Growing evidence suggests that survivin expression in cancer cell nuclei may represent an important prognostic marker to predict disease outcome for cancer patients. Current reports in this research area, however, are inconsistent and propose opposing conclusions regarding the significance and prognostic value of survivin nuclear expression. The aim of our study is to review and discuss the data reported in the original publications. We have also provided new experimental data to support our view regarding the possible reasons for the observed inconsistencies in the literature. This would alert researchers to pay attention to potential pitfalls in the determination of nuclear or cytoplasmic expression of survivin for the future. © 2004 Wiley-Liss, Inc. Key words: survivin expression; cancer; cytoplasmic; nuclear; immunohistochemistry; prognostic marker Among the 19 publications relevant to survivin localization in nuclei or cytoplasm in various cancer tissues, 9 showed that the expression of survivin in cancer cell nuclei is an unfavorable prognostic marker, 1-10 whereas studies from 5 of 19 proposed an opposing notion that the nuclear expression of survivin represented a favorable prognostic marker. 10 -14 The remaining 5 publications did not focus on studying the significance of nuclear expression of survivin in disease outcome, although these reports pointed out the fact that survivin could be expressed in either cytoplasm or nuclei. [15][16][17][18][19] Two of these 5 studies reported that overall, survivin expression was an unfavorable prognostic factor. 16,18 The localization of survivin in nuclei or cytoplasm was determined by immunohistochemistry (IHC) in all 19 reports. One of the 19 publications alternatively carried out Western blots using cell lysates from the fractionated cytoplasm and nuclei for the confirmation of survivin localization. 5 In addition, Nakagawa et al. 20 reported recently that nuclear localization of survivin, as well as cytoplasmic in some cases, was essentially found in acute lymphocytic leukemia (ALL) cells whereas cytoplasmic expression of survivin was predominantly showed in chronic lymphocytic leukemia (CLL) cells. The significance, however, was not investigated. Nuclear expression of survivin is an unfavorable prognostic markerIn hepatocellular carcinoma (HCC), studies from Ito et al. 1 indicated that 14 of 20 (70%) HCC tissues showed nuclear staining of survivin, whereas non-tumor tissues showed little survivin staining. Nuclear survivin expression strongly correlated with the proliferation index. 1 Similarly, studies from Moon et al. 4 showed that 22 of 35 (63%) survivin-positive specimens (total ϭ 47) showed punctate nuclear staining in HCC cells. In contrast, nonmalignant hepatocytes showed only cytoplasmic staining. HCC specimens with nuclear survivin expression showed the highest PCNA (proliferating cell nuclear antigen) labeling index and correlated with tumor cell de-differentiation. 4 Recently, Fields et al. 8 reported that immunohistochemical analyses of 72 hep...

In patients with acute leukemia, detection of minimal residual disease (MRD) before allogeneic hematopoietic cell transplantation (HCT) correlates with risk of relapse. However, the level of MRD that is most likely to preclude cure by HCT is unclear, and the benefit of further chemotherapy to reduce MRD before HCT is unknown. In 122 children with very-high-risk acute lymphoblastic leukemia (ALL; n = 64) or acute myeloid leukemia (AML, n = 58), higher MRD levels at the time of HCT predicted a poorer survival after HCT (P = .0019); MRD was an independent prognostic factor in a multivariate analysis (P = .0035). However, the increase in risk of death associated with a similar increment of MRD was greater in ALL than in AML, suggesting that a pretransplantation reduction of leukemia burden would have a higher impact in ALL. At any given MRD level, survival rates were higher for patients treated in recent protocols: the 5-year overall survival for patients with ALL was 49% if MRD was detectable and 88% if it was not and the corresponding rates for patients with AML were 67% and 80%, respectively. Although MRD before HCT is a strong prognostic factor, its impact has diminished and should not be regarded as a contraindication for HCT.

