Autotransplants increasingly are used to treat breast cancer. One-hundred-day mortality has decreased substantially. Three-year survival is better in women with earlier stage disease and in those who respond to pretransplant chemotherapy.

Summary:with median survivals of 3.0 and 10.5 months for nonHodgkin's lymphoma (NHL) and Hodgkin's disease (HD), respectively. 1Increasing numbers of patients have received autologous stem cell transplants (ASCT) for hematologic maligPotential benefits of allogeneic bone marrow transplantation (alloBMT) over ASCT include lack of graft tumor nancies. Since only a fraction of these patients are cured, physicians are more frequently faced with the contamination and the presence of a graft-versus-tumor effect. The graft-versus-leukemia effect is well established dilemma of how to manage relapse post-transplant. Potential advantages of allogeneic transplantation in alloBMT. 2 There is a significantly lower incidence of leukemia relapse in patients who undergo alloBMT com-(alloBMT) over ASCT include lack of graft tumor contamination and presence of a graft-versus-tumor effect.pared to patients who receive autografts. Evidence of a graft-versus-lymphoma effect has also been demonstrated For this reason, patients who relapse after ASCT are often considered candidates for allogeneic bone marrow in patients who received alloBMT for treatment of lymphoid malignancies. 3 Therefore, there is a theoretical benefit transplantation. However, there is limited knowledge on the outcome of alloBMT in patients who relapse after for patients who relapse after ASCT to receive subsequently an alloBMT. However, there is limited data on ASCT. We retrospectively analyzed the outcome of 20 patients with malignant lymphoma (n = 14) and AML the outcome of patients who undergo alloBMT for relapse after ASCT. (n = 6) who underwent alloBMT after failing an ASCT. The median age was 30 (17-41) years and the intervalThe purpose of this study was to evaluate therapy-related toxicities, long-term survival, and hematopoietic stem cell from ASCT to alloBMT was 10.5 (2-25) months. Seventeen patients died between 0.3 to 11 months (median engraftment in patients with hematologic malignancies who underwent alloBMT for progressive disease after ASCT. 2.0) after alloBMT, all due to BMT-related toxicities. Three patients remain alive and free of disease at 1.1, and 2.5 years after alloBMT. Sixteen of the 18 evaluable patients (89%) developed grade II-IV acute Materials and methods GVHD. Patients undergoing alloBMT after ASCT have a very high treatment-related mortality and incidence of Study cohort grade II-IV acute GVHD. Alternative treatments with salvage chemotherapy, radiation or investigationalWe retrospectively analyzed consecutive patients who underwent alloBMT after failing an ASCT for hematologic approaches should be considered in patients who relapse after ASCT.malignancies, from 1988 to 1995, at the following institutions: University of Texas Health Science Center at San Keywords: BMT; relapse; second transplant; lymphoma; leukemia Antonio (San Antonio, TX), Vanderbilt University (Nashville, TN), University of Oklahoma Health Science Center (Oklahoma City, OK), University of California at Los Angeles School of Medicine (Los Angeles, CA), and High-...

There are several independent but interrelated prognostic factors predictive of recurrence and survival in breast cancer. These include axillary nodal status, histopathology, steroid receptors, proliferative rate, ploidy, and oncogene amplification. Axillary nodal status has been the traditional mainstay predictor for recurrence and survival in primary breast cancer. In addition, the presence of the estrogen and progesterone receptors has correlated with longer disease-free interval and overall survival in stage I and II breast cancer. Thymidine-labeling index and percent S-phase as measured by flow cytometry are indices of cell proliferation that correlate with relapse rate in pre- and postmenopausal women with breast cancer. Estrogen and progesterone receptor-negative tumors are more commonly aneuploid, and have higher percent S-phase, factors that predict for recurrence in Stage I breast cancer.

Summary:ure is that they may benefit, not only from improved survival, but also from preventing or slowing the progression of further renal damage. Six patients with multiple myeloma and chronic renal insufficiency (serum creatinine Ͼ3.0 mg/dl), includingIn this report, we review the toxicities and response rates for six consecutive patients with multiple myeloma and four on dialysis, received high-dose busulfan and cyclophosphamide (BUCY) followed by autologous perirenal insufficiency who have received high-dose chemotherapy with busulfan and cyclophosphamide (BUCY), folpheral stem cell transplantation. Peripheral blood stem cells were collected after priming with cyclophosphamlowed by autologous peripheral stem cell transplantation (PBSCT) at our institution. ide, etoposide and G-CSF. Patterns of engraftment and toxicities were not apparently different from those seen in myeloma patients with normal renal function. There was one toxicity-related death, resulting from a massive Patients and methods spontaneous subdural hematoma. One patient died of disease progression 6 months after transplant, while the Between August 1993 and February 1996, we transplanted six patients with multiple myeloma and chronic renal failremaining four patients are alive and free of myeloma progression 6 to 39 months after high-dose therapy.ure, defined as a serum creatinine equal to or greater than 3.0 mg/dl. This group of patients included three females Two of these patients have remained in complete remission for 28 and 39 months. Our experience sugand three males with a median age of 50 years at diagnosis (range 38-67). Five patients presented with acute renal failgests that high-dose therapy with BUCY and autologous peripheral blood stem cell rescue is feasible in patients ure with a median serum creatinine of 8.0 mg/dl (range 2.6-9.0 mg/dl) and four of them received dialysis at the with multiple myeloma and renal failure.

