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2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003
In 2010, PDF awarded $1.2 million for Parkinson's disease (PD) research through its external grants program — $700,000 to support first-year studies of eight research scientists, and $500,000 to support a second year of funding for 2010 grantees who have demonstrated a successful first year of research.
The eight newly-selected grant recipients were chosen from a group of 150 applicants by a review committee that was chaired by Robert Burke, M.D., and included Stanley Fahn, M.D., PDF's Scientific Director.
International Research Grants
Telomere Biology in Patients with Incident Parkinson's Disease
Tobias Kurth, M.D., Sc.D., and Robert Y.L. Zee, PH.D., M.P.H.
Division of Preventive Medicine
Brigham and Women's Hospital
Boston, Massachusetts
Total Award Amount: $82,500
The chromosomes in all cells of the body have structures on their ends called telomeres. With time, telomeres become shorter, and shortened telomeres are associated with many diseases of aging. Drs. Kurth and Zee will investigate whether telomere shortening is associated with Parkinson's. Their study makes use of blood samples collected in 1997 from more than 15,000 healthy male physicians in the United States over the age of 55 as part of a clinical trial unrelated to PD. Among this group, 353 men have developed Parkinson's. Drs. Kurth and Zee will measure telomere length in the blood cells of these men living with Parkinson's and compare it to telomere length in the cells of study participants, matched for age, who do not have Parkinson's. In addition to seeking an association between telomere length and PD, they will study whether factors such as body mass index, smoking, and cardiovascular disease can strengthen or weaken this association.
Identification of Neuroprotective Factors in Tobacco
Leo J. Pallanck, Ph.D.
University of Washington
Seattle, Washington
Total Award Amount: $82,500
In the last decade, epidemiological studies — research that investigates the behaviors of large numbers of people in relation to disease — have suggested that people who smoke cigarettes have a lower risk of Parkinson's. Dr. Pallanck's goal is to identify specific chemicals in tobacco that are neuroprotective, meaning they may slow or prevent the development of PD. In past studies he has found that tobacco extract protects neurons in fruit flies (Drosophila) genetically engineered to have characteristics of Parkinson's. He also discovered that nicotine is not a neuroprotective agent. In new research, again using Drosophila, Dr. Pallanck will identify the chemical components in tobacco extract that are neuroprotective and characterize their chemical structures. Because the molecular pathways of neurodegeneration in Drosophila and humans are similar, this approach may lead to a potential therapy for PD.
Potential Role of DJ-1 in Modulating the VHL/HIF Pathway and its Relevance to PD
David Park, Ph.D.*
University of Ottawa
Ottawa, Canada
Total Award Amount: $82,500
In the last decade, scientists have discovered several genes that, in rare cases, cause Parkinson's that is inherited. One of these genes is called DJ-1. When a mutated DJ-1 gene is inherited from both parents, PD develops at a young age. Very little is known about the mechanism by which DJ-1 contributes to the underlying progression of PD. Dr. Park and colleagues have recently shown that DJ-1 plays an important role in protecting cells, including neurons, from stresses that can lead them to self-destruct. In seeking to understand how DJ-1 functions, he discovered that it interacts with another protein, VHL, that also plays a key role in molecular pathways needed for the survival of neurons. Dr. Park proposes to test the hypothesis that DJ-1 exerts its protective function through its inhibitory interaction with VHL, with experiments both in vitro and in laboratory animals.
Mechanism of FADD Recruitment and Activation in Mutant LRRK2-Induced Neurodegeneration
Hardy Rideout, Ph.D.*
Biomedical Research Foundation
Academy of Athens
Athens, Greece
Total Award Amount: $82,500
The most common genetic mutations leading to Parkinson's occur in a gene called LRRK2. The LRRK2 gene is responsible for a protein that plays a role in signaling cells to die. Dr. Rideout and colleagues have shown that, in neuron cells cultured in the laboratory, the LRRK2 protein must form a complex with another protein, called FADD, in order to induce cell death. LRRK2 proteins commonly link together in two-molecule chains, and longer chains are formed when LRRK2 is mutated. Dr. Rideout proposes that the formation of chains longer than two proteins is a critical step in the molecular pathway to cell death. His project aims to determine how long the chains must be for them to associate more frequently with FADD, and to discover whether this association can be blocked. He also will examine brain tissue from people whose Parkinson's developed due to LRRK2 mutations in order to better understand the connection between LRRK2 and FADD.
The Contribution of Dopaminergic System in Pathological Gambling in Parkinson's Disease
Antonio P. Strafella, M.D., Ph.D., F.R.C.P.C.*
Centre for Addiction and Mental Health
Toronto Western Hospital/Institute
University of Toronto
Toronto, Canada
Total Award Amount: $82,500
The motor symptoms of Parkinson's disease result from a loss of the chemical messenger dopamine in certain areas of the brain. Drug therapies to relieve motor symptoms generally work by increasing dopamine levels, but these therapies can have side effects. In the last five years, researchers and physicians have become more aware of people with Parkinson's developing impulse control disorders, including compulsive gambling, after beginning dopaminergic medication. This may happen because dopamine is involved not only in how the brain controls movement, but also in its reward system. This study uses positron emission tomography (PET) to conduct and study brain scans of people with PD. Dr. Strafella will use the scans to characterize abnormalities in dopamine levels in two brain areas, the striatum and the prefrontal cortex - comparing people who have developed pathological gambling with those who have not. Newly available PET tracers used to assess dopamine levels make it possible to assess dopaminergic dysfunction more accurately and comprehensively than ever before.
LINGO1 and LINGO2 in Parkinson's Disease
Christian Wider, M.D.* and Matthew J. Farrer, Ph.D.
CHUV Lausanne and University of British Columbia
Lasusanne, Switzerland and Vancouver, British Columbia, Canada
Total Award Amount: $82,500
In recent studies, researchers have used a technique called a genome-wide association study to scan the entire genomes of several groups of people with Parkinson's. Comparing the results to genome scans of healthy people, they discovered differences in LINGO1 and LINGO2, genes that were associated with a higher risk of PD. Other evidence also links these genes to PD: for example, people with PD have higher activity of LINGO1 in the substantia nigra, the brain region where dopamine neurons die, leading to Parkinson's. The first aim of this project is to do more thorough genetic studies with people with Parkinson's to identify all the mutations that occur in these genes and find the specific changes associated with Parkinson's. The next step will be to use mouse models of PD to study the function both of normal LINGO1 and LINGO2 and of the variations Dr. Wider identifies and links to PD.
Creating a South American Genetics Consortium on Parkinson's Disease
Cyrus Zabetian, M.D., M.S.*
VA Puget Sound Health Care System, Seattle Division
University of Washington
Seattle, WA
Total Award Amount: $82,500
Scientists have recently identified several genes that, when mutated, cause rare inherited forms of Parkinson's disease. However, it is becoming increasingly clear that the frequency and distribution of genetic risk factors — specific mutations in genes linked to PD — varies greatly between world populations. Few large-scale PD genetic studies have been carried out in people from developing nations. This goal of this project is to create a South American Genetics Consortium on PD, which will include institutions in Argentina, Brazil, Peru and Uruguay. Dr. Zabetian aims to collect blood specimens for DNA extraction and demographic, clinical, and environmental exposure data from 1,750 people with PD and 1,650 matched controls. The samples and data, held in a consortium coordinating center at the Seattle Institute for Biomedical and Clinical Research in Washington state, will provide a unique resource for future genetic research on PD.
Research Fellowship Grants
Ataxin-3-Mediated Regulation of Parkin Stability and Activity
Thomas Durcan, Ph.D.
Montreal Neurological Institute, McGill University
Montreal, Quebec, Canada
Total Award Amount: $45,000
Most cases of Parkinson's disease cannot be attributed directly to genetics. However, among people who develop PD at a young age, more than half have a mutation in the gene known as parkin. One important role of the parkin protein in cells is to help label damaged cell parts for disposal during a process called ubiquitination. Dr. Durcan's laboratory discovered that another gene, ataxin-3, can counteract parkin's ability to participate in ubiquitination. Mutations in ataxin-3 underlie Machado-Joseph disease (MJD), and people with MJD often have Parkinsonian symptoms. This and other evidence suggests that ataxin-3 mutations may contribute to PD. His goal is to understand the interaction between parkin and ataxin-3, and how mutations in these genes affect the normal function and stability of the parkin protein in MJD and PD. This research is fundamental to unraveling the causes of these diseases and to identifying new treatments for them.
Correlating the Structure of Membrane-Bound Alpha-Synuclein with Function and Toxicity
Khurshida Shahidullah, Ph.D.
