PurposePatients with chronic lymphocytic leukemia (CLL) with high-risk genomic features achieve poor outcomes with traditional therapies. A phase I study of a pharmacokinetically derived schedule of flavopiridol suggested promising activity in CLL, irrespective of high-risk features. Given the relevance of these findings to treating genetically high-risk CLL, a prospective confirmatory study was initiated.Patients and MethodsPatients with relapsed CLL were treated with single-agent flavopiridol, with subsequent addition of dexamethasone to suppress cytokine release syndrome (CRS). High-risk genomic features were prospectively assessed for response to therapy.ResultsSixty-four patients were enrolled. Median age was 60 years, median number of prior therapies was four, and all patients had received prior purine analog therapy. If patients tolerated treatment during week 1, dose escalation occurred during week 2. Dose escalation did not occur in four patients, as a result of severe tumor lysis syndrome; three of these patients required hemodialysis. Thirty-four patients (53%) achieved response, including 30 partial responses (PRs; 47%), three nodular PRs (5%), and one complete response (1.6%). A majority of high-risk patients responded; 12 (57%) of 21 patients with del(17p13.1) and 14 (50%) of 28 patients with del(11q22.3) responded irrespective of lymph node size. Median progression-free survival among responders was 10 to 12 months across all cytogenetic risk groups. Reducing the number of weekly treatments per cycle from four to three and adding prophylactic dexamethasone, which abrogated interleukin-6 release and CRS (P ≤ .01), resulted in improved tolerability and treatment delivery.ConclusionFlavopiridol achieves significant clinical activity in patients with relapsed CLL, including those with high-risk genomic features and bulky lymphadenopathy. Subsequent clinical trials should use the amended treatment schedule developed herein and prophylactic corticosteroids.

Natural T helper 17 (nTH17) cells are a population of interleukin 17 (IL-17)-producing cells that acquire effector function in the thymus during development. Here we demonstrate that the serine/threonine kinase Akt plays a critical role in regulating nTH17 cell development. While Akt and the downstream mTORC1–ARNT–HIFα axis were required for inducible TH17 (iTH17) cell generation in the periphery, nTH17 cells developed independently of mTORC1. In contrast, mTORC2 and inhibition of Foxo proteins were critical for nTH17 cell development. Moreover, Akt controlled TH17 subsets through distinct isoforms, as deletion of Akt2, but not Akt1, led to defective iTH17 cell generation. These findings reveal novel mechanisms regulating nTH17 cell development and previously unknown roles of Akt and mTOR in shaping T cell subsets.

The percentage of patients who died in an acute care hospital is higher than the 17% U.S. benchmark. Other indicators of receiving aggressive EOL care are consistent with existing care quality benchmarks. The considerable regional variation, however, indicates potential for system improvements.

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The major sugars in fruits, including glucose, fructose, and sucrose, play a critical role in fruit quality control and maturity evaluation. Many novel methods and techniques such as enzymatic and nonenzymatic biosensors, nuclear magnetic resonance, and near-infrared spectroscopy have been developed to provide the rapid estimation of sugar inversion under different storage conditions. This review provides a description of recent advancements in these technologies for the determination of sugar contents in fruits. The prospects of emerging spectroscopic technologies such as Raman spectroscopy, hyperspectral imaging, and terahertz imaging, for assessing sugars in intact fruits are discussed. The challenges for further developments of these methods and technologies to meet the increasing demand for rapid and on-line quality control are also presented.