The primary endpoint was the complete remission/complete remission with partial haematological recovery (CR/CRh*) rate within 2 cycles of treatment with BLINCYTO. Eighty-one of 189 (%) patients achieved CR/CRh* within the first 2 treatment cycles with the majority of responses (64 of 81) occurring within 1 cycle of treatment. In the elderly population (≥ 65 years of age) 11 of 25 patients (%) achieved CR/CRh* within the first 2 treatment cycles (see section for safety in elderly). Four patients achieved CR during consolidation cycles, resulting in a cumulative CR rate of % (67/189; 95% CI: % - %). Thirty-two of 189 (17%) patients underwent allogeneic HSCT in CR/CRh* induced with BLINCYTO (see table 1).
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In either case, flipping cis -aconitate allows the dehydration and hydration steps to occur on opposite faces of the intermediate.  Aconitase catalyzes trans elimination/addition of water, and the flip guarantees that the correct stereochemistry is formed in the product.   To complete the reaction, the serine and histidine residues reverse their original catalytic actions: the histidine, now basic, abstracts a proton from water, priming it as a nucleophile to attack at C2, and the protonated serine is deprotonated by the cis -aconitate double bond to complete the hydration, producing isocitrate.