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To characterize in detail the outcomes of HLA-identical sibling bone marrow transplantation for chronic lymphocytic leukemia (CLL) in patients younger than 60 years of age.Retrospective cohort study.30 centers for bone marrow transplantation worldwide, which reported data on outcome of HLA-identical sibling bone marrow transplantation for CLL to the European Group for Blood and Marrow Transplantation or the International Bone Marrow Transplant Registry between 1984 and 1992.54 patients diagnosed with CLL (median age, 41 years; range, 21 to 58 years). The median interval from diagnosis to transplantation was 37 months (range, 5 to 130 months). At the time of transplantation, 3 patients were at Rai stage 0; 10 were at stage 1; 10 were at stage 2; 7 were at stage 3; and 22 were at stage 4.Transplant regimens varied. Most patients received high-dose cyclophosphamide and total body irradiation, followed by infusion of bone marrow from an HLA-identical sibling. After transplantation, immune suppression with cyclosporine or methotrexate or both was generally used to prevent graft-versus-host disease.The primary outcome was survival. We also studied hematologic remission, defined as normalization of the leukocyte count, hemoglobin level, and platelet count, and absence of lymphadenopathy and splenomegaly.38 patients (70%) achieved hematologic remission. Twenty-four (44%) remain alive a median of 27 months (range, 5 to 80 months) after transplantation. Three-year survival probability was 46% (95% CI, 32% to 60%). Three patients who received transplants at Rai stage 0 remain alive 21, 32, and 45 months after transplantation. Three-year survival probabilities were as follows: 68% (CI, 38% to 98%) in 10 patients who received transplants at Rai stage 1, 30% (CI, 2% to 58%) in 10 patients who received transplants at Rai stage 2, 57% (CI, 21% to 93%) in 7 patients who received transplants at Rai stage 3, and 34% (CI, 12% to 56%) in 22 patients who received transplants at Rai stage 4 CLL. Five patients (9%) died of progressive leukemia and 25 (46%) of treatment-related complications.Bone marrow transplants from HLA-identical siblings can result in hematologic remission and survival in persons with CLL, but it is uncertain how these results compare with those of conventional therapies.

Analysis of prognostic factors has been made in 369 allogeneic transplants for multiple myeloma reported to the registry of the European Group for Blood and Bone Marrow Transplantation (EBMT). Favorable prognostic factors for obtaining a complete remission (CR) were stage I at diagnosis (CR 77%), one line of treatment before conditioning (CR 52%), CR before conditioning (CR 60%), and Ig A or light chain myeloma (CR 43% and 42%). Factors that predicted significantly for favorable survival in a univariate analysis included having received only one line of treatment, female sex, stage I at diagnosis, stage I at conditioning and a beta 2-Microglobulin less than 4 mg/l. Favorable post-BMT factors consisted of obtaining a CR following BMT and not being in graft-versus-host disease stage III or IV. A multivariate analysis of pre-BMT factors showed that the sex of the patient and the number of lines of treatment pretransplant were independent prognostic factors. Allogeneic BMT is a promising treatment method for patients who have received only one line of treatment, particularly if they are of the female sex. BMT late in the course of the disease is usually unsuccessful.

Allogeneic BMT is presently recognized as one of the reference anti-leukemic treatments for AML patients. It could be a very useful therapy in CR1 AML if it is efficient as an early form of consolidation after induction therapy. Later procedures may be of lesser importance since they concern a population which may have already been cured by chemotherapy. Alternatively it is not solved if very early BMT gives patients sufficient therapy and provides lower toxicity. To answer this question we analyzed data from the Société Française de Greffe de Moelle (SFGM) on a sub-group of patients according to the following criteria: (1) Allogeneic BMT carried out on patients with AML in CR1; (2) after January 1985; (3) conditioning with CyTBI; (4) GVHD prophylaxis with MTX-CsA; (5) interval between diagnosis and BMT100 days. Forty-two fulfilled all criteria. Age was 31 +/- 8 years and M/F ratio was 19/23. WBC at diagnosis were 36 +/- 49 x 10(9)/l and four patients needed two induction courses to achieve CR1. Median follow-up is now 51 (24-116) months. Twenty-two patients developed a gradeor = 2 acute GVHD. Early transplant mortality at 1 year is no higher than 14%. Two patients died of secondary malignancies at 3.5 and 6.5 years after BMT. Finally 5-year (and 7-year) probabilities for relapse, survival, leukemia and event-free survival are respectively 17% (17%), 71% (62%), and 71% (71%) and 68% (59%). These data indicate the feasibility of such an approach with low mortality and low relapse rates providing a good long-term outcome. This should prompt an invitation to initiate the search for an HLA-identical sibling when AML is diagnosed in a young patient eligible for allo-BMT.

