Re-treatment of previous non-responders and relapsers to interferon plus ribavirin with peginterferon alfa-2a (40KD), ribavirin +/- amantadine in patients with chronic hepatitis C: randomized multicentre clinical trial

Introduction. A large number of patients with chronic hepatitis C have not been cured with interferon-based therapy. Therefore, we evaluated the efficacy of amantadine combined with the standard of care (pegylated interferon plus ribavirin) in patients who had not responded to or had relapsed after 24 weeks of treatment with conventional interferon plus ribavirin. Material and methods. Patients stratified by previous response (i.e., non-response or relapse) were randomized to 48 weeks of open-label treatment with peginterferon alfa-2a (401(D) 180 pg/week plus ribavirin 1,000/1,200 mg/day plus amantadine 200 mg/day (triple therapy), or the standard of care (peginterferon alfa-2a [40KD] plus ribavirin). Results. The primary outcome was sustained virological response (SVR), defined as undetectable hepatitis C virus RNA in serum (< 50 IU/mL) at end of follow-up (week 72). Among patients with a previous non-response, 12/53 (22.6%; 95% confidence interval [CI] 12.3-36.2%) randomized to triple therapy achieved an SVR compared with 16/52 (30.8%; 95% CI 18.7-45.1%) randomized to the standard of care. Among patients with a previous relapse 22/39 (56.4%; 95% CI 39.6-72.2%) randomized to triple therapy achieved an SVR compared with 23/38 (60.5%; 95% CI 43.4-76.0%) randomized to the standard of care. Undetectable HCV RNA (< 50 IU/mL) at week 12 had a high positive predictive value for SVR. A substantial proportion of non-responders and relapsers to conventional interferon plus ribavirin achieve an SVR when re-treated with peginterferon alfa-2a (40KD) plus ribavirin. Conclusion. Amantadine does not enhance SVR rates in previously treated patients with chronic hepatitis C and cannot be recommended in this setting.

Clinical, epidemiological and molecular features of the HIV-1 subtype C and recombinant forms that are circulating in the city of Sao Paulo, Brazil

Background: The city of Sao Paulo has the highest AIDS case rate, with nearly 60% in Brazil. Despite, several studies involving molecular epidemiology, lack of data regarding a large cohort study has not been published from this city. Objectives: This study aimed to describe the HIV-1 subtypes, recombinant forms and drug resistance mutations, according to subtype, with emphasis on subtype C and BC recombinants in the city of Sao Paulo, Brazil. Study design: RNA was extracted from the plasma samples of 302 HIV-1-seropositive subjects, of which 211 were drug-naive and 82 were exposed to ART. HIV-1 partial pol region sequences were used in phylogenetic analyses for subtyping and identification of drug resistance mutations. The envelope gene of subtype C and BC samples was also sequenced. Results: From partial pol gene analyses, 239 samples (79.1%) were assigned as subtype B, 23 (7.6%) were F1, 16 (5.3%) were subtype C and 24 (8%) were mosaics (3 CRF28/CRF29-like). The subtype C and BC recombinants were mainly identified in drug-naive patients (72.7%) and the heterosexual risk exposure category (86.3%), whereas for subtype B, these values were 69.9% and 57.3%, respectively (p = 0.97 and p = 0.015, respectively). An increasing trend of subtype C and BC recombinants was observed (p < 0.01). Conclusion: The HIV-1 subtype C and CRFs seem to have emerged over the last few years in the city of Sao Paulo, principally among the heterosexual population. These findings may have an impact on preventive measures and vaccine development in Brazil.

Testosterone Induces Vascular Smooth Muscle Cell Migration by NADPH Oxidase and c-Src-Dependent Pathways

