The BCR-ABL fusion, the molecular equivalent of the Philadelphia translocation, gains importance for treatment stratification in adult acute lymphoblastic leukemia (ALL). In this prospective study, samples from 478 patients with CD10

Zygomycosis is an opportunistic fungal infection that is increasingly reported in hematological patients. We describe 2 cases of successfully treated rhino-cerebral zygomycosis and give an overview of 120 patients from the literature with underlying hematological or oncological disorders. These data document the improved survival in sinus (15/17 patients surviving) and cutaneous (6/9 patients surviving) disease. Hematological patients with pulmonary (9/30 patients surviving) or disseminated (4/38 patients surviving) zygomycosis still have a poor prognosis. The clinical course of sinus-orbital involvement (4/11 patients surviving) follows sinus-cerebral (2/3 patients surviving) or cerebral (3/6 patients surviving) disease. Besides deoxycholate amphotericin B (AmB) (24/62 patients surviving), patients seem to benefit from liposomal amphotericin B (L-AmB) (10/16 patients surviving) or sequential AmB/L-AmB treatment (6/8 patients surviving). Alternative treatment options lead only in a few patients to success.

This study performed CDR III PCR as a routine diagnostic technique applicable even on CSF samples with low cell counts. These data present low incidence of leptomeningeal involvement in this subset of pretreated PCNSL patients. Because the CSF evaluation did not predict outcome in our patients, further analysis in patients with PCNSL should focus on CSF samples that are obtained very early after diagnosis.

The frequency of central nervous system (CNS) dissemination in non-Hodgkin's lymphoma (NHL) varies and is dependent on NHL histology. More than 50% of patients with CNS involvement have advanced and progressive systemic disease. While CNS involvement at initial diagnosis may be treated curatively, treatment of CNS involvement in systemic relapsing or refractory lymphoma is challenging and most often palliative. Due to a paucity of randomized trials, treatment of lymphomatous metastases is not standardized. Nonetheless, treatment of LM entails administration of both CNS-directed and systemic chemotherapy that often includes high-dose chemotherapy regimens with stem cell support.

, for the GMALL Study GroupImmunophenotyping disclosed CD10 negativity in 70 of 2408 cases of B-lineage acute lymphoblastic leukemia (ALL), although other criteria followed classification of pre-B ALL (eg, cytoplasmic immunoglobulin positivity). These blasts showed high myeloid antigen expression (60% CD65 positivity) and reacted with antibody 7.1 in 95% of the cases. MLL-AF4 fusion transcripts or an 11q23/MLL rearrangement or both were evident in 46 of 56 samples (82%). Although 83% of the patients achieved complete remission, the remission duration remained remarkably low: 141 days for MLL rearrangement-positive and 245 days for MLL rearrangement-negative CD10 ؊ pre-B ALL. Thus, the overall survival probability 3 years after diagnosis was 0. 34 IntroductionImmunologic subtyping and molecular genetic analysis allow riskadapted treatment of acute lymphoblastic leukemia (ALL). One poorprognosis subgroup of adult B-lineage precursor ALL is characterized by translocations involving the mixed lineage leukemia (MLL) gene on chromosome 11q23. These translocations occur in approximately 3% to 6% of all adult ALL and correlate with a younger age, a higher leukocyte count, and a CD19 ϩ /CD10 Ϫ /cytoplasmic(cy)IgM Ϫ immunophenotype (pro-B ALL) coexpressing myeloid marker. [1][2][3] Recent reports have shown that 11q23 translocations occur in up to 8% of T-ALLs, which were characterized by a poor clinical outcome. 4,5 Here, we present evidence of another high-risk group with frequent MLL gene translocations involving 82% (46 or 56) of the distinct CD19 ϩ /CD10 Ϫ /cyIgM ϩ pre-B ALL subset. Study designDual-staining immunophenotyping of 3168 newly diagnosed ALL specimens was performed with commercially available fluorochrome monoclonal antibody conjugates (Dako, Hamburg, Germany; BD Biosciences, San Jose, CA; BeckmanCoulter, Fullerton, CA) identifying pro-B ALL, TdT ϩ /CD19 ϩ /CD10 Ϫ /cyIgM Ϫ / surface(S)Ig Ϫ ; c-ALL, TdT ϩ /CD19 ϩ /CD10 ϩ /cyIgM Ϫ /SIg Ϫ ; and pre-B ALL, TdT ϩ /CD19 ϩ /CD10 ϩ /cyIgM ϩ /SIg Ϫ . 1,6,7 Ambiguous cases of CD10 ϩ B-lineage marker-positive blasts (5%-15% CD10 positivity) were rechecked by a second antibody (BD Biosciences, Dako). Only consistently negative samples (Ͻ 20% positive cells) were considered for CD10 negativity. Molecular detection of MLL-AF4 and BCR-ABL fusion as well as cytogenetic analysis were carried out as described elsewhere. [6][7][8][9][10][11] Fluorescence in situ hybridization (FISH) used directly labeled dual-color break-apart MLL rearrangement probes (Vysis, Downers Grove, IL). 7 At least 200 nuclei were scored, setting the cut-off value for false-positive nuclei at 10%. Patients were treated according the German Multicenter Adult ALL (GMALL) trials, 1,6,12 allocating MLL-AF4 ϩ patients to the high-risk arm. 13 The median follow-up was 25.6 months (range, 1.8-70.4 months) for survivors. The protocols were reviewed and approved by institutional review boards at each of the participating sites, and all patients provided informed consent prior to enrollment. Results and di...

Candidal vertebral osteomyelitis represents an extremely rare invasive mycosis and can be difficult to treat due to poor drug penetration into bony tissue. We report on a case of vertebral osteomyelitis caused by Candida krusei in a patient who had neutropenia as a result of chemotherapy for acute myelogenous leukaemia. The patient received prophylactic liposomal amphotericin B during chemotherapy but became febrile and experienced severe lumbar pain. Magnetic resonance imaging revealed vertebral osteochondrosis. C. krusei was recovered from blood cultures and voriconazole monotherapy was initiated but proved unsuccessful. The patient was then started on caspofungin monotherapy, which was discontinued after Candida krusei was no longer recoverable from blood cultures. However, as lumbar pain increased and spinal biopsy confirmed the presence of Candida krusei, caspofungin therapy was resumed. Oral posaconazole was added to the regimen when the patient did not improve after 30 days of caspofungin therapy. Combined antimycotic therapy resulted in a successful outcome.

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