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The article examines whether B-cell count and imaging screening can affect clinical monoclonal B-cell lymphocytosis (cMBL). It analyzes a cohort of 684 patients who were diagnosed with Rai stage 0 chronic lymphosytic leukemia (CLL) or cMBL. It supports the recommendation of the guidelines which states that lymph node evaluation by physical examination is the most suitable assessment for the MBL workup.

The consensus views of an expert roundtable meeting are presented as updated management guidelines for using alemtuzumab in chronic lymphocytic leukemia. Since the publication of previous management guidelines in 2004, clinical experience with alemtuzumab has grown significantly, especially regarding its efficacy and safety, management of cytomegalovirus (CMV) reactivation, identification of patient subgroups likely to benefit from alemtuzumab therapy and subcutaneous administration of alemtuzumab. The updated recommendations include (1) alemtuzumab monotherapy can be safely used as first-line therapy; (2) suitable patient subgroups for alemtuzumab therapy include elderly patients, patients with 17p deletion, patients with refractory autoimmune cytopenias and patients with profound pancytopenia at baseline due to heavily infiltrated bone marrow; (3) alemtuzumab treatment should be continued for 12 weeks (36 doses) whenever possible, and bone marrow examination may be considered at week 12 to evaluate response; (4) monitoring CMV reactivation by weekly PCR is mandated during therapy; when CMV reactivation becomes symptomatic or viremia increases, alemtuzumab therapy should be interrupted and anti-CMV therapy started; (5) subcutaneous administration is safe, easy to perform and appears equally effective compared with intravenous infusion and (6) our strong recommendation is that alemtuzumab combination therapy and consolidation therapy shall not be used outside carefully controlled clinical studies. [ABSTRACT FROM AUTHOR]

Chronic lymphocytic leukemia (CLL) cells could be undetectable by flow cytometry or polymerase chain reaction after sequential treatment with fludarabine and Campath-1H. Concern has been raised regarding the ability to mobilize sufficient peripheral blood progenitor cells (PBPCs) for autografting after purine analogues, and there are few data about PBPC collection after Campath-1H. In all, 16 CLL patients responding to sequential chemo-immunotherapy entered the study. In 10, mobilization regimen consisted of granulocyte colony-stimulating factor (G-CSF) 5-10?µg/kg/die. Patients failing mobilization or not achieving the target of 2.5 × 106 CD34+ cells/kg underwent a second attempt using intermediate-dose (ID) Ara-C, 800?mg/m2 every 12?h for six doses+G-CSF. PBPC collection after G-CSF alone was successful in two out of 10 patients. An adequate number of CD34+ cells were collected after ID Ara-C+G-CSF in eight patients failing the mobilization with G-CSF alone and in five out of six who did not receive G-CSF before. Greater yields of PBPCs were collected with Ara-C+G-CSF compared with G-CSF alone (13.8 vs 3.3). The extrahematologic toxicity was manageable. In conclusion, PBPC collection is feasible in CLL patients treated with sequential therapy including fludarabine and Campath-1H. Excellent yields were obtained in 92.8% of patients primed with ID Ara-C+G-CSF.Leukemia (2004) 18, 57-62. doi:10.1038/sj.leu.2403190 [ABSTRACT FROM AUTHOR]

The article discusses updated results of chronic lymphocytic leukemia (CLL)11 study that compared obinutuzumab plus chlorambucil (G-Clb), rituximab plus chlorambucil (R-Clb) and chlorambucil alone (Clb) on progression-free survival (PFS) and overall survival (OS), as of April 2014. Findings discussed include significantly longer PFS with G-Clb compared to R-Clb treatment, G-Clb having longer time to next antileukemic treatment than with R-Clb, and no significant OS benefit for G-Clb over R-Clb.

