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Cytomegalovirus (CMV) infection causes morbidity and mortality after allogeneic haematopoietic stem cell transplantation (HSCT). We investigated whether prophylaxis with high dose valaciclovir is effective at reducing the incidence of clinically significant CMV infection (csCMVi) within six months of allogeneic HSCT. Consecutive allogeneic HSCT recipients who received 2g valaciclovir orally four times daily from transplant until day 100 (prophylaxis group) were compared to subsequent patients who received no CMV prophylaxis (control group). Forty‐nine patients in the prophylaxis group and 59 in the control group were included. The cumulative incidence of csCMVi at 6 months was 20% (95% confidence interval (CI): 9%‐27%) in the prophylaxis group and 39% (95% CI: 26%‐47%) in the control group (P =.009). There was no CMV disease in the prophylaxis group and three cases in the control group. There was no difference in time to neutrophil or platelet recovery nor graft failure between groups. On multivariable analysis, lack of high dose valaciclovir prophylaxis, positive recipient CMV IgG and age were associated with greater likelihood of csCMVi. There was no significant difference in acute graft versus host disease, non‐relapse mortality or overall survival between groups. In this retrospective cohort study, high dose valaciclovir prophylaxis resulted in a lower incidence of csCMVi within six months of HSCT. [ABSTRACT FROM AUTHOR]

We report a rare case of aggressive plasmablastic lymphoma with an initial presentation of dermatomyositis. The challenges associated with the diagnosis and treatment approach are also highlighted in this case report. [ABSTRACT FROM AUTHOR]

Summary: De novo diffuse large B‐cell lymphoma (DLBCL) presenting with synchronous central nervous system (CNS) and systemic disease (synDLBCL) is not well described and is excluded from clinical trials. We performed a retrospective analysis of 80 synDLBCL patients treated across 10 Australian and UK centres. Of these patients, 96% had extranodal systemic disease. CNS‐directed treatment with combination intravenous cytarabine and high‐dose methotrexate ("CNS‐intensive") (n = 38) was associated with favourable survival outcomes compared with "CNS‐conservative" strategies such as intravenous high‐dose methotrexate monotherapy, intrathecal therapy and/or radiotherapy (2‐year progression‐free survival [PFS] 50% vs. 31%, P = 0·006; 2‐year overall survival [OS] 54% vs. 44%, P = 0·037). Outcomes were primarily dictated by the ability to control the CNS disease, with 2‐year cumulative CNS relapse incidence of 42% and non‐CNS relapse 21%. Two‐year OS for CNS‐relapse patients was 13% vs. 36% for non‐CNS relapses (P = 0·02). Autologous stem cell transplantation as consolidation (n = 14) was not observed to improve survival in those patients who received CNS‐intensive induction when matched for induction outcomes (2‐year PFS 69% vs. 56%, P = 0·99; 2‐year OS 66% vs. 56%, P = 0·98). Hyperfractionated or infusional systemic treatment did not improve survival compared to R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) (2‐year OS 49% for both groups). Our study suggests that adequate control of the CNS disease is paramount and is best achieved by intensive CNS‐directed induction. [ABSTRACT FROM AUTHOR]