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Liposomal daunorubicin and cytarabine (CPX-351) improves overall survival (OS) compared to 7+3 chemotherapy in older patients with secondary acute myeloid leukaemia (AML); to date there have been no randomized studies in younger patients. The high-risk cohort of the UK NCRI AML19 trial (ISRCTN78449203) compared CPX-351 with FLAG-Ida in younger adults with newly-diagnosed adverse cytogenetic AML or high-risk myelodysplastic syndromes (MDS). 189 patients were randomized (median age 56y). By clinical criteria 49% had de novo AML, 20% secondary AML and 30% high risk MDS. MDS-related cytogenetics were present in 73% of patients, with complex karyotype in 49%. TP53 was the most commonly mutated gene, in 43%. Myelodysplasia-related gene mutations were present in 75 patients (44%). The overall response rate (CR + CRi) after course two was 64% and 76% for CPX-351 and FLAG-Ida (OR:0.54, 95%CI 0.28-1.04, p=0.06). There was no difference in OS (13.3 months vs 11.4 months, HR:0.78, 95%CI 0.55-1.12, p=0.17) or event-free survival (HR:0.90, 95%CI 0.64-1.27, p=0.55) in multivariable analyses. However, relapse-free survival was significantly longer with CPX-351 (median 22.1 vs 8.35 months, HR:0.58, 95% CI 0.36-0.95, p=0.03). There was no difference between the treatment arms in patients with clinically defined secondary AML (HR:1.1, 95%CI 0.52-2.30) or those with MDS-related cytogenetic abnormalities (HR:0.94, 95%CI 0.63-1.40), however an exploratory sub-group of patients with MDS-related gene mutations had significantly longer OS with CPX-351 (median 38.4 vs 16.3 months, HR:0.42, 95%CI 0.21-0.84, heterogeneity p=0.05). In conclusion, OS in younger patients with adverse risk AML/MDS was not significantly different between CPX-351 and FLAG-Ida.

Patients undergoing treatment for acute lymphoblastic leukaemia (ALL) are at risk of coagulopathy, especially thromboembolism. We conducted a survey on practices in the assessment and management of coagulopathy during the new ALLTogether protocol in 29 (17 paediatric, 12 adult) Nordic and Baltic cancer centres. While 92% of adult centres used thromboprophylaxis with low-molecular-weight heparin, no paediatric centre did. Almost all providers performed baseline coagulation studies, but only 59% continued the assessment. Fibrinogen replacement was conducted in 59%, and antithrombin replacement in 28% of the centres. The survey highlights the need for guidelines in the management of coagulopathy during ALL therapy. publishedVersion

As the prognoses of both heart and cancer patients have improved along with a longer life expectancy in the general population, the prevalence of both heart- and cancer diseases is increasing. Thus, a larger proportion of cancer patients will have cardiovascular co-morbidity and an increased risk of cardiovascular complications during and after cancer treatment. In this article, the current knowledge on the prevention, monitoring and treatment of cardiotoxicity induced by medical anti-cancer treatment with focus on anthracyclines, trastuzumab and 5-fluorouracil is described.

N. F. S. Grundtvigs foredrag i Danske Samfund 21. september 1841[N. F. S. Grundtvig's lecture to the Danske Samfund on 21 September 1841]By Ulrik OvergaardThe contemporary school system is the topic of Grundtvig’s lecture to the Danske Samfund on 21 September 1841. Grundtvig emphasises in the first place the necessity of compulsory school attendance (introduced in Denmark in 1814). He argues, though, that poor schools are much worse than none and that the number of bad schools is disturbingly high. Grundtvig then gives the definition of a good school: In a fine school the teachers should be vivid and engaged people, and the teaching methods should encourage the children to learn how to live a useful, wise and enjoyable life. Unfortunately, the contemporary schools do not fulfil this goal. On the contrary, the methods are characterised by punishments and rote learning, i.e. the teaching is dead. The only exceptions are the few schools where the schoolmaster himself is a living human being who wants to talk with the pupils and respect their opinions.

“Til Asylernes Venner og Veninder Kommenteret tekstudgivelse om Grundtvigs kamp for asylskolernes frihed[Grundtvig ’s fight for freedom of the charity schools]Transcription by Ulrik OvergaardIn May 1829 the Danish crown princess Caroline Amalie founded a sanctuary for orphans in Copenhagen. Grundtvig was a personal friend of the princess and from 1838 he usually gave a speech at the children’s annual Christmas party. On 19 September 1841, Caroline Amalie also took the initiative to establish a school, Dronningens Asylskole, which was connected to the sanctuary. Grundtvig became the director and P. O. Boisen the head of this school. The teachers were all grundtvigians and the grundtvigian ideas of a liberal alternative to the public Danish primary school were realized here, thus making Dronningens Asylskole the first of the so-called Danish friskoler (liberal schools).This article, hitherto unprinted, is an example of Grundtvig’s keen interest in the welfare of the sanctuaries in Copenhagen. It is printed here to emphasize Grundtvig’s commitment to the Danish primary school system in general, which scholarship has often neglected in favour of his interest in the folkhighschools. No major research has therefore been undertaken on this topic since K. E. Bugge’s dissertation Skolen for Livet from 1965, which was unquestionably a milestone in the research of Grundtvig’s educational ideas even though it dealt mostly with adult education.

Skrifter om Grundtvig udgivet af Grundtvig-Selskabet

Skrifter om Grundtvig udgivet af Grundtvig-Selskabet

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