Joan & Sanford I. Weill College of Cornell University
New York, NY
Total Award Amount: $45,000
Parkinson's disease is caused by the death of certain brain cells involved in controlling the body's movements. The cells that die contain clumps of a protein called alpha-synuclein, and mutations in the gene that produces alpha-synuclein cause inherited forms of PD. But the details of how alpha-synuclein becomes toxic remain to be discovered. Dr. Shahidulla's project aims to clarify how the shape of the alpha-synuclein molecule is related to its toxicity. Depending on where it is in a cell, an alpha-synuclein molecule can assume different forms in order to carry out different tasks. Dr. Shahidullah will use biophysical methods including fluorescence spectroscopy, CD spectroscopy, and NMR to characterize these structural changes. An in-depth picture of alpha-synuclein's normal conformations, in particular those that bind to membranes within cells, will shed light on how mutations disrupt both the molecule's shape and its function. The results also may suggest forms of the protein that could serve as targets for potential PD therapies.
Targeting the CMA Pathway in Cellular Models of Alpha-Synuclein-Induced Neurodegeneration
Maria Xilouri, Ph.D.
Biomedical Research Foundation
Academy of Athens
Athens, Greece
Total Award Amount: $45,000
The hallmark of Parkinson's is an overabundance and clumping together of the protein alpha-synuclein in certain brain cells. These cells normally maintain a balance between the synthesis of alpha-synuclein and its disposal, which takes place through a process called chaperone-mediated autophagy (CMA). During CMA, alpha-synuclein binds to a receptor known as Lamp2a on the membranes of the cell's lysosomes (the waste and recycling centers). As people age, however, Lamp2a levels decrease, and alpha-synuclein levels increase. Dr. Xilouri's studies, in cultured cells, will investigate the relationships among levels of Lamp2a, alpha-synuclein clearance, the functioning of the lysosome and cell death. In particular, she and her colleagues will study whether increasing the number of Lamp2a receptors, and thus enhancing CMA, clears away excess alpha-synuclein and prevents neurons from dying. If this is the case, then Lamp2a may be a potential target for Parkinson's therapies.
The Regulation of Somatodendritic Dopamine Release
James Maas, M.D., Ph.D.
University of California, San Francisco
San Francisco, CA
Total Award Amount: $60,000
Certain nerve cells in the brain use the chemical messenger dopamine to signal other brain cells that influence a person's movement, balance and coordination. Usually dopamine exits a nerve cell from an area called the axon terminal and binds to receptors on the receiving cell's dendrites. Sometimes, however, this signaling process works in reverse — dendrites release dopamine. Little is known about what stimulates neurons to release dopamine from dendrites or the molecular mechanisms by which this occurs. Dr. Maas' goal is to understand these processes, their roles in controlling movement and how they are disrupted in PD. His lab has developed a technique for directly visualizing dopamine in live, cultured midbrain neurons, as it leaves the cell from the vesicles where it is stored. He will use this technique to explore alternative hypotheses about how cells regulate the release of dopamine.
A Functional and Structural Neuroanatomic Analysis of Cognitive Impairment in Parkinson's Disease
Ryan Walsh, M.D., Ph.D.
University of Alabama at Birmingham
Birmingham, Alabama
Total Award Amount: $60,000
Ranging from mild attention difficulties to dementia, cognitive impairment is a debilitating symptom of PD. Dr. Walsh will use fMRI (functional MRI) imaging to see how well parts of the brain communicate with each other in people with PD who have no cognitive impairment. He will then compare these results with fMRI scans of people with PD who have cognitive impairment without dementia, and of healthy people who do not have PD. Dr. Walsh also will compare scans taken before and after study participants have taken dopamine-based medications. Another technique, known as DTI, will provide more detailed information on the health of the bundles of neurons that directly connect far-apart brain regions. Dr. Walsh's research aims to identify the anatomical features underlying cognitive impairment in PD and determine whether there are differences in how people with or without cognitive impairment respond to dopaminergic medication. The results may lead to imaging biomarkers for evaluating the nature, degree and progression of cognitive dysfunction in PD.
*Denotes second consecutive year of funding.


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Photographer's Note
Often it is not the spectacular interesting, but the rather inconspicuous. The important things for me I see on the side scenes. There are scenes in which the focus is on people.
The father and his daughter I saw on the Odeon Square in Munich.
Critiques | Translate
Apurba20 (984) 2014-01-28 0:50
Apart from the father and daughter, there is also a bird and a stuffed monkey. The door on the right too has a wonderful design. A very beautiful photograph, the black and white brings out each and every detail.
mesutilgim (98336) 2014-01-28 1:24
Hallo Wolfgang,
Fuer einen Schwarz&Weiss Fan wie ich, ein echtes Leckerbissen !
Schoen der Gesichtausdruck des kleinen Maedels, obwolh der Vater bischen uninteressiert zu sein scheint !
Danke schoen und
PS.Gerne moechte ich Dir zwei Fotos per e-mail schicken. Der eine meine noch intakte dunkelkammer und zum zweiten eine Gruppenaufnahme meiner Kamera-Harem einscliesslich eine Leica den ich im Jahre 1949 (damals noch als sieben Jaehriges Kind) von meinem Vater geschenkt bekam ! Aber deine E-Mail ueber TE funktioniert nicht.
Wenn Du mir an ([email protected]) ein e-mail schicken koenntest waere ich dankbar !
Sergiom (94685) 2014-01-28 3:40
Bonjour Wofgang,
J'aime beaucoup ce petit moment d'intimité de cette petite famille. Le moment est magique parce que le pigeon semble être au centre d'un rayon de lumière. L'utilisation du noir et blanc donne un petit côté documentaire à l'ensemble.
snunney (111821) 2014-01-28 4:27
Hello Wolfgang,
A charming composition beautifully presented in black and white. A picture that tells a story of a moment shared between man, daughter and pigeon.
photographer_sg (4414) 2014-01-28 8:02
Hello Wolfgang
Beautiful moment of daily life captured! Superb composition with the father, daughter and bird all perfectly positioned with the shaft of light in the FG. The door in the BG gives the picture perfect balance.
Thanks for sharing and have a great day.
your choice in sepia is the best
I liked this street scenery with the
little girl looking at the little bird
a picture that tells a moment story
no words only looking at this picture
one shot is one thousand words
have a nice evening
worldcitizen (9994) 2014-01-28 10:37
Hello Wolfgang,
This photo is like a scene from a movie. It has a timeless feeling, and could be from the past if not for the modern clothes of the father. I like the cobblestone street, and the shaft of light shining on the pigeon. The little girl with the map is adorable. This scene personally made me smile because of the monkey. My young nephew always has a stuffed monkey with him, and the adults are often carrying it, like the father in this photo. :-)
chrislo (4097) 2014-01-28 10:50
Hello Wolfgang,
The black and white works well with the styling of this photograph and the mood it creates. I like the light coming on the pigeon as if it was lit by a spotlight, making it the star of this shot. Birds are a common sight for adults, but they are signs of wonder for children. It's nice to see that the little girl did not try to frighten the animal, but showed respect for it. I like how the white stripes set a boundary not to be crossed. A nicely taken photograph.
Kind regards,
KristinsCamera (2384) 2014-01-28 17:37
i absolutely agree with you, wolfgang, about noticing the interesting, ordinary moments and people. and what a wonderful example you've given us. it's timeless. all eyes on the pigeon strutting his stuff. and the dad holding the monkey is a lovely & fun detail :)
a great moment, even better in sepia than it would be in color ~ thanks!
divail (8334) 2014-01-28 19:15
Bonsoir Wolfgang,
C'est vraiment une photo intéressante, un beau moment d'intimité bien capté. On dirait que la petite fille tient une carte touristique. Le papa est amusant avec le petit singe. Le noir et blanc donne plus d'intensité à la composition.
rbassin (25133) 2014-02-01 3:01
Hello Wolfgang,
une magnifique scène familiale, une bonne composition N-B, le rayon de lumière sur les pavés est très intéressante.
Bon W-E
mirosu (16279) 2014-02-01 3:03
Hi Wolfgang,
Superb monochrome street snapshot, excellent light, nice arrangement, very good viewpoint. The superb contrast adds nice toning to the scene.
Well done.
Wish you a very nice weekend.
John_F_Kennedy (43763) 2014-02-04 5:09
Hallo Wolfgang,
der Rollentausch Tochter mit Stadtplan, Vater mit Spielzeug ist einfach wudnerbar
holmertz (63224) 2014-02-04 12:41
Hello Wolfgang,
You made a fine observation of nothing spectacular. I like the look of the young father, standing on the white lines and carrying his daughter's doll, his nicely dressed daughter, maybe carrying her father's bag and maybe watching the pigeon standing in the spotlight like on a stage. A very simple event that probably went by unnoticed by the two persons but which is a pleasure to watch.
Kind regards,
annjackman (21903) 2014-02-09 0:30
Hello Wolfgang,
The diagonal made by the father, daughter and pigeon is most appealing especially set against the cobbled road. Lovely b/w treatment - I like it very much.
Kind Regards, Ann
abmdsudi (61982) 2014-02-09 8:06
Hi Wolfgang
Cool candid style here, a great moment alive with optimism full of awareness and beauty timely caught. Love the pov, positioning and the interaction between them and both are placed at the thirds. You've managed the light extremely well as you have managed the textures real good, I think this has great potential, the excitement and in that line of appearance from left to right and I find the space is amazing. Fabulous capture
Best regards
npecanhuk (79319) 2014-02-09 16:49
Hallo Wolfgang!
