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The autologous anti‐CD19 chimeric antigen receptor (CAR) T‐cell product, lisocabtagene maraleucel (liso‐cel), is administered at equal target doses of CD8+ and CD4+ CAR+ T cells. This analysis assessed safety and efficacy of liso‐cel in Japanese patients with relapsed or refractory (R/R) aggressive large B‐cell lymphoma (LBCL) in Cohort 3 of TRANSCEND WORLD (NCT03484702). Liso‐cel (100 × 106 total CAR+ T cells) was administered 2–7 days after lymphodepletion. The primary efficacy endpoint was objective response rate (ORR; Lugano 2014 criteria) assessed by an independent review committee. Fourteen patients were enrolled; 10 received liso‐cel infusion (median time to liso‐cel availability, 23 days) and were evaluable at data cutoff (median follow‐up, 12.5 months). Grade ≥ 3 treatment‐emergent adverse events were neutropenia (90%), leukopenia (80%), anemia (70%), and thrombocytopenia (70%). All‐grade cytokine release syndrome (CRS) was observed in 50% of patients, though no grade ≥3 CRS events were reported. Grade 1 neurological events occurred in 1 patient but were resolved without any intervention. Prolonged cytopenia (grade ≥ 3 at day 29) was reported for 60% of patients. The ORR was 70%, and complete response rate was 50%. The median duration of response was 9.1 months (95% confidence interval [CI], 2.1—not reached), and overall survival was 14.7 months (95% CI, 1.7—not reached). One patient diagnosed with central nervous system involvement after screening but before liso‐cel infusion, responded to liso‐cel. Liso‐cel demonstrated meaningful efficacy and a manageable safety profile in Japanese patients with R/R LBCL. This analysis assessed safety and efficacy of lisocabtagene maraleucel (liso‐cel), an autologous CD‐19‐directed CAR T‐cell product, in Japanese patients with R/R aggressive LBCL in Cohort 3 of TRANSCEND WORLD (NCT03484702). Liso‐cel demonstrated meaningful efficacy and a manageable safety profile in Japanese patients with R/R LBCL. We also report the first case of a patient who was diagnosed with secondary CNS lymphoma and achieved a response following treatment with liso‐cel.

Patients with large B-cell lymphoma (LBCL) primary refractory to or relapsed within 12 months of first-line therapy are at high risk for poor outcomes with current standard of care, platinum-based salvage immunochemotherapy and autologous haematopoietic stem cell transplantation (HSCT). Lisocabtagene maraleucel (liso-cel), an autologous, CD19-directed chimeric antigen receptor (CAR) T-cell therapy, has previously demonstrated efficacy and manageable safety in third-line or later LBCL. In this Article, we report a prespecified interim analysis of liso-cel versus standard of care as second-line treatment for primary refractory or early relapsed (within 12 months after response to initial therapy) LBCL. TRANSFORM is a global, phase 3 study, conducted in 47 sites in the USA, Europe, and Japan, comparing liso-cel with standard of care as second-line therapy in patients with primary refractory or early (≤12 months) relapsed LBCL. Adults aged 18–75 years, Eastern Cooperative Oncology Group performance status score of 1 or less, adequate organ function, PET–positive disease per Lugano 2014 criteria, and candidates for autologous HSCT were randomly assigned (1:1), by use of interactive response technology, to liso-cel (100 × 106 CAR+ T cells intravenously) or standard of care. Standard of care consisted of three cycles of salvage immunochemotherapy delivered intravenously—R-DHAP (rituximab 375 mg/m2 on day 1, dexamethasone 40 mg on days 1–4, two infusions of cytarabine 2000 mg/m2 on day 2, and cisplatin 100 mg/m2 on day 1), R-ICE (rituximab 375 mg/m2 on day 1, ifosfamide 5000 mg/m2 on day 2, etoposide 100 mg/m2 on days 1–3, and carboplatin area under the curve 5 [maximum dose of 800 mg] on day 2), or R-GDP (rituximab 375 mg/m2 on day 1, dexamethasone 40 mg on days 1–4, gemcitabine 1000 mg/m2 on days 1 and 8, and cisplatin 75 mg/m2 on day 1)—followed by high-dose chemotherapy and autologous HSCT in responders. Primary endpoint was event-free survival, with response assessments by an independent review committee per Lugano 2014 criteria. Efficacy was assessed per intention-to-treat (ie, all randomly assigned patients) and safety in patients who received any treatment. This trial is registered with ClinicalTrials.gov, NCT03575351, and is ongoing. Between Oct 23, 2018, and Dec 8, 2020, 232 patients were screened and 184 were assigned to the liso-cel (n=92) or standard of care (n=92) groups. At the data cutoff for this interim analysis, March 8, 2021, the median follow-up was 6·2 months (IQR 4·4–11·5). Median event-free survival was significantly improved in the liso-cel group (10·1 months [95% CI 6·1–not reached]) compared with the standard-of-care group (2·3 months [2·2–4·3]; stratified hazard ratio 0·35; 95% CI 0·23–0·53; stratified Cox proportional hazards model one-sided p<0·0001). The most common grade 3 or worse adverse events were neutropenia (74 [80%] of 92 patients in the liso-cel group vs 46 [51%] of 91 patients in the standard-of-care group), anaemia (45 [49%] vs 45 [49%]), thrombocytopenia (45 [49%] vs 58 [64%]), and prolonged cytopenia (40 [43%] vs three [3%]). Grade 3 cytokine release syndrome and neurological events, which are associated with CAR T-cell therapy, occurred in one (1%) and four (4%) of 92 patients in the liso-cel group, respectively (no grade 4 or 5 events). Serious treatment-emergent adverse events were reported in 44 (48%) patients in the liso-cel group and 44 (48%) in the standard-of-care group. No new liso-cel safety concerns were identified in the second-line setting. There were no treatment-related deaths in the liso-cel group and one treatment-related death due to sepsis in the standard-of-care group. These results support liso-cel as a new second-line treatment recommendation in patients with early relapsed or refractory LBCL. Celgene, a Bristol-Myers Squibb Company.

