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According to Hogan, the idea for the book originated around 1976 when he was asked by a friend about whether there was a solution to \"the Troubles\" in Northern Ireland. He said that there was no solution that he could see and that the only thing that might work was separating the children and the adults to prevent the prejudices from being taught at an early age. However, some years later he returned to the concept of a society free from conditioning, which formed part of the basis for Voyage from Yesteryear.[1]
In an attempt to crush this anarchist adhocracy, the Mayflower II government employs every available method of control; however, in the absence of conditioning the Chironians are not even capable of comprehending the methods, let alone bowing to them. The Chironians simply use methods similar to Gandhi's satyagraha and other forms of nonviolent resistance to win over most of the Mayflower II crew members, who had never previously experienced true freedom, and isolate the die-hard authoritarians.
Main outcome and measures: The primary end point was disease-free survival and the secondary end point was overall survival, both from the time of randomization. The threshold for statistical significance was set at a 1-sided P
Results: Among 208 randomized patients (median age, 9 years; 97 [47%] females), 118 (57%) completed the randomized therapy. Randomization was terminated at the recommendation of the data and safety monitoring committee without meeting stopping rules for efficacy or futility; at that point, 80 of 131 planned events occurred. With 2.9 years of median follow-up, 2-year disease-free survival was 54.4% for the blinatumomab group vs 39.0% for the chemotherapy group (hazard ratio for disease progression or mortality, 0.70 [95% CI, 0.47-1.03]); 1-sided P = .03). Two-year overall survival was 71.3% for the blinatumomab group vs 58.4% for the chemotherapy group (hazard ratio for mortality, 0.62 [95% CI, 0.39-0.98]; 1-sided P = .02). Rates of notable serious adverse events included infection (15%), febrile neutropenia (5%), sepsis (2%), and mucositis (1%) for the blinatumomab group and infection (65%), febrile neutropenia (58%), sepsis (27%), and mucositis (28%) for the chemotherapy group.
Conclusions and relevance: Among children, adolescents, and young adults with high- and intermediate-risk first relapse of B-ALL, postreinduction treatment with blinatumomab compared with chemotherapy, followed by transplant, did not result in a statistically significant difference in disease-free survival. However, study interpretation is limited by early termination with possible underpowering for the primary end point. 153554b96e
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