What a lovely moment!
What a beautiful and pleasant-looking picture!
Sharpness, exposure, sepia, chosen pov and composition are all excellent!
TFS - congrats,
Photo Information
- Copyright: Wolfgang Schanze (wolf38) (31296)
- Genre: People
- Medium: Black & White
- Date Taken: 2014-01-00
- Categories: Daily Life
- Photo Version: Original Version
- Date Submitted: 2014-01-28 0:04

subset: commoncrawl


text:
source GAIA package: Sx_MilitaryTimes_M6201310307260029_5675.zip Origin key: Sx_MilitaryTimes_M6201310307260029 imported at Fri Jan 8 18:18:10 2016
Competition for security forces jobs is getting tougher, and the Air Force no longer has any patience for screw-ups.
Security forces airmen are increasingly bearing the brunt of the cash-strapped Air Force as it attempts to reduce its enlisted ranks through date-of-separation rollbacks. Between 2004 and 2007, about 11 percent or 12 percent of airmen separated under rollbacks were security forces. But beginning in 2010, that percentage started to rise, until they represented about 18 percent of all rollbacks in 2012, and in the first round of 2013 rollbacks in May.
About the same time, security forces became increasingly overmanned, and have been at 105 percent capacity for the last three years. Chief Master Sgt. Stephen White, the enlisted career field manager for security forces, said in a July 12 interview that the security force's retention rate also is about 124 percent of what the Air Force wants it to be.
That has put the security forces on the overmanned list for NCO retraining and re-enlistment opportunities, forcing mid-career 3P0X1 airmen to retrain into other jobs to stay in the Air Force, and first-term airmen to compete for limited slots when it's time to re-enlist.
And the tougher competition for jobs means that the Air Force is cracking down on security forces airmen who step out of line.
"We are a police force, and as a police force, we enforce the laws, and we expect our airmen to uphold those very same laws," White said. "If it is found they conducted themselves improperly, we hold them accountable, and punish them fairly but swiftly. That's kind of who this is targeting [through rollbacks] — airmen who have stumbled along the way."
The ranks of Air Force security forces grew swiftly in the decade following 9/11, and peaked last August at 27,411 before starting a gradual decline. According to Air Force statistics, the career field has been manned at 105 percent since 2011.
Commanders have the option of sparing their airmen from rollbacks, in some cases, if they feel an airman deserves a second chance. But these days, White said, commanders in the security forces field have little incentive to do so. A misbehaving security forces airman who is spared a rollback could end up taking a re-enlistment slot that could have gone to a more-deserving airman who has stayed on the straight and narrow, he said.
If "one of my airmen is on this rollback sheet, and I have the option of perhaps changing their code to allow them to stay, I know that they are going to compete now with the airmen who haven't gotten in any trouble and, in theory, could possibly take one of those enlistment spots that are very sought after right now," White said.
Roughly two-thirds of security forces airmen who have been separated under DOS rollbacks were pushed out for punitive reasons, the Air Force said.
White said the Air Force isn't using rollbacks to push out more security forces airmen due to the end of the war in Iraq and the looming drawdown in Afghanistan. The wars have drawn vital security forces away from Air Force installations stateside, which didn't get additional manpower to fill those gaps.
As a result, White said, stateside installations have struggled and, in some cases, extended security forces' shifts to deal with the understaffing problem. And when those airmen return, their home stations are pleased to have them back.
"It's painful while they're gone," White said.
White also said the Air Force has always been able to easily recruit new security forces, which further tightens the job market.
"There are a lot of young men and women out there that want to come in and get the experience as a military police officer," White said. "Some want to do it so they can get out and pursue that in the civilian community when they're old enough, usually 21. Quite a few decide to make it a career.
"I think that's a good thing that we have so many that want to stay," he said. "The unfortunate part is, as the Air Force is drawing down, our career field is also."
Although security forces are making up more and more of the rollback separations, White said it is still an extremely viable career field.
"We're allowing quite a few to stay," he said. "We just can't allow all of them to stay."


text:
Asche close to beginning Class A rehab stint
PHILADELPHIA -- Cody Asche is scheduled to begin a rehab assignment Friday with Class A Lakewood.
Ryne Sandberg said Asche may need six to seven rehab games before he could rejoin the team.
The Phillies would like Asche back at third base as soon as possible. Cesar Hernandez and Reid Brignac have been manning the position since Asche landed on the disabled list May 23 with a strained left hamstring. They entered Wednesday hitting a combined .188 (12-for-64) with two doubles, two RBIs, six walks and 22 strikeouts at third base since then.
Asche had hit .317 (19-for-60) with five doubles, three home runs, 12 RBIs, nine walks, 11 strikeouts and a .956 OPS in May before the injury.
"He was at the bottom of the order and doing some good things," Sandberg said. "I'd say that we've missed that. In the meantime, it's a chance for some other guys to play. For Cesar, it's a position that could be necessary for him to be a utility guy on that side of the field, so he has some experience there. Brignac is more of a veteran guy. So, that's been the options."
Maikel Franco, rated the organization's top prospect by MLB.com, is hitting .162 (12-for-74) since May 23 at Triple-A, which would seem to rule him out.
Todd Zolecki is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.


text:
The Lazy ArtistLogic puzzles require you to think. You will have to be logical in your reasoning.
A king wished to build the most splendid palace imaginable. After years of construction, it was finally ready to be painted. Two artists were hired to make the palace look like no other in the world. The first artist was asked to decorate one side of each hallway, the second to adorn the facing walls.
The first artist searched the world for beautiful colors and designs, and spent five years painting wonderful images of animals and landscapes. The second artist spent most of his time doodling and daydreaming.
Finally the first artist was almost finished. The lazy artist began to worry, then to panic. With only a short time left to work, how could he equal the splendid pictures of his colleague?
HintHe did not paint it.
AnswerHe covered his walls with mirrors.
What Next?
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text:
Eureka Police Department detectives located half a gram of heroin and a Sony HD video camera believed to be related to a weekend burglary of News Channel 3 on Monday, during the search of an apartment on the 2500 block of Union Street after responding to a neighborhood complaint.
Channel 3 employees confirmed the recovered camera and related cables belong to the station, according to a press release. Additional cameras and equipment from the weekend burglary are still missing.
The complaint alleged excessive foot and vehicle traffic coming from an apartment located in the alley, according to an EPD press release.
Officials said a female in the apartment told detectives that Edward Charles Vercoe, 43, lived in the unit. Detectives then learned Vercoe is on parole, and subject to search at any time. He is wanted on suspicion of possession of a controlled substance and possession of stolen property.
The Eureka Police Department asks anyone with information to call the department at 441-4060, or the Problem Oriented Policing Unit at 441-4373.


text:
Topic: Update on Mom
Good Evening -
I thought I'd share a bit of good news.
Just some quick history - my mom had the Whipple procedure on October 31st, 2012. It was rough, but she came through it.
In February she started 6 months of Chemo (gemcitabine). Just finished up in July.
She had PET/CT last week. Results show no signs of any cancer at this time. They are going to monitor her every 3 months for 2 years. She also has to keep her port in, just in case the cancer returns, they can start treatment immediately.
I have not gotten through the site yet - does anyone have any experience with this? I know CC is very aggressive. Is it best to keep the port in? Has anyone had it resurface as fast as 3 months?
Thanks for listening!


text:
Breast cancer survivor offers wisdom at Faulkner satellite center
Call 877-422-3324 today to make an appointment
Make your appointment or second opinion with Dana-Farber today to meet with an onsite specialist.
Adult Patients:877-442-3324
Pediatric Patients:888-733-4662
Can't get to Boston? Explore our Online Second Opinion service to get expert advice from Dana-Farber oncologists.
Email Dana-Farber
Main Number617-632-3000
Toll-Free Number866-408-DFCI (3324)
Discover the ways to give and how to get involved to support Dana-Farber.
Poet Richard Fox gains insight – and material – through cancer treatment
A family faces cancer in an unfamiliar city – with help
Choosing mastectomy or not: Studying young women's surgical choices
Jeff's targeted therapy has kept his advanced lung cancer at bay.
Acute lymphoblastic leukemia (ALL) is a fast-growing type of leukemia in which too many immature white blood cells are found in the blood and bone marrow. Learn about acute lymphoblastic leukemia and find information on how we support and care for people with ALL before, during, and after treatment.
Your fight against acute lymphoblastic leukemia (ALL) calls for care that is both knowledgeable and compassionate. Our Adult Leukemia Program includes a team of knowledgeable, compassionate specialists who aren't just experts in treating cancer; they are global leaders in treating leukemia — and in treating your type of leukemia, in particular.
Exceptional Care for Patients with Acute Lymphoblastic Leukemia
World-class care from a full array of specialists — including medical and radiation oncologists, infectious disease specialists, nursing professionals, physician assistants, psychologists, and social workers — with years of expertise in caring for patients with ALL.
Development of the personalized treatment plan that's best for you — with options ranging from standard supportive care to intensive chemotherapy, as needed.
