Abstract: Thrombocytopenia is a common feature of myelofibrosis (MF), a myeloproliferative neoplasm driven by dysregulated JAK/STAT signaling; however, pivotal trials assessing the efficacy of ruxolitinib (a JAK1/2 inhibitor) excluded MF patients with low platelet counts ( 〈 100 × 10 9 /L). Objectives: Determination of the maximum safe starting dose (MSSD) of ruxolitinib was the primary endpoint, with long-term safety and efficacy as secondary and exploratory endpoints, respectively. Design: EXPAND (NCT01317875) was a phase 1b, open-label, ruxolitinib dose-finding study in patients with MF and low platelet counts (50 to 〈 100 × 10 9 /L). Methods: Patients were stratified according to baseline platelet count into stratum 1 (S1, 75 to 〈 100 × 10 9 /L) or stratum 2 (S2, 50 to 〈 75 × 10 9 /L). Previous analyses established the MSSD at 10 mg twice daily (bid); long-term results are reported here. Results: Of 69 enrolled patients, 38 received ruxolitinib at the MSSD (S1, n = 20; S2, n = 18) and are the focus of this analysis. The incidence of adverse events was consistent with the known safety profile of ruxolitinib, with thrombocytopenia (S1, 50%; S2, 78%) and anemia (S1, 55%; S2, 44%) the most frequently reported adverse events and no new or unexpected safety signals. Substantial clinical benefits were observed for patients in both strata: 50% (10/20) and 67% (12/18) of patients in S1 and S2, respectively, achieved a spleen response (defined as ⩾50% reduction in spleen length from baseline) at any time during the study. Conclusion: The final safety and efficacy results from EXPAND support the use of a 10 mg bid starting dose of ruxolitinib in patients with MF and platelet counts 50 to 〈 100 × 10 9 /L. Registration: ClinicalTrials.gov NCT01317875.

Abstract: A fast and efficient microwave (MW)‐assisted solid‐phase peptide synthesis protocol using the 2‐chlorotrityl chloride resin and the Fmoc/tBu methodology, has been developed. The established protocol combines the advantages of MW irradiation and the acid labile 2‐chlorotrityl chloride resin. The effect of temperature during the MW irradiation, the degree of resin substitution during the coupling of the first amino acids and the rate of racemization for each amino acid were evaluated. The suggested solid phase methodology is applicable for orthogonal peptide synthesis and for the synthesis of cyclic peptides. © 2015 Wiley Periodicals, Inc. Biopolymers (Pept Sci) 104: 506–514, 2015.

Abstract: Mitochondria-targeting drugs and diagnostics are used in the monitoring and treatment of mitochondrial pathologies. In this respect, a great number of functional compounds have been made mitotropic by covalently attaching the active moiety onto a triphenylphosphonium (TPP) cation. Among these compounds, a number of molecular detectors for reactive oxygen species (ROS) are based on fluorescent and chemiluminescent probes. In this regard, luminol (probably the most widely known chemiluminescent molecule) has been employed for a number of biological applications, including ROS detection. Its oxidation under specific conditions triggers a cascade of reactions, ultimately leading to the excited 3-aminophthalate (3AP *), which emits light upon deactivation. Hence, the photophysical interaction between the light-emitting species 3AP * and TPP cations needs to be evaluated, as it can add valuable information on the design of novel emission-based mitotropic systems. We herein investigate the quenching effect of ethyltriphenylphosphonium cation onto substituted 3-aminophthalates. These were prepared in situ upon hydrolysis of the corresponding anhydrides, which were synthesized from 3-aminophthalimides. Steady-state fluorescence and time-resolved experiments were employed for the evaluation of a possible electron transfer quenching by phosphonium ions. Our experimental results confirmed such quenching, suggesting it is mainly dynamic in nature. A minor contribution of static quenching that was also detected is attributed to complex formation in the ground state. Accordingly, the chemiluminescence of luminol was indeed strongly reduced in the presence of phosphonium ions. Our results have to be taken into account during the design of new chemiluminescent mitotropic drugs or diagnostic agents of the luminol family.

