This population-based registry was designed to provide robust and updated information on the characteristics and the epidemiology of chronic myeloid leukemia (CML). All cases of newly diagnosed ...Philadelphia positive, BCR-ABL1+ CML that occurred in a sample of 92.5 million adults living in 20 European countries, were registered over a median period of 39 months. 94.3% of the 2904 CML patients were diagnosed in chronic phase (CP). Median age was 56 years. 55.5% of patients had comorbidities, mainly cardiovascular (41.9%). High-risk patients were 24.7% by Sokal, 10.8% by EURO, and 11.8% by EUTOS risk scores. The raw incidence increased with age from 0.39/100,000/year in people 20-29 years old to 1.52 in those >70 years old, and showed a maximum of 1.39 in Italy and a minimum of 0.69 in Poland (all countries together: 0.99). The proportion of Sokal and Euro score high-risk patients seen in many countries indicates that trial patients were not a positive selection. Thus from a clinical point of view the results of most trials can be generalized to most countries. The incidences observed among European countries did not differ substantially. The estimated number of new CML cases per year in Europe is about 6370.
The European Treatment and Outcome Study (EUTOS) population-based registry includes data of all adult patients newly diagnosed with Philadelphia chromosome-positive and/or BCR-ABL1+ chronic myeloid ...leukemia (CML) in 20 predefined countries and regions of Europe. Registration time ranged from 12 to 60 months between January 2008 and December 2013. Median age was 55 years and median observation time was 29 months. Eighty percent of patients were treated first line with imatinib, and 17% with a second-generation tyrosine kinase inhibitor, mostly according to European LeukemiaNet recommendations. After 12 months, complete cytogenetic remission (CCyR) and major molecular response (MMR) were achieved in 57% and 41% of patients, respectively. Patients with high EUTOS risk scores achieved CCyR and MMR significantly later than patients with low EUTOS risk. Probabilities of overall survival (OS) and progression-free survival for all patients at 12, 24 and 30 months was 97%, 94% and 92%, and 95%, 92% and 90%, respectively. The new EUTOS long-term survival score was validated: the OS of patients differed significantly between the three risk groups. The probability of dying in remission was 1% after 24 months. The current management of patients with tyrosine kinase inhibitors resulted in responses and outcomes in the range reported from clinical trials. These data from a large population-based, patient sample provide a solid benchmark for the evaluation of new treatment policies.
We report the outcomes of 45 patients with relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) treated with a combination of ifosfamide, carboplatinum and etoposide (ICE) and 28 patients ...treated with a combination of ifosfamide, methotrexate and etoposide (IMVP) during two 5-year periods. The response rate (RR) to ICE was 47%, 2-year overall survival (OS) 31% and 2-year event-free survival (EFS) 22%. These results were similar to those obtained with IMVP (RR 39%, 2-year OS 23%, 2-year EFS 13%; p=0.355 for RR, 0.275 for OS, 0.668 for EFS). Higher IPI scores and refractoriness to treatment were negative prognostic factors, immunophenotype (B vs. T) had no influence on prognosis. Changing from IMVP to ICE does not substantially improve the outcome of patients with relapsed or refractory aggressive NHL. Patients with relapsed/refractory aggressive B-NHL do not have a superior out-come in comparison to those with T-NHL if treated with chemotherapy alone.
In 1998, Toronto City Council approved the proposal made by the Commissioner of Works to end the incineration of biosolids
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Biosolids, also known as treated sewage sludge, are a nutrient-rich ...organic material, resulting from the biological treatment of the sludge generated during the treatment of municipal wastewater.
at the Ashbridges Bay Sewage Treatment Plant. Biosolids, also known as treated sewage sludge, are a nutrient-rich organic material, resulting from the biological treatment of the sludge generated during the treatment of municipal wastewater. The biosolids were to be used partly for spreading on agricultural land with the remainder used as fertilizer in the form of pellets. This necessitated improvement in the biosolids quality so that they would meet or exceed the provincial guidelines. Based on the provincial guidelines for biosolids and the federal quality requirements for certain organics, a list of 38 parameters called “subject pollutants” was created. These subject pollutants were included in the new Pollution Prevention (P2) planning requirements for facilities. This paper outlines the changes in the new City of Toronto Sewer Use By-law and its P2 planning component. It includes the reduced limits on existing parameters, a new list of subject pollutants including 11 heavy metal and 27 toxic organics, and the mandatory P2 planning requirements. A graphical presentation of P2 planning compliance and the impact of P2 planning on the quality of biosolids is made. The paper reviews those business sectors that must complete P2 plans, experiences with various sectors and P2 implementation. It also discusses lessons learned and changes being made in the P2 requirements for certain sectors. The future direction for this unique mandatory P2 planning requirement is also discussed.
High-flow ports have been used for apheresis in adults. The purpose of this study was to demonstrate the efficacy of ports for apheresis in children and to survey satisfaction of patients and their ...families with their use. A retrospective review of clinical details was combined with a prospective assessment of the experience of patients and their families. Eight patients (mean age, 10.4 y; mean weight, 35 kg) had nine ports placed for long-term apheresis. All 246 treatment sessions were completed successfully. Access difficulties occurred in eight of 246 sessions (3%). Alarms occurred in 40 of 246 sessions (16%), resulting in delays in 10 of 246 sessions (4%). A survey of early experience indicated overall satisfaction with and a preference for ports for apheresis.
Introduction: Historically, many revolutionary advances in therapy for chronic myeloid leukemia (CML) have been achieved over time, among them most important being imatinib mesylate (IM). More ...precise assessment of response to therapy with IM and an accurate measure of the degree of BCR-ABL transcript reduction can be achieved by using real-time quantitative polymerase chain reaction (RQ-PCR). Aim: To quantitate BCR-ABL transcripts in CML patients and to monitor response to treatment with tyrosine kinase inhibitors. Materials and methods: The study included a 31 patients treated with IM. RQ-PCR was performed according to the Europe Against Cancer protocol, with ABL as a housekeeping gene. BCR-ABL/ABL ratio was calculated. Patients were divided into groups according to the European Leukemia Net criteria for achievement of major molecular response (MMoR). Group I consisted of 11 patients with more than 3 log reduction, group II consisted of 13 patients with less than 3 log reduction, and group III included 7 patients with a follow up of less than 18 months. Results: Group I patients achieved MMoR with detectable or undetectable BCR-ABL transcript in a period of 2 years of follow up and fulfilled the criteria for favorable long term prognosis. Group II patients never achieved MMoR with IM and required different therapy approach, higher dose of the same tyrosine kinase inhibitor or a second generation drug. Seven newly diagnosed CML patients from group III were monitored for less than 18 months and therefore MMoR could not be estimated. Using the same analogy as in the first two groups, prediction of the course of disease could be possible. Conclusion: Study results show that RQ-PCR is mandatory for careful monitoring of therapeutic response to tyrosine kinase inhibitors in order to ensure that an individual patient receives proper treatment and to decide whether and when therapy should be changed.
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