Access to both conventional and innovative treatments, including bone marrow/stem cell transplantation, combination chemotherapy, radiation therapy, and immune-based therapies and vaccines.
Close collaboration with you and your family as key members of the treatment team.
Partnership with your referring physician at each stage of your treatment, including follow-up care that's closer to your home.
Comprehensive support services for you and your family, including patient and caregiver education and survivorship programs to help you live well beyond cancer.
The full expertise of two renowned medical centers: Brigham and Women's Hospital and Dana-Farber Cancer Institute.
To schedule a consultation or request a second opinion from our multidisciplinary team, please contact us at 617-632-6028 or 617-632-5138 or fill out our secure online form.
Adult acute lymphoblastic leukemia (ALL; also called acute lymphocytic leukemia) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated.
Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.
A myeloid stem cell becomes one of three types of mature blood cells:
A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):
In ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are also called leukemia cells. These leukemia cells are not able to fight infection very well. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may cause infection, anemia, and easy bleeding. The cancer can also spread to the central nervous system (brain and spinal cord).
This summary is about adult acute lymphoblastic leukemia. See the following PDQ summaries for information about other types of leukemia:
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Possible risk factors for ALL include the following:
The early signs and symptoms of ALL may be like the flu or other common diseases. Check with your doctor if you have any of the following:
These and other signs and symptoms may be caused by adult acute lymphoblastic leukemia or by other conditions.
The following tests and procedures may be used:
The following tests may be done on the samples of blood or bone marrow tissue that are removed:
The prognosis (chance of recovery) and treatment options depend on the following:
The extent or spread of cancer is usually described as stages. It is important to know whether the leukemia has spread outside the blood and bone marrow in order to plan treatment. The following tests and procedures may be used to determine if the leukemia has spread:
The disease is described as untreated, in remission, or recurrent.
Untreated adult ALL
The ALL is newly diagnosed and has not been treated except to relieve signs and symptoms such as fever, bleeding, or pain.
Adult ALL in remission
The ALL has been treated.
Recurrent adult acute lymphoblastic leukemia (ALL) is cancer that has recurred (come back) after going into remission. The ALL may come back in the blood, bone marrow, or other parts of the body.
Different types of treatment are available for patients with adult acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
The treatment of adult ALL is done in phases:
Treatment called central nervous system (CNS) sanctuary therapy is usually given during each phase of therapy. Because standard doses of chemotherapy may not reach leukemia cells in the CNS (brain and spinal cord), the cells are able to "find sanctuary" (hide) in the CNS. High doses of certain anticancer drugs, intrathecal chemotherapy, and radiation therapy to the brain are able to reach leukemia cells in the CNS. They are given to kill the leukemia cells and keep the cancer from recurring (coming back). CNS sanctuary therapy is also called CNS prophylaxis.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein.
See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.
Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Stem Cell Transplant
Stem cell transplant (Step 1). Blood is taken from a vein in the arm of the donor. The patient or another person may be the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in the other arm.
Stem cell transplant (Step 2). The patient receives chemotherapy to kill blood-forming cells. The patient may receive radiation therapy (not shown).
Stem cell transplant (Step 3). The patient receives stem cells through a catheter placed into a blood vessel in the chest.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Targeted therapy drugs called tyrosine kinase inhibitors are used to treat some types of adult ALL. These drugs block the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (blasts) than the body needs. Three of the drugs used are imatinib mesylate (Gleevec), dasatinib, and nilotinib.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of treatment for ALL may include the risk of second cancers (new types of cancer). Regular follow-up exams are very important for long-term survivors.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Standard treatment of adult acute lymphoblastic leukemia (ALL) during the remission induction phase includes the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated adult acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Standard treatment of adult ALL during the post-remission phase includes the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with adult acute lymphoblastic leukemia in remission. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
Standard treatment of recurrent adult ALL may include the following:
Some of the treatments being studied in clinical trials for recurrent adult ALL include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent adult acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about adult acute lymphoblastic leukemia, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
This information is provided by the National Cancer Institute.
This information was last updated on June 6, 2014.
ALL (also called acute lymphocytic leukemia) is an aggressive type of leukemia characterized by the presence of too many lymphoblasts or lymphocytes in the bone marrow and peripheral blood. It can spread to the lymph nodes, spleen, liver, central nervous system (CNS), and other organs. Without treatment, ALL usually progresses quickly.
Signs and symptoms of ALL may include the following:
ALL occurs in both children and adults. It is the most common type of cancer in children, and treatment results in a good chance for a cure. For adults, the prognosis is not as optimistic. This summary discusses ALL in adults. (Refer to the PDQ summary on Childhood Acute Lymphoblastic Leukemia Treatment for more information about ALL in children.)
Estimated new cases and deaths from ALL in the United States in 2014:[1]
ALL presumably arises from malignant transformation of B- or T-cell progenitor cells.[2] It is more commonly seen in children, but can occur at any age. The disease is characterized by the accumulation of lymphoblasts in the marrow or in various extramedullary sites, frequently accompanied by suppression of normal hematopoiesis. B- and T-cell lymphoblastic leukemia cells express surface antigens that parallel their respective lineage developments. Precursor B-cell ALL cells typically express CD10, CD19, and CD34 on their surface along, with nuclear terminal deoxynucleotide transferase (TdT), while precursor T-cell ALL cells commonly express CD2, CD3, CD7, CD34, and TdT.
It has been recognized for many years that some patients presenting with acute
leukemia may have a cytogenetic abnormality that is cytogenetically
indistinguishable from the Philadelphia chromosome (Ph1).[3] The Ph1 occurs in only 1% to 2% of patients with acute myeloid leukemia (AML), but it occurs in about 20% of
adults and a small percentage of children with ALL.[4] In the majority of
children and in more than one-half of adults with Ph1-positive
ALL, the molecular abnormality is different from that in Ph1-positive chronic
myelogenous leukemia (CML).
Many patients who
have molecular evidence of the bcr-abl fusion gene, which characterizes the Ph1, have no evidence of the abnormal chromosome by cytogenetics.
The bcr-abl fusion gene may be detectable only by fluorescence in situ hybridization (FISH) or reverse-transcriptase polymerase chain reaction (RT-PCR) because many patients have a different fusion protein from the one found in
CML (p190 vs. p210). These tests should be performed, whenever
possible, in patients with ALL, especially in those with B-cell lineage disease.
L3 ALL is associated with a variety of translocations that
involve translocation of the c-myc proto-oncogene to the immunoglobulin gene
locus t(2;8), t(8;12), and t(8;22).
Patients with ALL may present with a variety of hematologic derangements ranging from pancytopenia to hyperleukocytosis. In addition to a history and physical, the initial workup should include:
A bone marrow biopsy and aspirate are routinely performed even in T-cell ALL to determine the extent of marrow involvement. Malignant cells should be sent for conventional cytogenetic studies, as detection of the Ph1 t(9;22), myc gene rearrangements (in Burkitt leukemia), and MLL gene rearrangements add important prognostic information. Flow cytometry should be performed to characterize expression of lineage-defining antigens and allow determination of the specific ALL subtype. In addition, for B-cell disease, the malignant cells should be analyzed using RT-PCR and FISH for evidence of the bcr-abl fusion gene. This last point is of utmost importance, as timely diagnosis of Ph1 ALL will significantly change the therapeutic approach.
confusion with AML, hairy cell leukemia, and
malignant lymphoma is not uncommon. Proper diagnosis is crucial because of the
difference in prognosis and treatment of ALL and AML. Immunophenotypic
analysis is essential because leukemias that do not express myeloperoxidase
include M0 AML, M7 AML, and ALL.
The examination of bone marrow
aspirates and/or biopsy specimens should be done by an experienced oncologist,
hematologist, hematopathologist, or general pathologist who is capable of
interpreting conventional and specially stained specimens.
Factors associated with prognosis in patients with ALL include the following:
Two other chromosomal abnormalities with poor prognosis are t(4;11), which is characterized by rearrangements of the MLL gene and may be rearranged despite normal cytogenetics, and t(9;22). In addition to t(4;11) and t(9;22), compared with patients with a normal karyotype, patients
with deletion of chromosome 7 or trisomy 8 have been reported to have a lower
probability of survival at 5 years.[13] In a multivariate analysis, karyotype was the most important
predictor of disease-free survival.[13][Level of evidence: 3iiDii]
Long-term follow-up of 30 patients with ALL in remission for at least 10 years has demonstrated ten cases of secondary malignancies. Of 31 long-term female survivors of ALL or AML younger than 40 years, 26 resumed normal menstruation following completion of therapy. Among 36 live offspring of survivors, two congenital problems occurred.[14]
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The following leukemic cell characteristics are important:
In adults, French-American-British (FAB) L1 morphology (more mature-appearing lymphoblasts) is present in fewer than 50% of patients, and L2
morphology (more immature and pleomorphic) predominates.[1] L3 (Burkitt) ALL is much less common than the other two FAB subtypes. It is characterized by blasts with cytoplasmic vacuolizations and surface expression of immunoglobulin, and the bone marrow often has an appearance described as a "starry sky" owing to the presence of numerous apoptotic cells. L3 ALL is associated with a variety of translocations that
involve translocation of the c-myc proto-oncogene to the immunoglobulin gene
locus t(2;8), t(8;12), and t(8;22).
