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The article discusses a next-generation sequencing (NGS)-based mutation analysis performed in 6 cases of isolated myeloid sarcoma (MS) to test feasibility of systematic, comprehensive mutation testing using DNA from formalin-fixed paraffin-embedded (FFPE) MS tissue and evaluate cases of isolated MS for the presence of mutations implicated in typical acute myeloid leukemia (AML). It suggests the feasibility of performing comprehensive mutation analysis of MS in research and clinical settings.

The article discusses the association of miR-155 expression with chemoimmunotherapy outcome modulated by Bruton's tyrosine kinase inhibition with Ibrutinib. It mentions the miR expression profiling in chronic lymphocytic leukemia (CLL) which has been used to identify miR signatures that predict disease progression. It also explores the regulation of B-cell receptor (BCR) pathways to investigate the close association between BCR activation and miR-155 in CLL.

Patients with relapsed/refractory leukemias or advanced myelodysplastic syndrome (MDS) fare poorly following allogeneic hematopoietic cell transplant (HCT). We report prospective phase II study results of 29 patients given clofarabine 30 mg/m2/day i.v. × 5 days followed immediately by HCT conditioning while at the cytopenic nadir. A total of 15/29 patients (52%) were cytoreduced according to pre-defined criteria (cellularity <20% and blasts <10%). Marrow cellularity (P<0.0001) and blast% (P=0.03) were reduced. Toxicities were acceptable, with transient hyperbilirubinemia (48%) and gr3-4 infections (10%). In all, 28/29 proceeded to transplant; 27 received ATG or alemtuzumab. Post HCT, 180 day non-relapse mortality (NRM) was 7% (95% confidence interval (CI): 1-21), relapse was 29% (95% CI: 13-46) and OS was 71% (95% CI: 51-85), comparing favorably to published data for high-risk patients. Two-year graft vs host disease incidence was 40% (95% CI: 21-58) and 2 year OS was 31% (95% CI: 14-48). Disease at the nadir correlated with inferior OS after HCT (HR=1.22 for each 10% marrow blasts, 95% CI: 1.02-1.46). For AML/MDS patients, there was a suggestion that successful cytoreduction increased PFS (330 vs 171 days, P=0.3) and OS (375 vs 195 days, P=0.31). Clofarabine used as a bridge to HCT reduces disease burden, is well tolerated, and permits high-risk patients to undergo HCT with acceptable NRM. Late relapses are common; thus, additional strategies should be pursued. NCT-00724009. [ABSTRACT FROM AUTHOR]

The purpose was to assess predictive factors for outcome in patients with chronic myeloid leukemia (CML) in chronic phase (CML-CP) treated with nilotinib after imatinib failure. Imatinib-resistant and -intolerant patients with CML-CP (n=321) were treated with nilotinib 400 mg twice daily. Of 19 baseline patient and disease characteristics and two response end points analyzed, 10 independent prognostic factors were associated with progression-free survival (PFS). In the multivariate analysis, major cytogenetic response (MCyR) within 12 months, baseline hemoglobin 120 g/l, baseline basophils <4%, and absence of baseline mutations with low sensitivity to nilotinib were associated with PFS. A prognostic score was created to stratify patients into five groups (best group: 0 of 3 unfavorable risk factors and MCyR by 12 months; worst group: 3 of 3 unfavorable risk factors and no MCyR by 12 months). Estimated 24-month PFS rates were 90%, 79%, 67% and 37% for patients with prognostic scores of 0, 1, 2 and 3, respectively, (no patients with score of 4). Even in the presence of poor disease characteristics, nilotinib provided significant clinical benefit in patients with imatinib-resistant or -intolerant CML. This system may yield insight on the prognosis of patients. [ABSTRACT FROM AUTHOR]

Nilotinib (Tasigna) is a BCR-ABL1 tyrosine kinase inhibitor approved for the treatment of patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase (CML-CP) who are newly diagnosed or intolerant of or resistant to imatinib. The 48-month follow-up data for patients with CML-CP treated with nilotinib after imatinib resistance or intolerance on an international phase II study were analyzed. Overall, 59% of patients achieved major cytogenetic response; 45% achieved complete cytogenetic response while on study. The estimated rate of overall survival (OS) and progression-free survival (PFS) at 48 months was 78% and 57%, respectively. Deeper levels of molecular responses at 3 and 6 months were highly positively correlated with long-term outcomes, including PFS and OS at 48 months. Of the 321 patients initially enrolled in the study, 98 (31%) were treated for at least 48 months. Discontinuations were primarily due to disease progression (30%) or adverse events (21%). Nilotinib is safe and effective for long-term use in responding patients with CML-CP who are intolerant of or resistant to imatinib. Further significant improvements in therapy are required for patients who are resistant or intolerant to imatinib. [ABSTRACT FROM AUTHOR]

Evaluating Nilotinib Efficacy and Safety in Clinical Trials Newly Diagnosed Patients compares nilotinib and imatinib in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP). With a minimum follow-up of 3 years, major molecular response, molecular response of BCR-ABL0.01% expressed on the international scale (BCR-ABLIS; MR4) and BCR-ABLIS0.0032% (MR4.5) rates were significantly higher with nilotinib compared with imatinib, and differences in the depth of molecular response between nilotinib and imatinib have increased over time. No new progressions occurred on treatment since the 2-year analysis. Nilotinib was associated with a significantly lower probability of progression to accelerated phase/blast crisis vs imatinib (two (0.7%) progressions on nilotinib 300 mg twice daily, three (1.1%) on nilotinib 400 mg twice daily and 12 (4.2%) on imatinib). When considering progressions occurring after study treatment discontinuation, the advantage of nilotinib over imatinib in preventing progression remained significant (nine (3.2%) progressions on nilotinib 300 mg twice daily, six (2.1%) on nilotinib 400 mg twice daily and 19 (6.7%) on imatinib). Both nilotinib and imatinib were well tolerated, with minimal changes in safety over time. Nilotinib continues to demonstrate superior efficacy in all key response and outcome parameters compared with imatinib for the treatment of patients with newly diagnosed CML-CP. [ABSTRACT FROM AUTHOR]

The article explores the partial tandem duplication of the MLL gene (MLL-PTD) among adults aged 60 years old and above who have de novo cytogenitically normal acute myeloid leukemia (CN-AML). It examines blood or bone marrow of such patients who were treated on Cancer and Leukemia Group B. Also, it conducts genome-wide gene and microRNA-expression profiling, and assays to observe other molecular aberrations with prognostic significance in CN-AML.

