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As more centres consider autologous bone marrow and peripheral blood stem cell transplantation for patients with high risk Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in first complete remission (CR1) the long term sequelae of such treatments have to be considered. One of the most important side effects of such intensive treatment is loss of fertility. Sperm banking before treatment commences is available for males but unfortunately cryopreservation of ova/ovarian tissue is not yet possible for females. We have transplanted 30 women, 23 were under 40 years and report ten females who have had successful pregnancies (including two twin pregnancies and one triplet pregnancy), leading to live births following autologous bone marrow transplantation (ABMT) for poor prognosis HD and NHL in first or second complete remission. None of these children have shown evidence of birth defects (median follow up of two years). Of the twenty one pregnancies reported to the European Bone Marrow Transplantation Registry (EBMTR) following ABMT for lymphoma, eight of the seventeen unassisted cases came from our centres. The Newcastle/SNLG autotransplant differs from the approach in many EBMTR centres in that it uses melphalan or melphalan/etoposide alone instead of the more common four drug containing regimens and yet sustained complete remission rates indicate that the non-ablative approach is equally effective as more aggressive regimens on the disease with the huge advantage of preserved fertility in females. This approach to conditioning for ABMT should be considered when treating women in the reproductive age group.

SUMMARY Eighty-four children with acute lymphoblastic leukaemia (ALL) who had relapsed in bone marrow were studied to assess whether treatment would be more successful if relapse was detected before the disease became clinically evident. Patients whose relapse was detected by routine bone marrow examination before the disease became apparent were compared with those whose relapse was suspected from clinical examination or peripheral blood findings. In the former there was a lower percentage of blast cells in the marrow (p < 0 02) and the patients suffered less from complications of the disease, but there was no difference in the incidence or duration of second remissions between the two groups.It is often assumed that early detection of relapse in leukaemia makes reinduction of remission easier. In order to detect relapse before clinically evident disease develops, many schedules, for example Medical Research Council protocols, include regular bone marrow examinations. Few children like having bone marrow aspirations performed, and these increase the work load in the clinic and laboratory. In an attempt to assess their value, we compared children whose relapse was detected only by routine bone marrow aspiration with those whose relapse was suspected from clinical examination or from examination of the peripheral blood. Patients and methodsThe status of all children treated for acute lymphoblastic leukaemia at the Royal Manchester Children's Hospital from January 1970 to June 1979 was noted. Patients who had a relapse in the bone marrow after first remission were qualified to enter into the study. Concurrent relapse in the testis or the central nervous system, however, excluded children from entry. In patients who fulfilled the above criteria the following were noted:(1) Whether relapse was an unsuspected finding on a routine bone marrow aspirate or was found on bone marrow aspiration performed because (4) The duration of the second remission.(5) The development of serious complications during the induction of a second remission. (A serious complication was defined as one requiring admission to hospital.) (6) The total white cell count at initial diagnosis. Various conventional chemotherapy regimens were used in the reinduction attempts over the nineyear period. The patients were divided into two groups. Group I were those patients in whom relapse was an unsuspected finding, while group II were patients in whom relapse was suspected from clinical examination or from examination of the peripheral blood and confirmed by bone marrow aspiration. Patients who had findings indicating relapse on a day when they were due to have a routine bone marrow examination were placed in group It.The incidence and duration of second remissions were compared between the two groups by calculating remission duration curves using a life-table method.' These were compared using the logrank test.2 The number and nature of serious complications in the two groups were also noted. The patients in the study were classified according to the p...

We report the cases of four pregnant women with primary hypogammaglobulinaemia, who received intramuscular, intravenous or no replacement therapy with IgG in late pregnancy, and review the literature. Intravenous replacement administered to the mother during pregnancy produces adequate serum IgG levels in the neonate, and should be the treatment of choice in this situation.

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