of the prototype ITER VUV spectrometer, the prototype spectrometer was installed at KSTAR, and various impurity emission lines could be measured. By analyzing about 100 shots, strong positive correlation between the O VI and the C IV emission intensities could be found.

Development of the prototype pneumatic transfer system for ITER neutron activation system

The neutron activation system (NAS) measures neutron fluence at the first wall and the total neutron flux from the ITER plasma, providing evaluation of the fusion power for all operational phases. The pneumatic transfer system (PTS) is one of the key components of the NAS for the proper operation of the system, playing a role of transferring encapsulated samples between the capsule loading machine, irradiation stations, counting stations, and disposal bin. For the validation and the optimization of the design, a prototype of the PTS was developed and capsule transfer tests were performed with the developed system.

Integration of HIV testing in tuberculosis drug resistance surveillance in Kazakhstan and Kenya

In Kenya and Kazakhstan, integration of human immunodeficiency virus (HIV) testing results into the routine surveillance of multidrug-resistant tuberculosis (MDR-TB) proved feasible and useful. The integration process improved overall data quality and data validation capacity, and integrated data are a useful addition to routine cohort and treatment outcome data. Besides their importance for individual patient care, they provide trends on the association of MDR-TB and HIV in the routine programme setting. They also form a useful epidemiological basis for more specific studies, such as on nosocomial outbreaks. Whether the system itself is sensitive enough to monitor possible outbreaks needs further investigation.

Development of two-channel prototype ITER vacuum ultraviolet spectrometer with back-illuminated charge-coupled device and microchannel plate detectors

A vacuum ultraviolet (VUV) spectrometer of a five-channel spectral system is designed for ITER main plasma impurity measurement. To develop and verify the system design, a two-channel prototype system is fabricated with No. 3 (14.4-31.8 nm) and No. 4 (29.0-60.0 nm) among the five channels. The optical system consists of a collimating mirror to collect the light from source to slit, two holographic diffraction gratings with toroidal geometry, and two different electronic detectors. For the test of the prototype system, a hollow cathode lamp is used as a light source. To find the appropriate detector for ITER VUV system, two kinds of detectors of the back-illuminated charge-coupled device and the microchannel plate electron multiplier are tested, and their performance has been investigated.

154. EFFECT OF KOREAN RED GINSENG EXTRACT IN STEROID-INDUCED POLYCYSTIC OVARY MURINE MODEL

Experimental induction of polycystic ovary (PCO) resembling some aspects of human PCO syndrome was produced using the long-acting compound estradiol valerate (EV). Our previous study on the role of Korean red ginseng total saponins in a steroid-induced PCO rat model demonstrated that electro-acupuncture modulates nerve growth factor (NGF) concentration in the ovaries. In fact, the involvement of a neurogenic component in the pathology of PCO-related ovarian dysfunction is preceded by an increase in sympathetic outflow to the ovaries. In the present study, we tested the hypothesis that Korean red ginseng extract (KRGE) administration modulates sympathetic nerve activity in rats with PCO. This was done by analysing NGF protein and NGF mRNA expression involved in the pathophysiological process underlying steroid-induced PCO. EV injection resulted in significantly higher ovarian NGF protein and NGF mRNA expression in PCO rats compared to control rats, and PCO ovaries were counteracted by KRGE administration with significantly lower expression of NGF protein and NGF mRNA compared to EV treated ovaries. These results indicate that EV modulates the neurotrophic state of the ovaries, which may be a component of the pathological process by which EV induces cyst formation and anovulation in rodents.

In-vessel design of ITER diagnostic neutron activation system

A neutron activation system utilizing an encapsulated metal sample technique will be implemented to evaluate total fusion power from ITER plasma. The positions of seven irradiation ends for each poloidal section are determined to optimize the measurements from asymmetric, elongated plasma with minimum uncertainty. To determine the exact location of the irradiation end, some physical and technical aspects for each location are investigated. Monte Carlo neutronic calculations are performed to assess the physical characteristics and optimize the design of each irradiation end.

