Post-remission treatment with allogeneic stem cell transplantation in patients aged 60 years and older with acute myeloid leukaemia: a time-dependent analysis

BACKGROUND Acute myeloid leukaemia mainly affects elderly people, with a median age at diagnosis of around 70 years. Although about 50-60% of patients enter first complete remission upon intensive induction chemotherapy, relapse remains high and overall outcomes are disappointing. Therefore, effective post-remission therapy is urgently needed. Although often no post-remission therapy is given to elderly patients, it might include chemotherapy or allogeneic haemopoietic stem cell transplantation (HSCT) following reduced-intensity conditioning. We aimed to assess the comparative value of allogeneic HSCT with other approaches, including no post-remission therapy, in patients with acute myeloid leukaemia aged 60 years and older. METHODS For this time-dependent analysis, we used the results from four successive prospective HOVON-SAKK acute myeloid leukaemia trials. Between May 3, 2001, and Feb 5, 2010, a total of 1155 patients aged 60 years and older were entered into these trials, of whom 640 obtained a first complete remission after induction chemotherapy and were included in the analysis. Post-remission therapy consisted of allogeneic HSCT following reduced-intensity conditioning (n=97), gemtuzumab ozogamicin (n=110), chemotherapy (n=44), autologous HSCT (n=23), or no further treatment (n=366). Reduced-intensity conditioning regimens consisted of fludarabine combined with 2 Gy of total body irradiation (n=71), fludarabine with busulfan (n=10), or other regimens (n=16). A time-dependent analysis was done, in which allogeneic HSCT was compared with other types of post-remission therapy. The primary endpoint of the study was 5-year overall survival for all treatment groups, analysed by a time-dependent analysis. FINDINGS 5-year overall survival was 35% (95% CI 25-44) for patients who received an allogeneic HSCT, 21% (17-26) for those who received no additional post-remission therapy, and 26% (19-33) for patients who received either additional chemotherapy or autologous HSCT. Overall survival at 5 years was strongly affected by the European LeukemiaNET acute myeloid leukaemia risk score, with patients in the favourable risk group (n=65) having better 5-year overall survival (56% [95% CI 43-67]) than those with intermediate-risk (n=131; 23% [19-27]) or adverse-risk (n=444; 13% [8-20]) acute myeloid leukaemia. Multivariable analysis with allogeneic HSCT as a time-dependent variable showed that allogeneic HSCT was associated with better 5-year overall survival (HR 0·71 [95% CI 0·53-0·95], p=0·017) compared with non-allogeneic HSCT post-remission therapies or no post-remission therapy, especially in patients with intermediate-risk (0·82 [0·58-1·15]) or adverse-risk (0.39 [0·21-0·73]) acute myeloid leukaemia. INTERPRETATION Collectively, the results from these four trials suggest that allogeneic HSCT might be the preferred treatment approach in patients 60 years of age and older with intermediate-risk and adverse-risk acute myeloid leukaemia in first complete remission, but the comparative value should ideally be shown in a prospective randomised study. FUNDING None.

Features of Land Conflicts in Post Civil War Rwanda

Land conflicts in Rwanda have attracted particular attention because they have both environmental and political causes. This paper attempts to shed light on the nature of land conflicts in present-day Rwanda based on popular justice records and interviews collected in two rural areas. From the analyses of these data, two types of land confl ict can be distinguished. The first type consists of those among family members. Given that land is the most important asset for ordinary rural households, its inheritance often brings about conflicts between right-holders. Those of the second type are triggered by political change. Impacts of the two national-level violent conflicts in Rwanda, the “social revolution” just before independence and the civil war in the 1990s, are of tremendous significance in this context. The military victory of the former rebels in 1994 caused a massive return of Tutsi refugees, who were officially permitted to acquire land from the original inhabitants. Although no serious protestation against this policy has occurred thus far, it has produced various land conflicts. Dealing with potential grievances among original inhabitants is an important challenge for the present government.