Testosterone has been implicated in vascular remodeling associated with hypertension. Molecular mechanisms underlying this are elusive, but oxidative stress may be important. We hypothesized that testosterone stimulates generation of reactive oxygen species (ROS) and migration of vascular smooth muscle cells (VSMCs), with enhanced effects in cells from spontaneously hypertensive rats (SHRs). The mechanisms (genomic and nongenomic) whereby testosterone induces ROS generation and the role of c-Src, a regulator of redox-sensitive migration, were determined. VSMCs from male Wistar-Kyoto rats and SHRs were stimulated with testosterone (10(-7) mol/L, 0-120 minutes). Testosterone increased ROS generation, assessed by dihydroethidium fluorescence and lucigenin-enhanced chemiluminescence (30 minutes [SHR] and 60 minutes [both strains]). Flutamide (androgen receptor antagonist) and actinomycin D (gene transcription inhibitor) diminished ROS production (60 minutes). Testosterone increased Nox1 and Nox4 mRNA levels and p47phox protein expression, determined by real-time PCR and immunoblotting, respectively. Flutamide, actinomycin D, and cycloheximide (protein synthesis inhibitor) diminished testosterone effects on p47phox. c-Src phosphorylation was observed at 30 minutes (SHR) and 120 minutes (Wistar-Kyoto rat). Testosterone-induced ROS generation was repressed by 3-(4-chlorophenyl) 1-(1,1-dimethylethyl)-1H-pyrazolo[3,4-day]pyrimidin-4-amine (c-Src inhibitor) in SHRs and reduced by apocynin (antioxidant/NADPH oxidase inhibitor) in both strains. Testosterone stimulated VSMCs migration, assessed by the wound healing technique, with greater effects in SHRs. Flutamide, apocynin, and 3-(4-chlorophenyl) 1-(1,1-dimethylethyl)-1H-pyrazolo[3,4-day] pyrimidin-4-amine blocked testosterone-induced VSMCs migration in both strains. Our study demonstrates that testosterone induces VSMCs migration via NADPH oxidase-derived ROS and c-Src-dependent pathways by genomic and nongenomic mechanisms, which are differentially regulated in VSMCs from Wistar-Kyoto rats and SHRs. (Hypertension. 2012; 59: 1263-1271.). Online Data Supplement

Microbial transformation of the sesquiterpene lactone tagitinin C by the fungus Aspergillus terreus

The biotransformation of the sesquiterpene lactone tagitinin C by the fungus Aspergillus terreus MT 5.3 yielded a rare derivative that was elucidated by spectrometric methods. The fungus led to the formation of a different product through an unusual epoxidation reaction between C4 and C5, formation of a C3,C10 ether bridge, and a methoxylation of the C1 of tagitinin C. The chemical structure of the product, namely 1 beta-methoxy-3 alpha-hydroxy-3,10 beta-4,5 alpha-diepoxy-8 beta-isobutyroyloxygermacr-11(13)-en-6 alpha,12-olide, is the same as that of a derivative that was recently isolated from the flowers of a Brazilian population of Mexican sunflower (Tithonia diversifolia), which is the source of the substrate tagitinin C. The in vitro cytotoxic activity of the substrate and the biotransformed product were evaluated in HL-60 cells using an MTT assay, and both compounds were found to be cytotoxic. We show that soil fungi may be useful in the biotransformation of sesquiterpene lactones, thereby leading to unusual changes in their chemical structures that may preserve or alter their biological activities, and may also mimic plant biosynthetic pathways for production of secondary metabolites.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study

Abstract Background Hepatitis C chronic liver disease is a major cause of liver transplant in developed countries. This article reports the first nationwide population-based survey conducted to estimate the seroprevalence of HCV antibodies and associated risk factors in the urban population of Brazil. Methods The cross sectional study was conducted in all Brazilian macro-regions from 2005 to 2009, as a stratified multistage cluster sample of 19,503 inhabitants aged between 10 and 69 years, representing individuals living in all 26 State capitals and the Federal District. Hepatitis C antibodies were detected by a third-generation enzyme immunoassay. Seropositive individuals were retested by Polymerase Chain Reaction and genotyped. Adjusted prevalence was estimated by macro-regions. Potential risk factors associated with HCV infection were assessed by calculating the crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p values. Population attributable risk was estimated for multiple factors using a case–control approach. Results The overall weighted prevalence of hepatitis C antibodies was 1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older groups but was similar for both sexes. The multivariate model showed the following to be predictors of HCV infection: age, injected drug use (OR = 6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups socially deprived by the lack of sewage disposal (OR = 2.53), and injection with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1 (subtypes 1a, 1b), 2b and 3a were identified. The estimated population attributable risk for the ensemble of risk factors was 40%. Approximately 1.3 million individuals would be expected to be anti-HCV-positive in the country. Conclusions The large estimated absolute numbers of infected individuals reveals the burden of the disease in the near future, giving rise to costs for the health care system and society at large. The known risk factors explain less than 50% of the infected cases, limiting the prevention strategies. Our findings regarding risk behaviors associated with HCV infection showed that there is still room for improving strategies for reducing transmission among drug users and nosocomial infection, as well as a need for specific prevention and control strategies targeting individuals living in poverty.

