Radioimmunotherapy-augmented BEAM chemotherapy vs BEAM alone as the high-dose regimen for autologous stem cell transplantation (ASCT) in relapsed follicular lymphoma (FL): a retrospective study of the EBMT Lymphoma Working Party.

Relapse remains the most common cause of treatment failure in patients receiving autologous stem cell transplantation (ASCT) for follicular lymphoma (FL). The aim of this study was to evaluate the effect of adding radioimmunotherapy or rituximab (R) to BEAM (carmustine, etoposide, ara-c, melphalan) high-dose therapy for ASCT in patients with relapsed FL. Using the European Society for Blood and Marrow Transplantation registry, we conducted a cohort comparison of BEAM (n=1973), Zevalin-BEAM (Z-BEAM) (n=207) and R-BEAM (n=179) and also a matched-cohort analysis of BEAM vs Z-BEAM including 282 and 154 patients, respectively. BEAM, Z-BEAM and R-BEAM groups were well balanced for age, time from diagnosis to ASCT and disease status at ASCT. The cumulative incidences of relapse (IR) at 2 years were 34, 34 and 32% for Z-BEAM, R-BEAM and BEAM, respectively. By multivariate analysis, there were no significant differences with Z-BEAM or R-BEAM compared with BEAM for IR, non-relapse mortality, event-free survival or overall survival. With the caveat that the limitations of registry analyses have to be taken into account, this study does not support adding radioimmunotherapy or R to BEAM in ASCT for relapsed FL. However, we cannot rule out the existence a particular subset of patients who could benefit from Z-BEAM conditioning that cannot be identified in our series, and this should be tested in a randomized trial.

Thalidomide in newly diagnosed multiple myeloma: influence of thalidomide treatment on peripheral blood stem cell collection yield.

In a phase III randomized, multicenter study, the German-speaking Myeloma-Multicenter Group (GMMG) and the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON) group investigated the influence of thalidomide (Thal) on the outcome of peripheral blood stem cell (PBSC) collection in multiple myeloma (MM) before peripheral autologous blood stem cell transplantation (ABSCT). We analyzed the data of 398 myeloma patients after induction with Thal, doxorubicin and dexamethasone (TAD) in comparison with vincristine, doxorubicin and dexamethasone (VAD) followed by mobilization with cyclophosphamide, doxorubicin, dexamethasone (CAD) and PBSC collection. Within both the study groups, patients treated with TAD showed to collect significantly fewer CD34(+) cells compared with VAD (GMMG, TAD: median 9.8 x 10(6)/kg; range 2.0-33.6; VAD: median 10.9 x 10(6)/kg range 3.0-36.0; P=0.02) (HOVON, TAD: median 7.4 x 10(6)/kg; range 2.0-33.0; VAD: median 9.4 x 10(6)/kg; range 0.0-48.7; P=0.009). However, engraftment after peripheral autologous stem cell transplantation showed no difference between Thal and VAD groups. We conclude that Thal as a part of induction regimen is associated with better response rates (GMMG-HD3: CR/PR 79%, VAD: CR/PR 58%; HOVON-50: TAD: CR/PR 81%, VAD: CR/PR 61%), but significantly affects the yield of PBSC collection. Nevertheless, the number of total CD34(+) cells collected was sufficient for double autologous transplantation in 82% of the Thal patients, with at least 2.5 x 10(6)/kg CD34(+) cells.

[Chorionic villi (placental) biopsy in the 2d and 3d trimester: new perspectives in prenatal diagnosis]. / Die Chorionzotten-(Plazenta-)Biopsie im II. und III. Trimenon: Neue Perspektiven der Pränataldiagnostik.

A report of our first experience in second and third trimester chorionic villus (placental) biopsy is given. In all 16 cases a cytogenetic result could be received within 2 to 5 days. There were 6 normal female and 9 normal male karyotypes. A third trimester CVS showed a mosaicism of a structural aberration of chromosome 9 (46, XX/46, XX, 9p+). Blood cultures of the fetus revealed a normal female karyotype. The following indications of a second and third trimester CVS are discussed: direct or indirect signs of fetal malformations in ultrasound scanning (Oligo- or Anhydramnios with severe intrauterine growth retardation), placental anomalies (exclusion of triploidies), non immunologic hydrops fetalis, low serum alpha FP and failed amniotic fluid culture. We believe that transabdominal CVS in the second and third trimester is a simple and rapid tool to exclude distinctively any chromosomal anomaly and therefore influences further management of pregnancy and parturition.

[The postpartum course of the HCG titer of maternal blood and its clinical relevance]. / Der postpartale HCG-Titer-Verlauf im mütterlichen Blut und seine klinische Relevanz.

In 62 postpartum patients serial beta-HCG-measurements were performed. These tests show that beta-HCG should disappear entirely during the third week postpartum. Significant titers beyond this time are seen when placental tissue remains in utero. This condition may lead to late postpartum hemorrhage which is best treated by curettage. If there is only mild bleeding and beta-HCG-titers are negative, a hormonal curettage with subsequent estrogen administration (3 weeks) can be performed. In doing so, unnecessary and potentially harmful intrauterine manipulations can be avoided.