Nilotinib is a selective inhibitor of BCR-ABL approved for use in newly diagnosed and imatinib-resistant or -intolerant patients with chronic myeloid leukemia (CML) in chronic phase. In this study, 400 mg of nilotinib was administered twice daily to the patients with myeloid (MBP, n=105) or lymphoid blastic phase (LBP, n=31) CML. After a minimum follow-up of 24 months, major hematologic responses were observed in 60% (MBP) and 59% (LBP) of patients. Major cytogenetic responses (MCyR) were attained in 38% (MBP) and 52% (LBP) of patients; and complete cytogenetic responses in 30% and 32%, respectively. Median duration of MCyR was 10.8 (MBP) and 3.2 months (LBP). Median overall survival was 10.1 (MBP) and 7.9 (LBP) months with 12- and 24-month survival of 42% (MBP 44%, LBP 35%) and 27% (MBP 32%, LBP 10%), respectively. Twelve MBP patients and two LBP patients received subsequent stem cell transplantation. Myelosuppression was frequent, with grade 3/4 neutropenia, thrombocytopenia, and anemia in 68%, 63% and 47% of patients, respectively. Grade 3/4 hypophosphatemia, hyperbilirubinemia and lipase elevation were observed in 15%, 11% and 11% of patients, respectively. Nilotinib has significant efficacy in patients with BP CML, but given the limited long-term survival of these patients, novel agents are needed. [ABSTRACT FROM AUTHOR]

Untreated de novo (n=421) and secondary (n=189) acute myeloid leukemia (AML) patients ≥60 years received intensified chemotherapy, including daunorubicin 60 mg/m(2) and etoposide 100 mg/m(2) during days 1, 2, 3 with cytarabine 100 mg/m(2) during days 1-7, with a second induction if needed and one consolidation course with these drugs and doses for 2, 2 and 5 days, respectively. In all, 287 (47%) achieved complete remission (CR), 136 (22%) died and 187 (31%) were non-responders. CR rates were 27, 44 and 52% for complex karyotypes, rare aberrations and neither (P<0.001), 52 and 37% for de novo and secondary AML (P=0.003), and 53 and 42% for age 60-69 and ≥70 years (P=0.015). In multivariable analysis, CR predictors included non-complex/non-rare karyotypes (P<0.001), de novo AML (P<0.001), better performance status (PS) (P<0.001) and younger age (P=0.001). Disease-free (DFS) and overall (OS) survival medians were 6.8 (95% CI: 6.2, 7.8) and 7.2 (95% CI: 6.4, 8.6) months. In multivariable analysis, DFS was shorter for complex karyotypes (P<0.001) and increasing white blood count (WBC) (P<0.001) and age (P=0.038), and OS for complex karyotypes (P<0.001), increasing WBC (P=0.001) and age (P<0.001), poorer PS (P<0.001) and secondary AML (P=0.010). Outcomes and prognostic factors were similar to those in previous Cancer and Leukemia Group B studies. [ABSTRACT FROM AUTHOR]

We studied the feasibility and efficacy of a two-step approach to Auto-SCT for patients with AML in second remission. Step 1 consisted of consolidation chemotherapy using cytarabine 2000 mg/m2 i.v. every 12 h for 4 days plus etoposide 40 mg/kg total dose by continuous i.v. infusion over the same 4 days. PBSC were collected after G-CSF stimulation during recovery from this chemotherapy. Step 2, auto-SCT, used a preparative regimen of oral BU 16 mg/kg over 4 days followed by etoposide 60 mg/kg i.v. Of the 50 patients entered on Step 1, two died from treatment complications, and seven failed to proceed to transplantation. A median CD34+ cell dose of 5.9 × 106/kg was collected in a median of three collections. With a median follow-up of 8.2 years, 5-year disease-free survival (DFS) is 28%. The most important prognostic factor was cytogenetics, with acute promyelocytic leukemia (APL) patients having a 5-year DFS of 67% compared with 16% for others. We conclude that this two-step approach to autologous transplantation produces good CD34+ mobilization and that this approach has cured some patients. Results in patients with APL are especially promising. [ABSTRACT FROM AUTHOR]

Imatinib mesylate is considered standard of care for first-line treatment of chronic phase chronic myeloid leukemia (CML-CP). In the phase III, randomized, open-label International Randomized Study of Interferon vs STI571 (IRIS) trial, previously untreated CML-CP patients were randomized to imatinib (n=553) or interferon-α (IFN) plus cytarabine (n=553). This 6-year update focuses on patients randomized to receive imatinib as first-line therapy for newly diagnosed CML-CP. During the sixth year of study treatment, there were no reports of disease progression to accelerated phase (AP) or blast crisis (BC). The toxicity profile was unchanged. The cumulative best complete cytogenetic response (CCyR) rate was 82%; 63% of all patients randomized to receive imatinib and still on study treatment showed CCyR at last assessment. The estimated event-free survival at 6 years was 83%, and the estimated rate of freedom from progression to AP and BC was 93%. The estimated overall survival was 88%––or 95% when only CML-related deaths were considered. This 6-year update of IRIS underscores the efficacy and safety of imatinib as first-line therapy for patients with CML.Leukemia (2009) 23, 1054–1061; doi:10.1038/leu.2009.38; published online 12 March 2009 [ABSTRACT FROM AUTHOR]

ALL is a heterogeneous disease, and outcomes vary by patient age, immunophenotype and clinical, cytogenetic and molecular features. Modern treatment strategies use a risk-adapted approach. The optimal post-remission therapy for adults with ALL remains unclear. Available data indicate no consensus as to whether there is an advantage to allogeneic hematopoietic cell transplant (Allo-HCT) over chemotherapy for the consolidation of adults with ALL with standard risk features while in the first CR (CR1). However, Allo-HCT is recommended in CR1 for patients with high-risk ALL, for those in a second CR (CR2) and for certain other subsets of patients with this disease.Bone Marrow Transplantation (2008) 42, S18–S24; doi:10.1038/bmt.2008.107 [ABSTRACT FROM AUTHOR]