An observational, longitudinal, multicentre study (ORHEO; place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) is being conducted in France to assess the efficacy and safety of biosimilar epoetins for the treatment of CIA in the clinical setting. A total of 2310 patients with solid tumours, myeloma and lymphoma were included in the study. In the subanalysis, we assess the use of biosimilar epoetins in patients with lung cancer. A total of 421 patients >18 years with CIA (haemoglobin [Hb] Of the patients included in this study, 33.5% had a stage III tumour and 30.8% a stage IV tumour, while metastases were identified in 71.5% of patients. At baseline, average Hb levels were 9.5 g/dL, with 36.8 % of patients classed as having moderate anaemia. All patients received epoetin zeta (Retacrit®, Hospira UK Ltd.) Response to treatment with biosimilar epoetin was achieved in 76.7% and 86.0% of patients after 3 and 6 months, respectively, while average Hb levels had increased by 1.4 g/dL and 1.7 g/dL at 3 and 6 months, respectively. At 6 months, the transfusion rate was 1.1%, the rate of clinically significant adverse events was 16.7%, while the rate of thrombotic events was 2.4%. In conclusion, biosimilar epoetin was effective and well tolerated in the treatment of CIA in patients with lung cancer. Disclosure M. Michallet: I have received honoraria from Hospira for advisory boards and consulting, E. Luporsi: I have received honoraria from Hospira for advisory boards and consulting, P. Soubeyran: I have received honoraria from Hospira for advisory boards and consulting, H. Albrand: Employed by Hospira.

CMV pneumonia is rare following ABMT. No information has been presented concerning risk factors or outcome of antiviral therapy. Information concerning CMV pneumonia after ABMT was collected from bone marrow transplant centers in Europe. Twenty-one patients who fulfilled the diagnostic criteria of CMV pneumonia were reported. Eighteen of these patients were reported from centers who also reported the total number of ABMT performed. The CMV pneumonia frequency among 2252 reported ABMT patients was 0.8%, and this varied from 0% to 8.6% between different centers. Survival for30 days from diagnosis of pneumonia was 43%. Three patients suffered relapses, which were fatal, giving a total survival of 28%. Patients treated with or without TBI had a survival of 18% and 50%, respectively. Among patients given ganciclovir or foscarnet with or without intravenous immune globulin, survival at 30 days was 50% and total survival 28%. There was no difference in survival with or without the addition of intravenous immune globulin. CMV pneumonia is an infrequent but serious complication of ABMT.

In sterile hospital units filamentous fungal infections are an unacceptable risk in patients with prolonged agranulocytosis. The occurrence of 3 successive cases in the Sterile unit of University Hospital of Grenoble prompted us to investigate in all elements of sterile unit, and notably food-processing. Two cooked rice dishes given to these patients were found to contain a substantial amount of Aspergillus fumigatus and were probably responsible for these infections. A more detailed study was carried out to evaluate the degree of food contamination by fungi in sterile unit. The study included 97 cooked dishes which had been sterilized in a 250 degrees oven for 40 minutes and 176 industrially packed foods delivered in single packs (e.g. milk and its derivatives, sweets and drinks). Each foodstuff was mycologically examined 3 to 5 times in different packs according to a procedure used in food analysis laboratories and raised to the standards of mycological examination. In this way, a 3-monthly food testing protocol in sterile unit could be set up. This protocol has a dual purpose: regular checking of the cooked dishes chain and maximum diversification of the dishes.

The BGMT 87 study was designed to compare prospectively Allogeneic Bone Marrow Transplantation (AlloBMT), Autologous Stem Cell Transplantation (ASCT) and Chemotherapy (CT). Of the patients who could not undergo AlloBMT and were still in remission after two cycles of intensive CT were randomized for ASCT (n = 39) or CT (n = 38). The actuarial risk of relapse was 48.7 +/- 8.8% (95% ci) in the ASCT group and 61.1 +/- 8.4% (95% ci) in the CT group (p = NS). The estimated chance of surviving without disease at three years was similar in both groups (48.3 +/- 8.5% versus 38.9 +/- 8.4; p = NS).

Transplants were performed in 281 patients (pts) with chronic myeloid leukemia (CML) in France between 1979 and 1986. The actuarial survival after 5 years is 55% for the patients receiving grafts in first chronic phase (CP), 43% for the patients given grafts in accelerated phase (AP) or second CP, and 35% for the patients receiving grafts in blastic crisis (BC). The main cause of death was interstitial pneumonitis and/or acute graft-versus-host disease (AGVHD). The incidence of AGVHD appears correlated with prophylactic treatment: 58% after methotrexate alone (MTX), 41% after cyclosporine (CSA), 26% after MTX + CSA, and only 14% after T-cell depletion. On the contrary, the relapse rate was much higher after T-cell depletion or syngeneic bone marrow transplantation (BMT) (70%) than after allogeneic non-T-cell-depleted BMT (18%). In this last group of patients, the relapse rate is correlated with the phase of CML at time of BMT: 10% for 102 patients in first CP and 30% for 77 patients in more advanced disease. Finally, the incidence of long-term disease-free survival is 55% for patients receiving grafts in first CP with a non-T-cell-depleted marrow. We conclude that the probability of cure after allogeneic BMT is very high, especially for patients in CP receiving non-T-cell-depleted marrow.

