Lenalidomide is clinically active in patients with relapsed or refractory B-CLL. These findings are encouraging and warrant further investigation of this agent in the treatment of this disorder.

Following a similar report on multiple myeloma, Ghione and colleagues report the expected observation that patients with non-Hodgkin lymphoma (NHL) receiving anti-B cell therapies have markedly reduced antibody responses to COVID-19 immunization. Although there is no information regarding T-cell immunity, this suggests that while vaccination is certainly still recommended for this population, patients should be strongly encouraged to maintain social distancing precautions and should be revaccinated after an appropriate interval from the end of their antilymphoma therapy.

Rituximab plus fludarabine was well tolerated and associated with an excellent complete response rate, including molecular remissions, in patients with low-grade or follicular lymphoma.

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Novel agents have demonstrated enhanced efficacy when combined with other antimyeloma agents especially dexamethasone. The steroid doses employed in myeloma regimens are often poorly tolerated. Therefore, in a phase II clinical trial we investigated the efficacy of a steroid-free combination including bortezomib, pegylated liposomal doxorubicin and thalidomide (VDT regimen). Twenty-three patients with relapsed or refractory myeloma or other plasma cell cancers were treated with the VDT regimen. Patient had a median of five prior therapies and 65.2% were refractory to their last regimen. The overall response rates were 55.5% and 22%, respectively. The median progression free survival was 10.9 months (95% CI: 7.3-15.8) and the median overall survival was 15.7 months (95% CI: 9.1-not reached). Fatigue and sensory neuropathy were the most common side effects noted. We observe that VDT is an effective steroid-free regimen with ability to induce durable remission even in patients with refractory myeloma.

Summary:Respiratory syncytial virus (RSV) infection is an important cause of respiratory mortality in immunosuppressed patients, including bone marrow transplant (BMT) recipients. The presence of lower respiratory tract infection and infection in the pre-engraftment phase of BMT is believed to confer a poor prognosis. Three patients who underwent allogeneic BMT at our institution developed RSV pneumonia over 1 year post BMT, with the underlying disease in remission. All three were hypoxic with extensive pulmonary disease at presentation. Treatment consisted of aerosolized ribavirin and intravenous immune globulin with successful clearing of viral shedding and excellent clinical outcomes. RSV infection is probably less severe in the late post-BMT period, but needs to be considered early in the differential diagnosis of pulmonary infiltrates in this patient population. Bone Marrow Transplantation (2001) 27, 1071-1073. Keywords: RSV infection; late; BMT; ribavirin Respiratory syncytial virus (RSV) is a common pediatric pathogen with a predilection for winter outbreaks. In the adult population, RSV infections are increasingly recognized as important causes of respiratory mortality, primarily in immunosuppressed patients, including allogeneic bone marrow transplant (BMT) recipients. The clinical presentation in these sub-groups is frequently as an upper respiratory tract infection (URTI) that can rapidly progress to viral pneumonia if untreated. This progression from URTI to pneumonia is much higher in the immediate posttransplant period.1,2 RSV pneumonia in allogeneic BMT patients has been associated with mortality rates between 60% and 80%, despite aggressive treatment. Negative predictors of outcome following RSV infection in BMT recipients remain ill-defined, but include infection in the pre- There are few data regarding RSV infections in adult BMT recipients 1 year or more after transplant. We report three such cases of RSV infection at the Roswell Park Cancer Institute (Buffalo, NY) treated successfully with aerosolized ribavirin and intravenous immune globulin (IVIG) during the winter of 1999-2000. The absolute neutrophil count was normal and the underlying disease was in complete remission in all three patients. Case reportsPatient 1 is a 24-year-old female, who was 384 days following an allogeneic BMT for chronic myelogenous leukemia from an HLA-matched sibling donor. The conditioning regimen used for BMT was busulfan and cyclophosphamide. The post-BMT course was complicated by acute and chronic graft-versus-host disease (GVHD) requiring methyprednisolone, cyclosporine and tacrolimus therapy. She had completed a course of immunosuppressive therapy 2 weeks prior to detection of RSV infection. The patient was receiving trimethoprim/sulfamethoxazole, penicillin and acyclovir prophylaxis. Presenting symptoms included sinus congestion, cough with mucopurulent expectoration and dyspnea on exertion. Her 15-month-old infant had had symptoms of URTI within the preceding weeks. She was afebrile and hemodynamically sta...

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