Some patients presenting with acute
leukemia may have a cytogenetic abnormality that is morphologically
indistinguishable from the Philadelphia chromosome (Ph1).[2] The Ph1 occurs in only 1% to 2% of patients with acute myeloid leukemia (AML), but it occurs in about 20% of
adults and a small percentage of children with ALL.[3] In the majority of
children and in more than one-half of adults with Ph1-positive
ALL, the molecular abnormality is different from that in Ph1-positive chronic
myelogenous leukemia (CML).
Many patients who
have molecular evidence of the bcr-abl fusion gene, which characterizes the Ph1, have no evidence of the abnormal chromosome by cytogenetics.
The bcr-abl fusion gene may be detectable only by pulsed-field gel electrophoresis or reverse-transcriptase polymerase chain reaction for the bcr-abl fusion gene because many patients have a different fusion protein from the one found in
CML (p190 vs. p210).
Using heteroantisera and monoclonal antibodies, ALL cells can be divided into several subtypes (see Table 1 ).[1][4][5][6]
Cell Subtype
Approximate Frequency
Early B-cell lineage
T cells
B cells with surface immunoglobulins
About 95% of all types of ALL (except Burkitt, which usually has an L3 morphology by the FAB classification) have elevated terminal deoxynucleotidyl transferase (TdT) expression. This elevation is extremely useful in diagnosis; if concentrations of the enzyme are not elevated, the diagnosis of ALL is suspect. However, 20% of cases of AML may express TdT; therefore, its usefulness as a lineage marker is limited. Because Burkitt leukemias are managed according to different treatment algorithms, it is important to specifically identify these cases prospectively by their L3 morphology, absence of TdT, and expression of surface immunoglobulin. Patients with Burkitt leukemias will typically have one of the following three chromosomal translocations:
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There is no clear-cut staging system for this disease. This disease is classified as untreated, in remission, or recurrent.
For a newly diagnosed patient with no prior treatment, untreated adult ALL is defined by the following:
A patient who has received remission-induction treatment of ALL is in remission if all of the following criteria are met:
Successful treatment of ALL consists of the
control of bone marrow and systemic disease and the treatment (or
prevention) of sanctuary-site disease, particularly the central nervous system
(CNS).[1][2] The cornerstone of this strategy includes systemically
administered combination chemotherapy with CNS preventive therapy. CNS
prophylaxis is achieved with chemotherapy (intrathecal and/or high-dose
systemic therapy) and, in some cases, cranial radiation therapy.
Treatment is divided into the following three phases:
The average length of treatment for ALL
varies between 1.5 and 3 years in the effort to eradicate the leukemic cell
population. Younger adults with ALL may be eligible for selected clinical
trials for childhood ALL. (Refer to the PDQ summary on Childhood Acute Lymphoblastic Leukemia Treatment for more information.)
Entry into a clinical trial is highly desirable to assure adequate patient treatment and maximal information retrieval from the treatment of this highly responsive, but usually fatal, disease.
Disease Status
Standard Treatment Options
Untreated ALL
Remission induction therapy
CNS prophylaxis therapy
ALL in remission
Postremission therapy
Recurrent ALL
Reinduction chemotherapy
Palliative radiation therapy
CNS = central nervous system.
Clarkson BD, Gee T, Arlin ZA, et al.: Current status of treatment of acute leukemia in adults: an overview of the Memorial experience and review of literature. Crit Rev Oncol Hematol 4 (3): 221-48, 1986.
Hoelzer D, Gale RP: Acute lymphoblastic leukemia in adults: recent progress, future directions. Semin Hematol 24 (1): 27-39, 1987.
Standard treatment options for untreated adult ALL include the following:
Sixty percent to 80% of adults with ALL usually achieve a complete remission (CR) status following appropriate induction therapy. Appropriate initial treatment, usually consisting of a regimen that includes the combination of vincristine, prednisone, and an anthracycline, with or without asparaginase, results in a CR rate of up to 80%. In patients with Ph1-positive ALL, the remission rate is generally greater than 90% when standard induction regimens are combined with Bcr-abl tyrosine kinase inhibitors. In the largest study published to date of Ph1-positive ALL patients, overall survival (OS) for 1,913 adult ALL patients was 39% at 5 years.[1]
Patients who experience a
relapse after remission usually die within 1 year, even if a
second CR is achieved. If there are appropriate available
donors and if the patient is younger than 55 years, bone marrow
transplantation may be a consideration in the management of this disease.[2] Transplant centers performing five or fewer transplants annually usually have
poorer results than larger centers.[3] If allogeneic transplant is considered,
transfusions with blood products from a potential donor should be avoided, if
possible. [4][5][6][7][8][9][10]
Most current induction regimens for patients with adult ALL
include combination chemotherapy with prednisone, vincristine, and an anthracycline. Some regimens, including those used in a Cancer and Leukemia Group B (CALGB) study (CLB-8811), also add
other drugs, such as asparaginase or cyclophosphamide. Current multiagent
induction regimens result in complete response rates that range from 60% to
Imatinib mesylate is often incorporated into the therapeutic plan for patients with Ph1-positive ALL. Imatinib mesylate, an orally available inhibitor of the BCR-ABL tyrosine kinase, has been shown to have clinical activity as a single agent in Ph1-positive ALL.[13][14][Level of evidence: 3iiiDiv] More commonly, particularly in younger patients, imatinib is incorporated into combination chemotherapy regimens. There are several published single-arm studies in which CR rate and survival are compared with historical controls.
Evidence (Imatinib mesylate):
Several studies have suggested that the addition of imatinib to conventional combination chemotherapy induction regimens results in complete response rates, event-free survival rates, and OS rates that are higher than those in historical controls.[15][16][17] At the present time, no conclusions can be drawn regarding the optimal imatinib dose or schedule.
In each of these studies, common toxicities were nausea and liver enzyme abnormalities, which necessitated interruption and/or dose reduction of imatinib.[13][14] (Refer to the PDQ summary on Nausea and Vomiting for more information.) Subsequent allogeneic transplant does not appear to be adversely affected by the addition of imatinib to the treatment regimen.
Imatinib is generally incorporated into the treatment of patients with Ph1-positive ALL because of the responses observed in monotherapy trials. If a suitable donor is available,
allogeneic bone marrow transplantation should be considered because remissions
are generally short with conventional ALL chemotherapy clinical trials.
Since myelosuppression is an anticipated consequence of both leukemia and
its treatment with chemotherapy, patients must be closely monitored during
remission induction treatment. Facilities must be available for hematological
support and for the treatment of infectious complications.
Supportive care during remission induction treatment should routinely include
red blood cell and platelet transfusions, when appropriate.[19][20]
Evidence (Supportive care):
Empiric broad-spectrum antimicrobial therapy is an absolute necessity for
febrile patients who are profoundly neutropenic.[23][24] Careful instruction in
personal hygiene and dental care and in recognizing early signs of infection are
appropriate for all patients. Elaborate isolation facilities, including
filtered air, sterile food, and gut flora sterilization, are not routinely
indicated but may benefit transplant patients.[25][26]
Rapid marrow ablation
with consequent earlier marrow regeneration decreases morbidity and mortality.
White blood cell transfusions can be beneficial in selected patients with
aplastic marrow and serious infections that are not responding to
antibiotics.[27] Prophylactic oral antibiotics may be appropriate in patients
with expected prolonged, profound granulocytopenia (<100/mm3 for 2 weeks), though further studies are necessary.[28] Serial surveillance cultures may be helpful in detecting the presence or acquisition of resistant organisms in these patients.
As suggested in a CALGB study (CLB-9111), the use of myeloid growth factors during
remission-induction therapy appears to decrease the time to hematopoietic
The early institution of CNS prophylaxis is critical to achieve control of
sanctuary disease.
Two additional subtypes of adult ALL require special consideration. B-cell ALL, which
expresses surface immunoglobulin and cytogenetic abnormalities such as t(8;14),
t(2;8), and t(8;22), is not usually cured with typical ALL regimens.
Aggressive brief-duration high-intensity regimens, including those previously used in CLB-9251 (NCT00002494), that are similar to those used in aggressive non-Hodgkin lymphoma have shown high response rates and cure rates
(75% CR; 40% failure-free survival).[31][32][33] Similarly, T-cell ALL,
including lymphoblastic lymphoma, has shown high cure rates when
treated with cyclophosphamide-containing regimens.[4]
Whenever possible, patients with B-cell or T-cell ALL should be entered in clinical trials designed to improve the outcomes
in these subsets. (Refer to the Burkitt Lymphoma/Diffuse Small Noncleaved-cell Lymphoma and Lymphoblastic lymphoma sections in the PDQ summary on Adult Non-Hodgkin Lymphoma
Treatment for more information.)
