SummaryA phase 2 trial was performed to study the combination of bortezomib (VELCADEÒ) with intermediate-dose dexamethasone (DEX), and continuous low-dose oral cyclophosphamide (CY) in patients with relapsed multiple myeloma (MM). Fifty-four patients with advanced MM were enroled to receive eight 3-week treatment cycles with bortezomib 1AE3 mg/m 2 on days 1, 4, 8, and 11, followed by three 5-week cycles with bortezomib 1AE3 mg/m 2 on days 1, 8, 15, and 22. Within all cycles, DEX 20 mg/d was given orally on the day of bortezomib injection and the day thereafter. In addition, patients received CY continuous oral treatment at a dose of 50 mg/d p.o. once daily. Fifty patients completing at least one treatment cycle were evaluable for response. Complete, partial, and minor responses occurred in 16%, 66% and 8% of patients, respectively; overall response rate 90% (efficacy analysis). Median event-free survival was 12 months, with a median overall survival of 22 months. Adverse events (AE) of grades 3 or 4 occurring in at least 10% of patients comprised leucopenia, infection, herpes zoster, thrombocytopenia, neuropathy and fatigue. Bortezomib combined with DEX and CY is a highly effective treatment for relapsed MM at an acceptable rate of grade 3/4 AE. Antiviral prophylaxis appears to be mandatory.

Existential behavioural therapy appears to exert beneficial effects on distress and QOL of informal caregivers of palliative patients. Further longitudinal evidence is needed to confirm these findings.

Summary. Sixty patients with advanced multiple myeloma received 2-6 monthly treatment courses combining hyperfractionated cyclophosphamide (300 mg/m 2 i.v. over 3 h q 12 h · 6, d 1-3) with pulsed dexamethasone (20 mg/m 2 /d p.o., d 1-4, 9-12, 17-20) and once daily thalidomide at individually escalating doses (100-400 mg/d) depending on tolerability (HyperCDT). Responding patients were maintained on daily thalidomide and monthly dexamethasone pulses. Complete, partial and minor response rates were 4%, 68% and 12% respectively; overall response rate was 84% (efficacy analysis). Median event-free and overall survival was 11 and 19 months respectively. During at least one treatment cycle, 67% of patients experienced grade 4 neutropenia resulting in 17% grade 3 and 9% grade 4 infections. Side-effects, presumably related to thalidomide, included neuropathy (40% grade 2, 16% grade 3), constipation (17%), oedema (5%), bradycardia (5%), skin reactions (3%), cerebrovascular events (5%) and deep vein thromboses (8%). Thromboses were not related to known thrombophilic risk factors. Four patients with prior myeloma therapy > 50 months developed myelodysplastic syndrome or secondary acute myeloid leukaemia 2-4 months after study entry. HyperCDT is a highly active and reasonably well-tolerated salvage regimen in advanced or refractory multiple myeloma.

Autologous stem cell transplantation (ASCT) has been successfully used in HIV-related lymphoma (HIV-Ly

Summary. To prove the hypothesis that central venous catheter‐related thrombosis and infection are associated, 43 haemato‐oncological patients with an internal jugular vein catheter underwent ultrasound screening for thrombosis every 4 d. Catheter‐related thrombosis was detected in 13/43 patients (30%). Catheter‐related infection, as defined by the U.S. Hospital Infection Control Practices Advisory Committee, was found in 14/43 patients (33%) with colonization of the catheter in two patients, exit site infection in eight patients and catheter‐related bloodstream infection in four patients. Catheter‐related thrombosis and catheter‐related infection coincided in 12 patients and were significantly correlated (Fisher's exact test, P < 0·0001). Detection of thrombosis indicated a catheter‐related infection with a superior sensitivity (86%vs 57%) and an equivalent specificity (97%) compared with the presence of clinical signs (erythema, tenderness, warmth or swelling). Neutropenia, which occurred in 32 patients, was found in 13/14 patients (93%) with a catheter‐related infection and, therefore, seemed to be an important covariate for the development of a catheter‐related infection. This study showed a close correlation between catheter‐related thrombosis and infection. Ultrasound screening for thrombosis was helpful for detecting catheter‐related infection. These findings could be clinically useful for the handling of central venous catheters in patients with an elevated risk of infectious complications.