In vivo dosimetry allows for a specified total whole-body radiation dose to be delivered accurately. This schedule of intensification of (131)I-mIBG therapy by dose escalation and radiosensitization with topotecan with a haemopoietic autograft is safe and practicable. This approach should now be tested for efficacy in a phase II clinical trial.

This study has established an effective method of activity prescription that predicts subsequent toxicity, with the maximally tolerated dose being sufficient activity to deliver a whole-body-absorbed radiation dose of 2.5 Gy. The objective response rate is comparable to other single agents in chemoresistant neuroblastoma and suggests that 131I mIBG may be a useful method for targeting radiotherapy in metastatic neuroblastoma.

Summary:mortality are high as are relapse rates. [1][2][3] While some groups have reported reasonable results with second transplants in patients with relapsed acute leukemia, 4-14 these We studied 231 acute leukemia patients relapsing after allogeneic (n = 114) or autologous (n = 117) BMT to results may reflect the outcome of a highly selected group of patients because only a small proportion of relapsed assess the outcome of further therapy. In general, all patients in good condition were eligible for second patients is actually suitable for second grafts. 1,2 Alternative approaches which have been used to treat transplants except for post-allograft relapses from 1993-1994 onwards who received cytokine-or cellrelapse after allogeneic BMT have included stimulation of donor-type hematopoiesis with filgrastim 15 and immunomediated immunotherapy. The major reason for patients not progressing to second graft was death from therapy. [16][17][18][19][20][21] Cell-or cytokine-mediated adoptive immunotherapy is increasingly being utilized to treat acute leukeprogressive disease or toxicity of salvage chemotherapy. Seventeen of 231 patients (7%) were alive at the last mia relapsing after allogeneic BMT, and is a potentially useful and less toxic alternative to second allografts. 16-21 follow-up. Six of 14 post-autograft relapses treated with second transplants were alive and well, compared with For patients relapsing after autografts, repeat autografting in a subsequent remission 22,23 or allogeneic transplanfive of 103 not undergoing second grafts (P Ͻ 0.0001). One of 23 post-allograft recipients treated with second tation 14,24 have been utilized as salvage therapy. The overall denominator of relapsing patients needs to be taken into allografts was alive with an extramedullary relapse, compared with five of 13 receiving immunotherapy and account to determine the exact place of second transplants in the management of relapsed acute leukemia; something none of 78 receiving standard-dose or palliative therapy (P Ͻ 0.0001). We conclude that only a small proportion which has usually not been done in previous retrospective analyses. [4][5][6][7][8][9][10][11][12][13][14]22-24 of highly selected acute leukemia patients relapsing after a transplant reach the stage of a conventional This analysis was undertaken to assess the outcome of all acute leukemia patients relapsing after allogeneic or second transplant. In our experience, second allografts after myeloablative therapy in patients relapsing after autologous BMT between 1980 and August 1995 at our center to study the utility of second transplants and alternaone allograft are associated with very poor results, and immunotherapy may be a better approach in such cases.tive therapy including immunotherapy. Selected patients relapsing after an autograft may become long-term survivors following a second autograft or an allograft.

The aims of this study were to examine the relationship between whole-body absorbed dose and hematologic toxicity and to assess the most accurate method of delivering a prescribed whole-body absorbed dose in 131 I-metaiodobenzylguanidine ( 131 I-MIBG) therapy for neuroblastoma. Methods: A total of 20 children (1-12 y), 5 adolescents (13-17 y), and 1 adult (20 y) with stage 3 or 4 neuroblastoma were treated to a prescribed whole-body absorbed dose, which in most cases was 2 Gy. Forty-eight administrations of 131 I-MIBG were given to the 26 patients, ranging in activity from 1,759 to 32,871 MBq. For 30 administrations, sufficient data were available to assess the effect of whole-body absorbed dose on hematologic toxicity. Comparisons were made between the accuracy with which a whole-body absorbed dose could be predicted using a pretherapy tracer study and the patient's most recent previous therapy. The whole-body absorbed dose that would have been delivered if the administered activity was fixed (7,400 MBq) or determined using a weight-based formula (444 MBqÁkg 21 ) was also estimated. Results: The mean whole-body absorbed dose for patients with grade 4 Common Terminology Criteria for Adverse Events (CTCAE) neutropenia after therapy was significantly higher than for those with grade 1 CTCAE neutropenia (1.63 vs. 0.90 Gy; P 5 0.05). There was no correlation between administered activity and hematologic toxicity. Absorbed whole-body doses predicted from previous therapies were within 610% for 70% of the cases. Fixed-activity administrations gave the largest range in whole-body absorbed dose (0.30-3.11 Gy). Conclusion: The results indicate that even in a highly heterogeneous and heavily pretreated patient population, a whole-body absorbed dose can be prescribed accurately and is a more accurate predictor of hematologic toxicity than is administered activity. Therefore, a whole-body absorbed dose can be used to deliver accurate and reproducible 131 I-MIBG therapy on a patient-specific basis.

Primary synovial sarcomas of the heart are exceptionally rare tumours, only five being previously documented. We report a sixth case and review published data. Ages ranged from 13-53 (mean 40.8) years. There were four men and two women who characteristically presented with syncope or dyspnoea. Most of the tumours arose in the right atrium where they formed pedunculated or polypoid masses. In the previously documented cases, all patients died within 9 months. However in our case, local excision was felt to have been complete and the patient remains disease free at 10 months.