Current evidence leads to uncertainty whether mild CDAD needs to be treated. The studies provide little evidence for antibiotic treatment of severe CDAD as many studies excluded these patients. Considering the two goals of therapy: improvement of the patient's clinical condition and prevention of spread of C. difficile infection to other patients, one should choose the antibiotic that brings both symptomatic cure and bacteriologic cure. A recommendation to achieve these goals cannot be made because of the small numbers of patients in the included studies and the high risk of bias in these studies, especially related to dropouts. Most of the active comparator studies found no statistically significant difference in efficacy between vancomycin and other antibiotics including metronidazole, fusidic acid, nitazoxanide or rifaximin. Teicoplanin may be an attractive choice but for its limited availability (Teicoplanin is not available in the USA) and great cost relative to the other options. More research of antibiotic treatment and other treatment modalities of CDAD is required.

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The British National Lymphoma Investigation (BNLI) trial comparing carmustine 300 mg/m 2 , etoposide 200 mg/m 2 , cytarabine 200 mg/m 2 and melphalan 140 mg/m 2 (BEAM) with autologous rescue with mini-BEAM in the Lancet in 1993 [1], established BEAM as the 'gold standard' conditioning regimen for patients with relapsed Hodgkin lymphoma (HL) in the UK. Subsequently, the 'Parma Study' reported significant benefit from the carmustine containing regime (BEAC-carmustine, etoposide, cytarabine and cyclophosphamide) for patients with Non-Hodgkin's Lymphoma (NHL) [2]. Carmustine is an alkylating agent licensed for use in adults with HL and NHL with relapsed or refractory disease [3]. BEAM has been used throughout Europe as standard conditioning for autologous stem cell transplant in HL and NHL. An international shortage of carmustine has meant that lomustine 200 mg/m 2 has been used as a replacement. It is therefore important to assess whether the lomustine

BackgroundAutologous haemopoietic stem cell transplantation (AHSCT) is an evolving therapy for multiple sclerosis (MS). Here we present the Sheffield experience since 2006.MethodsRetrospective review of MS cases referred for and treated with AHSCT. Toxicity, clinical and radiological outcome were assessed.Results14 patients (8 Rapidly evolving severe [REMS], 3 Relapsing Remitting [RRMS], 3 Secondary Progressive [SPMS]) were selected for AHSCT. One patient underwent AHSCT on a clinical trial (data excluded from analysis). Mean age 34.6 years (SD 8.69), median pretreatment EDSS 6.5 (IQR0.5). All had clinically and radiologically aggressive disease, non-responsive to standard treatment. Follow up range was 3 to 96 months.All patients were successfully mobilized, 2 patients progressed only to harvest (1 compliance issues, 1 leg ulcer). All patients were treated according to international guidelines. No excess toxicity or treatment related mortality was observed.Post-transplant MRI's showed no active disease. No patients with RRMS suffered relapse post-transplant, median reduction in EDSS scores was 2 at both 100 days (IQR 2) and at last follow up (IQR 2.5). EDSS scores stabilised in patients with SPMS.ConclusionAHSCT is an effective treatment with acceptable toxicity in patients with aggressive, inflammatory MS.