Clinical, epidemiological and molecular features of the HIV-1 subtype C and recombinant forms that are circulating in the city of São Paulo, Brazil

Abstract Background The city of Sao Paulo has the highest AIDS case rate, with nearly 60% in Brazil. Despite, several studies involving molecular epidemiology, lack of data regarding a large cohort study has not been published from this city. Objectives This study aimed to describe the HIV-1 subtypes, recombinant forms and drug resistance mutations, according to subtype, with emphasis on subtype C and BC recombinants in the city of São Paulo, Brazil. Study design RNA was extracted from the plasma samples of 302 HIV-1-seropositive subjects, of which 211 were drug-naive and 82 were exposed to ART. HIV-1 partial pol region sequences were used in phylogenetic analyses for subtyping and identification of drug resistance mutations. The envelope gene of subtype C and BC samples was also sequenced. Results From partial pol gene analyses, 239 samples (79.1%) were assigned as subtype B, 23 (7.6%) were F1, 16 (5.3%) were subtype C and 24 (8%) were mosaics (3 CRF28/CRF29-like). The subtype C and BC recombinants were mainly identified in drug-naïve patients (72.7%) and the heterosexual risk exposure category (86.3%), whereas for subtype B, these values were 69.9% and 57.3%, respectively (p = 0.97 and p = 0.015, respectively). An increasing trend of subtype C and BC recombinants was observed (p < 0.01). Conclusion The HIV-1 subtype C and CRFs seem to have emerged over the last few years in the city of São Paulo, principally among the heterosexual population. These findings may have an impact on preventive measures and vaccine development in Brazil.

Assessment of cumulative damage by using ultrasonic C-scan on carbon fiber/epoxy composites under thermal cycling

In recent years, structural composites manufactured by carbon fiber/epoxy laminates have been employed in large scale in aircraft industries. These structures require high strength under severe temperature changes of -56° until 80 °C. Regarding this scenario, the aim of this research was to reproduce thermal stress in the laminate plate developed by temperature changes and tracking possible cumulative damages on the laminate using ultrasonic C-scan inspection. The evaluation was based on attenuation signals and the C-scan map of the composite plate. The carbon fiber/epoxy plain weave laminate underwent temperatures of -60° to 80 °C, kept during 10 minutes and repeated for 1000, 2000, 3000 and 4000 times. After 1000 cycles, the specimens were inspected by C-scanning. A few changes in the laminate were observed using the inspection methodology only in specimens cycled 3000 times, or so. According to the found results, the used temperature range did not present enough conditions to cumulative damage in this type of laminate, which is in agreement with the macro - and micromechanical theory.

Precipitating factors of porphyria cutanea tarda in Brazil with emphasis on hemochromatosis gene (HFE) mutations. Study of 60 patients

BACKGROUND: Porphyria cutanea tarda is the most common form of porphyria, characterized by the decreased activity of the uroporphyrinogen decarboxylase enzyme. Several reports associated HFE gene mutations of hereditary hemochromatosis with porphyria cutanea tarda worldwide, although up to date only one study has been conducted in Brazil. OBJECTIVES: Investigation of porphyria cutanea tarda association with C282Y and H63D mutations in the HFE gene. Identification of precipitating factors (hepatitis C, HIV, alcoholism and estrogen) and their link with HFE mutations. METHODS: An ambispective study of 60 patients with PCT was conducted during the period from 2003 to 2012. Serological tests for hepatitis C and HIV were performed and histories of alcohol abuse and estrogen intake were investigated. HFE mutations were identified with real-time PCR. RESULTS: Porphyria cutanea tarda predominated in males and alcohol abuse was the main precipitating factor. Estrogen intake was the sole precipitating factor present in 25% of female patients. Hepatitis C was present in 41.7%. All HIV-positive patients (15.3%) had a history of alcohol abuse. Allele frequency for HFE mutations, i.e., C282Y (p = 0.0001) and H63D (p = 0.0004), were significantly higher in porphyria cutanea tarda patients, compared to control group. HFE mutations had no association with the other precipitating factors. CONCLUSIONS: Alcohol abuse, hepatitis C and estrogen intake are prevalent precipitating factors in our porphyria cutanea tarda population; however, hemochromatosis in itself can also contribute to the outbreak of porphyria cutanea tarda, which makes the research for HFE mutations necessary in these patients

Detección de interacciones proteína-proteína del producto de los proto-oncogenes c-fgr y fyn

[ES] Se describe el desarrollo de una técnica que permite la identificación de proteínas que se unen a p55 c-fgr y p59 fyn. Concretamente se destaca la interacción con proteínas del peso molecular 51, 59, 60, 70, 95 y 114 kDalton en la línea celular HL60.