Dasatinib, a potent inhibitor of BCR-ABL in vitro, is effective for patients with chronic myelogenous leukemia (CML) resistant or intolerant to imatinib. To provide a more definitive assessment of dasatinib in chronic-phase (CP)-CML, we report extended follow-up of a phase II trial, presenting data for the entire patient cohort (N=387). Dasatinib (70 mg) twice daily was administered to patients with imatinib-resistant or -intolerant CP-CML. With median follow-up of 15.2 months (treatment duration, <1-18.4 months), a complete hematologic response was attained or maintained in 91% of patients. A major cytogenetic response (MCyR) was attained or maintained by 59% (52% imatinib resistant and 80% imatinib intolerant); this was complete in 49% of patients (40% imatinib resistant and 75% imatinib intolerant). Of 230 patients achieving an MCyR, 7 experienced disease progression. Fifteen-month progression-free survival was 90% while overall survival was 96%. Grade 3/4 thrombocytopenia and neutropenia were reported in 48 and 49% of patients, respectively. Non-hematologic toxicity (any grade) consisted primarily of diarrhea (37%), headache (32%), fatigue (31%), dyspnea (30%) and pleural effusion (27%). Pleural effusions were classified as grade 3 in 6% of reported events, with no incidence of grade 4. Dasatinib is associated with high response rates in patients with imatinib-resistant or -intolerant CP-CML. [ABSTRACT FROM AUTHOR]

We describe treatment, outcomes and prognostic factors for patients who relapse following transplantation with a reduced intensity conditioning regimen. Seventy consecutive patients with high-risk myeloid malignancies underwent transplant and 25 (36%) relapsed, a median of 120 days later. The median percentage of bone marrow blasts at relapse was 24, the median donor chimerism was 73% and new karyotypic abnormalities occurred in 8 out of 20 (40%) evaluable patients. Twenty-one patients (84%) received aggressive treatment for relapse, including chemotherapy (60%), second hematopoietic cell transplantation (HCT; 52%) and/or donor lymphocyte infusion (DLI; 12%). Thirteen achieved a complete response (CR) and four remain in CR. Median overall survival (OS) after relapse was 6 months (95% confidence interval=2.7–9.9 months), and actuarial 1 year OS was 24%. Most deaths were due to disease progression (17/20, 85%). We did not observe an advantage for cellular therapy (DLI or second transplant) compared to chemotherapy. Salvage therapy for relapse after reduced intensity HCT is feasible, associated with low treatment-related mortality, and may result in prolonged survival in select patients. Studies exploring the optimal treatment for relapse following reduced intensity HCT are warranted.Bone Marrow Transplantation (2007) 40, 1027–1032; doi:10.1038/sj.bmt.1705852; published online 10 September 2007 [ABSTRACT FROM AUTHOR]

We conducted a retrospective review of medical charts of patients, aged 18 to 59 years old, who underwent either a total knee replacement (TKR) or total hip replacement (THR) from January 2002 to December 2004. Of the 204 study subjects, 52% had a TKR while 48% had a THR. Obesity was significantly associated with the need for a TKR or THR when comparing the study group to adults of similar age in the general population (P< 0.0001). Seventy-two percent (146) of the study group was obese and 21% (42) overweight (BMI 25.0 to 29.9 kg/m(2)) compared to only 26% (596) obese and 34% (732) overweight in the general population. Patients undergoing a TKR were significantly more likely to be obese (BMI>30 kg/m(2)) than those having a THR, 83% (89) compared to 59% (57) (P< .0006). Our findings support those previously observed in the elderly population. Primary and secondary prevention programs aimed at reducing obesity are strongly recommended. [ABSTRACT FROM AUTHOR]

Alemtuzumab (Campath-1H)-based conditioning regimens are effective in preventing GVHD, but are associated with very high rates of cytomegalovirus (CMV) infection, a major limitation to their use. We evaluated 85 patients receiving conditioning with fludarabine 30 mg/m2/day (day −7 to day −3), alemtuzumab 20 mg/day (day −7 to day −3), and melphalan 140 mg/m2 on day −2. The initial patients received post transplant CMV prophylaxis with high-dose acyclovir. A very high incidence of CMV viremia was observed as has been commonly reported after alemtuzumab-based conditioning. Sixty-seven subsequent patients received pre-transplant ganciclovir and high-dose valacyclovir after engraftment. The cumulative incidence of CMV infection in the valacyclovir cohort was 29%. This compared favorably to the cumulative incidence of 53% in patients receiving only acyclovir (P=0.004) and to literature data. CMV prophylaxis with pre-transplant ganciclovir and high-dose valacyclovir after engraftment appears effective in preventing the excessive incidence of CMV infection after alemtuzumab-based conditioning regimens.Bone Marrow Transplantation (2006) 37, 307–310. doi:10.1038/sj.bmt.1705249; published online 9 January 2006 [ABSTRACT FROM AUTHOR]

Summary:The impact of disease burden on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (SCT) has not been well defined. Data from several retrospective series suggest that overt leukemia at the time of transplant increases the risk of relapse. We reviewed the outcomes of 68 consecutive adults with AML (n=60) or myelodysplastic syndromes (MDS) (n=8) who received an allogeneic SCT at the University of Chicago between May 1986 and October 2002 to confirm the importance of currently recognized risk factors for overall survival (OS) and progression-free survival (PFS). In addition, we wanted to determine whether quantification of residual disease by blast percentage or cytogenetic abnormalities at the time of SCT was correlated with outcome. AML subtypes based on the FAB classification were as follows: M0=9, M1=9, M2=16, M3=2, M4=16, M5=3, M6=5. Cytogenetic analysis was available from 52 patients. Using standard morphologic criteria, 34 patients were in complete remission (CR) and 34 had visible leukemia present. The majority of donors were HLA-identical siblings (n=55). In all, 56 patients received myeloablative conditioning regimens and 12 received a reduced-intensity, fludarabine-based conditioning regimen. OS and PFS times were 7.1 months (95%CI, 4.8-10.4) and 5.1 months (95%CI, 3.2-7.8), respectively. Median follow-up from SCT was 4.6 years (range, 0.6-17.0) for survivors. In multivariate analysis, the following factors were found to be associated with worse survival: (1) increased percentage of blasts in the bone marrow at the time of SCT, (2) presence of acute graft-versus-host disease, (3) mismatched donor, (4) Zubrod performance score of?2, and (5) age?45 years. We also found a trend towards improved outcome among patients in cytogenetic remission as compared to those who had residual cytogenetic abnormalities and those in overt relapse. These data support an association between pre-transplant disease burden and poor outcome after SCT.Bone Marrow Transplantation (2005) 35, 965-970. doi:10.1038/sj.bmt.1704938 Published online 4 April 2005 [ABSTRACT FROM AUTHOR]