We evaluated 190 children with very highrisk leukemia, who underwent allogeneic hematopoietic cell transplantation in 2 sequential treatment eras, to determine whether those treated with contemporary protocols had a high risk of relapse or toxic death, and whether non-HLA-identical transplantations yielded poor outcomes. For the recent cohorts, the 5-year overall survival rates were 65% for the 37 patients with acute lymphoblastic leukemia and 74% for the 46 with acute myeloid leukemia; these rates compared favorably with those of earlier cohorts (28%, n ‫؍‬ 57; and 34%, n ‫؍‬ 50, respectively). Improvement in the recent cohorts was observed regardless of donor type (sibling, 70% vs 24%; unrelated, 61% vs 37%; and haploidentical, 88% vs 19%), attributable to less infection (hazard ratio [HR] ‫؍‬ 0.12; P ‫؍‬ .005), regimen-related toxicity (HR ‫؍‬ 0.25; P ‫؍‬ .002), and leukemiarelated death (HR ‫؍‬ 0.40; P ‫؍‬ .01). Survival probability was dependent on leukemia status (first remission vs more advanced disease; HR ‫؍‬ 0.63; P ‫؍‬ .03) or minimal residual disease (positive vs negative; HR ‫؍‬ 2.10; P ‫؍‬ .01) at the time of transplantation. We concluded that transplantation has improved over time and should be considered for all children with very high-risk leukemia, regardless of matched donor availability. (Blood. 2011;118(2):223-230)

Killer-cell immunoglobulin-like receptors (KIRs) on natural killer (NK) cells have been linked to a wide spectrum of health conditions such as chronic infections, autoimmune diseases, pregnancy complications, cancers, and transplant failures. A small subset of effector memory T cells also expresses KIRs. Here, we use modern analytic tools including genome-wide and multiplex molecular, phenotypic, and functional assays to characterize the KIR+ T cells in human blood. We find that KIR+ T cells primarily reside in the CD56+ T population that is distinctively DNAM-1high with a genome-wide quiescent transcriptome, short telomere, and limited TCR excision circles. During cytomegalovirus (CMV) reactivation in bone marrow transplant recipients, KIR+CD56+ T cells rapidly expanded in real-time, but not KIR+CD56− T cells or KIR+ NK cells. In CMV+ asymptomatic donors, as much as 50% of CD56+ T cells are KIR+, and most are distinguishably KIR2DL2/3+NKG2C+CD57+. Functionally, the KIR+CD56+ T-cell subset lyses cancer cells and CMVpp65-pulsed target cells in a dual KIR-dependent and TCR-dependent manner. Analysis of metabolic transcriptome confirms the immunological memory status of KIR+CD56+ T cells, in contrast to KIR−CD56+ T cells that are more active in energy metabolism and effector differentiation. KIR−CD56+ T cells have >25-fold higher level of expression of RORC than the KIR+ counterpart and are a previously unknown producer of IL-13 rather than IL-17 in multiplex cytokine arrays. Our data provide fundamental insights intoKIR + T cells biologically and clinically.

Background Dexamethasone contributes to high cure rates in pediatric acute lymphoblastic leukaemia (ALL) but significantly and adversely alters sleep and fatigue. Herein we explored three mechanisms (pharmacokinetics, serum albumin, and pharmacogenetics) through which dexamethasone may cause debilitating fatigue and disrupted sleep. Methods We enrolled 100 patients on a 10-day study: 5 days of no dexamethasone (OFF DEX) followed by 5 days of dexamethasone (ON DEX) during continuation chemotherapy. Sleep variables were collected with continuous actigraphy on Days 1 through 5, both OFF DEX and ON DEX. On Days 2 and 5 of each 5-day period, parents and patients 7 years of age and older completed a sleep diary and Fatigue Scale questionnaire. Blood was collected at 0 (pre-dexamethasone), 1, 2, 4, and 8 hours after the first oral dexamethasone dose for pharmacokinetic analysis. Serum albumin concentration was retrospectively analyzed in stored samples. Patient DNA was genotyped for 99 polymorphic loci in candidate genes associated with glucocorticoid metabolism. Results Dexamethasone clearance was significantly greater in younger patients than in older ones and in lower risk patients. In multiple regression models, risk group was significantly related to pharmacokinetic parameters. We found that polymorphisms in three genes (AHSG, IL6, POLDIP3) were significantly associated with sleep measures but not fatigue. Conclusion Risk group had the most significant relationship with disrupted sleep in patients while on dexamethasone. Serum albumin levels had neither a direct relationship with sleep or fatigue variables nor an indirect relationship through systemic exposure to dexamethasone. We identified candidate genes that may help explain the adverse events of disrupted sleep in pediatric patients receiving dexamethasone.