Evaluación de la calidad de vida de los pacientes entre 18 y 60 años de la Comunidad Autónoma de Canarias portadores de implante coclear

Programa de doctorado: Nuevas perspectivas en cirugía

Strutture a pareti portanti in C. A. caratterizzate da elevate prestazioni sismiche

Per quanto riguarda le costruzioni in conglomerato cementizio armato gettato in opera, i sistemi strutturali più comunemente utilizzati sono quelli a telaio (con trasmissione di momento flettente), a setti portanti o una combinazione di entrambi. A partire dagli anni ’60, numerosissimi sono stati gli studi relativamente al comportamento sismico di strutture in c.a. a telaio. Lo stesso si può affermare per le costruzioni costituite da pareti miste a telai. In particolare, l’argomento della progettazione sismica di tali tipologie di edifici ha sempre riguardato soprattutto gli edifici alti nei quali, evidentemente, l’impiego delle pareti avveniva allo scopo di limitarne la elevata deformabilità. Il comportamento sismico di strutture realizzate interamente a pareti portanti in c.a. è stato meno studiato negli anni, nonostante si sia osservato che edifici realizzati mediante tali sistemi strutturali abbiano mostrato, in generale, pregevoli risorse di resistenza nei confronti di terremoti anche di elevata intensità. Negli ultimi 10 anni, l’ingegneria sismica si sta incentrando sull’approfondimento delle risorse di tipologie costruttive di cui si è sempre fatto largo uso in passato (tipicamente nei paesi dell’Europa continentale, in America latina, negli USA e anche in Italia), ma delle quali mancavano adeguate conoscenze scientifiche relativamente al loro comportamento in zona sismica. Tali tipologie riguardano sostanzialmente sistemi strutturali interamente costituiti da pareti portanti in c.a. per edifici di modesta altezza, usualmente utilizzati in un’edilizia caratterizzata da ridotti costi di realizzazione (fabbricati per abitazioni civili e/o uffici). Obiettivo “generale” del lavoro di ricerca qui presentato è lo studio del comportamento sismico di strutture realizzate interamente a setti portanti in c.a. e di modesta altezza (edilizia caratterizzata da ridotti costi di realizzazione). In particolare, le pareti che si intendono qui studiare sono caratterizzate da basse percentuali geometriche di armatura e sono realizzate secondo la tecnologia del cassero a perdere. A conoscenza dello scrivente, non sono mai stati realizzati, fino ad oggi, studi sperimentali ed analitici allo scopo di determinare il comportamento sismico di tali sistemi strutturali, mentre è ben noto il loro comportamento statico. In dettaglio, questo lavoro di ricerca ha il duplice scopo di: • ottenere un sistema strutturale caratterizzato da elevate prestazioni sismiche; • mettere a punto strumenti applicativi (congruenti e compatibili con le vigenti normative e dunque immediatamente utilizzabili dai progettisti) per la progettazione sismica dei pannelli portanti in c.a. oggetto del presente studio. Al fine di studiare il comportamento sismico e di individuare gli strumenti pratici per la progettazione, la ricerca è stata organizzata come segue: • identificazione delle caratteristiche delle strutture studiate, mediante lo sviluppo/specializzazione di opportune formulazioni analitiche; • progettazione, supervisione, ed interpretazione di una estesa campagna di prove sperimentali eseguita su pareti portanti in c.a. in vera grandezza, al fine di verificarne l’efficace comportamento sotto carico ciclico; • sviluppo di semplici indicazioni (regole) progettuali relativamente alle strutture a pareti in c.a. studiate, al fine di ottenere le caratteristiche prestazionali desiderate. I risultati delle prove sperimentali hanno mostrato di essere in accordo con le previsioni analitiche, a conferma della validità degli strumenti di predizione del comportamento di tali pannelli. Le elevatissime prestazioni riscontrate sia in termini di resistenza che in termini di duttilità hanno evidenziato come le strutture studiate, così messe a punto, abbiano manifestato un comportamento sismico più che soddisfacente.

