•Only 12.3% of patients with ATLL underwent alloHSCT.•No suitable donor was available for 25% of alloHSCT HLA-typed eligible patients.•Early mortality, loss to follow-up, uninsured status, and lack ...of available suitable donors, including haploidentical, were major barriers to alloHSCT.
In the United States adult T cell lymphoma–leukemia (ATLL) carries a dismal prognosis and mainly affects immigrants from human T cell lymphotropic virus 1 endemic areas. Allogeneic hematopoietic stem cell transplant (alloHSCT) can be effective and is recommended as an upfront treatment in the National Comprehensive Cancer Network guidelines. We studied the barriers to alloHSCT in one of the largest ATLL populations in the United States. Comprehensive chart and donor registry reviews were conducted for 88 ATLL patients treated at Montefiore Medical Center from 2003 to 2018. Among 49 patients with acute and 32 with lymphomatous subtypes, 48 (59.5%) were ineligible for alloHSCT because of early mortality (52%), loss to follow-up (21%), uninsured status (15%), patient declination (10%), and frailty (2%). Among 28 HLA-typed eligible patients (34.6%), matched related donors were identified for 7 (25%). A matched unrelated donor (MUD) search yielded HLA-matched in 2 patients (9.5%), HLA mismatched in 6 (28.5%), and no options in 13 (62%). Haploidentical donors were identified for 6 patients (46%) with no unrelated options. There were no suitable donors for 7 (25%) alloHSCT-eligible patients. The main limitation for alloHSCT after donor identification was death from progressive disease (82%). AlloHSCT was performed in 10 patients (12.3%) and was associated with better relapse-free survival (26 versus 11 months, P = .04) and overall survival (47 versus 10 months, P = .03). Early mortality and progressive disease are the main barriers to alloHSCT, but poor follow-up, uninsured status, and lack of suitable donor, including haploidentical, are also substantial limitations that might disproportionally affect this vulnerable population. AlloHSCT can achieve long-term remissions, and strategies aiming to overcome these barriers are urgently needed to improve outcomes in ATLL.
ATLL is an aggressive T cell malignancy with dismal prognosis which occurs mainly in Caribbean immigrants in the US. AlloSCT is an effective treatment option in eligible patients (pts). We sought to ...identify barriers to alloSCT for these pts in a tertiary center with one of the largest ATLL populations in the US.
Pts with ATLL treated at Montefiore Medical Center were identified from 2003 to 2018. Comprehensive review of charts and donor registry searches were conducted.
We identified 88 pts, mean age 56 yrs, 7 (8%) with chronic/smoldering subtypes. Of pts with acute (49, 60.5%) or lymphomatous (32, 39.5%) types, 48 (59.5%) were not considered for alloSCT due to early death (52%, n=25), lost to follow up (19%, n=10), uninsured (13%, n=7), declined HSCT (9%, n=5) and frailty (2%, n=1).
Of 33 (40.7%) pts evaluated for alloSCT, 28 (34.6%) underwent HLA typing. A 10/10 matched related donor (MRD) was identified in 7 (25%). Registry search for matched unrelated donors (MUD) in the remainder 21 showed 10/10 (9.5%, n=2), 9/10 (19%, n=4), 8/10 (9.5%, n=2) and none (62%, n=13). Haploidentical donors were identified for 6 of 13 (46%) pts with no MUD. No donor options were available for 7 (25%) HLA-typed pts.
AlloSCT was performed in 10/21 (47.6%) pts. Reasons for not undergoing alloSCT were progressive disease (50%, n=9), and patient declination (11%, n=2).
AlloHSCT was associated with better median relapse-free (RFS) (26 vs. 11 mo, p=0.04) and overall survival (OS) (47 vs. 10 mo, p=0.03). Early transplant-related mortality (TRM) rate was 40%. Pts transplanted in complete remission (CR) and with MRD/MUD had better outcomes.
This is the first study demonstrating the barriers for alloHSCT for ATLL in the US. Only 12.3% pts proceed to alloSCT in ATLL. Early mortality, lost to follow up, uninsured status, lack of available suitable donors, including haploidentical, are significant problems. In pts who have successful induction, alloSCT can achieve long term remissions. Hence, better upfront treatments to achieve CR, early alloSCT, and consolidation/maintenance strategies in those who do not proceed to alloSCT are urgently needed to improve outcomes in ATLL.
Playable Experiences at AIIDE 2016 Zook, Alexander; Cook, Michael; Butler, Eric ...
Proceedings of the AAAI Conference on Artificial Intelligence and Interactive Digital Entertainment,
06/2021, Letnik:
12, Številka:
1
Journal Article
Odprti dostop
The AIIDE Playable Experiences track celebrates innovations in how AI can be used in polished interactive experiences. Four 2016 accepted submissions display a diversity of approaches. Rogue Process ...combines techniques for medium-permanence procedurally generated hacking worlds. Elsinore applies temporal predicate logic to enable a time-traveling narrative with character simulation. A novel level generator uses conceptual blending to translate Mario Bros. design styles across levels. And Bad News uses deep simulation of a town and it's residents to ground a mixed-reality performance. Together these playable experiences showcase the opportunities for AI in interactive experiences.
A new technique is described for study of the study of high velocity animal movements using a continuous wave Doppler radar operating at 24 GHz. The movement studied was tongue projection kinematics ...during prey capture by the lizard Chamaeleo Jacksonii. The measurements were verified with a high speed video reference, recorded at 1000 frames per second. The limitations and advantages of both the methodologies are compared and tongue speeds of 3:65 m/s were observed. These results show a useful application of radar to augment visual sensing of biological motion and enable the use of monitoring in a wider range of situations.
The objective of this study was to fully characterize the macular dystrophy phenotype and genotype in a large family of the Zermatt area of Switzerland. Clinical and molecular studies of the family ...included a comprehensive eye examination and a mutational analysis of the RDS, rhodopsin, and TIMP-3 genes. In selected cases, fluorescein angiography, perimetry, and electroretinography were performed. Forty-two family members at risk of expressing the maculopathy were studied. Of these, 24 were found to be clinically affected. The severity of macular disease in these patients was clearly age-related and different stages of progression were identified. Central pigmentary alterations were seen in adolescent patients, while patients in their late teens and twenties exhibited drusen-like deposits. Later, these defects formed focal areas of atrophy which eventually led to central geographic atrophy with severe visual loss by the fifth decade and cone-rod dysfunction. The transmission of this condition is autosomal dominant with complete penetrance. The underlying genetic defect is a mutation in codon 172 of the RDS/peripherin gene, a gene expressed in both rods and cones, which results in the substitution of tryptophan for an arginine residue at that position. 'Zermatt macular dystrophy' is a dominant, age-related, progressive macular dystrophy which in later stages resembles atrophic age-related macular degeneration. The size of the family studied allowed definition of the clinical spectrum of this condition and identification of the related genetic defect which allows more precise diagnosis and counseling.
Abstract
The Online Electron Microscopy Platform makes electron microscopy education accessible by combining simulation-based practice with a range of educational content. Students learn how to ...operate electron microscopes by using virtual microscopes that precisely simulate the functions of real microscopes. Built as a web application, the platform can be used by an unlimited number of people and at any time. This platform reduces the time needed for training users to operate a real microscope. By preparing students in STEM disciplines to use electron microscopes, the system helps them acquire the skills they need to succeed in the modern workforce.
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