No abstract

BackgroundAllogeneic stem cell transplantation is a potentially curative treatment for myelofibrosis, although its use is limited by a high rate of transplant-related mortality. In this study, we evaluated the outcome of patients with myelofibrosis who underwent allogeneic stem cell transplantation, and the impact of prognostic factors.

Diffusion-weighted MRI is an accurate tool in evaluating advanced liver fibrosis if an optimised single-shot spin-echo echo-planar sequence with maximum intermediate b value is used. The ADC threshold for liver fibrosis was 1.31.10(-3)mm(2)/s.

Objective:  To evaluate the long‐term activity and toxicity profile of rituximab in adult patients with idiopathic immune thrombocytopenic purpura (ITP). Patients and methods:  Twenty‐six patients with active and symptomatic ITP relapsed or refractory received weekly infusions of rituximab 375 mg/m2 for 4 wk. Median time from diagnosis to rituximab was 34.5 months. The following parameters of efficacy and toxicity were considered: complete response (CR) and partial response (PR), relapse rate, relapse‐free survival (RFS), therapy‐free survival (TFS), short‐ and long‐term toxicity. Results:  CR and PR were 14/26 (54%) and 4/26 (15%), respectively. Median time of observation was 56.5 months (range 39–77). Nine of the 18 responding patients relapsed after a median of 21 months (range 8–66); 9/26 patients (35%) maintained the response, with a median follow‐up of 57 months (range 39–69), and 11/26 (42%) did not necessitate further therapy; estimated 5 yr RFS and TFS were 61% and 72%, respectively. Younger age and shorter interval from diagnosis to rituximab appeared indicators of better outcome. Rituximab administration was associated with two episodes of short‐term toxicity, with one case of serum sickness syndrome; no infectious or other significant long‐term complications were documented. Conclusion:  Rituximab therapy may achieve long‐lasting remission in nearly one‐third of patients with relapsed or refractory ITP, with a good safety profile.

Purpose:To investigate the relevance of increasing b-values in evaluating liver fibrosis through the agreement of two diffusion-weighted (DW) sequences. Materials and Methods:A total of 29 cirrhotic patients and 29 healthy volunteers were studied on a 1.5T system. Two single-shot spin-echo echo-planar sequences were acquired using sets of increasing b-values: 0, 150, 250, and 400 seconds/mm 2 (first sequence: DW1a) and 0, 150, 250, 400, 600, and 800 seconds/mm 2 (second sequence: DW2a). Apparent diffusion coefficients (ADCs) of the hepatic parenchyma were calculated on ADC maps. Noisescaled single-point ADCs were calculated for each sequence from b ϭ 400 seconds/mm 2 .Results: ADCs resulted significantly lower in cirrhotic patients compared to controls using both DW1a (mean 1.14 Ϯ 0.20 ϫ 10 2 /second vs. 1.04 Ϯ 0.18 ϫ 10 Ϫ3 mm 2 /second; P ϭ 0.0089). DW1 and DW2, respectively significantly differed in diagnostic performance at receiver operating characteristic (ROC) curve analysis (P ϭ 0.003), showing AUCs of 0.93 (sensitivity 89.7%, specificity 100%) and 0.73 (sensitivity 62.1%, specificity 79.3%), respectively. Noise-scaled single-point ADCs showed a progressive convergence to similar values in cirrhotic and healthy livers at b ϭ 800 seconds/mm 2 (1.12 Ϯ 0.27 ϫ 10 Ϫ3 mm 2 /second vs. 1.13 Ϯ 0.17 ϫ 10 Ϫ3 mm 2 /second). Conclusion:A DW sequence is accurate in assessing liver fibrosis using intermediate (400 seconds/mm 2 ) rather than high (800 seconds/mm 2 ) maximum b-values, but after proper recalculation of ADCs the effects of perfusion rather than diffusion should be considered responsible for the higher accuracy at lower b-values.