Synthese, 11 C- und 18 F-Markierung und Evaluierung von Repaglinid-Derivaten zur Quantifizierung der pankreatischen beta-Zell-Masse in vivo mittels PET

Diabetes mellitus umfasst eine heterogene Gruppe von Stoffwechselfunktionsstörungen, die durch hohe Blut-Glukose-Werte gekennzeichnet sind. Zwei Haupttypen von Diabetes mellitus wurden definiert: Typ 1- und Typ 2-Diabetes. Repaglinid ist ein neuer, schnell wirksamer, bei Typ 2-Diabetikern eingesetzter prandialer Glukose-Regulator mit einer kurzen Plasmahalbwertszeit (<1 Stunde) und der erste Vertreter der Carbamoylmethylbenzoesäure Familie, der in klinischen Studien getestet wurde. Die 18F- und 11C-markierten Repaglinid-Derivate (S)-2-(2-[18F]Fluorethoxy)-4-((3-methyl-1-(2-piperidin-1-yl-phenyl)-butylcarbamoyl)-methyl)-benzoesäure ([18F]Fluorethoxy-desethoxy-Repaglinid) und (S)-2-([11C]Methoxy)-4-([3-methyl-1-(2-piperidin-1-yl-phenyl)-butyl-carba-moyl]-benzoesäure ([11C]Methoxy-desethoxy-Repaglinid) wurden als potentielle Tracer für die nicht-invasive Quantifizierung des Sulfonylharnstoffrezeptor-Typ1-Status (SUR-1) der Insulin-sezernierenden -Zellen mittels Positronen-Emissions-Tomographie (PET) synthetisiert. [18F]Fluorethoxy-desethoxy-Repaglinide konnte in einer radiochemischen Ausbeute (RCA) von 20% nach 135 Minuten mit einer radiochemischen Reinheit >98% unter Verwendung des sekundären Markierungsvorläufers 2-[18F]Fluorethyltosylat erhalten werden. Die spezifische Aktivität lag im Bereich von 50-60 GBq/µmol. Für die radioaktive Synthese des [11C]Methoxy-desethoxy-Repaglinids wurde der sekundäre Markierungsvorläufer [11C]Methyliodid verwendet. Der 11C-Radiotracer wurde in einer RCA von 35% (bezogen auf [11C]CO2) mit einer spezifischen Aktivität von 40-70 GBq/µmol erhalten. Um die Eigenschaften des fluorierten sowie des methoxylierten Repaglinids zu charakterisieren, wurde die Affinität beider Verbindungen zum humanen SUR-1 evaluiert. [19F]Fluorethoxy-desethoxy-Repaglinid und Methoxy-desethoxy-Repaglinid induzierten Verdrängungskurven mit Hill-Koeffizienten nahe 1 und ergaben Dissotiationskonstanten (KD) von 142 nM beziehungsweise 83 nM - vergleichsweise geringe Verluste relativ zu Original-Repaglinid. Die biologische Aktivität wurde mittels Insulin-Sekretionstests an isolierten Ratten-Inselzellen gezeigt und war ebenfalls mit der des Repaglinids vergleichbar. Schließlich wurde die Biodistribution des [18F]Fluorethoxy-desethoxy-Repaglinids in gesunden Sprague-Dawley-Ratten durch Messung der Konzentration der Verbindung in verschiedenen Organen nach intravenöser Injektion untersucht. Das pankreatische Gewebe zeigte im Zeitintervall zwischen 10 und 30 Minuten nach Injektion eine stabile Akkumulation von etwa 0.12% der injizierten Dosis. 50% dieser Tracer-Akkulmulation konnten durch zusätzliche Injektion von nicht-radioaktiv-markiertem Repaglinid verdrängt werden, was auf eine mögliche Eignung des [18F]Fluorethoxy-desethoxy-Repaglinids für in vivo-Untersuchungen mittels PET schließen lässt. Eine erste humane PET-Studie zeigte zwar ebenfalls eine stabile, allerdings nur geringere Akkumulation von [18F]Fluorethoxy-desethoxy-Repaglinid im Pankreas und eine überproportional hohe Aktivitätsanreicherung in der Leber. Die Radioaktivitäts-akkumulation im Blut fiel nach wenigen Minuten unter die des Pankreas.

