Bendamustine + rituximab chemoimmunotherapy and maintenance lenalidomide in relapsed, refractory chronic lymphocytic leukaemia and small lymphocytic lymphoma: A Wisconsin Oncology Network Study.

Bendamustine + rituximab (BR) has demonstrated high response rates in relapsed/refractory (R/R) chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL). However, progression-free survival (PFS) after BR is <18 months. This study was designed to determine if maintenance lenalidomide after BR induction could improve PFS in R/R CLL/SLL. Thirty-four patients with R/R CLL/SLL who had received 1-5 prior chemotherapy regimens were treated with 6 cycles of BR induction. Patients achieving at least a minor response received twelve 28-d cycles of lenalidomide 5-10 mg/d. The primary endpoint was PFS. The median age was 67 years, with a median of 2 prior therapies. Eleven patients had confirmed presence of 17p and/or 11q deletions. Twenty-five (74%) completed 6 cycles of induction BR (response rate 56%). Nineteen (56%) patients received maintenance lenalidomide; only 6 patients completed the intended 12 cycles, highlighting the limited feasibility of lenalidomide in this setting, primarily due to haematological and infectious toxicities. The observed median PFS of 18·3 months is not significantly different from that of BR induction in R/R CLL/SLL without maintenance therapy (15·2 months). It is possible that lenalidomide maintenance may be more feasible and effective in the front-line setting, which is being tested in an ongoing trial (NCT01754857).

Efficacy of pre-treatment with lufenuron for the prevention of Microsporum canis infection in a feline direct topical challenge model.

Oral lufenuron is reportedly an effective treatment for some cats with dermatophytosis. The purpose of this study was to determine if lufenuron, when used as a pre-treatment prior to challenge exposure, would be protective against the development of infection after the direct topical application of fungal macrocondia (Microsporum canis spores). Three groups (n = 6/group) of juvenile cats were treated with either monthly oral lufenuron (30 or 133 mg/kg) or placebo. After 2 months of treatment, kittens were challenged using 10(5)Microsporum canis spores applied to the skin under occlusion. Cats were examined weekly and the following data collected: Wood's lamp examination; scoring for scale/crust, erythema and induration; lesion size; and the development of satellite lesions. Fungal cultures were performed bi-weekly. All cats became infected; the infections progressed, and then regressed, in a similar fashion in all groups. There were no consistent statistically significant differences in weekly infection scores between treated and untreated cats throughout the study. Treated cats did not recover faster than untreated cats. We conclude that oral lufenuron at the dosing schedule and conditions used in this study did not prevent dermatophytosis or alter the course of infection by direct topical challenge.

Development of an in vitro, isolated, infected spore testing model for disinfectant testing of Microsporum canis isolates.

The isolated infected hair model is a commonly used technique to test the fungicidal efficacy of topical therapies against Microsporum canis. The most commonly used model uses mats of infective hairs, and results from various laboratories have differed. The objectives of this study were to develop a method to produce spores for testing when only mycelial forms were available and to develop a semiquantitative testing method that used only infective spores from hairs, and not pooled hair samples for testing. Ten isolates of M. canis were used in this study. Juvenile guinea pigs were easily infected using mycelial forms of M. canis and large numbers of spores were easily harvested for testing. Eight dilutions of disinfectants were tested. Fungal culture data were evaluated using an endpoint dilution at which there was 100% fungicidal activity, i.e. no growth on the plates. The 10 samples showed identical results. Chlorhexidine and Virkon(R) S were ineffective even when used at x4 the manufacturer's recommended dilution. Lime sulphur (1 : 33), enilconazole (20 microL mL(-1)), and bleach (1 : 10) were consistently effective when used at the recommended dilution. In addition, lime sulphur and enilconazole were 100% fungicidal even when the recommended concentration was diluted 1 : 4 or x4 as dilute as recommended.

Effects of lufenuron treatment in cats on the establishment and course of Microsporum canis infection following exposure to infected cats.