Abstract: The surface modification of fabrics composed of Kevlar®, Nomex®, or VAR was extensively investigated. Kevlar® and Nomex® are widely-utilized aramid materials, whereas VAR is a technical fabric comprising 64% viscose, 24% para-aramid (Kevlar®), 10% polyamide, and 2% antistatic fibers. Both aramid materials and cellulose/viscose exhibit exceptional mechanical properties that render them valuable in a wide range of applications. For the herein studied modification of Kevlar®, Nomex®, and VAR, we used small organic molecules 3-allyl-5,5-dimethylhydantoin (ADMH) and 3-(acrylamidopropyl)trimethylammonium chloride (APTAC), which were anchored onto the materials under study via graft polymerization. By doing so, excellent antibacterial properties were induced in the three studied fabrics. Their water repellency was improved in most cases as well. Extensive characterization studies were conducted to probe the properties of the modified materials, employing Raman and FTIR spectroscopies, Scanning Electron Microscopy (SEM), and thermogravimetric analysis (TGA).

Abstract: BACKGROUND RUX, a potent oral JAK1/JAK2 inhibitor, has shown superiority over standard therapies in MF. RUX was approved for the treatment of MF on the basis of the phase 3 COMFORT trials, in which RUX led to sustained improvements in splenomegaly and symptom burden as well as longer survival compared with placebo (COMFORT-I) and best available therapy (COMFORT-II). The starting dose (prescribing information) is based on PLT count: & gt; 200 × 109/L, 20 mg bid; 100-200 × 109/L, 15 mg bid. Due to limited data available at the time, the recommended starting dose in pts with PLT counts of 50 to & lt; 100 × 109/L was determined to be 5 mg bid. However, findings from COMFORT-I and Study 258 (phase 2 study of RUX in pts with MF with low PLT count) demonstrated that final titrated doses of ≥ 10 mg bid were safe and resulted in larger improvements in spleen volume and MF-related symptoms compared with titrated doses of ≤ 5 mg bid. The EXPAND study established a maximum safe starting dose (MSSD) in pts with low baseline PLT count (50 to & lt; 100 × 109/L) and evaluated the safety and tolerability of RUX in this population. The 24-wk (Vannucchi AM, et al. ASH 2015 #2817) and 48-wk (Vannucchi AM, et al. Haematologica. 2019) analyses determined the MSSD to be 10 mg bid for pts with baseline PLT count of 50 to & lt; 100 × 109/L. We present the final results from the study, confirming 10 mg bid as a safe starting dose for pts with low PLT count. METHODS EXPAND is a phase 1b, dose-finding study (NCT01317875) in pts with MF and baseline PLT count of 50 to & lt; 100 × 109/L (Stratum [S] 1, 75 to & lt; 100 × 109/L; S2, 50 to & lt; 75 × 109/L). The study had a core period (up to wk 24) consisting of 2 phases (dose escalation and safety expansion) followed by an extension period (up to 3 years total). The primary objective was determination of the MSSD for both strata; safety and efficacy were secondary objectives. RESULTS Of 69 enrolled pts, 38 received RUX at the MSSD of 10 mg bid (S1, n = 20; S2, n = 18) and are the focus of this analysis. Baseline characteristics were indicative of advanced disease in both strata. Overall, 50% of pts in S1 and 83% of pts in S2 discontinued study treatment. Primary reasons for discontinuation were progressive disease (15%), adverse events (AEs; 10%), and other (10%) in S1 and AEs (33%), death (17%), and physician decision (17%) in S2. Median (range) duration of exposure was 155 (4-210) wk in S1 and 83 (4-161) wk in S2; 17/20 pts (85%) in S1 and 11/18 (61%) in S2 received RUX for ≥ 48 wk. AEs were consistent with the known safety profile of RUX (Table). The most common AEs were thrombocytopenia (S1, 50%; S2, 78%) and anemia (S1, 55%; S2, 44%); other common ( & gt; 30% all grade) AEs included diarrhea, ecchymosis, PLT decrease, and pyrexia (each 30%) in S1, and cough (33%) in S2. A total of 85% of pts in S1 and 89% in S2 had grade ≥ 3 AEs; thrombocytopenia (S1, 40%; S2, 78%) and anemia (25%; 17%) were most common. Overall, 20% and 50% of pts in S1 and S2 had AEs leading to study drug discontinuation, most commonly thrombocytopenia (S1, 5%; S2, 