Regulation der Zeaxanthin- und der Diatoxanthin-Epoxidase in Chlorophyll a/b- und Fucoxanthin-Chlorophyll a/c-haltigen Pflanzen

In der vorliegenden Arbeit wird der Vx-Zyklus und der Ddx-Zyklus unterschiedlicher Pflanzen hinsichtlich ihrer Regulation untersucht. Es konnte an Hand von in vivo Messungen gezeigt werden, dass bei zwei Kieselalgen unterschiedlicher Ordnung (Pennales bzw. Centrales) und einer Haptophyte mit Ddx-Zyklus die Dtx-Epoxidase delta-pH-reguliert ist. Im Gegensatz dazu steht die nicht-regulierte Zx-Epoxidase des Vx-Zyklus einer Raphidophyceae, einer Grünalge und einer aquatischen Höheren Pflanze. Es konnte gezeigt werden, dass der Grund für diese unterschiedliche Regulation der beiden Epoxidasen die verschiedenen Quench-Eigenschaften der Pigmente Dtx bzw. Zx ist. Durch parallele Messungen des NPQ und des De-Epoxidierungsgrads wurde deutlich, dass Zx zum Aufbau eines Quenching direkt den im Licht aufgebauten delta-pH benötigt, während Dtx alleine ausreichend ist, um ein Quenching zu verursachen. Bei diesen in vivo Messungen wurde außerdem deutlich, dass die Aktivitäten der untersuchten Epoxidasen große Unterschiede aufweisen. Diese sind abhängig von der entsprechenden Pigmentierung des jeweiligen Lichtsammelsystems, stehen also in Zusammenhang mit den Carotinoidbiosynthesen. Es konnte gezeigt werden, dass bei allen untersuchten Organismen, die eine Xanthophyll-dominierte Antenne mit Fx als Massenpigment enthielten, die Umsatzraten der Epoxidase sehr hoch waren, im Gegensatz zu Chl-dominierten Antennen. Nach diesen Erkenntnissen wurde die Dtx-Epoxidase weiter untersucht und so erstmalig durch Western-Blotting identifiziert. Es ergaben sich, allerdings erst nach zusätzlicher Proteinstabilisierung, zwei Signale, eins bei 60 kDa, das andere bei 57 kDa. Hierbei ist nach wie vor unklar, warum das Antiserum zwei Signale lieferte und ob es sich dabei um Isoformen, um anderweitige Modifizierungen, oder um eine Kreuzreaktion handelt. Auch der Mechanismus der delta-pH-Regulation der Dtx-Epoxidase konnte trotz in vivo und in vitro durchgeführter Studien nicht endgültig geklärt werden. Allerdings konnten verschiedene Mechanismen, wie z.B. eine direkte pH-Abhängigkeit des Enzyms, eine Regulation durch Reduktion und Oxidation oder durch Phosphorylierung und Dephosphorylierung, auf Grund der Daten falsifiziert werden. Es konnte schließlich die Regulation mit Hilfe eines transmembranen Rezeptors als das einzige, mit allen Daten konsistente Regulationsmodell vorgeschlagen werden.

Gemtuzumab ozogamicin as postremission treatment in AML at 60 years of age or more: results of a multicenter phase 3 study

In older patients with acute myeloid leukemia (AML), the prevention of relapse has remained one of the major therapeutic challenges, with more than 75% relapses after complete remission. The anti-CD33 immunotoxin conjugate gemtuzumab ozogamicin (GO) has shown antileukemic remission induction activity in patients with relapsed AML. Patients with AML or refractory anemia with excess blasts in first complete remission attained after intensive induction chemotherapy were randomized between 3 cycles of GO (6 mg/m(2) every 4 weeks) or no postremission therapy (control) to assess whether GO would improve outcome. The 2 treatment groups (113 patients receiving GO vs 119 control patients) were comparable with regard to age (60-78 years, median 67 years), performance status, and cytogenetics. A total of 110 of 113 received at least 1 cycle of GO, and 65 of 113 patients completed the 3 cycles. Premature discontinuation was mainly attributable to incomplete hematologic recovery or intercurrent relapse. Median time to recovery of platelets 50 x 10(9)/L and neutrophils 0.5 x 10(9)/L after GO was 14 days and 20 days. Nonhematologic toxicities were mild overall, but there was 1 toxic death caused by liver failure. There were no significant differences between both treatment groups with regard to relapse probabilities, nonrelapse mortality, overall survival, or disease-free survival (17% vs 16% at 5 years). Postremission treatment with GO in older AML patients does not provide benefits regarding any clinical end points. The HOVON-43 study is registered at The Netherlands Trial Registry (number NTR212) and at http://www.controlled-trials.com as ISRCTN77039377.