Research review : searching for a new framework for Thailand's foreign policy in the post-cold war era

Thai foreign policy in the 1990s has been said to be contingent on the government in power, which changes between (or within) these groups and vacillates between pro-democratic reformists/principle-pursuers and the conservatives/profit-seekers. In these studies, Thailand’s Indochinese policy has often been referred to as a typical consequence of politics between the pragmatists and the reformists. However, whether or not domestic oppositional politics is the key determinant of foreign policy in the post-Cold War era still requires further examination, precisely because the model is now facing serious challenges between theory and reality. In this paper, I review the existing arguments concerning Thailand’s foreign policy in the post-Cold War Era and point out their limitations and questions for future study.

Rotten Symbol Mongering: Scapegoating in Post-9/11 American War Literature

A rhetorical approach to the fiction of war offers an appropriate vehicle by which one may encounter and interrogate such literature and the cultural metanarratives that exist therein. My project is a critical analysis—one that relies heavily upon Kenneth Burke’s dramatistic method and his concepts of scapegoating, the comic corrective, and hierarchical psychosis—of three war novels published in 2012 (The Yellow Birds by Kevin Powers, FOBBIT by David Abrams, and Billy Lynn’s Long Halftime Walk by Ben Fountain). This analysis assumes a rhetorical screen in order to subvert and redirect the grand narratives the United States perpetuates in art form whenever it goes to war. Kenneth Burke’s concept of ad bellum purificandum (the purification of war) sought to bridge the gap between war experience and the discourse that it creates in both art and criticism. My work extends that project. I examine the symbolic incongruity of convenient symbols that migrate from war to war (“Geronimo” was used as code for Osama bin Laden’s death during the S.E.A.L team raid; “Indian Country” stands for any dangerous land in Iraq; hajji is this generation’s epithet for the enemy other). Such an examination can weaken our cultural “symbol mongering,” to borrow a phrase from Walker Percy. These three books, examined according to Burke’s methodology, exhibit a wide range of approaches to the soldier’s tale. Notably, however, whether they refigure the grand narratives of modern culture or recast the common redemptive war narrative into more complex representations, this examination shows how one can grasp, contend, and transcend the metanarrative of the typical, redemptive war story.

Russia's Clandestine War against the United States: The Resurrection of the KGB and Russian Organized Crime Post 9/11

As American leadership has narrowly focused on fighting global terror in Iraq and Afghanistan, the modern version of the KGB, now known as the FSB, has been conducting continuous clandestine warfare operations against the United States. These warfare operations include strategic economic and political partnerships with anti-American entities worldwide and direct embedding of double agents in the US intelligence community. This paper investigates the role of Russia's cultural history leading to the merger of the Russian Federal Security Service (FSB) and Russian Organized Crime (ROC). This paper concludes that the FSB is the most pervasive security threat to the United States and that employing Russian native and heritage speakers of Russian in the US intelligence community compromises US national security.

The European Union and Post-Cold War Defence Policies in South America. Jean Monnet/Robert Schuman Paper Series Vol. 14 No. 10, May 2014

None.

Rome and the world today; a study, in comparison with present conditions, of the reorganization of civilization under the Roman empire which brought to a war-worn world two hundred years of peace,

Mode of access: Internet.

Post cold war challenges to U.S. military : hearings before the Committee on Armed Services, United States Senate, One Hundred Fifth Congress, second session, January 29, March 19, 25, and June 4, 1998.

Shipping list no.: 99-0081-P.

"Let's go!" 10 years' retrospect of the World War; historical official statistics, copies of documents and intimate anecdotes pertaining to the 1 Division, United States Army, from June 14th, 1917, to November 11th, 1918,

Lettered on cover of this copy: Nelson M. Holderman, M.H., Captain U.S. Army, retired.

The motor-bus in war; being the impressions of an A.S.C. officer during two and a half years at the front,

Mode of access: Internet.

Gun fodder; the diary of four years of war,

Mode of access: Internet.

Richmond during the war; four years of personal observation.

Mode of access: Internet.