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated adult acute lymphoblastic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Goldstone AH, Richards SM, Lazarus HM, et al.: In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood 111 (4): 1827-33, 2008.
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Doney K, Buckner CD, Kopecky KJ, et al.: Marrow transplantation for patients with acute lymphoblastic leukemia in first marrow remission. Bone Marrow Transplant 2 (4): 355-63, 1987.
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Kantarjian H, Thomas D, O'Brien S, et al.: Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer 101 (12): 2788-801, 2004.
Druker BJ, Sawyers CL, Kantarjian H, et al.: Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med 344 (14): 1038-42, 2001.
Ottmann OG, Druker BJ, Sawyers CL, et al.: A phase 2 study of imatinib in patients with relapsed or refractory Philadelphia chromosome-positive acute lymphoid leukemias. Blood 100 (6): 1965-71, 2002.
Thomas DA, Faderl S, Cortes J, et al.: Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood 103 (12): 4396-407, 2004.
Yanada M, Takeuchi J, Sugiura I, et al.: High complete remission rate and promising outcome by combination of imatinib and chemotherapy for newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia: a phase II study by the Japan Adult Leukemia Study Group. J Clin Oncol 24 (3): 460-6, 2006.
Wassmann B, Pfeifer H, Goekbuget N, et al.: Alternating versus concurrent schedules of imatinib and chemotherapy as front-line therapy for Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL). Blood 108 (5): 1469-77, 2006.
Bassan R, Rossi G, Pogliani EM, et al.: Chemotherapy-phased imatinib pulses improve long-term outcome of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: Northern Italy Leukemia Group protocol 09/00. J Clin Oncol 28 (22): 3644-52, 2010.
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Larson RA, Dodge RK, Linker CA, et al.: A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood 92 (5): 1556-64, 1998.
Thomas DA, Cortes J, O'Brien S, et al.: Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol 17 (8): 2461-70, 1999.
Standard treatment options for adult ALL in remission include the following:
Current approaches to postremission therapy for adult ALL include short-term, relatively intensive chemotherapy followed by any of the following:
Because the optimal postremission therapy for patients with ALL is still
unclear, participation in clinical trials should be considered. (Refer to the
B-cell (Burkitt) lymphoma section in the PDQ summary on Adult Non-Hodgkin Lymphoma Treatment for more information.)
Evidence (Chemotherapy):
Administration of the newer dose-intensive schedules can be difficult and should be performed by physicians experienced in these regimens at centers equipped to deal with potential complications. Studies in
which continuation or maintenance chemotherapy was eliminated had outcomes
inferior to those with extended treatment durations.[8][9] Imatinib has been incorporated into maintenance regimens in patients with Ph1-positive ALL.[10][11][12]
Evidence (Allogeneic and autologous BMT):
AlloBMT results in the lowest incidence of leukemic relapse, even when compared
with a BMT from an identical twin (syngeneic BMT). This
finding has led to the concept of an immunologic graft-versus-leukemia effect
similar to graft-versus-host disease (GVHD). The improvement in DFS in patients undergoing alloBMT as primary postremission therapy is
offset, in part, by the increased morbidity and mortality from GVHD,
veno-occlusive disease of the liver, and interstitial pneumonitis.[13]
The use of matched unrelated donors for alloBMT is
currently under evaluation but, because of its current high treatment-related
morbidity and mortality, it is reserved for patients in second remission or
beyond. The dose of total-body radiation therapy administered is associated with the
incidence of acute and chronic GVHD and may be an independent predictor of
leukemia-free survival.[18][Level of evidence: 3iiB]
Evidence (B-cell ALL):
Aggressive cyclophosphamide-based regimens similar to those used in aggressive
non-Hodgkin lymphoma have shown improved outcome of prolonged DFS for patients with B-cell ALL (L3 morphology, surface immunoglobulin
The early institution of CNS prophylaxis is critical to achieve control of
sanctuary disease. Some authors have suggested that there is a subgroup of
patients at low risk for CNS relapse for whom CNS prophylaxis may not be
necessary. However, this concept has not been tested prospectively.[20]
Aggressive CNS prophylaxis remains a prominent component of treatment.[19]
This report, which requires confirmation in other cooperative group settings,
is encouraging for patients with L3 ALL. Patients with surface immunoglobulin
and L1 or L2 morphology did not benefit from this regimen. Similarly, patients
with L3 morphology and immunophenotype, but unusual cytogenetic features, were
not cured with this approach. A WBC count of less than 50,000 per
microliter predicted improved leukemia-free survival in a univariate analysis.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with adult acute lymphoblastic leukemia in remission. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Zhang MJ, Hoelzer D, Horowitz MM, et al.: Long-term follow-up of adults with acute lymphoblastic leukemia in first remission treated with chemotherapy or bone marrow transplantation. The Acute Lymphoblastic Leukemia Working Committee. Ann Intern Med 123 (6): 428-31, 1995.
Cuttner J, Mick R, Budman DR, et al.: Phase III trial of brief intensive treatment of adult acute lymphocytic leukemia comparing daunorubicin and mitoxantrone: a CALGB Study. Leukemia 5 (5): 425-31, 1991.
Dekker AW, van't Veer MB, Sizoo W, et al.: Intensive postremission chemotherapy without maintenance therapy in adults with acute lymphoblastic leukemia. Dutch Hemato-Oncology Research Group. J Clin Oncol 15 (2): 476-82, 1997.
Finiewicz KJ, Larson RA: Dose-intensive therapy for adult acute lymphoblastic leukemia. Semin Oncol 26 (1): 6-20, 1999.
Horowitz MM, Messerer D, Hoelzer D, et al.: Chemotherapy compared with bone marrow transplantation for adults with acute lymphoblastic leukemia in first remission. Ann Intern Med 115 (1): 13-8, 1991.
Sebban C, Lepage E, Vernant JP, et al.: Allogeneic bone marrow transplantation in adult acute lymphoblastic leukemia in first complete remission: a comparative study. French Group of Therapy of Adult Acute Lymphoblastic Leukemia. J Clin Oncol 12 (12): 2580-7, 1994.
Forman SJ, O'Donnell MR, Nademanee AP, et al.: Bone marrow transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood 70 (2): 587-8, 1987.
Fière D, Lepage E, Sebban C, et al.: Adult acute lymphoblastic leukemia: a multicentric randomized trial testing bone marrow transplantation as postremission therapy. The French Group on Therapy for Adult Acute Lymphoblastic Leukemia. J Clin Oncol 11 (10): 1990-2001, 1993.
Corvò R, Paoli G, Barra S, et al.: Total body irradiation correlates with chronic graft versus host disease and affects prognosis of patients with acute lymphoblastic leukemia receiving an HLA identical allogeneic bone marrow transplant. Int J Radiat Oncol Biol Phys 43 (3): 497-503, 1999.
Standard treatment options for recurrent adult ALL include the following:
Patients with ALL who experience a relapse following chemotherapy and maintenance
therapy are unlikely to be cured by further chemotherapy alone. These patients
should be considered for reinduction chemotherapy followed by alloBMT.
Low-dose palliative radiation
therapy may be considered in patients with symptomatic recurrence either within
or outside the central nervous system.[1]
Patients with Ph1-positive ALL will often be taking imatinib at the time of relapse and thus will have imatinib-resistant disease. Dasatinib, a novel tyrosine kinase inhibitor with efficacy against several different imatinib-resistant BCR-ABL mutations, has been approved for use in Ph1-positive ALL patients who are resistant to or intolerant of imatinib. The approval was based on a series of trials involving patients with chronic myelogenous leukemia, one of which included small numbers of patients with lymphoid blast crisis or Ph1-positive ALL.
Evidence (Dasatinib):
Patients for whom an HLA-matched donor is not
available are excellent candidates for enrollment in clinical trials that are
studying the following:[3][4][5][6][7][8][9]
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent adult acute lymphoblastic leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Gray JR, Wallner KE: Reversal of cranial nerve dysfunction with radiation therapy in adults with lymphoma and leukemia. Int J Radiat Oncol Biol Phys 19 (2): 439-44, 1990.
Talpaz M, Shah NP, Kantarjian H, et al.: Dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias. N Engl J Med 354 (24): 2531-41, 2006.
Herzig RH, Bortin MM, Barrett AJ, et al.: Bone-marrow transplantation in high-risk acute lymphoblastic leukaemia in first and second remission. Lancet 1 (8536): 786-9, 1987.
Thomas ED, Sanders JE, Flournoy N, et al.: Marrow transplantation for patients with acute lymphoblastic leukemia: a long-term follow-up. Blood 62 (5): 1139-41, 1983.
Sallan SE, Niemeyer CM, Billett AL, et al.: Autologous bone marrow transplantation for acute lymphoblastic leukemia. J Clin Oncol 7 (11): 1594-601, 1989.
Paciucci PA, Keaveney C, Cuttner J, et al.: Mitoxantrone, vincristine, and prednisone in adults with relapsed or primarily refractory acute lymphocytic leukemia and terminal deoxynucleotidyl transferase positive blastic phase chronic myelocytic leukemia. Cancer Res 47 (19): 5234-7, 1987.