Aim: Among the world's three major nectar-feeding bird taxa, hummingbirds are the most phenotypically specialized for nectarivory, followed by sunbirds, while the honeyeaters are the least phenotypically specialized taxa. We tested whether this phenotypic specialization gradient is also found in the interaction patterns with their floral resources. Location: Americas, Africa, Asia and Oceania/Australia. Methods: We compiled interaction networks between birds and floral resources for 79 hummingbird, nine sunbird and 33 honeyeater communities. Interaction specialization was quantified through connectance (C), complementary specialization (H2′), binary (QB) and weighted modularity (Q), with both observed and null-model corrected values. We compared interaction specialization among the three types of bird–flower communities, both independently and while controlling for potential confounding variables, such as plant species richness, asymmetry, latitude, insularity, topography, sampling methods and intensity. Results: Hummingbird–flower networks were more specialized than honeyeater–flower networks. Specifically, hummingbird–flower networks had a lower proportion of realized interactions (lower C), decreased niche overlap (greater H2′) and greater modularity (greater QB). However, we found no significant differences between hummingbird– and sunbird–flower networks, nor between sunbird– and honeyeater–flower networks. Main conclusions: As expected, hummingbirds and their floral resources have greater interaction specialization than honeyeaters, possibly because of greater phenotypic specialization and greater floral resource richness in the New World. Interaction specialization in sunbird–flower communities was similar to both hummingbird–flower and honeyeater–flower communities. This may either be due to the relatively small number of sunbird–flower networks available, or because sunbird–flower communities share features of both hummingbird–flower communities (specialized floral shapes) and honeyeater–flower communities (fewer floral resources). These results suggest a link between interaction specialization and both phenotypic specialization and floral resource richness within bird–flower communities at a global scale.

The near-Earth cosmic ray flux has been monitored for more than 70 years by a network of ground-based neutron monitors (NMs). With the ever-increasing importance of quantifying the radiation risk and effects of cosmic rays for, e.g., air and space-travel, it is essential to continue operating the existing NM stations, while expanding this crucial network. In this paper, we discuss a smaller and cost-effective version of the traditional NM, the mini-NM. These monitors can be deployed with ease, even to extremely remote locations, where they operate in a semi-autonomous fashion. We believe that the mini-NM, therefore, offers the opportunity to increase the sensitivity and expand the coverage of the existing NM network, making this network more suitable to near-real-time monitoring for space weather applications. In this paper, we present the technical details of the mini-NM’s design and operation, and present a summary of the initial tests and science results.

The near-Earth cosmic ray flux has been monitored for more than 70 years by a network of ground-based neutron monitors (NMs). With the ever-increasing importance of quantifying the radiation risk and effects of cosmic rays for, e.g., air and space-travel, it is essential to continue operating the existing NM stations, while expanding this crucial network. In this paper, we discuss a smaller and cost-effective version of the traditional NM, the mini-NM. These monitors can be deployed with ease, even to extremely remote locations, where they operate in a semi-autonomous fashion. We believe that the mini-NM, therefore, offers the opportunity to increase the sensitivity and expand the coverage of the existing NM network, making this network more suitable to near-real-time monitoring for space weather applications. In this paper, we present the technical details of the mini-NM's design and operation, and present a summary of the initial tests and science results.