Prevalence of capsular polysaccharide (CP) types of Staphylococcus aureus isolated from bovine mastitic milk and protection of S. aureus infection in mice with CP vaccine

To determine the prevalence of capsular polysaccharide (CP) types of Staphylococcus aureus isolated from bovine mastitic milk in Korea, the protective effect of the conjugates, composed of microencapsulated S. aureus clinical isolate type 8 CP bound to Pseudomonas aeruginosa exotoxin A (ETA) was evaluated in mice. Of 107 S. aureus isolates, serotype 5 and 8 accounted for only 26 or 24.2%. When serotype 336 antiserum was employed, fifty of the remaining 81 isolates were typed as 336, 26 reacted with two serotypes, and 5 were nontypeable. Mice challenged with the same strain used for immunization had fewer S. aureus cells in their kidneys than mice challenged with the heterologous strain. But the magnitudes of difference on bacterial clearance were similar in both groups, indicating that the significance of this result remains to be determined. Mice immunized with the conjugate elicited an antibody response 3 days post injection, which persisted for 13 days of the observation period after second injection in some mice. The mice immunized with the CP8-ETA conjugates developed antibodies significantly higher than those immunized with CP-Freund's adjuvant or PBS. In in vivo bacterial challenge experiment, the survival rate of mice immunized with CPS-ETA conjugate was significantly higher than that of mice immunized with PBS. It was suggested that CP8-ETA vaccine had a potential to protect mice against experimental S. aureus bacteremia.

Monitoring Piscirickettsia salmonis by denaturant gel electrophoresis and competitive PCR

Reported strains of Piscirickettsia salmonis, a pathogen of salmonid fishes, were analyzed by amplifying part of the internal transcribed spacer (ITS) of the ribosomal RNA (rRNA) operon followed by denaturing gradient gel electrophoresis (DGGE) of the amplicons. All amplified fragments differing in sequence were distinguished by migration during DGGE. A simpler format, constant denaturant gel electrophoresis (CDGE), allowed the same diagnostic distinctions among strains. Sampling during 1997 and 1998 of salmonids from 5 different sites on and near Chiloé Island in southern Chile displaying piscirickettsiosis revealed only P. salmonis resembling LF-89, the type strain first isolated in 1989. These observations are encouraging for control strategies, which might otherwise be compromised by unpredictable shifts of P. salmonis types in salmon farms. A competitive PCR assay offered insight about the power of PCR for quantification and about specific tissue invasiveness by this intracellular pathogen. This approach revealed that the PCR could amplify approximately 1 to 10 P. salmonis genome equivalents against a background of > 99.9% salmonid DNA. It also raised the possibility that the salmonid brain is an important site for P. salmonis survival, with its bacterial load in 1 individual having been about 100 times the loads observed in liver and kidney. Pathogen detection by competitive PCR in a surface seawater sample from a netpen in use indicated a density of about 3000 to 4000 P. salmonis cells (or their DNA remnants) 1(-1). Such quantitative estimates should aid decisions about disease prevention and management as, for example, choice of netpen sites following fallow periods and certification of ova, which are known conduits of infection.

Reduction aortoplasty for moderately sized ascending aortic aneurysms

Enlargement of the ascending aorta may coexist with concomitant valvular, coronary, or other cardiac diseases. If dilation is moderate (i.e., <6 cm diameter) and another cardiac procedure is being performed, we have reduced the diameter of the ascending aorta with an S-shaped incision and excision of the curves of the "S" as a modified Z-plasty. We have performed the procedure in 23 patients with concomitant procedures including aortic valve replacement in 21 (1 as a pulmonary autograft), coronary bypass in 1, and resection of subaortic stenosis in 1. There were 15 males and 8 females with a mean age of 53 years (range 8-67 years). The mean maximal preoperative diameter on transesophageal echocardiography was 5.0+/-0.7 cm (range 3.2-6.6 cm). The mean intraoperative postreduction diameter was 3.1+/-0.6 cm (range 2.1-4.1) (p<0.01). All patients tolerated their procedures well. Sixteen patients were studied by transthoracic echocardiography postoperatively. These patients had a mean intraoperative postreduction diameter of 2.9+/-0.65 cm that increased to 3.1+/-0.45 cm (p = NS) after a mean follow-up of 9.9+/-12.6 months. Of these, seven patients were studied >1 year postoperatively. Their mean intraoperative postreduction diameter of 2.9+/-0.5 cm increased to 3.1+/-0.35 cm (p = NS) after a mean follow-up of 22.1+/-9.2 months. No known recurrences of the aneurysms have occurred. We feel this technique is valid in patients with moderate aortic dilation undergoing concomitant cardiac procedures and in whom more aggressive aortic interventions are not warranted.

Cardiac assessment prior to vascular surgery: is dipyridamole-sestamibi necessary?