Calcific myonecrosis is a rare and latent condition characterized by a dystrophic calcified lesion that can present 10-64 years following initial trauma. Of the 25 cases documented in English world literature, all have occurred in the lower extremity exclusively. We report a case of a 60-year-old man with a painless enlarging left forearm mass that was subsequently diagnosed as calcific myonecrosis. Awareness of this lesion arising outside of the lower extremity is important to avoid unnecessary surgical intervention and patient reassurance. [ABSTRACT FROM AUTHOR]

Chronic myeloid leukaemia (CML) is a malignant disease of the bone marrow characterised by the presence of the Philadelphia (Ph) chromosome. About 20% of acute lymphoblastic leukaemia (ALL) patients also show this genetic abnormality. A new drug, imatinib (Glivec®, Novartis Pharma AG, Basel, Switzerland, and formerly STI571) is having a profound effect on the treatment and management of all stages of CML and Philadelphia chromosome positive (Ph+) ALL. New treatment algorithms are being developed. Should imatinib replace or be combined with existing therapies? To address this question, we review the pros and cons of therapy with interferon-α (IFN-α), allogeneic transplantation, autologous transplantation, imatinib, and in the case of Ph+ ALL, chemotherapy and experimental approaches. Conservative and aggressive treatments will be discussed and new molecular methods of monitoring cytogenetic response and their significance will also be reviewed. [ABSTRACT FROM AUTHOR]

Leukemia (2003) 17, 488-491. doi:10.1038/sj.leu.2402809 [ABSTRACT FROM AUTHOR]

Renal precipitation of uric acid associated with tumor lysis syndrome (TLS) is a major complication in the management of leukemia, lymphoma, and other drug-sensitive cancers. Management of hyperuricema has historically consisted of administration of allopurinol, hydration, alkalinization to maintain pH between 7.0 and 7.3, and in some cases diuresis. Allopurinol, a xanthine analogue, blocks xanthine oxidase and formation of uric acid. Urate oxidase converts uric acid to allantoin, which is 5-10 times more soluble than uric acid. Homo sapiens cannot express urate oxidase because of a nonsense mutation. Urate oxidase was initially purified from Aspergillus flavus fungus. Treatment with this nonrecombinant product had been effective in preventing renal precipitation of uric acid in cancer patients, but was associated with a relatively high frequency of allergic reactions. This enzyme was recently cloned from A. flavus and is now manufactured as a recombinant protein. Clinical trials have shown this drug to be more effective than allopurinol for prevention and treatment of hyperuricemia in leukemia and lymphoma patients. This drug has been approved in Europe as well as the US and several clinical trials are in progress to further determine its clinical utility in other patient subsets. The purpose of this meeting was to discuss usefulness of recombinant urate oxidase, also known as rasburicase, Fasturtec®, and Elitek™, for the management of TLS in certain cancer patients. [ABSTRACT FROM AUTHOR]

Cladribine has been reported to have little activity in fludarabinerefractory chronic lymphocytic leukemia (CLL). We sought to determine whether resistance to therapy with cladribine in fludarabine-refractory CLL patients represented primary drug resistance or the inability to tolerate the myelosuppression associated with this therapy. Patients with fludarabine refractory CLL patients without severe thrombocytopenia (platelets ≥50 × 10[sup 9]/I) or granulocytopenia (neutrophils >1.5 × 10[sup 9]/I) were enrolled. All patients received cladribine (0.14 mg/kg) as a 2-h intravenous infusion daily for 5 days, repeated every 4 weeks. Patients received up to six cycles of therapy. Twenty-eight patients enrolled; 13 had intermediate (Rai stage I or II) and 15 high (Rai stage III and IV) risk stages. No patient had a complete remission, but nine (32%; 95% confidence interval, 15-49%) attained a partial remission when assessed using the modified NCl criteria (1996). The median time to relapse for responders was 12 months, while median progression-free survival for the entire group was 9 months (95% confidence interval, 4-14 months). The median overall survival was 2.2 years (95% confidence interval, 0.8-3.1 years). Response was predicted by pre-treatment Rai status with seven of 13 (54%) intermediate risk vs two of 15 (13%) high-risk patients responding (P = 0.04). Toxicity was myelosuppression and infections (grade 3-5: neutropenia 75%, thrombocytopenia 68%, and infections 43%). Cladribine has modest clinical activity and considerable toxicity in a very selected group of patients with fludarabine-refractory CLL lacking pre-treatment neutropenia and thrombocytopenia. [ABSTRACT FROM AUTHOR]

There are many studies that examine the psychosocial adjustment of survivors of bone marrow transplantation (BMT). On the other hand, there are relatively few studies that examine the psychosocial adjustment of patients prior to BMT, and even fewer that focus on the psychosocial adjustment of the patient’s caregiver. The purpose of the present study was to assess performance status and psychosocial adjustment to illness, mood and stress response of patients and caregivers prior to admission for allogeneic BMT. Forty patients and their 39 caregivers were assessed using standardized measures. One-fourth of the patients reported clinical levels of psychosocial maladjustment on the Psychosocial Adjustment to Illness Scale and had greater adjustment problems than BMT survivors. Approximately one-third (35%) and one-quarter (23%) of the patients reported significant symptoms of intrusive and avoidance stress responses, respectively on the Impact of Events Scale. Caregivers reported more impairments in family relationships than patients, but overall reported similar distress to that of patients. Information about the pre-BMT process appears to be critical to understanding the psychosocial impact that BMT can have on patients and their caregivers. Bone Marrow Transplantation (2001) 27, 1181–1188. [ABSTRACT FROM AUTHOR]