Biggs JC, Horowitz MM, Gale RP, et al.: Bone marrow transplants may cure patients with acute leukemia never achieving remission with chemotherapy. Blood 80 (4): 1090-3, 1992.
This information was last updated on February 21, 2014.
Our licensed social workers are here to help adult patients and their loved ones face the many new concerns and anxieties following a cancer diagnosis, offering emotional support and assistance with obtaining needed resources.
Our support groups are geared to specific cancers and methods of treatment. They give patients the opportunity to meet and share information and moral support. Our experienced, compassionate staff facilitates and guides discussion.
If you are dealing with the death of a loved one, grief can be a lonely and isolating experience. The Bereavement Program provides support to bereaved family members and friends following the death of a patient.
Concierge Services is your one-stop place to learn about Dana-Farber programs, services and resources, as well as information on getting around Boston, finding lodging or restaurants, and activities in the area.
The Expressive Arts Therapy program, sponsored by the Leonard P. Zakim Center for Integrative Therapies, provides adult patients, family members, and caregivers with a variety of options to support well-being during cancer treatment. From live music meditation to painting technique workshops, the program offers a range of creative outlets to suit every interest.
Dana-Farber and Brigham and Women's Hospital, including parking facilities, are fully accessible to people with disabilities. There are wheelchairs at the main entrance, and security staff can provide personal assistance. We also have many educational materials available in large print and audiotape formats.
The Ethics Consultation Service is available for patients and families who may be facing difficult decisions and choices regarding care. Our goal is to bring together patients, families and health care providers to talk about ethical concerns and help everyone involved arrive at a resolution that is right for all.
This comprehensive resource offers guidance, information and resources to support the entire family, including how to talk to children about cancer, advice for the well partner, and creating a support network.
Find practical tips and suggestions for individuals caring for a family member or friend with cancer, including creating a caregiving plan, finding community resources, and looking after your own well-being.
Friends' Place provides personal consultations to help cancer patients of all ages cope with changes in physical appearance that result from cancer treatment. Our experienced, compassionate team provides fittings for compression garments or breast prostheses, helps with wigs and other head coverings, and offers make-up and skincare advice.
The Friends' Corner Gift Shop, located on the first floor of the Yawkey Center for Cancer Care, offers a wide selection of unique gifts and everyday items for patients, families and staff.
Dana-Farber offers several services to help you and your family manage the financial side of cancer treatment. From creating bill payment schedules and estate planning advice to debt management and resource assistance for patients in need, our team is here for you.
Every year, thousands of patients with cancer from around the world come to Dana-Farber for their care. We provide a wide array of logistical and other services for individuals who live outside the United States.
Dana-Farber provides interpreting services for patients whose first language is not English. Interpreters may be requested for any activity, including registration, booking appointments, attending treatments and exams, support groups, and meetings with doctors and other members of your health care team.
Our nutritionists are registered dietitians who can assist you in planning an optimal diet during any stage of your cancer journey, cope with any side effects you may experience, and answer your questions about the latest findings on cancer and nutrition.
One-to-One connects adult patients, family members and caregivers with individuals who have gone through cancer themselves, providing an experienced and reassuring perspective for those facing a cancer diagnosis, treatment and recovery.
The Eleanor and Maxwell Blum Patient and Family Resource Center and its satellite resource rooms are staffed by health care professionals and provide computer stations, books, brochures, videos, and CDs to help you find information and support on a variety of issues about cancer treatment and care.
Patients websites help friends and family members stay up-to-date on their loved ones' condition and write messages of support and encouragement.
The Dana-Farber pharmacy fills prescriptions for all pediatric and adult patients. Our pharmacists are an extension of the patient care team and work closely with your physicians to provide seamless, convenient, safe care.
More than 1,200 Dana-Farber patients and their families have enjoyed free trips to baseball games, theater shows, museums, and other attractions this year through the Recreational Resources program.
The Sexual Health Program provides education, consultation and personalized rehabilitation for patients and their partners who have experienced changes in sexual health during and after cancer treatment.
Through all stages of cancer treatment and survivorship, our Spiritual Care staff is available 24 hours a day to provide emotional and spiritual support for adults and pediatric patients and family members.
Young adults with cancer face very different challenges than patients who were diagnosed earlier in childhood or later in adulthood. The Young Adult Program can help you to find the resources and expertise available at Dana-Farber to help support your cancer experience.
Integrative therapies, also known as complementary therapies, range from acupuncture and massage to nutritional guidance and music therapy. Patients treated at the Zakim Center credit its services with easing nausea, improving circulation, and reducing pain, stress, and anxiety associated with cancer treatment.
In this video, Dr. Corey Cutler talks about his work in the Hematologic Oncology Treatment Center at Dana-Farber/Brigham and Women's Cancer Center.


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Herald staff
Happy holidays!
Not to alarm you, but if you still need to do some Christmas shopping, this is your second to last weekend. Don't worry, though, we have some excellent ideas for you — and all of them are local. You won't have to pay for shipping or worry if your package will arrive in one piece and on time.
We asked our friends on Facebook for their favorite places to shop – with an emphasis on local and unique stores. The response was fabulous and we've collected the ideas, along with some suggestions from our staff, into a nice long list of ideas.
So, get out your list and plan your trip. And don't forget, if you find somewhere else great, leave a comment here or tell us on our Facebook page.
Toys and games
• BobaKhan Toys, toys, 2916 Hewitt Ave., Everett, 425-258-3582, shop.bobakhan.com/
• Toys That Teach, toys, 23716 Eighth Ave. Suite F, Bothell, 425-481-2577, toysthatteachbothell.com
• Wandering Havoc Games, games, 514 State Ave., Marysville, 425-609-4527, www.facebook.com/wanderinghavoc
Food and drink
• Mukilteo Coffee Roasters, coffee, 3228 Lake Leo Way, Langley, 360-321-5263, www.mukilteocoffee.com
• Norm's Market, keg and bottleshop, 10027 Lundeen Parkway, Lake Stevens, 425-334-4646, www.facebook.com/normsmarket
• Paula's Wine Knot and Pepper Jelly, wine and food, 19829 168th St. SE, Monroe, 425-501-7563, www.facebook.com/pages/Paulas-Wine-Knot-Beer-and-Wine-Bar/199113116828184
• Skip Rock Distillers, local artisan liquor, 104 Avenue C, Snohomish, 425-330-4885, skiprockdistillers.com
• St. Rita Supreme Chocolat, chocolate, 10208 State Ave. B, Marysville, 425-530-9950 or 425-308-4485, www.stritasupremechocolat.com
• Sweet Indulgence, candy and more, 19555 Highway 2, Monroe, 360-805-1440, www.facebook.com/pages/Sweet-Indulgence/219750327159
• The Mercantile Wine &Goods, wine, 23732 Bothell-Everett Highway, Suite B., Bothell, 425-780-5880, www.facebook.com/MercantileWine
• The Root Beer Store, specialty root beer and sodas, 20015 Highway 99, Lynnwood, 425-885-5585, www.therootbeerstore.com
• The Wine Shoppe, wine, 2704 171st Place NE, Marysville, 360-652-9200, www.maryswineshop.com
• Beat Street, women's clothing, 1010 First Street, Snohomish, 360-568-7254
• Monique's Boutique, women's clothing, 902 First Street, Snohomish, 425-760-8476, www.facebook.com/pages/Moniques-Boutique/169427456416253
• Hoity Toity, clothing and gifts, 8825 34th Ave. NE, Marysville, 360-716-2982, and 1234 First St., Snohomish, 360-217-7684, www.shophoitytoity.com
• Trusty Threads, used clothing, 1515 Third St., Marysville, 360-454-0298, www.trustythreads.com
• Gigi's Closet, used clothing, 12926 Mukilteo Speedway, Lynnwood, 425-374-3470, www.gigiscloset.net
• Uppercase Books, new, used and collectible, 1118 First Street, Snohomish, 360-568-5987, uppercasebookshop.com
• Vision Quest Bookstore and Wellness Center, books and more, 3602 Colby Ave., Everett, 425-252-1591, visionquestcenter.com
• Bee Bops &Lollipops, kids clothing and gifts, 1112 First St., Snohomish, 360-568-2333, www.beebopsandlollipops.com
• Clayful Creations, paint-your-own pottery, 102 Avenue D, Snohomish, 360-217-7671
• Ethical Choices, fair-trade gift shop, 2612 Colby Ave., Everett, 425-404-3972, www.facebook.com/EthicalChoicesLlc
