Objectives: To investigate the prevalence of ocular injuries in a large population of boxers over a period of 16 years, in particular, the most severe lesions that may be vision threatening. Methods: Clinical records of the medical archive of the Italian Boxing Federation were analysed. A total of 1032 boxers were examined from February 1982 to October 1998. A complete ophthalmological history was available for 956, who formed the study population (a total of 10 697 examinations). The following data were collected: age when started boxing; duration of competitive boxing career (from the date of the first bout); weight category; a thorough ocular history. The following investigations were carried out: measurement of visual acuity and visual fields, anterior segment inspection, applanation tonometry, gonioscopy, and examination of ocular fundus. Eighty age matched healthy subjects, who had never boxed, formed the control group. Results: Of the 956 boxers examined, 428 were amateur (44.8%) and 528 professional (55.2%). The median age at first examination was 23.1 (4.3) years (range 15-36). The prevalence of conjunctival, corneal, lenticular, vitreal, ocular papilla, and retinal alterations in the study population was 40.9% compared with 3.1% in the control group (p(0.0001). The prevalence of serious ocular findings (angle, lens, macula, and peripheral retina alterations) was 5.6% in boxers and 3.1% in controls (NS). Conclusions: Boxing does not result in a higher prevalence of severe ocular lesions than in the general population. However, the prevalence of milder lesions (in particular with regard to the conjunctiva and cornea) is noteworthy, justifying the need for adequate ophthalmological surveillance.

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Management of Malignant Gliomas continues to be a challenge. We prospectively studied the role of adding weekly Paclitaxel to Fractionated Stereotactic Radiation Therapy (FSRT) in the treatment of Malignant Gliomas. Twenty-three Glioblastoma Multiforme and two Anaplastic Astrocytoma were studied. Patients received 46 Gy at 2 Gy/fraction followed by a boost utilizing FSRT at a fraction of 2.5 Gy for 8 fractions. Paclitaxel is delivered concomitantly at 150 mg/m(2) weekly for six cycles. Eighteen patients had pharmacokinetic assays of Paclitaxel levels. All patients were followed until death or for a maximum of 36 months. The overall survival of the whole group was 14 months. The median survival for RPA prognostic classes III, IV, V, and VI were 20, 14, 12, and 11 months. Higher survival (14 months) was noted in the subtherapeutic phenytoin level group compared to 10 months in the therapeutic group (P=0.271). No grade 4 CTCAE (version 3.0) toxicities were observed. Enhanced survival was demonstrated with gross tumor resection (20.8 months), KPS > or =80 (18.7 months) and age < or =60 years (27 months) as compared to subtotal resection or biopsy (12.1 months, P< 0.005), KPS < or =70 (10.8 months, P=0. 005) and older age > 60 (10.46 months, P=0.006), respectively. Our study suggests that: i) the use of weekly Paclitaxel and FSRT in Gliomas is well tolerated with a survival of 14 months; ii) the regimen resulted in improvement of survival of RPA classes IV, V, VI; and iii) the use of FSRT boost may be studied with other chemotherapeutic agents to see if superior results can be attained.

The impact of KMT2A-AFF1 rearrangement in pediatric-like, minimal residual disease (MRD)-based clinical trials and the effect of transplant in KMT2A-AFF1 ALL are still debated.By analyzing 926 BCR-ABL1-negative ALL treated in GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto) clinical trials since 1996, we documented that KMT2A-AFF1-positive ALL -accounting for 10.5% of cases -had a significantly shorter survival than KMT2A-AFF1-negative (20.3% vs 45.5%, p = 0.003), also after censoring for transplant. Within KMT2A-AFF1-positive patients, the only independent prognostic factor was allogeneic stem cell transplant (ASCT, HR: 0.318, p = 0.002), that confers a survival advantage to KMT2A-AFF1positive patients.The prognosis of adult B-lineage acute lymphoblastic leukemia (B-ALL), thought greatly improved over the years, is still suboptimal with survival rates approaching 50% at 5 years. The only subset that witnessed a dramatic improvement of outcome is BCR-ABL1-positive ALL that benefited from the introduction of tyrosine kinase inhibitors. Within BCR-ABL1-negative ALL, t(4;11)(q21;q23) is the most common chromosomal abnormality, accounting for roughly 10% of adult patients. 1 In ALL the KMT2A-AFF1 fusion gene, derived from t(4;11)(q21;q23), is the most recurrent rearrangement of the promiscuous KMT2A gene and functions as a transcriptional activator. 2,3 KMT2A-AFF1/t(4;11)(q21;q23) leukemia is associated with a pro-B immunophenotype and it is recognized by the major cooperative groups as a subset with a particularly poor outcome. 4 For the latter reason, KMT2A-AFF1-positive ALL patients are managed more intensively and allocated to allogeneic transplant. 5,6 However, the datasets analyzed so far are too small to draw definitive conclusions on the role of KMT2A-AFF1 in pediatric-like, minimal residual disease (MRD)based clinical trials, and on the impact of transplant in this poor prognostic subgroup. To this respect, in the largest study conducted on patients enrolled in the UKALLXII/ECOG2993 clinical trial -including 88 KMT2A-AFF1-positive patientspatients undergoing ASCT had a survival advantage in comparison to those who received chemotherapy, though allograft was not an independent factor in multivariate analysis. 7 The PETHEMA group observed a trend towards a longer CR duration in KMT2A-AFF1 undergoing HSCT vs those receiving chemotherapy. 8 With regards to MRD-based protocols, the GRAALL study showed that KMT2A-AFF1 fusion gene retains prognostic significance in a multivariate model -that included MRD as a covariate -for cumulative incidence of relapse. 9 Alongside, Issa et al. analyzed the impact of cytogenetic alterations in roughly 400 BCR-ABL1-negative ALL in the context of protocols contemplating MRD quantification. 10 The authors confirmed the negative impact of KMT2A-AFF1-positivity on survival but, in a multivariate model, KMT2A-AFF1 rearrangement was not independently predictive of survival while MRD-positivity retained statistical significance. 10 To get insights into these issues, in the pre...