Since approximately 30% of leukemia patients relapse after allogeneic BMT using total body irradiation (TBI)-based preparative regimens, treatment intensity may be suboptimal. The killing of leukemia cells is proportional to the radiation absorbed dose. We studied the feasibility and toxicity of escalating the doses of fractionated TBI above our previous prescription of 13.5 Gy. Sixteen evaluable patients with advanced hematologic malignancies were treated with twice daily TBI using a high-energy source (18–24 MV). The first patient cohort (n = 11) received a total dose of 14.4 Gy in nine fractions, and the second cohort (n = 5) received doses escalated to 15.3 Gy. All patients received high-dose etoposide (60 mg/kg) and allogeneic stem cell transplantation following the TBI. All patients had HLA-identical sibling donors. The median times for neutrophil and platelet engraftment were 13.5 and 12 days, respectively, and did not differ between the two cohorts. All but one patient developed treatment-related grade 3 or 4 mucositis. There were three cases of grade 4 pulmonary toxicity and three cases of grade 4 hepatic toxicity among the 14.4 Gy cohort, and one case each of grade 4 pulmonary and hepatic toxicities among the 15.3 Gy cohort. In most cases comorbid conditions contributed to these toxicities. Two patients had significant GVHD of the GI tract. Six relapses occurred, five (45%) in the 14.4 Gy cohort and one (20%) in the 15.3 Gy cohort. The 100-day treatment-related mortality rates were 9% and 20% for the 14.4 Gy and 15.3 Gy cohorts, respectively, and the median survivals were 226 and 201 days, respectively. We conclude that TBI dose escalation above the previously used 13.5 Gy dose is feasible using a high-energy source and high-dose etoposide. Acute and chronic toxicities were primarily related to GVHD, infection and relapse rather than to TBI. Bone Marrow Transplantation (2000) 25, 807–813. [ABSTRACT FROM AUTHOR]

Among its multiple toxic effects, L-asparaginase induces allergic reactions that may reduce its biological effect. The impact of hypersensitivity reactions on the duration of leukemia-free survival (LFS) was assessed in adults with newly diagnosed acute lymphoblastic leukemia (ALL) receiving intensive multi-agent chemotherapy. In CALGB study 8811 (Blood 1995; 85: 2025-2037), 197 adults were scheduled to receive 14 doses of Escherichia coil L-asparaginase (6000 U/m2 SC) during 7 of the first 12 weeks of chemotherapy. No further L-asparaginase was given. Chemotherapy was given for 24 months. The median follow-up time has been 5.7 years. Of the 141 patients who remained on study after 12 weeks, 82 (58%) had received all 14 planned doses; 38 (27%) had 12-13 L-asparaginase doses documented in their treatment record; 21 (15%) patients had received < or =11 doses due to a variety of toxic effects. The mean number of doses received prior to experiencing any hypersensitivity reaction was seven (range 1-11). Seven patients had mild hypersensitivity reactions, but all seven eventually received 12-14 doses of E. coil L-asparaginase. Twenty-one other patients had severe hypersensitivity reactions that required discontinuation of E. coil L-asparaginase; 20 of these patients were switched to Erwinia L-asparaginase to complete their treatment. Ultimately, 12 of these 20 patients received 14 doses of L-asparaginase in total, and six received 12-13 doses. Thus, only three of the 21 patients who had severe hypersensitivity reactions received < or =11 total L-asparaginase doses. Other L-asparaginase-related complications included pancreatitis (15 patients), hypofibrinogenemia <100mg/dl (29 patients), and deep venous thrombosis or pulmonary embolism (eight patients); some of these patients had L-asparaginase discontinued after these complications. The estimates for LFS at 3 years were 55% (95% confidence interval, 44-65%) for the patients who received all 14 L-asparaginase doses (median LFS, 5.1 years), 47% (95% CI, 33-62%) for those who received 12-13 doses, and 48% (95% CI, 29-67%) for those who received < or =11 doses. There were no significant differences between these three groups in the length of LFS (P=0.68). LFS did not correlate with a history of severe hypersensitivity reaction (P=0.67). In general, E. coil L-asparaginase was well tolerated in these adult patients, and most patients received all of the planned therapy. Patients who had mild L-asparaginase hypersensitivity reactions and patients who switched to Erwinia L-asparaginase because of more severe allergic reactions did not have significantly shorter LFS than the remaining adults treated on this ALL protocol. The possibility that E. coli L-asparaginase is inactivated or destroyed in those individuals who have become hypersensitive to it becomes less important when allergic patients are secondarily treated with Erwinia L-asparaginase. [ABSTRACT FROM AUTHOR]

We find that symptoms of polymer melt fracture, such as a time-dependent decrease in apparent sample modulus and apparent slip, can be induced by oscillatory torsional shearing flow of polystyrene melts and solutions, even when the polymer molecular weight is below the entanglement threshold, and thre strain amplidute is as low as 3%. Visualization of samples during and after fracture show crack and bubble formation, as well as delamination of the polymer from the rheometer tools. For polystyrene melts, the critical stress for fracture is τ ≈ 0.1-1.0 MPa, depending on polymer molecular weight and temperature, and for solutions it is as low as 5 × 10 Pa. Since 'constitutive instabilities' require the viscoelastic properties to be highly nonlinear, our observations of melt fracture in unentangled polymers at shearing strains well within the linear viscoelastic range rule out this mechanism for some of our experiments, and show that melt fracture is not always caused by constitutive instabilities. [ABSTRACT FROM AUTHOR]

The frequency-dependence of the viscoelastic shear modulus at low frequencies in a lamellar polystyrene-polyisoprene block copolymer is qualitatively identical to that measured in small-molecule smectics, namely, the rod-like 4-cyano-4′-octylbiphenyl and the flexible n-nonyl-1-O-β-D-glucopyranoside. All three materials were studied after quenching from the isotropic state, and during and after alignment by large-amplitude oscillatory shearing. The kinetics of aligning, as measured by changes in moduli during shearing, are similar, despite great differences in molecular characteristics. These moduli and the aligning process are evidently controlled by smectic fluctuations and defects, the dynamics of which have universal features. [ABSTRACT FROM AUTHOR]

In polymer solutions or blends, flow can strongly influence the degree of mixing of the components. In a shearing flow, droplets in a dispersion can be broken down to sizes comparable to the dimensions of the polymer molecules themselves, thereby inducing molecular-scale mixing. Demixing can also occur when the two components of the mixture differ greatly in viscoelastic properties. Shear or extensional flow can induce polymer migration in nonhomogeneous flows or in flows with curved streamlines, and can render turbid solutions or blends that are otherwise transparent. Flow can also induce polymer gelation, and can induce ordering transitions in liquid crystals or block copolymers. Here, we review these phenomena, discuss proposed mechanisms, and assess the degree to which recent theories can account for the observations. Because the phenomena are complex, multiple experimental probes and theoretical methods are required to study them. Successful theories must incorporate polymer/polymer or polymer/solvent thermodynamics, critical phenomena, and phase transitions, as well as polymer theology and the kinetics of diffusion or crystallization. The experimental techniques used to study these phenomena are equally wide ranging, and include turbidity measurements, light, x-ray, and neutron scattering, fluorescence quenching, microscopy, and theology. [ABSTRACT FROM AUTHOR]