Lung cancer is the leading cause of cancer-related death in the United States and approximately 85% of all lung cancers are classified as nonsmall cell (NSCLC). We here use an innovative approach that may ultimately allow for the clinician to target tumors and aggressively reduce tumor burden in patients with NSCLC. In this study, a platinum (Pt)-based chemotherapeutic (cisplatin, carboplatin, or oxaliplatin) and holmium-165 (Ho), which can be neutron-activated to produce the holmium-166 radionuclide, have been incorporated together in a garnet magnetic nanoparticle (HoIG-Pt) for selective delivery to tumors using an external magnet. The synthesized magnetic HoIG nanoparticles were characterized using PXRD, TEM, ICP-MS, and neutron-activation. Platinum(II) drugs were incorporated onto HoIG, and these were characterized using FTIR, EDX, ICP-MS, and zeta potential measurements, and in vitro and in vivo studies were performed using a HoIG-platinum system. Results indicate that neutron-activated (166)HoIG-cisplatin is more toxic toward NSCLC A549 cells than is blank (166)HoIG and free cisplatin, and that when an external magnetic field is applied in vivo, higher tumor to liver ratios of Ho are observed than when no magnet is applied, suggesting that magnetic targeting is achieved using this system. Furthermore, an efficacy study demonstrated the inhibition of tumor growth by chemoradiotherapeutic magnetic nanoparticles, compared to no treatment controls.

In this phase II trial, irinotecan, carboplatin, and bevacizumab achieved response, TTP, and survival outcomes that compare favorably with larger randomized trials using chemotherapy alone. Randomized trials can best assess bevacizumab's impact in the first-line treatment of extensive-stage SCLC.

BACKGROUND The purpose of the current study was to evaluate the efficacy and toxicity of the combination of fludarabine and rituximab, followed by alemtuzumab, as first‐line treatment for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). METHODS In a nonrandomized phase 2 trial, 41 patients who had previously untreated CLL or SLL and required treatment received 4 cycles of the fludarabine and rituximab combination followed 5 weeks later by 4 weeks (12 doses) of intravenous alemtuzumab therapy. The response to treatment was evaluated after completion of treatment with fludarabine and rituximab, and again after the completion of alemtuzumab consolidation. RESULTS Initial treatment with the combination of fludarabine and rituximab was well tolerated, and produced a 71% overall response rate (13% complete response). Thirty‐four patients began treatment with intravenous alemtuzumab, but this drug was relatively poorly tolerated when given at a short interval after fludarabine and rituximab, and only 20 patients (49% of total) were able to complete the prescribed course. Five patients had an improvement in their response with alemtuzumab; the final complete response rate was 21%. The median progression‐free survival for the entire group was 42 months. Toxicity with alemtuzumab included infusion‐related toxicity, myelosuppression, and opportunistic infections. CONCLUSIONS The intravenous schedule of alemtuzumab employed in the trial was relatively poorly tolerated in this community‐based trial. The relatively low complete response rates after treatment with the combination of fludarabine and rituximab and after the completion of treatment suggest that these abbreviated courses may compromise efficacy. The generalized use of alemtuzumab as consolidation therapy cannot yet be recommended for community practice. However, optimization of the route of administration, duration of treatment, and interval after completion of induction therapy may improve efficacy, and further investigation is ongoing. Cancer 2008. © 2008 American Cancer Society.

Gram-positive pathogens are increasingly implicated in today's changing epidemiology of hospital-acquired infections. Staphylococci, streptococci, and enterococci are among the most frequently identified causes of surgical site, complicated skin-structure, and bloodstream infections. In accordance, the use of antimicrobial agents with gram-positive activity, especially those with activity against resistant organisms, has also increased. We describe a septic, neutropenic patient with bacteremia due to Enterococcus gallinarum. Therapeutic options were restricted due to resistance factors of the organism, limited guidance in the medical literature, and the patient's history and underlying condition. Despite these challenges, the patient was successfully treated with a combination of daptomycin and gentamicin and replacement of her indwelling central line. As antimicrobial stewards and diagnosticians, we must bear in mind that selective pressures exerted by the increasing use of agents with gram-positive activity may result in an increased prevalence of organisms such as E. gallinarum.