20%); other AEs led to discontinuation in 1 pt each. On-treatment deaths included 1 cardiac arrest (S1), 1 AML (S1), 1 multiorgan failure (S2), and 1 sepsis (S2). The death due to cardiac arrest was assessed as related to study drug; the others were unrelated. Overall, 40% (6/15) and 38% (3/8) of evaluable pts in S1 and S2 achieved a spleen response (≥ 50% reduction in spleen length from baseline) at wk 24; 33% (5/15) and 30% (3/10) of evaluable pts in S1 and S2 achieved a spleen response at wk 48; 55% (11/20) and 67% (12/18) of pts achieved a response at any time. A symptom response (≥ 50% reduction in MF-SAF TSS from baseline to wk 24) was achieved by 31% (4/13) of evaluable pts in S1 and 40% (4/10) in S2; at wk 24, there was a mean (SD) decrease (improvement) in total daily score from baseline by 7.7 (9.7) in S1 and 3.9 (11.4) in S2. There was no significant difference in the PK of RUX among pts with low PLT counts in this study compared with that in pts with PLT ≥ 100 × 109/L. CONCLUSIONS A starting dose of RUX 10 mg bid was manageable in this previously unstudied MF pt population with low PLT counts (50 to & lt; 75 × 109/L and 75 to & lt; 100 × 109/L). AEs were consistent with the known safety profile of RUX, with no new or unexpected adverse findings. This was supported by the PK/PD results as well. RUX treatment at a starting dose of 10 mg bid provided the benefit of spleen length reductions and clinical symptom improvements. EXPAND results confirm that a starting dose of RUX 10 mg bid is suitable for pts with MF and low PLT counts. Disclosures Kiladjian: AbbVie: Membership on an entity's Board of Directors or advisory committees; AOP Orphan: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Vannucchi:Incyte: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Blueprint: Membership on an entity's Board of Directors or advisory committees. He:F. Hoffmann-La Roche: Consultancy, Other: Medical writing support, furnished by Scott Battle, PhD, of Health Interactions, was funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland; LongBio Pharma: Consultancy, Research Funding. Verstovsek:ItalPharma: Research Funding; Protagonist Therapeutics: Research Funding; AstraZeneca: Research Funding; PharmaEssentia: Research Funding; Sierra Oncology: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Genentech: Research Funding; Blueprint Medicines Corp: Research Funding; CTI Biopharma Corp: Research Funding; Promedior: Research Funding; Gilead: Research Funding; Incyte Corporation: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Roche: Research Funding; NS Pharma: Research Funding. Boyer-Perrard:Novartis (RUMYCUP study only): Consultancy. Niederwieser:Novartis: Speakers Bureau; Amgen: Speakers Bureau; Cellectis: Membership on an entity's Board of Directors or advisory committees; Daiichi: Research Funding. Liberati:Janssen: Honoraria, Research Funding; Onconova: Research Funding; Verastem: Research Funding; Oncopeptides: Research Funding; Incyte: Honoraria; GSK: Research Funding; Novartis: Research Funding; Morphosys: Research Funding; Karyopharm: Research Funding; Pfizer: Research Funding; Takeda: Research Funding; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Honoraria, Research Funding. Harrison:AOP Orphan Pharmaceuticals: Honoraria; Roche: Honoraria; Promedior: Honoraria; Incyte Corporation: Speakers Bureau; Janssen: Speakers Bureau; Celgene: Honoraria, Research Funding, Speakers Bureau; Shire: Honoraria, Speakers Bureau; Gilead Sciences: Honoraria, Speakers Bureau; Sierra Oncology: Honoraria; Novartis: Honoraria, Research Funding, Speakers Bureau; CTI Biopharma Corp: Honoraria, Speakers Bureau. Roussou:Novartis: Current Employment, Other: I have Novartis shares. Wroclawska:Novartis Pharma AG: Current Employment. Majidi:Novartis: Current Employment. Gisslinger:Janssen-Cilag: Honoraria; Roche: Honoraria; Celgene: Honoraria; AOP Orphan Pharmaceuticals AG: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; MyeloPro Diagnostics and Research: Honoraria; PharmaEssentia: Honoraria. OffLabel Disclosure: Label dose in this patient population is 5 mg bid starting dose. EXPAND presents data for a 10 mg bid starting dose.