Viscoelastic instabilities are of practical importance, and are the subject of growing interest. Reviewed here are the fresh developments as well as earlier work in this area, organized into the following categories: instabilities in Taylor-Couette flows, instabilities in cone-and-plate and plate-and-plate flows, instabilities in parallel shear flows, extrudate distortions and fracture, instabilities in shear flows with interfaces, instabilities in extensional flows, instabilities in multidimensional flows, and thermohydrodynamic instabilities. Emphasized in the review are comparisons between theory and experiment and suggested directions for future work. [ABSTRACT FROM AUTHOR]

A technique to do step planar extension on polymer melts has been developed using a rectangular channel with lubricated walls and the linear motor of the Rheometrics System Four rheometer. Using this method we probe the stress relaxation of two polymer melts, a linear low density polyethylene (LLDPE) and a highly branched low density polyethylene (IUPAC X), and compare the step planar extensional data to step shear data. Since a step planar deformation is theoretically equivalent to a step shear in a rotating frame of reference, we expect that the nonlinear modulus for step planar extension should be equivalent to that for step shear. Although we find the time dependence of the stress relaxation modulus to be the same in both shear and planar extension, the strain dependence is surprisingly different for the two experiments. [ABSTRACT FROM AUTHOR]

By assuming that in a strong extensional flow a polymer molecule in dilute solution is quickly driven into a folded or kinked state in which drag and entropic elastic forces dominate over the Brownian force, we derive 'kink dynamics' equations that describe the unraveling of the molecule in the extensional flow. Solving these equations numerically, we find that although the ends of the chain move, on average, affinely in the flow field until the chain is unfolded to about 1/3 of its fully extended length, large viscous stresses are produced because the solvent must flow around nonextending strands of polymer that lie between neighboring kinks. These predictions are compared with available experimental data and with other theoretical models. [ABSTRACT FROM AUTHOR]

The stability of Taylor-Couette flow of entangled polymeric solutions to small axisymmetric stationary disturbances is analyzed using the Doi-Edwards constitutive equation in the small gap limit. A previous analysis of Karlsson, Sokolov, and Tanner for the general K-BKZ equation, of which the Doi-Edwards equation is a special case, reduces the problem to one of numerically evaluating seven viscoelastic functions of the shear rate $$\dot \gamma$$ in the gap. Of these seven, only three - two of which are related to the second normal stress difference, and one of them to shear thinning - significantly affect the flow stability. The negative second normal stress difference of the Doi-Edwards fluid stabilizes the flow at low values of the Weissenberg number λ $$\dot \gamma$$ , while shear thinning produces strong destabilization at moderate Weissenberg number. Here λ is the longest relaxation time. Non-monotonic effects of viscoelasticity on Taylor-Couette stability analogous to those predicted here have been observed in experiments of Giesekus. The extreme shear thinning of the Doi-Edwards fluid is also predicted to produce a large growth in the height of the Taylor cells, a phenomenon that has been seen experimentally by Beavers and Joseph. [ABSTRACT FROM AUTHOR]

Experimental evidence of a non-inertial, cellular instability in the Taylor-Couette flow of a viscoelastic fluid is presented. A linear stability analysis for an Oldroyd-B fluid, which is successful in describing many features of the experimental fluid, predicts the critical Deborah number, De, at which the instability is observed. The dependence of De on the value of the dimensionless gap between the cylinders is also determined. [ABSTRACT FROM AUTHOR]

The experimental properties of different polymer melts, polystyrene, high density polyethylene and low density polyethylene are compared for the first time in three different deformations: step shear, step biaxial extension and steady uniaxial extension. Properties of three other melts are also studied in step biaxial and shear experiments. For our comparative purposes some data of Laun and Winter from the literature are used, as well as new data reported here. In all the step strain experiments, the stresses can be factored into a time dependent relaxation modulus and a strain dependent damping function. The data are interpreted using a differential constitutive equation of Larson which satisfies this time-strain separability and has a single parameter that describes the strain softening character of the material. Results show that differences in the properties of the melts are most pronounced in uniaxial extension and least in biaxial extension. All melts follow the Doi-Edwards prediction relatively closely in biaxial extension. In uniaxial extension, the branched material shows a strong strain hardening effect although its shear and biaxial properties are similar to the other melts. The constitutive model gives a reasonably good fit to the data in all three deformations for unbranched materials for the same value of the adjustable parameter; the model, however, fails for the branched low density polyethylene. [ABSTRACT FROM AUTHOR]

It is herein shown that for separable integral constitutive equations with power-law distributions of relaxation times, the streamlines in creeping flow are independent of flow rate. For planar flows of constant stretch history, the stress tensor is the sum of three terms, one proportional to the rate-of-deformation tensor, one to the square of this tensor, and the other to the Jaumann derivative of the rate-of-deformation tensor. The three tensors are the same as occur in the Criminale-Ericksen-Filbey Equation, but the coefficients of these tensors depend not only on the second invariant of the strain rate, but also on another invariant which is a measure of flow strength. With the power-law distribution of relaxation times, each coefficient is equal to the second invariant of the strain rate tensor raised to a power, times a function that depends only on strength of the flow. Axisymmetric flows of constant stretch history are more complicated than the planar flows, because three instead of two nonzero normal components appear in the velocity gradient tensor. For homogeneous axisymmetric flows of constant stretch history, the stress tensor is given by the sum of the same three terms. The coefficients of these terms again depend on the flow strength parameter, but in general the dependences are not the same as in planar flow. [ABSTRACT FROM AUTHOR]

The linear relaxation modulus of polydisperse polymer melts and solutions can often be approximated by a power law, ct over some range of time, t. If, in addition, the nonlinear rheology is given by a separable integral equation, with a strain-dependent factor typical of those observed experimentally, then some commonly observed empirical rules and equations can be readily derived as approximations, namely the Cox-Merz relationship between complex viscosity and steady-state shear viscosity, Bersted's predictions of steady shear stress and first normal-stress difference from a truncated spectrum of linear relaxation times, and the observation of Koyama and coworkers that the ratio of the nonlinear to the linear time-dependent elongational viscosity is independent of strain rate, over a range of strain rates outside the linear regime. [ABSTRACT FROM AUTHOR]

