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- Lund, Johan, et al.
(författare)
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Lenalidomide versus lenalidomide plus dexamethasone prolonged treatment after second-line lenalidomide plus dexamethasone induction in multiple myeloma
- 2018
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Ingår i: Cancer Medicine. - : WILEY. - 2045-7634. ; 7:6, s. 2256-2268
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Tidskriftsartikel (refereegranskat)abstract
- Lenalidomide (Len) plus dexamethasone (Dex) is approved for the treatment of relapsed or refractory multiple myeloma (RRMM). It is possible that single-agent Len may be effective as prolonged treatment regimen in RRMM once patients demonstrate an initial response to Len+Dex induction. Patients with RRMM who responded to first-line Len+Dex in an observational study (NCT01430546) received up to 24 cycles of either Len (25mg/day) or Len+Dex (25mg/day and 40mg/week) as prolonged treatment in a subsequent phase 2 clinical trial (NCT01450215). In the observational study (N = 133), median time to response was 1.7 (range 0.6-9.6) months. A complete response to all treatments received in both studies was observed in 11% of patients; very good partial response and partial response rates were 31% and 38%, respectively. Corresponding response rates in the subgroup of patients who did not enter the phase 2 trial (n = 71) were 3%, 18%, and 39%, respectively. Rates of disease progression at 2years in the phase 2 trial were 47% versus 31% for Len versus Len+Dex (P = 0.14). After 36months median follow-up in surviving patients, median time to progression was not reached with Len+Dex and was 24.9months (95% confidence interval 12.5-not calculable, P amp;lt; 0.001) with Len. Three-year OS among the total observational study population was 61% (95% CI, 52-69%). The corresponding rate among patients who entered the phase 2 clinical trial was 73% (95% CI, 60-83%) and was significantly lower among those patients who achieved PR but did not proceed into the phase 2 trial (55%; P = 0.01). In the phase 2 trial, OS was 73% in both treatment arms (P = 0.70). Neutropenia and thrombocytopenia were more common with prolonged (phase 2 trial) versus short-term (observational study) Len administration but remained manageable. Prolonged treatment with Len with or without Dex provides sustained, clinically relevant responses and demonstrates an acceptable safety profile.
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- Abalaka, Jacinta, et al.
(författare)
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Genetic diversity and population structure of the range restricted rock firefinch Lagonosticta sanguinodorsalis
- 2015
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Ingår i: Conservation Genetics. - : Springer Science and Business Media LLC. - 1566-0621 .- 1572-9737. ; 16:2, s. 411-418
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Tidskriftsartikel (refereegranskat)abstract
- Understanding the degree of genetic population differentiation is important in conservation genetics for inferring gene flow between populations and for identifying small and isolated threatened populations. We evaluated the genetic variation within and between three populations of the rock firefinch (Lagonosticta sanguinodorsalis), a range restricted firefinch endemic to Nigeria and Cameroon. The populations were closely located (c. 100 km apart) within the species' core distribution in Central Nigeria. We found that the populations had similar levels of gene diversities (H (E) ) and low but significant inbreeding coefficients (F (IS) ). Despite the short distance between populations there was a weak but significant population structure, which indicates that the populations are somewhat isolated and affected by drift within the species' core distribution in Nigeria. The knowledge of the genetic status of the rock firefinch will serve as a foundation to future studies to help understand population demography and for managing and maintaining viable populations.
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- Ahlqvist, Emma, et al.
(författare)
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Novel subgroups of adult-onset diabetes and their association with outcomes : a data-driven cluster analysis of six variables
- 2018
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Ingår i: The Lancet Diabetes and Endocrinology. - 2213-8587 .- 2213-8595. ; 6:5, s. 361-369
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDiabetes is presently classified into two main forms, type 1 and type 2 diabetes, but type 2 diabetes in particular is highly heterogeneous. A refined classification could provide a powerful tool to individualise treatment regimens and identify individuals with increased risk of complications at diagnosis.MethodsWe did data-driven cluster analysis (k-means and hierarchical clustering) in patients with newly diagnosed diabetes (n=8980) from the Swedish All New Diabetics in Scania cohort. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance), and were related to prospective data from patient records on development of complications and prescription of medication. Replication was done in three independent cohorts: the Scania Diabetes Registry (n=1466), All New Diabetics in Uppsala (n=844), and Diabetes Registry Vaasa (n=3485). Cox regression and logistic regression were used to compare time to medication, time to reaching the treatment goal, and risk of diabetic complications and genetic associations.FindingsWe identified five replicable clusters of patients with diabetes, which had significantly different patient characteristics and risk of diabetic complications. In particular, individuals in cluster 3 (most resistant to insulin) had significantly higher risk of diabetic kidney disease than individuals in clusters 4 and 5, but had been prescribed similar diabetes treatment. Cluster 2 (insulin deficient) had the highest risk of retinopathy. In support of the clustering, genetic associations in the clusters differed from those seen in traditional type 2 diabetes.InterpretationWe stratified patients into five subgroups with differing disease progression and risk of diabetic complications. This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes.
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- Alvåsen, Karin, et al.
(författare)
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Animal Welfare and Economic Aspects of Using Nurse Sows in Swedish Pig Production
- 2017
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Ingår i: Frontiers in Veterinary Science. - : Frontiers Media SA. - 2297-1769. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- The number of born piglets per litter has increased in Swedish pig industry, and farmers are struggling to improve piglet survival. A common practice is to make litters more equally sized by moving piglets from large litters to smaller to make sure that all piglets get an own teat to suckle. Litter equalization is not always enough, as many sows have large litters and/or damaged teats, which results in an insufficient number of available teats. One way to solve this problem is to use nurse sows. A nurse sow raises, and weans, her own piglets before receiving a foster litter. The objectives of this study were to address how the use of nurse sows affects the welfare of sows and piglets and to explore how it impacts the contribution margin of pig production in Sweden. A literature search was made to investigate welfare aspects on sows and piglets. As there were few published studies on nurse sows, an expert group meeting was organized. In order to explore the impact on the contribution margin of pig production, a partial budgeting approach with stochastic elements was used for a fictive pig farm. Standard templates for calculating costs and benefits were supplemented with figures from existing literature and the gathered expert opinions. In Sweden, the minimum suckling period is 28 days while published studies involving nurse sows, all from outside of Sweden, weaned the piglets at 21 days. A Swedish nurse sow will thus get longer lactation period which might increase the risk of poor body condition, damaged teats, and shoulder ulcers. This indicates a reduced welfare of the sow and may lead to impaired fertility and increased culling risk. On the other hand, the piglet mortality could be reduced with the use of nurse sows, but the separation and mixing of piglets could be stressful. The partial budgeting suggested that the nurse sow system is slightly more profitable (+6,838 Swedish krona) per farrowing group during one dry and one lactation period compared to the conventional system. The result is, however, highly dependent on the input values, and welfare aspects were not considered in the calculations.
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