Although not all children did well with treatment, the favorable outcomes we noted indicate the importance of diagnosis and treatment of infants with congenital toxoplasmosis.

This trial determined the safety and efficacy of the combination regimen clarithromycin (Biaxin), lenalidomide (Revlimid), and dexamethasone (BiRD) as first-line therapy for multiple myeloma. Patients received BiRD in 28-day cycles. Dexamethasone (40 mg) was given orally once weekly, clarithromycin (500 mg) was given orally twice daily, and lenalidomide (25 mg) was given orally daily on days 1 to 21. Objective response was defined by standard criteria (ie, decrease in serum monoclonal protein [M-protein] by at least 50%, and a decrease in urine Mprotein by at least 90%). Of the 72 patients enrolled, 65 had an objective response (90.3%). A combined stringent and conventional complete response rate of 38.9% was achieved, and 73.6% of the patients achieved at least a 90% decrease in Mprotein levels. This regimen did not interfere with hematopoietic stem-cell harvest. Fifty-two patients who did not go on to receive transplants received continued therapy (complete response, 37%; very good partial response, 33%). The major adverse events were thromboembolic events, corticosteroid-related morbidity, and cytopenias. BiRD is an effective regimen with manageable side effects in the treatment of symptomatic, newly diagnosed multiple myeloma. This trial was registered at www.clinicaltrials.gov as

PURPOSE-To determine the incidence of new chorioretinal lesions in children with toxoplasmosis diagnosed after, and therefore not treated during, their first year. RESULTS-Twenty-eight of 38 children had one of the following: diagnosis with serum antibody to T. gondii indicative of chronic infection at age 24 months, central nervous system calcifications, hydrocephalus, illness compatible with congenital toxoplasmosis perinatally but not diagnosed at that time. Twenty-five returned for follow-up during 1981 to 2005. Their mean (range) age at last exam was 10.9 ± 5.7 (range, 3.5 to 27.2) years and mean follow-up was 5.7 ± 2.9 years. Eighteen (72%) children developed at least one new lesion. Thirteen (52%) had new central lesions, 11 (44%) had new peripheral lesions, and six (24%) had both. Thirteen (52%) had new lesions diagnosed at age ≥ 10 years. New lesions were found at more than one visit in four (22%), and bilateral new lesions developed in seven (39%) of 18 children who developed new lesions. Of 10 additional children with eye findings and serologic tests indicative of chronic infection, six returned for follow-up, four (67%) developing new lesions at ≥ 10 years of age. CONGENITAL TOXOPLASMOSIS THAT WAS UNTREATED or treated only for one month has been described in small series of patients as a relapsing, recrudescent disease causing significant visual impairment. 1,2 However, the prospective follow-up into adolescence of chorioretinal lesions in children with congenital toxoplasmosis, other than a small group of those with congenital toxoplasmosis diagnosed at birth and treated during the first year of life, has not been rigorously defined. Herein we describe a cohort of 38 children with toxoplasmosis presenting after one year of age, who were followed prospectively in a single center according to a standardized protocol. DESIGN-Prospective longitudinal cohort study. METHODS-Thirty-eight CONCLUSIONS-More METHODS DESIGN OF STUDYThe children in this study and their mothers were referred by their physicians and evaluated at the University of Chicago by a group of specialists at the onset of enrollment into the study and later at prespecified times: 1, 3.5, 5, 7.5, 10, 15, 20, 25, 30, 35, 40, and 45 years of age. 3, 4 Written informed consent was obtained from all parents or legal guardians of participating minor-age children and/or directly from the patient (if of legal adult age). PATIENT COHORTThis cohort consists of 38 persons who were children at the time of diagnosis of their ocular toxoplasmosis, who, with their mothers, had nonacute serologic tests for Toxoplasma gondii infection at the time their contact with the Chicago Toxoplasmosis Center was initiated. They were not diagnosed until after their first year of life. Patients in this cohort were not treated during their first year of life. All children with active chorioretinitis were treated when this occurred and was detected. It appears that children in the present cohort seem to have much more frequent new lesions than we report in a co...

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