Risk-adapted, treosulfan-based therapy with auto- and allo-SCT for relapsed/refractory aggressive NHL: a prospective phase-II trial.

Since the outcome of relapsed/refractory aggressive non-Hodgkin's lymphoma (NHL) is highly variable, a risk-adapted treatment approach was evaluated. After two cycles of DHAP, patients received high-dose treosulfan/etoposide/carboplatinum (TEC) and autologous stem cell rescue. After TEC, low-risk patients with late relapse (>1 year after first CR who achieved CR after DHAP received no further treatment. Patients with late relapse who achieved CR or PR only after TEC underwent a second cycle of TEC. High-risk patients with early relapse/refractory disease received treosulfan/fludarabine followed by allogeneic transplantation. Rituximab was added in patients with B-cell lymphoma (86%). At entry, 36% of all 57 patients had refractory disease, 32% early and 32% late relapse. During DHAP treatment, progression occurred in 32% of patients. Of 33 patients who received TEC, 5 received second TEC and 15 allogeneic transplantation. Main toxicity after TEC was oral mucositis (CTC grades 3 and 4 in 50% and 13%, respectively). In total, 42% patients achieved CR. Median OS was 21.4 months for all patients and 32.6 for those who underwent allogeneic transplantation. International prognostic index (IPI) at study entry was highly discriminative at predicting OS (P<0.0001). Risk-adapted, treosulfan-based therapy with auto- and allo-SCT is feasible. Long-term survival is possible with allogeneic transplantation.

Imaging at high magnetic fields: initial experiences at 4 T.

This article reviews the preliminary experiences and the results obtained on the human brain at 4 T at the University of Minnesota. Anatomical and functional images are presented. Contrary to initial expectations and the early results, it is possible to obtain high-resolution images of the human brain with exquisite T1 contrast, delineating structures especially in the basal ganglia and thalamus, which were not observed clearly in 1.5-T images until now. These 4-T images are possible using a new approach that achieves maximal contrast for different T1 values at approximately the same repetition time and has built-in tolerance to variations in B1 magnitude. For functional images, the high field provides increased contribution from the venuoles and the capillary bed because the susceptibility-induced alterations in 1/T2* from these small-diameter vessels increase quadratically with the magnitude of the main field. Images obtained with short echo times at 4 T, and by implication at lower fields with correspondingly longer echo times, are expected to be dominated by contributions from large venous vessel or in-flow effects from the large arteries; such images are undesirable because of their poor spatial correspondence with actual sites of neuronal activity.

Functional magnetic resonance imaging of Broca's area during internal speech.

Conventional gradient-echo magnetic resonance imaging (MRI) at 4 Tesla was used successfully to study the activity of Broca's area during internal speech word generation in healthy right-handed volunteers. Activity was demonstrated in the internal gray matter surrounding the ascending ramus of the lateral sulcus, deep to the cortical surface representation of Broca's area, in all the subjects. These studies demonstrate the capability of functional MRI to non-invasively map language related cognitive functions. Such functional mapping has value for both the study of basic neuroscience and neurosurgical planning.