Since February 21 2020, when the Italian National Institute of Health (Istituto Superiore di Sanità–ISS) reported the first autochthonous case of infection, a dedicated surveillance system for SARS‐CoV‐2‐positive (COVID+) cases has been created in Italy. These data were cross‐referenced with those inside the Information Transplant System in order to assess the cumulative incidence (CI) and the outcome of SARS‐COV‐2 infection in solid organ transplant recipients (SOTRs) who are assumed to be most at risk. We compared our results with those of COVID+ nontransplanted patients (Non‐SOTRs) with follow‐up through September 30, 2020. The CI of SARS‐CoV‐2 infection in SOTRs was 1.02%, higher than in COVID+ Non‐SOTRs (0.4%, p < .05) with a greater risk in the Lombardy region (2.89%). The CI by type of organ transplant was higher for heart (CI 1.57%, incidence rate ratio [IRR] 1.36) and lower for liver (CI 0.63%, IRR 0.54). The 60‐day CI of mortality was 30.6%, twice as much that of COVID+ Non‐SOTRs (15.4%) with a 60‐day gender and age adjusted odds ratio (adjusted‐OR) of 3.83 for COVID+ SOTRs (95% confidence interval [3.03–4.85]). The lowest 60‐day adjusted‐OR was observed in liver SOTRs (OR 0.46, 95% confidence interval [0.25–0.86]). More detailed studies on disease management and evolution will be necessary in these patients at greater risk of COVID‐19.

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Purpose: The European Collaborative MMT4-91 trial was conducted as a prospective nonrandomized study to evaluate the potential benefit of high-dose melphalan as consolidation of first complete remission in children with stage IV rhabdomyosarcoma.Patients and Methods: Fifty-two patients in complete remission after six courses of chemotherapy received ''megatherapy'': 42 received melphalan alone, whereas 10 received melphalan in combination with etoposide, carboplatin/etoposide, or thiotepa/busulfan and etoposide. The outcome of this group of patients was compared with that observed in 44 patients who were also in complete remission after six courses of identical chemotherapy (plus surgery or radiotherapy) but went on to receive a total of up to 12 courses of conventional chemotherapy (four cycles). No differences were found between the two groups regarding clinical characteristics, chemotherapy received before complete remission, or response to chemotherapy. In particular, there was no significant difference between the groups for site of primary tumor, histologic subtype, age at presentation, presence of bone or bone marrow metastases, or number of metastases.Results: The 3-year event-free survival (EFS) and overall survival (OS) rates were 29.7% and 40%, respectively, for those receiving high-dose melphalan or other multiagent high-dose regimens and 19.2% and 27.7%, respectively, for those receiving standard chemotherapy. The difference was not statistically significant (P ‫؍‬ .3 and P ‫؍‬ .2 for EFS and OS, respectively). There was a significant prolongation in the time from the last day of high-dose chemotherapy or the end of chemotherapy cycle 4 to the time of relapse in those receiving megatherapy (168 days for patients receiving megatherapy v 104 days for those receiving standard therapy; P ‫؍‬ .05).Conclusion: The addition of a high-dose alkylating agent to consolidation therapy may have prolonged progression-free survival in this poor-risk patient group, but it did not significantly improve the ultimate outcome. J Clin Oncol 17:2796-2803. 1999 by AmericanSociety of Clinical Oncology. T HE OUTCOME OF treatment for children with metastatic rhabdomyosarcoma (RMS) remains disappointing. Despite intensification of conventional chemotherapy, there has been little evidence of any significant improvement in overall survival, which has remained at approximately 20% to 30%. 1,2 A preliminary analysis of prognostic factors in 175 children on the European Collaborative Studies MMT4-89 and MMT4-91 has shown the following factors to have a significant adverse impact on prognosis: presence of bone and bone marrow metastases; number of metastases; limbs, parameningeal head and neck, and ''other'' sites as primary sites; and age older than 10 years at presentation. In particular, on multivariate analysis, age, site of primary tumor, and bone marrow metastases each achieved statistical significance for prognostic impact. 3 Similar observations have been confirmed in recent analyses of the Intergroup Rhabdomyosarcoma Study...