VEPEMB is an effective and low toxic regimen for HL in the elderly. Co-morbidity is a prognostic factor more important than age itself.

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Summary:We developed a PCR-based method to monitor clonogenic IgH VDJ rearrangement as a possible predictor of relapse in patients with acute B-ALL after allogeneic bone marrow transplantation (BMT). We studied 23 patients at diagnosis, before and after BMT. At the time of BMT, 13 patients were in first complete remission, eight in second complete remission and two in relapse. Four patients were PCR negative before BMT and remained PCR negative also after BMT (؊/؊ pattern). They are still in remission after a median follow-up of 41 months. Nineteen patients were MRD-positive before BMT: three were PCR negative at first determination after BMT (+/؊ pattern) and maintain remission. Sixteen patients were PCR-positive at first determination after BMT (+/+ pattern): five became PCR negative (+/+/؊ pattern) (four with chronic graft-versus-host disease (GVHD) and two after donor lymphocyte infusions (DLI)). Nine patients remained PCR-positive (+/+/+ pattern) (four remain in remission, and six relapsed); two patients died before transplant. In conclusion, PCR negative patients before BMT remained negative post-BMT; many pre-BMT positive patients had initial MRD positivity after BMT: 37% of them achieved a molecular remission with cGVHD or DLI. significant relapse risk. 4 A lower relapse rate in ALL patients with chronic graft-versus-host disease (cGVHD) has been reported and GVHD was the most significant predictor of relapse in multivariate analysis in a large series of patients.3 This study suggests that the alloimmune response is crucial both to prevent leukemic relapse and to improve survival. Nevertheless donor lymphocyte infusion (DLI) does not exert a significant antileukemic effect in ALL patients relapsing after BMT, 5 differently from patients with CML, where more than 80% of patients relapsing after BMT are responsive to DLI. A possible explanation for this different behavior relies on the fact that in CML patients DLI is performed in early (ie cytogenetic) relapse, possibly when the tumor burden is low. According to this hypothesis, in CML DLI are ineffective in hematologic relapse, especially when it occurs in the accelerated or blastic phase. In CML this has suggested close cytogenetic and molecular monitoring after BMT.