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To evaluate the efficacy and toxic effects of intensive chemoradiotherapy as a primary modality for organ preservation in patients with advanced squamous cell carcinoma of the head and neck (SCCHN) and to define the patterns of treatment failure associated with this therapy. Design: Retrospective review. Setting: Tertiary care referral center. Patients: A total of 127 consecutive patients with advanced SCCHN treated with primary concurrent chemoradiotherapy. Main Outcome Measures: Efficacy data included the rates of tumor response to therapy, organ preservation, disease recurrence, overall and disease-specific survival, and patterns of treatment failure. Toxic effect data included the rate and grade of treatment-related complications and the rate of unscheduled hospital admissions for managing treatment-related toxic effects. Results: Ninety-six patients (76%) were men and 31 (24%) were women. Average age at diagnosis was 62 years (range, 37-85 years). The primary tumor site was the oropharynx in 58 patients (46%), the larynx in 36 (28%), the hypopharynx in 20 (16%), the oral cavity in 10 (8%), and another site in 3 (2%). Most patients (91%) had stage III or IV disease. Average follow-up was 36 months. Primary chemoradiotherapy achieved complete response at the primary tumor site in 109 patients (86%). Patients with partial response, stable or progressive disease, or recurrence at the primary site underwent salvage surgery.

Treatment-related myelodysplasia (t-MDS IntroductionAlkylating agent therapy does not cure patients with indolent lymphoma and can result in late morbidity such as treatmentrelated myelodysplasia (t-MDS). 1 Alternatives to alkylators include biologic agents and purine nucleoside analogs, which have a low reported frequency of t-MDS. 2 The combination of fludarabine, mitoxantrone, and dexamethasone (FND) is an effective regimen for patients with indolent lymphoma. [3][4][5] Recently, we combined rituximab with FND, either concurrently (R-FND) or sequentially (FND3R), followed by interferon alpha (IFN-␣) maintenance, for patients with stage IV indolent lymphoma. Preliminary reports have described good short-term safety and efficacy of this program, including a 3-year failure-free survival rate of greater than 65% and a 3-year survival rate of 95%. 6,7 The current report describes the occurrence of t-MDS in 8 patients in this trial. The lymphoma protocol included FND for the majority of patients, either concurrently with rituximab or followed by rituximab. Patients also received IFN-␣ maintenance. The doses of FND were as follows: fludarabine 25 mg/m 2 intravenously days 1 to 3, mitoxantrone 10 mg/m 2 intravenously on day 1, and dexamethasone 20 mg orally or intravenously days 1 to 5, every 4 weeks for 8 cycles. In R-FND, rituximab 375 mg/m 2 was given intravenously on days 1 and 8 of course 1; in courses 2 to 5, it was given on day 1 only. Responding patients received maintenance with 3 million units/m 2 interferon alpha 2b subcutaneously daily on days 2 to 14 and dexamethasone 40 mg orally on days 1 to 3, given monthly for 1 year. In FND3R, rituximab 375 mg/m 2 was given intravenously once monthly for 6 doses, starting at month 12. Patients and methods PatientsPatients with follicular lymphoma without BCL2 gene rearrangement 8 received alternating triple therapy (ATT) with concurrent rituximab, followed by maintenance IFN-␣. ATT is a rotation of 3 regimens, CHOD-Bleo (cyclophosphamide, doxorubicin, vincristine, dexamethasone, bleomycin), ESHAP (etoposide, methylprednisolone, cytarabine, cisplatin), and NOPP (mitoxantrone, vincristine, prednisone, procarbazine), for 12 courses (3-4 courses of each); doses have previously been reported. 4 Six doses of rituximab (375 mg/m 2 ) were included with ATT: 2 in courses 1 and 3 and 1 dose in courses 4 and 6. Diagnosis of t-MDS and t-AMLThe diagnosis of t-MDS, using World Health Organization criteria, 9 was considered when the bone marrow contained excess blasts (Ͼ 5%) or was dysplastic or when unexpected cytopenias occurred. Marrow assessment was done pretreatment and every 3 to 6 months if initially positive. However, neither pretreatment nor follow-up cytogenetic monitoring was part of the study design; cytogenetics was performed only when MDS was The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked ''advertisement'' in accordance with 18 U.S.C. section 1734. Statist...

A 72-year-old man originally seen for anemia and thrombocytopenia was determined to have chronic lymphocytic leukemia (CLL). Bone marrow examination at the time of CLL diagnosis revealed a small but significant population of atypical blasts. Cytogenetic analysis of the bone marrow aspirate disclosed chromosomal abnormalities (-7, +8) suggestive of a myelodysplastic syndrome. Shortly after treatment of the CLL, there was proliferation of the previously noted blast population, which cytochemical studies demonstrated to be of the myeloid series thus indicating acute myeloid leukemia superimposed on CLL. This report presents microscopic, cytogenetic, immunophenotypic, and cytochemical evidence to document the evolution of acute myeloid leukemia in the bone marrow of a patient with CLL after one course of chemotherapy.