Dipyridamole-sestamibi (PMIBI) is recommended prior to vascular surgery in patients with > or = 1 Eagle criteria (Q waves, history of ventricular ectopy, diabetes, advanced age, and/or angina). To review our cardiac morbidity and mortality and the need for preoperative PMIBI, we reviewed 109 consecutive patients with a mean age of 59 years who underwent 145 elective major vascular procedures over a 1-year period. Seventy patients (with a mean of 0.8 Eagle criteria) underwent 92 vascular procedures without preoperative PMIBI and without coronary revascularization. Thirty-one patients (with a mean of 1.1 Eagle criteria) underwent 39 procedures without coronary revascularization following PMIBI, which showed reversible ischemia in seven and a fixed defect in 10; findings were normal in 14. Preoperative coronary bypass or angioplasty was limited to eight patients (14 procedures, mean of 1.6 Eagle criteria) who had unstable angina with (2 patients) or without (6 patients) acute myocardial infarction. There were four perioperative myocardial infarctions (2.8%), seven cardiac events overall (4.8%), and one cardiac death (0.7%). Three (43%) of the seven cardiac events occurred in patients with a normal scan or fixed defect on PMIBI imaging. In the absence of unstable angina, PMIBI had a sensitivity of only 25% and a specificity of 80% for cardiac events. We conclude that among patients without severe cardiac symptoms (1) PMIBI has a very limited ability to identify patients at risk for cardiac complications, and (2) preoperative PMIBI is neither necessary nor cost-effective.

Segmenting the senior health care market

This paper addresses the issue of health market segment comparisons for the senior population. The analysis demonstrates how initial self-assessed health comparisons among three racial/ethnic categories can be adjusted to reflect compositional (age and income) differences among the three groups. The adjustments provide additional insight into the nature of these segments.

Absence of transitory [Ca2+]i flux during early in vitro metacyclogenesis of Trypanosoma cruzi

The phorbol ester TPA (phorbol 12-myristate 13-acetate) substitutes for CO2 as an agonist for transforming Trypanosoma cruzi epimastigotes to the metacyclic trypomastigote stage in a starvation medium consisting of phosphate buffered saline + 10 mM proline, 10 mM sodium acetate and 0.035% NaHCO3. Since TPA is thought to stimulate protein kinase C by mimicking the activity of the secondary messenger diacylglycerol, the above result suggested that T. cruzi metacyclogenesis could be activated by a Ca(2+)-dependent protein kinase C signal induction pathway. Accordingly, cytosolic calcium flux ([Ca2+]i) in epimastigotes, activated with 5% CO2 or TPA (10(-7) M), was measured with the Ca2+ molecular probe, fluo-3AM. In addition, [Ca2+]i was measured in cells incubated with putative metacyclogenic agonists (e.g. proline, glutamate, bioamines, ionophores and catecholamines). None of the compounds studies, except for EGTA, affected cytosolic Ca2+ levels. Control assays with 11 microM thapsigargin, which mobilizes noncytoplasmic Ca2+ stores by inhibiting endoplasmic reticulum Ca(2+)-ATPase, validated our fluorometric assay procedure. Although thapsigargin significantly increases cytoplasmic Ca2+ fluorescence, it has no effect on transformation. The protein kinase C inhibitors staurosporine, H-7 and HA 1004 were tested for their effect on T. cruzi metacyclogenesis. Low concentrations of staurosporine and HA 1004 significantly elevated Peru strain transformation while H-7 had no effect on Peru strain metacyclogenesis. Inhibitor H-7 did significantly depress CL transformation. The results indicate that induction of T. cruzi metacyclic trypomastigote formation by CO2 and TPA is not accompanied by changes in cytosolic Ca2+ and do not provide supporting evidence for participation of a protein kinase C-mediated phosphoinositide cascade in metacyclogenesis.

Spontaneous rupture of pyelocaliceal diverticulum

One rare case of spontaneous rupture of pyelocaliceal diverticulum is reported in a 31-year-old Japanese man presented with a severe left flank pain. Intravenous pyelography and computerized tomography demonstrated extravasation of contrast medium from his diverticulum which contained numerous calculi. As a possible cause of spontaneous rupture of pyelocaliceal diverticulum in this case, we suggest that the paper-thin parenchyma covering the diverticulum was not strong enough to tolerate the minimum elevation of intrapelvic pressure due to the obstruction of delivered stones.