For the low density polyethylene Melt I, which is the melt for which the most complete set of shear and elongational data exists, the semi-empirical single integral Wagner model gives an excellent data-fit, but suffers the drawback of having no entropic constitutive equation, that is a relationship between strain history and elastic free energy from which viscous heating and cohesive failure can be predicted. We show here that the BKZ model, which does possess an entropic constitutive equation, gives as good a fit as does the Wagner model to both the shear and elongational data. [ABSTRACT FROM AUTHOR]

The basic thermodynamic ideas from rubber-elasticity theory which Leonov employed to derive his constitutive model are herein summarized. Predictions of the single-mode version are presented for homogeneous elongational flows including stress growth following start-up of steady flow, stress decay following sudden stretching and following cessation of steady flow, elastic recovery following cessation of steady flow, energy storage in steady-state flow, and the velocity profile in constantforce spinning. Using parameters of the multiple-mode version which fit the linearviscoelastic data, the Leonov-model predictions of elongational stress growth during, and elastic recovery following, steady elongation are calculated numerically and compared to the experimental results for Melt I and to the Wagner model. It is found that the Leonov model, as originally formulated, agrees qualitatively with the data, but not quantitatively; the Wagner model gives quantitative agreement, but requires much nonlinear data with which to fit model parameters. Quantitative agreement can be obtained with the Leonov model, if the nonequilibrium potential which relates recoverable strain to strain rate is adjusted empirically. This can most simply be done by making each relaxation time dependent upon the recoverable strain. The Leonov model, unlike the Wagner model, is derived from an entropic constitutive equation, which is advantageous for calculating stored elastic energy or viscous dissipation. The Leonov model also has an appealingly simple differential form, similar to the upper-convected Maxwell model, which, in numerical calculations, may be an important advantage over the integral Wagner model. [ABSTRACT FROM AUTHOR]

The relation between a monoidal category which has an exact faithful monoidal functor to a category of finite rank projective modules over a Dedekind domain, and the category of continuous modules over a topological bialgebra is discussed. If the monoidal category is braided, the bialgebra is topologically quasitriangular. If the monoidal category is rigid monoidal, the bialgebra is a Hopf algebra. [ABSTRACT FROM AUTHOR]

A new cell line with megakaryoblastic features, designated UoC-M1, was established from the malignant cells of a 68-year-old patient with acute myeloid leukemia. The patient's leukemic cells reacted with alpha-naphthyl acetate esterase and acid phosphatase and expressed CD7, CD24, CD34, CD38, CD45, HLA-DR and CD61. Cytogenetic analysis of the patient's malignant cells (and of the UoC-M1 cells) showed a human, male hypodiploid karyotype with many chromosome rearrangements and marker chromosomes. Spectral karyotyping (SKY) analysis complemented the G-banded karyotyping and clarified several chromosomal translocations and identified the marker chromosomes. Fluorescence in situ hybridization (FISH) and SKY analysis demonstrated that one marker chromosome contained three segments of chromosome 9 interspersed with three segments of chromosome 11, as well as a portion of chromosome 19. FISH analysis with a probe for MLL revealed that the UoC-M1 cells contained four copies of the MLL gene. Southern blot analysis determined that the MLL gene had a germline profile while Northern and Western analyses showed that the MLL mRNAs and protein were of the appropriate sizes. This is the first report of amplification of the MLL gene which may be an additional mechanism of leukemogenesis or disease progression. [ABSTRACT FROM AUTHOR]

The results of polymerase chain reaction (PCR) analysis after transplantation for chronic myelogenous leukemia (CML) are difficult to interpret clinically. Positive findings for BCR/ABL can be seen not only in patients who go on to relapse but also in patients who, after years of follow-up, remain in complete remission. The cause for the lack of concordance between PCR findings and relapse is not clear. We identified two patients with CML who had rare pseudo-Gaucher cells in their bone marrow aspirate specimens prior to, and at 1, and 6 or 12 months following syngeneic or allogeneic hematopoietic transplantation. After the transplant, the patients obtained clinical remission and were shown to be cytogenetically normal and to have germline MBCR in blood or bone marrow by Southern analysis. One patient was PCR-positive for BCR/ABL in the marrow at 12 months. In order to determine whether the pseudo-Gaucher histiocytes were BCR/ABL-positive, we used fluorescence in situ hybridization and probes for MBCR and ABL and analyzed Wright-stained smears to correlate molecular cytogenetic findings with cell type. On three aspirate smears from each patient (at 6 or 12 months post-transplant), all of the pseudo-Gaucher cells studied (10/10 in one patient and 12/12 in the other) showed the fusion for BCR/ABL. Other cells analyzed randomly (erythroid precursors, granulocytes and rare monocytes, lymphocytes and plasma cells) did not. Our cases provide the first proof that pseudo-Gaucher cells carry the BCR/ABL fusion. Furthermore, they illustrate that these cells can be found in the marrow for up to 12 months following transplantation. Our results permit speculation that pseudo-Gaucher cells or other long-lived histocytes may be one cause of persistent PCR positivity after transplantation that is not predictive of disease relapse. [ABSTRACT FROM AUTHOR]

The relative benefit of allogeneic bone marrow transplantation (alloBMT) vs autologous BMT (autoBMT) for patients with relapsed or refractory Hodgkin’s disease (HD) or non-Hodgkin’s lymphoma (NHL) remains uncertain. Toxicity from graft-versus-host disease (GVHD) may diminish the potential benefits both of graft-versus-tumor activity and of receiving uncontaminated donor marrow stem cells. From 1987 to 1995, 27 adults (ages 18–60 years; median 36) underwent alloBMT for lymphoma after failure of standard chemotherapy. Twenty-one had NHL and six had HD (nodular sclerosis). Thirteen patients had primary refractory disease or chemotherapy-resistant relapses; two of these had relapsed after autoBMT. Three patients had untested relapses (one of them had relapsed after autoBMT), and 11 had chemotherapy-sensitive relapses. Twenty-four received HLA-matched bone marrow from a sibling (one twin); three received haploidentical marrow cells. Nine (33%) died from lymphoma. Eleven (41%) died of treatment-related causes. Opportunistic infections were a substantial problem leading to eight of these deaths (30%). Six patients (22%) survive free of lymphoma 17–70 months post-BMT (median, 56 months); four had had sensitive relapses, one had had a resistant relapse, and one had had nontested relapse. Three have chronic GVHD (limited in one; extensive in two). One HD patient who had relapsed after autoBMT remains in remission 19 months after alloBMT. No therapy-related myelodysplasia has been observed. We conclude that alloBMT has substantial morbidity in heavily pretreated lymphoma patients due to acute toxicity, infections and GVHD. However, 22% of our HD/NHL patients have had long-term disease-free survival. [ABSTRACT FROM AUTHOR]

