This brief but intensive therapy was effective in treating poor-prognosis patients with non-Hodgkin's lymphoma. With this therapy, patients with small noncleaved-cell lymphoma or Shipp's category 3 disease had treatment outcome similar to the group as a whole. This therapy was not well tolerated by patients older than 60 years, and should not be given to this subgroup. Verification of these results in a randomized trial setting is indicated.

patients with relapsed or refractory IGL received intensified preparative therapy and underwent autologous transplantation at a single institution. Two intensified preparative regimens were used: cyclophosphamide, etoposide, total body irradiation (CY-VP-TBI) (n = 66) and cyclophosphamide, BCNU, etoposide (CBV) (n = 33). As clinical features and results were not different for the two preparative regimens, results were combined. For all patients undergoing autologous transplantation, 5-year actuarial overall survival (OS) was 34% ± 6%; 5-year event-free survival (EFS) was 26% ± 5%. For patients who responded to primary therapy, salvage therapy, or both, OS was 42% ± 7%; for nonresponders to prior therapy, OS was 14% ± 7%, P Ͻ 0.025. OS was better among patients responding to salvage therapy (50% ± 9%), than among patients who had a complete response to initial therapy, but failed to respond or were untested/unevaluable with respect to salvage therapy (26% ± 10%; P Ͻ 0.025). On multivariate analysis, response to salvage therapy was associated with survival following autologous transplantation (P Ͻ 0.005). Treatment related mortality was 9% overall and only 6% after G-CSF and GM-CSF were introduced into routine clinical practice. High-intensity preparative therapy is highly effective, with acceptable treatmentrelated mortality, in patients with IGL who have responded to induction therapy, salvage therapy, or both. The best responses are observed in patients responding to salvage therapy. Randomized prospective studies will be needed to further define the role of intensified preparative regimens. Bone Marrow Transplantation (2000) preparative regimens, long-term disease-free survival (DFS) has been associated with disease chemoresponsiveness. 3-7 However, even among patients with sensitive disease, long-term DFS has generally been seen in only 30-50% of patients. 2,5-8 Among patients with resistant disease, less than 10% survive long-term. 3,6 Intensification of the preparative regimen is one potential means of improving these clinical results. [9][10][11][12] Since 1986, we have studied two intensified preparative regimens in patients with relapsed or refractory IGL. One regimen added etoposide to the standard cyclophosphamide-TBI regimen, the other used augmented dose BCNU in combination with etoposide and cyclophosphamide. This report summarizes our experience with augmented preparative therapy in patients with relapsed or refractory IGL undergoing autologous transplantation. Patients and methods Patients and eligibilityRecords of all patients who received autologous stem cell transplantation (ASCT) at Vanderbilt University Medical Center or the affiliated Nashville Veteran's Affairs Hospital between September 1986 and June 1998 were reviewed. Patients were included in the study if both the initial and the most recent pathological material prior to transplantation were interpreted as IGL. Following review by two of the authors (WRM, TLM) at the time this report was prepared, patients with low-grade NHL evolving...

Summary:A retrospective single center study was performed to evaluate the safety and efficacy of valacyclovir for prevention of cytomegalovirus (CMV) infection (reactivation) after allogeneic stem cell transplantation (SCT). We compared a group of 31 patients at risk for CMV reactivation (donor, recipient or both seropositive for CMV) who received valacyclovir at an oral dose of 1 g three times a day for CMV prophylaxis with a matched cohort of 31 patients who did not receive the drug or any other form of CMV prophylaxis. Valacyclovir was used as primary prophylaxis in 12 patients and as secondary prophylaxis (after a prior CMV reactivation was effectively treated with either ganciclovir or foscarnet and without CMV antigenemia at the start of valacyclovir) in the remaining 19 patients. The two treatment groups were well matched for the donorrecipient CMV serological status and other pre-transplant characteristics. CMV reactivation was detected by blood antigenemia testing using a commercially available immunofluorescence assay for CMV lower matrix protein pp65 in circulating leukocytes. For primary prophylaxis, 3/12 patients who received valacyclovir reactivated CMV compared to 24/31 patients in the control group (P Ͻ 0.001). For secondary prophylaxis, 5/19 valacyclovir patients reactivated compared to 16/24 control patients (P Ͻ 0.05). Valacyclovir was well tolerated except for infrequent and mild gastrointestinal sideeffects. There was no difference in the incidence of CMV disease in the two groups. Prophylaxis with valacyclovir appears to be safe and efficacious in preventing both primary and secondary CMV reactivation in at-risk patients after allogeneic SCT. Larger prospective randomized studies will be required to confirm these observations. Bone Marrow Transplantation (2001) 28, 265-270.

Twenty patients with myelodysplastic syndromes (MDS) entered a randomized, placebo-controlled, double-blind trial designed to evaluate the efficacy and toxicity of high doses of recombinant human erythropoietin (rhEPO). Patients completing the trial were eligible to receive rhEPO as part of an open-label study. Eighteen patients were transfusion dependent; 10 had refractory anemia (RA), and 10 had refractory anemia with ringed sideroblasts (RARS). A response to rhEPO was defined as an increase in hematocrit of 4 percentage points or more over baseline, or the elimination of all transfusions with the hematocrit stable at the baseline level. In the double-blind trial, 1 patient (12.5%) receiving rhEPO responded, as compared with no responses in the placebo group. Overall, responses occurred in 4 of 17 patients (24%) receiving rhEPO at a dose of 1,200 to 1,600 U/kg intravenously (IV) twice weekly. Changes in granulocyte or platelet counts were not observed. Despite the administration of high doses of rhEPO, toxicity attributable to rhEPO was not observed in either the double-blind or open-label study. Response to rhEPO was not significantly related to age, gender, type of MDS, time since diagnosis, time since initiation of transfusion therapy, or baseline serum EPO. These studies indicate that rhEPO can be administered safely in very high doses to patients with MDS and that 24% of these patients will respond with increased erythropoiesis.