European development of clofarabine as treatment for older patients with acute myeloid leukemia considered unsuitable for intensive chemotherapy.

PURPOSE:
Treatment options for older patients with acute myeloid leukemia (AML) who are not considered suitable for intensive chemotherapy are limited. We assessed the second-generation purine nucleoside analog, clofarabine, in two similar phase II studies in this group of patients.
PATIENTS AND METHODS:
Two consecutive studies, UWCM-001 and BIOV-121, recruited untreated older patients with AML to receive up to four or six 5-day courses of clofarabine. Patients in UWCM-001 were either older than 70 years or 60 to 69 years of age with poor performance status (WHO > 2) or with cardiac comorbidity. Patients in BIOV-121 were >or= 65 years of age and deemed unsuitable for intensive chemotherapy.
RESULTS:
A total of 106 patients were treated in the two monotherapy studies. Median age was 71 years (range, 60 to 84 years), 30% had adverse-risk cytogenetics, and 36% had a WHO performance score >or= 2. Forty-eight percent had a complete response (32% complete remission, 16% complete remission with incomplete peripheral blood count recovery), and 18% died within 30 days. Interestingly, response and overall survival were not inferior in the adverse cytogenetic risk group. The safety profile of clofarabine in these elderly patients with AML who were unsuitable for intensive chemotherapy was manageable and typical of a cytotoxic agent in patients with acute leukemia. Patients had similar prognostic characteristics to matched patients treated with low-dose cytarabine in the United Kingdom AML14 trial, but had significantly superior response and overall survival.
CONCLUSION:
Clofarabine is active and generally well tolerated in this patient group. It is worthy of further evaluation in comparative trials and might be of particular use in patients with adverse cytogenetics.

Entrepreneurial and Business Growth and the Quest for a “Comprehensive Theory”: Tilting at Windmills?

Even though there has been sustained interest in growth for almost 50 years, relatively little is known about this phenomenon and much confusion and misunderstanding surrounds it. Based on a literature review and the articles in this special issue we make three recommendations that we believe will allow theory to advance and be applicable in practice. First, that discourse between key stakeholders is encouraged in order to achieve greater understanding. Second, that focus is placed on " growth as a process," rather than as a " change in amount." Third, that knowledge production requires inclusivity and pluralism in research perspectives and approaches. © 2010 Baylor University.

Laïcité is what Laïcité does: Rethinking the French cult controversy

France’s distinctive reaction towards “cults” is generally described as a result of laïcité’s consubstantial problems with religious diversity. The aim of this article is to present an alternative way of thinking about the French cult controversy and, ultimately, about the concept of “laïcité” as an explanatory framework for France’s response to religious diversity. It draws on empirical data to look at how notions such as “laïcité” and “cults” are used in official discourses and translated into administrative practice. This approach will underline that laïcité is not a driving force that predetermines a unilateral response to “cults”, but that laïcité is as laïcité does, in other words a highly claimed and contested value, reflecting divergent political and administrative approaches of the cult phenomenon. The framework “laïcité versus religious diversity” is also undermined by another crucial observation. While it sees the cult controversy as primarily a religious issue, it seems that the recent revitalisation of the combat against “cults” was made possible by its partial dissociation from the religious sphere and its extension to a wide range of practices and new areas.

Global down-regulation of HOX gene expression in PML-RAR alpha(+) acute promyelocytic leukemia identified by small-array real-time PCR

Acute promyelocytic leukemia (APL) is associated with a reciprocal and balanced translocation involving the retinoic acid receptor-alpha (RARalpha). All-trans retinoic acid (ATRA) is used to treat APL and is a potent morphogen that regulates HOX gene expression in embryogenesis and organogenesis. HOX genes are also involved in hematopoiesis and leukemogenesis. Thirty-nine mammalian HOX genes have been identified and classified into 13 paralogous groups clustered on 4 chromosomes. They encode a complex net-Work of transcription regulatory proteins whose precise targets remain poorly understood. The overall function of the network appears to be dictated by gene dosage. To investigate the mechanisms involved in HOX gene regulation in hematopoiesis and leukemogenesis by precise measurement of individual HOX genes, a small-array real-time HOX (SMART-HOX) quantitative polymerase chain reaction (PCR) platform was designed and validated. Application of SMART-HOX to 16 APL bone marrow samples revealed a global down-regulation of 26 HOX genes compared with normal controls. HOX gene expression was also altered during differentiation induced by ATRA in the PML-RARalpha(+) NB4 cell line. PML-RARalpha, fusion proteins have been reported to act as part of a repressor complex during myelold cell differentiation, and a model linking HOX gene expression to this PML-RARalpha repressor complex is now proposed.