Summary:is generally believed that immunosuppresion enhances viral replication with consequent increase in hepatocyte infection. Withdrawal of cytotoxic or immunosuppressive drugs Hepatitis B reactivation following chemotherapy withdrawal may result in hepatitis, hepatic failure and leads to restoration of immune function, resulting in rapid destruction of infected hepatocytes. This may give rise to death. We studied the clinical outcome and the causes of hepatic events of hepatitis B surface antigen positive a clinical picture of hepatitis and even hepatic failure and death. 6 Bone marrow transplantation (BMT) has become a recipients undergoing bone marrow transplantation. Twenty-four hepatitis B surface antigen patients were standard treatment for various hematological malignancies. 7 During the procedure, intensive chemotherapy with and matched with 24 hepatitis B surface antigen negative patients for age, sex, CMV positive serology, underlying without total body irradiation was required to ablate the recipients' marrow. Furthermore, immunosuppressive hematological disease and type of bone marrow transplantation. Post-BMT, there were 18 patients in the agents have to be administered for at least 6 months after BMT for prevention or treatment of graft-versus-host dishepatitis B surface antigen positive group and four patients in the hepatitis B surface antigen negative ease (GVHD). Therefore, one would anticipate that chemotherapy withdrawal HBV reactivation would be a problem group who suffered from hepatitis (P Ͻ 0.05). Thirteen of the 18 hepatitis were related to HBV reactivation in after bone marrow transplantation. In fact, fatal fulminant hepatitis due to HBV reactivation has been reported in the hepatitis B surface antigen positive group and none of the four hepatitis in the hepatitis B surface antigen HBsAg positive carriers undergoing BMT. 8 The aim of this study was to define the incidence of hepatic events negative group (P = 0.01). The hepatitis B surface antigen positive group also had an increased incidence of (hepatitis and hepatic failure) in the HBsAg positive patients undergoing BMT and the causes of the hepatic acute graft-versus-host disease of liver (6 vs 1, P = 0.03). However, there was no significant increase in the incievents. dence of veno-occlusive disease (10 vs 7, P = 0.40) and persistent hepatitis (3 vs 0, P = 0.07) in the hepatitis B Patients and methods surface antigen positive group. Using the log-rank test, there was no significant difference in survival betweenPatients studied the hepatitis B surface antigen positive and negative recipients.Two hundred and twenty-four patients received a BMT at Keywords: HBV; bone marrow transplantation; hepatitis;Queen Mary Hospital between May 1990 and March 1995. VOD; GVHD; HBV reactivation All of them were screened before BMT for hepatitis serology (HBsAg/Ab, HBeAg/Ab, anti-HCV (EIA II), anti-HDV). Twenty-five patients were HBsAg positive and among them one was also HCV Ab positive (EIA II). Chronic hepatitis B infection is endemic in ...

Summary:Donor lymphocyte infusion (DLI) has been used successfully to induce remissions in relapse of acute myeloid leukaemia (AML) after bone marrow transplantation (BMT), but molecular eradication of leukaemia has rarely been documented. A patient with AML-M4Eo relapsed after HLA-identical sibling BMT in first complete remission (CR). Cytogenetic and molecular genetic investigations confirmed inv(16) and CBF␤/MYH11 fusion characteristic of M4Eo. A second remission was obtained with chemotherapy. Full donor chimerism was demonstrated by fluorescence in situ hybridisation. However, molecular evidence of minimal residual disease still persisted, and donor lymphocyte infusion (DLI) was administered. This resulted in molecular eradication, and the patient remained in clinical and molecular remission 16 months from DLI. Our observations showed that, for AML relapse after BMT, molecular leukaemia eradication could be achieved by DLI so that, in cases where genetic markers are available, molecular monitoring should be performed to assess the efficacy of treatment. Keywords: acute myeloid leukaemia; donor lymphocyte infusion; molecular remission Effective consolidation of remission by either additional chemotherapy or myeloablative treatment with stem cell rescue (bone marrow transplantation, BMT) is a key factor leading to long-term survival in patients with acute myeloid leukaemia (AML). In patients receiving allogeneic BMT, a graft-versus-leukaemia (GVL) effect contributes significantly to disease eradication. 1 Therefore, in leukaemia patients relapsing after BMT, donor lymphocyte infusion (DLI) to boost the GVL effect is a therapeutic option. [2][3][4] Although DLI has been shown to be highly effective for the treatment of post-BMT relapse of chronic myeloid leukaemia (CML), data on other haematological malignancies are scanty. Furthermore, DLI has been less effective in AML relapses, 2 with little data to show molecular eradication of leukaemia. 5 We report the serial cytogenetic and molecular genetic findings in a patient with AML-M4Eo who relapsed after BMT, and achieved a second remission with chemotherapy consolidated with DLI. Materials and methods Case reportA 43-year-old woman presented in 1994 with acute myelomonocytic leukaemia with eosinophilia (AML-M4Eo), which was confirmed by the presence of inv (16)(p13;q22) cytogenetically. A complete remission (CR) was obtained with idarubicin (12 mg/m 2 /day ϫ 3 days) and cytosine arabinoside (ara-C) (100 mg/m 2 /day ϫ 7 days). This was followed by two consolidation courses with the same drugs. BMT was performed at CR1 with an HLA-identical brother as donor. Busulphan (16 mg/kg) and cyclophosphamide (120 mg/kg) were used for conditioning. Cyclosporin and methotrexate were used as graft-versus-host disease (GVHD) prophylaxis. There was no acute or chronic GVHD. She relapsed 2 years later, and a second CR was obtained with chemotherapy (ara-C 1 g/m 2 /day ϫ 4 days, mitoxantrone 12 mg/m 2 /day ϫ 3 days; followed by one course of ara-C 6 g/m 2 /day ϫ 2 days). To furt...

From 1991 to 1997, we have treated 78 newly diagnosed patients with aggressive non-Hodgkin's lymphoma with a modified CHOP regimen in which epirubicin (60 mg/m2) was used in place of doxorubicin (50 mg/m2), i.e. CEOP (cyclophosphamide, epirubicin, vincristine and prednisolone). The median age was 41 years (range: 17 to 67). Sixty-four (82 per cent) had diffuse large cell (Working Formulation category G) histology. The median LDH level was 453 u/l. Thirty-three (42.3 per cent) and 45 (57.7 per cent) had stage I/II and stage III/IV disease, respectively. Fifty-five of 78 (71 per cent) CEOP-treated patients achieved CR, and the projected DFS and OS were both 65 per cent. In an earlier cohort of patients (from 1985-1991) treated with second or third-generation chemotherapy regimens (m-BACOD, MACOP-B, ProMACE-CytaBOM), CR was achieved in 95/123 (77 per cent) patients and the projected DFS and OS were 62 per cent and 55 per cent. There was no significant difference in the clinical characteristics, CR rates (p = 0.26), DFS (p = 0.38) or OS (p = 0.68) between patients who received CEOP or second/third-generation chemotherapy regimens. Of the patients treated with CEOP, 37.9 per cent, 28.8 per cent, 24.2 per cent and 9.1 per cent were in the age-adjusted International Index L, LI, HI and H risk groups, with CR rates of 82 per cent and 57 per cent in the L/LI and HI/H risk groups (p = 0.03). Moreover, patients in the L, LI and HI/H risk groups had significantly different projected DFS (87 per cent, 62 per cent and 39 per cent, p = 0.02) and OS (85 per cent, 80 per cent and 36 per cent, p = 0.006). In conclusion, CEOP is an effective regimen and the age-adjusted International Index is valid for Chinese patients with aggressive NHL.