All-trans-retinoic acid (ATRA) increases the efficacy of chemotherapy when used for induction and maintenance treatment of acute promyelocytic leukemia (APL), but its role in consolidation is unknown. Since November 1996, 426 patients with newly diagnosed APL have received induction therapy with ATRA and idarubicin. Before November 1999 (LPA96 study), consolidation therapy consisted of 3 courses of anthracycline monochemotherapy. After November 1999 (LPA99 study), patients with intermediate and high risks of relapse received consolidation therapy with ATRA and increased doses of anthracyclines. Of the 384 patients who achieved complete remission (90%), 382 proceeded to consolidation therapy. Seven patients died in remission (1.8%). The 3-year cumulative incidence of relapse for patients in the LPA96 and LPA99 studies was 17.2% and 7.5%, respectively (P ‫؍‬ .008). Patients treated with ATRA in consolidation therapy showed an overall reduction in the relapse rate from 20.1% to 8.7% (P ‫؍‬ .004). In intermediate-risk patients the rate decreased from 14.0% to 2.5% (P ‫؍‬ .006). This improved antileukemic efficacy also translated into significantly better disease-free and overall survival. A risk-adapted strategy combining anthracycline monochemotherapy and ATRA for induction and consolidation therapy of newly diagnosed APL results in improved antileukemic efficacy and a high degree of compliance. (Blood.

Summary. Of 167 newly diagnosed acute promyelocytic leukaemia patients, 83 patients were long (L)-form (50%), eight variable (V)-form (5%) and 76 short (S)-form (45%). The V-form and S-form groups presented a significantly higher percentage of patients with white blood cell counts . 10 Â 10 9 /l (P , 0´05). The S-form cases displayed a significantly higher number of cases with M3v microgranular features (P 0´005) and CD34 expression (P , 0´0001). There were no differences between the three isoforms in complete remission (CR) rate (overall CR 90%), but the 3-year disease-free survival was lower for Vform cases than it was for L-and S-form cases (62% vs. 94% and 89%, P 0´056). We conclude that the V-form and Sform types are associated with some negative prognostic features at diagnosis. However, our data were only able to demonstrate an association with adverse prognosis in the Vform type and, moreover, as the number of cases was limited, needs to be confirmed in large, uniformly treated series.

Summary. Disparity for the minor histocompatibility antigen HA-1 between patient and donor has been associated with an increased risk of acute graft-versus-host disease (GvHD) after allogeneic human leucocyte antigen (HLA)-identical sibling donor stem cell transplantation (SCT). However, no data concerning the impact of such disparity on chronic GvHD, relapse or overall survival are available. A retrospective multicentre study was performed on 215 HLA-A2-positive patients who received an HLA-identical sibling SCT, in order to determine the differences in acute and chronic GvHD incidence on the basis of the presence or absence of the HA-1 antigen mismatch. Disease-free survival and overall survival were also analysed. We detected 34 patient±donor pairs mismatched for HA-1 antigen (15´8%). Grades II±IV acute GvHD occurred in 51´6% of the HA-1-mismatched pairs compared with 37´1% of the non-mismatched. The multivariate logistic regression model showed statistical significance (P: 0´035, OR: 2´96, 95% CI: 1´07±8´14). No differences were observed between the two groups for grades III±IV acute GvHD, chronic GvHD, disease-free survival or overall survival. These results confirmed the association between HA-1 mismatch and risk of mild acute GvHD, but HA-1 mismatch was not associated with an increased incidence of chronic GvHD and did not affect relapse or overall survival.

Chagas' disease (American trypanosomiasis) is a very uncommon disease in non-endemic areas. A few cases in immunosuppressed patients have been reported in America. This report describes, to our knowledge, the first fatal case of acute Chagas' disease in Europe following bone marrow transplantation.

Summary:(CGVHD), older age, use of methotrexate (MTX) as prophylaxis for GVHD and low levels of serum immunoglobulin (Ig). 5,6 Classical management of these patients To describe clinical outcome with first line immunosuppression therapy for obstructive airways disease includes bronchodilators (aerosolised ␤-agonists), antiinfectious prophylaxis, Igs replacement, and immunosup-(OAD) after allogeneic BMT, we have retrospectively examined 20 long-term survivors affected by OAD. All pressive agents such as prednisone (PRD), AZT or CsA. Despite aggressive treatment, the mortality rate is over 50% patients had normal pulmonary function test (PFTs) before BMT. OAD was defined as FEV1 less than 80%, (ranging from 21 to 100%), in most published series, 7,8 significantly higher than in comparable cohorts without OAD. FER less than 80%, maximum midexpiratory flow rate of 50% vital capacity (MMFR) less than 65%, orComplexity in the management of these patients is due largely to the lack of standardised approaches and the fact residual volume greater than 120. Prednisone (n = 4), CsA (n = 8) and azathioprine (n = 8) have been used as that the effectiveness of specific regimens has never been established. Furthermore, there are no well-defined first-line immunosuppression agents. Mean follow-up was 65 months (range 15-142). We identified three catresponse criteria and consequently the optimal duration of immunosuppression therapy remains uncertain. egories of patients according to response to treatment: complete (n = 6, 30%), partial (n = 6, 30%) or noIn this retrospective study we analysed 20 patients affected by OAD from 275 patients who underwent allogeneic response (n = 8, 40%). Age, FEV1, time of onset after BMT, Karnofsky index or immunosuppression modality BMT at a single institution over a 12 year period and had had long-term follow-up. Presence of risk factors was do not seem to be related to subsequent response. However, patients with low values of MMFR and high values assessed. The aims of the study were to analyse the patterns of pulmonary function evolution over the treatment period, of RV at the beginning of therapy are likely to show poor response. In the complete response group, normaland evaluate the role of different immunosuppression regimens in clinical outcome. isation of PFTs is achieved within the first months of treatment (median 6 months ranging from 3 to 9 months), suggesting that prolonged therapy is not advantageous and could increase morbidity and morPatients and methods tality if there are no other signs of CGVHD. Keywords: obstructive airways; immunosuppression; Patients BMT Between May 1981 and July 1995, allogeneic bone marrow transplantation was performed on 275 patients at the University Hospital Reina Sofia. Of these patients 225 who Respiratory complications after BMT, both early (occurring survived more than 3 months after BMT and were at risk within the first 3 months) and late, affect 40-60% of of developing OAD were included in this study. Patient patients and are the major cause of mo...