No abstract

Despite improvements in first-line therapies, published results on the treatment of relapsed adult acute lymphoblastic leukemia (ALL) show that prognosis is still poor. The aim of the present retrospective analysis of the German Multicenter Study Group for Adult ALL was to identify prognostic factors and options for improvement. A total of 547 patients with a median age of 33 years (range, 15-55) experiencing their first relapse (406 vs 141 shorter or longer than 18 months from diagnosis) were evaluated. The aim of salvage therapy was to achieve a complete remission (CR) with subsequent a stem cell transplantation (SCT). The CR rate (assessed in Philadelphia chromosomeand BCR-ABL-negative ALL without CNS involvement) after the first salvage in relapse after chemotherapy (n ‫؍‬ 224) was 42%. After failure of first salvage (n ‫؍‬ 82), the CR rate after second salvage was 33%. In relapse after SCT (n ‫؍‬ 48) the CR rate after first salvage was 23%. The median overall survival after relapse was 8.4 months and survival was 24% at

Quantification of minimal residual disease (MRD) by real-time PCR directed to

The mortality of central nervous system (CNS) aspergillosis approaches 100%, requiring improved therapies. Voriconazole gives superior efficacy and survival in invasive aspergillosis, compared with amphotericin B. Also, in contrast to other antifungal drugs, voriconazole penetrates well into the CNS. We evaluated, retrospectively, the outcome and survival of 81 patients who were treated with voriconazole for definite (n ‫؍‬ 48) or probable (n ‫؍‬ 33) CNS aspergillosis. Complete and partial responses were recorded in 35% of patients and varied by the underlying disease group: hematologic malignancies (54%), other underlying conditions (50%), chronic immunosuppression (45%), solid organ transplantation (36%), and hematopoietic stem cell transplantation (16%). Thirty-one percent of patients survived CNS aspergillosis for a median observation time of 390 days. There were 31 patients who underwent neurosurgical procedures, including craniotomy/abscess resection (n ‫؍‬ 14), abscess drainage (n ‫؍‬ 12), ventricular shunt (n ‫؍‬ 4), and Ommaya-reservoir (n ‫؍‬ 1). Multifactorial analysis revealed that neurosurgery was associated with improved survival (P ‫؍‬ .02). Patients who underwent hematopoietic stem cell transplantation had a poorer survival (P ‫؍‬ .02), but 7 (22%) of 32 survived for a median of 203 days. We conclude from this large cohort of patients that voriconazole treatment together with neurosurgical management, whenever feasible, is currently the best approach to treat patients with CNS aspergillosis. (Blood. 2005;106:2641-2645)