Twenty-six patients affected by acute myeloid leukemia (AML) who relapsed after autologous stem cell transplantation (ASCT) were treated with the FLAG regimen (fludarabine, cytarabine, and G-CSF). Their median age was 39 years (range 14-59). The median interval from achievement of CR to ASCT was 4 months (2-8). The conditioning regimen was BAVC (BCNU, amsacrine, VP-16, cytarabine) in eight patients, BuCy (busulfan, cyclophosphamide) in 13, and TBI-Cy (total body irradiation, cyclophosphamide) in five. Relapse occurred after a median of 7 months (2-18). ASCT had been performed in CR1 for 23 patients and in CR2 for three. Nineteen patients had been given bone marrow, seven peripheral blood stem cells collected following consolidation plus G-CSF. Overall, CR was obtained by 13 patients (50%), all remitters requiring a single course. The median time for hematological recovery of neutrophils >500/microl and platelets >20,000/microl was 24 and 30 days, respectively. The median duration of G-CSF administration was 25 days, while the median hospitalization was 31 days. There were four deaths in induction (15%), while nine patients (35%) were resistant. After achieving CR, two patients received allogeneic BMT, five a second ASCT, and four were consolidated with HD-ARA-C. Only two patients were judged unable to receive any further therapy. There were 14 documented infections, while nine patients experienced fever of unknown origin. WHO >2 nonhematological toxicity consisted of stomatitis (50%), hepatic dysfunction (11%), diarrhea (11%), and lethargy (4%). Median overall survival and disease-free survival were 6 and 13 months, respectively. Six patients are in CCR at present. We conclude that FLAG is effective in patients with AML who are relapsing after ASCT. The toxicity is acceptable, enabling most patients to receive further treatment, including second transplantation procedures. [ABSTRACT FROM AUTHOR]

Infections are the major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). Predisposition to infection in CLL is mediated through various abnormalities including both the immune defects inherent in the primary disease (impairment in humoral and cellular immunity) and in the further immunosuppression related to the management of CLL. Hypogammaglobulinemia is probably the most important immune defect in terms of risk of severe bacterial infections, its frequency and severity progressing with the duration of the disease. Newer antineoplastic agents such as purine analogues, especially when used in previously treated patients, may be associated with a new spectrum of pathogens ( Listeria monocytogenes, Pneumocystis carinii, cytomegalovirus, herpes simplex virus, and mycobacteria) involving T-cell dysfunction. In this review we focus on the clinical characteristics of infections in CLL and on the risk factors involved in the pathogenesis of this complication. Furthermore, we describe the evolving patterns of infections associated with purine analogues and discuss the currently accepted approaches to prophylaxis and treatment. Les complications infectieuses de la leucémie lymphoïde chronique [ABSTRACT FROM AUTHOR]

The Italian Co-operative Group GIMEMA conducted a randomized trial in adult acute nonlymphocytic leukemia (ANLL) to assess the role of postconsolidation treatment. Of 448 evaluable patients entered into the study, 305 (68%) achieved a complete remission after a standard induction with daunorubicin and cytosine arabinoside (3 + 7; 2 + 5). Those in remission after a consolidation therapy including 4 courses of daunorubicin, cytosine arabinoside, and 6-thioguanine (DAT) were allocated to one of three arms: no treatment, conventional maintenance, or intensive postconsolidation therapy. The median disease-free survival (DFS) was 13 months, and the median survival was 14 months, with 26% surviving at 6.5 years. There was no difference in survival and in disease-free survival among the three postconsolidation arms. In conclusion our study, as others, suggests that the critical period of ANLL treatment is within the first 5-6 months. [ABSTRACT FROM AUTHOR]

In a study to determine the value of antigen and antibody detection in the serological diagnosis of invasive aspergillosis in patients with hematological malignancies, 436 sequential serum samples from 79 neutropenic patients were tested. Circulating galactomannan antigen was detected with a latex agglutination method (Pastorex Aspergillus) and antibody to Aspergillus fumigatus with an immunodiffusion test on agar gel. Among the 79 patients 18 cases of invasive aspergillosis were detected (4 proven, 6 highly probable, 3 probable, 5 suspected). Antigen was detected in 7 of these 18 patients. The sensitivity of the antigen test was 38.8 % and the specificity 95 %. The antibody test showed 55.5 % sensitivity and 100 % specificity. In this study the antigen test was less sensitive than previously reported but highly specific and might serve as a supplementary diagnostic test. [ABSTRACT FROM AUTHOR]

Leukemia (2002) 16, 2455–2456. doi:10.1038/sj.leu.2402716 [ABSTRACT FROM AUTHOR]

Comments on the issue regarding the prolonged molecular remission after arsenic trioxide and all-trans retinoic acid for acute promyelocytic leukemia relapse after allogeneic stem cell transplantation. Increase of the rate of molecular remission; Accounts on the number of treatment options available for treating molecular relapse; Efficacy of arsenic trioxide in the treatment of patients with hematological relapse.