OBJECTIVE: To determine effects of lufenuron treatment in cats on the establishment and course of Microsporum canis infection following exposure to infected cats. DESIGN: Experimental trial. ANIMALS: 24 healthy juvenile domestic shorthair cats. PROCEDURE: 8 cats were given lufenuron PO (133 mg/cat/mo, equivalent to a dose of 100 to 130 mg/kg [45 to 59 mg/lb] at the beginning of the study and 25 to 35 mg/kg [11 to 16 mg/lb] at the end of the study), and 8 were given lufenuron SC (40 mg every 6 months). The remaining 8 were used as untreated control cats. After 4 months, cats were challenged by the introduction of cats with mild, experimentally induced M canis infection into the rooms where cats were housed. Extent of resulting infections in the naïve cats was monitored for 22 weeks by physical examination and fungal culture. RESULTS: All lufenuron-treated and control cats became infected with M canis. Cats treated with lufenuron had significantly lower infection scores, compared with control cats, during the early weeks following exposure, and there was a more prolonged initial progression phase of the infection. Once infections reached peak intensity, they resolved over similar periods in lufenuron-treated and control cats. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that oral or SC administration of lufenuron to cats, at the dosages used and under the conditions of this study, did not prevent establishment of dermatophytosis following exposure to infected cats. Infection was established more slowly among cats treated with lufenuron, but once established, infection resolved in approximately the same amount of time in lufenuron-treated as in control cats.

Safety and immunologic effects after inoculation of inactivated and combined live-inactivated dermatophytosis vaccines in cats.

OBJECTIVE: To determine antidermatophyte immunologic effects of an experimental combined live-inactivated dermatophytosis vaccine (CLIDV) and a commercial inactivated dermatophytosis vaccine (IDV) in cats and to evaluate adverse effects associated with administration of these vaccines. ANIMALS: 20 healthy juvenile domestic shorthair cats. PROCEDURE: Cats were injected with 2 doses of CLIDV at the standard dosage or 1 dose of CLIDV at 10 times the standard dosage; IDV was administered at the manufacturer-recommended dosage. Cats were observed for illness and reactions at inoculation sites. Periodically, samples were obtained for fungal culture, lymphocyte blastogenesis test (LBT) as an indicator of cell-mediated immunity against dermatophyte antigens, and antidermatophyte IgG titers. Following vaccination, cats were challenge-exposed by topical application of Microsporum canis macroconidia and examined weekly for clinical signs of dermatophytosis. RESULTS: of 10 cats given CLIDV developed focal crusts at the injection site that resolved without treatment; these were areas of dermatophyte infection with the vaccine strain. Antidermatophyte IgG titers increased significantly with all vaccination protocols. Cellular immunity against M canis increased slightly and variably during the vaccination period and did not differ significantly between vaccinated and control cats. All cats developed dermatophyte infection after challenge exposure. Vaccination with CLIDV or IDV was associated with slightly reduced severity of initial infection. CONCLUSIONS AND CLINICAL RELEVANCE: Noculation with IDV or CLIDV did not provide prophylactic immunity against topical challenge exposure with M canis. Inoculation with either vaccine did not provide a more rapid cure of an established infection.

Application of rapid CD3 immunophenotype analysis and argyrophilic nucleolar organizer region (AgNOR) frequency to fine needle aspirate specimens from dogs with lymphoma.

Determinations of CD3 immunoreactivity (CD3-IR) and argyrophilic nucleolar organizer region (AGNOR) frequency from fine needle aspirate (FNA) samples were compared with those from formalin-fixed, paraffin-embedded surgical biopsy samples in 51 dogs with lymphoma. Both CD3-IR (using a rapid EPOS polymer system) and AGNOR techniques were readily applied to FNA samples. CD3-IR from FNA samples matched those of histologic samples with 100% concordance. A linear relationship (r=0.981; P<0.001) was found between AGNOR frequency obtained from FNA samples and those obtained from surgical biopsy samples. Application of the techniques presented here should allow clinically relevant information to be procured rapidly and inexpensively. As CD3-IR and AGNOR frequency have been shown to be predictive of response to combination chemotherapy in dogs with lymphoma, such information could be used to better educate clients as to the likelihood of achieving meaningful responses, as well as allowing prospective tailoring of individual treatments in future trials prior to initiating therapy.