• Gifts on Broadway, gift shop, 3224 Broadway, Everett, 425-252-4792
• He-Said-She-Said Shop, gift shop, 12199 Village Center Place Suite 103, Mukilteo, 425-322-4635, www.he-said-she-said-shop.com
• J. Matheson, gift shop and kitchen items, 2615 Colby Ave., Everett, 425-258-2287, www.jmatheson.com
• Joyworks, gift shop, 1002 First Street, Snohomish, 360-568-5050, joyworks-shopgirl.blogspot.com
• Mill Creek Sports, authentic autographed memorabilia, 15704 Mill Creek Blvd. Suite 5, Mill Creek, 425-742-8500, www.millcreeksports.com
• Pinch Knitter, yarn shop, 8712 271st St., Stanwood, 360-939-0769, www.pinchknitter.com
• Quilceda Leather, leather items, 3922 88th St. SE, Marysville, 360-659-1333, www.quilcedaleather.com
• Recycled Biker Stuff, motorcycle gear and more, 2211 Highway 530, Arlington, 360-926-8770, www.recycledbikerstuff.com
• Robin's Nest Gifts and Fine Jewelry, gift shop, 109 S. Granite Ave., Granite Falls, 360-454-0256, www.facebook.com/pages/Robins-Nest-Gifts-Fine-Jewlery/169887233048757
• Ruffles and Rust, gift shop, 1234 First St., Snohomish, 360-217-7557, rufflesandrustsquare.com
• The Speckled Hen, home décor, 915 First St., Snohomish, 360-568-9758, www.speckledhencountrystore.com
• The Wishing Stone, jewelry, 317 Main Street, Edmonds, 425-712-1060, www.facebook.com/pages/The-Wishing-Stone/330291710218
• Tommy's Guitar Shop, guitars and accessories, 1911 Hewitt Ave., Everett, 425-252-9252, www.tommysguitarshop.com
• Town Hall Antiques, antiques, 820 237th St SE Suite A, Bothell, 425-487-8979, www.facebook.com/townhallantiques
• Vic's 66, retro gift shop, 2902 W. Marine View Drive, Everett, 206-381-3500, www.vics66.com
• Yesterday, today and tomorrow, fair-trade gift shop, 8717 271st St. Stanwood, 360-629-5001, ytt4good.com
• Avenue D Gallery, custom frame shop and gallery, 124 Avenue D, Snohomish, www.avenue-d-gallery.com
• Fogdog Gallery, art gallery, 233 N. Olympic Ave., Arlington, 505-660-6825, www.fogdoggallery.com
• Gallery North, art gallery, 508 Main St., Edmonds, 425-774-0946, www.gallerynorthedmonds.com
• Ornamental Art Gallery, art gallery, 13805 Smokey Point Blvd. Suite 105, Marysville, 425-422-5232, www.ornamentalartsgallery.com
• Schack Art Center, arts and classes, 2921 Hoyt Ave., Everett, 425-259-5050, www.schack.org
• Enchanted Florist, flowers and more, 2809 Colby Ave., 425-258-1065, enchantedfloristeverett.com
• Flowers by George, flowers and gifts, 335 N. Olympic Ave., Arlington, 877-550-5789, www.flowersbygeorge.com
• Ash Way Pets, pet store, 2902 164th St. SW, Lynnwood, 425-741-2977, www.ashwaypetsupply.com
• Muddy Paws All Pet Supply and Grooming, pet supplies and grooming, 12926 Mukilteo Speedway, Lynnwood, www.facebook.com/pages/Muddy-Paws-All-Pet-Supply-And-Grooming/116337528384834


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Shoo, Fly!Riddles are little poems or phrases that pose a question that needs answering. Riddles frequently rhyme, but this is not a requirement.
I'm not found on the tip of the tongue
But I'm usually quite close by
Add a letter and you will see
That I'll soon take wing and fly.
HintThe letter to add is an E.
AnswerHang your head if you missed the clue,
For the title gives you the word shoo.
A shoe has a tongue that is covered in lace,
With an AGLET at its tip
To keep frayed ends in place.
Add an "e" and you will see,
As well as the eagle does.
The EAGLET will soar above you and me,
As soon as it loses its downy fuzz.
What Next?
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Remember going away to summer camp? You got to learn new things, tell stories by the campfire and make new friends. Now it's your kids' turn to go (and a chance for you to take a kid-free break!). As you get your children packed up and ready to go, check out these neat little things you can do to make their summer camp experience extra memorable.
These thoughtful extras can keep your children organized away from home, and also let them know you're thinking of them. And with these little touches, you can help make their summer camp experience something they'll always remember.


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Prague to Meissen by Bike CCZ
Visiting: Czech Republic , Germany
Trip Duration 8 Days
Cycling In The Czech Republic And Germany
Explore this ancient landscape as we cycle through the basalt hills of the Czech Republic to the sandstone canyons of 'Saxon Switzerland'. The Vltava and Elbe Rivers meander throughout this delightful region and link some of central Europe's finest historic towns and cities. Along the way we visit the fortress town of Terezin and explore the beautiful Czech capital of Prague.
Tour Highlights
- Prague - Wander the streets and soak up the atmosphere in one of Europe's most beautiful cities
- Cycling the Elbe Valley - Relaxing cycling on attractive river-side cycle paths
- Terezin - Historic fortress and World War II Nazi concentration camp
- Saxon Switzerland - Bike through sandstone gorges and wooded valleys
- Dresden - Traffic-free arrival into the heart of Germany's finest Baroque city
- Litomerice and Pirna - Attractive and characterful market towns, built around wide, cobbled squares
- Meissen - Medieval town famed for its porcelain
1Join trip in Prague
2Cycle to Melnik via the 'Garden of Bohemia'
3Pedal to Litomerice stopping to visit the vast Terezin fortress
4Ride through wooded valleys, rolling hills and along the river via Strekov Castle to Decin
5Cross into Germany, visit the impressive Konigstein fortress and continue on to Pirna
6Cycle via Dresden to Meissen
7Drive to Prague; afternoon walking tour
8Trip ends in Prague
Trip notes
Each departure date has its own dedicated trip note, detailing all you need to know about that trip. Whether you've already booked, or weighing up your options, please choose carefully the relevant itinerary for you.
We have the following different versions of the Prague to Meissen by Bike trip available at present.
Please select a date:
Why Book this trip
Unlike many other operators, we include the hire of your bike in the overall cost of the holiday: you don't need to bring your own or pay extra to hire one locally. We also provide a support vehicle, spare parts and take care of day to day bike maintenance. All you need bring is your own helmet.
|Included meals
TransportBus, Bicycle
Accommodation7 nights Standard Hotel
Trip StaffDriver(s), Explore Tour Leader / Cycle guide
Cycling Information
On this trip we cycle 229 km over five days (an average of 46 km per day). The terrain is mostly flat with several short uphill sections, generally when ascending out of river valleys. We mostly follow well maintained asphalt riverside cycle paths (70%), with short sections on gravel tracks and minor roads. A support vehicle carries our luggage from point to point throughout but cannot escort the rides along the cycle paths. We have graded the route as easy.
Included Bike
21 gear Bird custom hybrid bike.
Electric bikes (e-bikes) are available for an additional cost for the duration of the holiday (£110). You will be required to pay a refundable deposit upon collection of the e-bike in country. Please contact us for more details or to request your e-bike.
Electric bikes (e-bikes) are available for an additional cost for the duration of the holiday (£110). You will be required to pay a refundable deposit upon collection of the e-bike in country. Please contact us for more details or to request your e-bike.


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If you're looking to make a night of it and spend the night take a look at our favourite selection of hotels and accommodation convenient for the Beckett Theatre. If you can't find what you're looking for below, please try our main New York City Theater hotels page for more choices.
Staybridge Suites - Times Square - New York City
0.14 mi away at 340 West 40th Street
4 Star, Prices from $126
Cassa Hotel Times Square
0.16 mi away at 515 Ninth Avenue
4 Star, Prices from $199
The Out NYC
0.19 mi away at 510 West 42nd Street
4 Star, Prices from $80
InterContinental New York Times Square
0.2 mi away at 300 West 44th Street
4 Star, Prices from $220
Westin New York at Times Square
0.21 mi away at 270 West 43rd Street
4 Star, Prices from $199
Row NYC
0.25 mi away at 700 8th Avenue
4 Star, Prices from $143
Hilton Times Square
0.26 mi away at 234 West 42nd Street
4 Star, Prices from $179
Homewood Suites Midtown Manhattan Times Square South
0.29 mi away at 312 West 37th Street
4 Star, Prices from $199
Courtyard by Marriott New York Manhattan/Times Square West
0.29 mi away at 307 West 37th Street
4 Star, Prices from $134
Please note: The term Beckett Theatre as well as all associated graphics, logos, and/or other tradermarks, tradenames or copyrights are the property of the Beckett Theatre and are used herein for factual descriptive purposes only. We are in no way associated with or authorized by the Beckett Theatre and neither that entity nor any of its affiliates have licensed or endorsed us to sell tickets, goods and or services in conjunction with their events.


text: Thank you for partnering with us to meet the comprehensive medical needs of your patients. We value our relationship with you and are committed to providing accurate and timely information so that we can advance the health and well-being of animals together. In this section, we have provided important information and resources that will help to ensure that your patients receive expeditious, quality care; your clients enjoy a smooth and well-coordinated experience; and you have access to the most up-to-date information about your patients' care and the latest news from Cornell.