Seven species of medusae were collected using scuba equipment in neritic waters of McMurdo Sound, Ross Sea, Antarctica. Two species dominated, the narcomedusa Solmundella bitentaculata and the scyphomedusa Diplulmaris antarctica. Two new taxa were found. Leuckartiara brownei n. sp., a pandeid anthomedusa, has gonads with two major longitudinal folds in the interradii and several smaller perradially directed folds. Besides four large perradial tentacles, it has up to 28 short 'rudimentary' tentacles. This is the first report of this genus from the Southern Ocean. Benthocodon hyalinus n. gen., n. sp., a rhopalonematoid trachymedusa, has 8 linear to sinuous gonads on the radial canals. The tubular manubrium is attached to a gastric peduncle. The tentacles are numerous (about 800) and grow successively. This is the second reported trachymedusa from the Ross Sea. Solmundella bitentaculata ate the thecosome pteropod Limacina helicina. Diplulmaris antarctica medusae fed on the gymnosome pteropod Clione antarctica and on L. helicina. The hyperiid amphipod Hyperiella dilatata, mostly females, was seen attached to the exumbrellas of both D. antarctica and S. bitentaculata. Up to 54 amphipods were seen on each D. antarctica medusa. The amphipods did no visible damage to the medusae. [ABSTRACT FROM AUTHOR]

Hepsulfam is a bisulfamic ester which is similar in structure to busulfan and is believed to act as a bifunctional alkylator inducing both DNA-DNA and DNA-protein crosslinks. Prior studies in patients with refractory solid tumors have identified the dose-limiting toxicity of hepsulfam to be cumulative myelosuppression resulting in prolonged leukopenia and thrombocytopenia. This phase I trial was designed to determine the maximally tolerated dose of hepsulfam administered intravenously in patients with refractory leukemias and other advanced hematologic malignancies. Hepsulfam was administered as a 30-min or 2-h intravenous infusion to 21 patients with advanced leukemia or multiple myeloma. All patients had been extensively treated and had progressive disease. Cycles were repeated every 5 weeks. Cohorts of patients were treated at 360, 480, 640, and 800 mg/m2. The dose-limiting toxicity of intravenous hepsulfam was severe encephalopathy. The single patient treated at 800 mg/m2 became comatose within 48 h and required 3 weeks for his mental status to return to baseline. There were, however, no irreversible neurological sequelae. Several patients treated at 640 mg/m2 had clinical evidence of toxic deliriums and slowing of alpha rhythm waves on electroencephalograms indicative of a gray-matter encephalopathy. When hepsulfam was infused over 30 min, patients complained of uncomfortable parasthesias, but when the drug was administered over 2 h, these acute symptoms were less common. Myelosuppression was observed in most patients. Among those patients who had some suppression of their leukemia, peripheral blood counts recovered to pretreatment levels after 3-5 weeks. Apart from CNS toxicity, non-hematologic toxicity was minimal. Pharmacokinetic studies demonstrated rapid clearance of hepsulfam so that the drug was not reliably detected in the plasma after 24 h. The recommended phase II dose of hepsulfam as a single 2-h intravenous infusion is 480 mg/m2, but this dose provided relatively little clinical benefit for patients with refractory leukemia. The dose-limiting toxicity is CNS toxicity with increasingly severe encephalopathy at doses > or = 640 mg/m2. It would be reasonable to investigate further dose escalation of hepsulfam in a divided dose schedule to minimize the peak concentrations which may be related to the encephalopathy. EEG monitoring is recommended for early detection of slowing of alpha rhythm waves. Hematopoietic stem cell support will probably be required at total doses exceeding 800 mg/m2. [ABSTRACT FROM AUTHOR]

Male Sprague-Dawley rats were given single i.p. injections of 1,3-bis(2-chloroethyl)-1-Nitrosourea (BCNU) to investigate changes in hepatic microsomal cytochrome P-450 content and metabolic activity. On day 14 after treatment (20 mg/kg), cytochrome P-450 content had decreased by approximately 25% and ethylmorphine N-demethylase activity (nmol product/nmol P-450/min) had decreased by 36%. In contrast, ethylmorphine O-deethylase and 7-ethoxycoumarin O-deethylase activities were not significantly decreased by BCNU treatment. Hepatic delta-aminolevulinic acid synthetase activity was only 60% of control values, and microsomal heme oxygenase activity was slightly but not statistically elevated. Cytochrome P-450 content in control and BCNU-treated rats increased in a similar manner after phenobarbital or beta-naphthoflavone induction. Electrophoretic analysis of cytochrome P-450 proteins isolated from hepatic endoplasmic reticular membranes of treated and control rats suggested that alterations in these proteins occurred in BCNU-treated rats. These changes in cytochrome P-450 content and activity are very similar to those reported in isolated systems exposed to bile acids or in rats with experimentally produced cholestasis. BCNU has been shown to produce cholestasis, which precedes its effects on microsomal mixed-function oxygenase activity. Thus, the delayed effects of BCNU on microsomal drug metabolism are probably secondary to its interference with bile formation. [ABSTRACT FROM AUTHOR]

High-dose cytosine arabinoside therapy was administered to 29 patients with poor-prognosis acute nonlymphocytic leukemia. In an attempt to reduce toxicity, therapy was divided into an initial 4-day course of therapy, followed by a 3-day course of the marrow aspirate examined 1 week after the end of treatment contained substantial numbers of leukemic cells. Of the 29 patients, 5 entered complete remission, 2 of them after the initial 4-day course of therapy. The toxicity of split-course therapy was the same as that of conventional 6-day high-dose cytosine arabinoside therapy. This study demonstrates that the modification of high-dose cytosine arabinoside therapy used in this study failed to reduce toxicity and produced a lower remission rate than that obtained with the 6-day course of therapy. [ABSTRACT FROM AUTHOR]