The classic treatment of chronic lymphocytic leukemia (CLL) aims at prolonging survival, without attempting to eradicate the disease. CLL commonly affects the elderly, but a small proportion of patients are less than 50 years old. In this age group a novel form of therapy, high-dose chemoradiotherapy and allogeneic bone marrow transplantation (BMT), has been used recently. Review of the literature and the IBMTR data show that 26 patients have received BMT (24 allogeneic, two syngeneic). Patients were predominantly male (20/26) with an age ranging between 21 and 49 years; 18 had advanced disease at BMT and had received multiple courses of chemotherapy to which they were considered refractory. Conditioning consisted of cyclophosphamide and fractionated total body irradiation, plus additional agents in one-third of the patients. Graft-versus-host disease (GVHD) prevention was variable. Twenty-five patients are evaluable: 12 died of early complication of BMT (GVHD, infection, haemorrhage, etc.) and only two died of CLL. The effect of BMT on the disease was evaluable in 22 patients: 19 achieved a remission, three showed persistent disease and two relapsed; 11 were alive and apparently disease-free, with follow-up between 5 and 48 months. In two of these patients molecular biology studies showed no residual disease. These results indicate that further studies of the use of BMT for selected patients with CLL appear to be justified.

Thirty-nine patients with relapsed acute lymphoblastic leukemia (ALL) and four with primarily refractory ALL were treated with a regimen that included cytarabine 1 gm/m2 (2-hour infusion) twice daily days 1 to 5, mitoxantrone 12mg/m2 daily days 1 to 5, prednisone 0.5 mg/kg daily days 1 to 5, and etoposide 200 mg/m2/day daily days 6 to 8. Of the 43 patients, 30 achieved a complete remission (CR), 28 out of the 39 relapsed patients and two among the four with refractory disease. Five patients died in aplasia. Eight patients were nonresponders. Nonhematologic side effects consisted predominantly of nausea, vomiting, and mucositis. One patient had transient cerebellar dysfunction. Recovery of blood counts occurred at a median of 24 days. The median time to CR was 38 days. As this regimen is highly effective in relapsed or refractory ALL, its use during earlier stage of the disease is warranted.

The results of chemotherapy in adults with acute lymphoblastic leukemia (ALL) have improved in recent years but have lagged behind those in children with ALL [1, 2]. The overall probability of achieving complete remission (CR) exceeds 75%, and it now appears that approximately 35% of patients achieving CR can be cured using chemotherapy alone [2, 3]. It is therefore appropriate to study alternative forms of treatment such as allogeneic or autologous bone marrow transplantation (BMT) in adult ALL.

The dosage regimen of cyclosporine (CsA) can be individualized in patients by means of a test dose (TD) method in the few days before bone marrow graft. To simplify the test dosing protocol, we used a Bayesian estimation (BE) of CsA clearance requiring population data and partial kinetic information for a given patient. In the first part, 42 patients, aged 11-47 years, were given a 2-h infusion of CsA (4 mg.kg-1). CsA concentrations were determined in several blood samples. The obtained concentration-time curves were fitted according to a three-compartment model. Maximum likelihood estimation (MLE) allowed CsA determination of pharmacokinetic parameters. Early population parameters of CsA were determined using 22 TD by a two-stage method. In the remaining 20 patients, individual pharmacokinetic parameters were also computed by BE procedure, taking into account the above determined population parameters and CsA concentration determinations from three blood samples drawn at 5 and 30 min and 3 h after the end of TD infusion. In the second part, 16 patients were used to evaluate performance of BE in directly predicting target concentration values. Finally, early population characteristics were updated on the basis of 42 patients. Statistical comparisons between MLE and BE estimates of CsA clearance and between concentrations predicted after BE and those experimentally obtained showed that three blood CsA determinations allowed accurate clearance estimation and target concentration predictions. The method presented here can be used to calculate an individual CsA dosage regimen in real time, thus improving patient comfort.(ABSTRACT TRUNCATED AT 250 WORDS)

Ninety-two elderly patients (ages 50-70) with "de novo" acute myeloid leukemia were given induction chemotherapy consisting of aclacinomycin-A (ACLA) (100 mg/m2/day x 3) and cytosine arabinoside (ARA-C) (100 mg/m2 day, continuous infusion, 7 days). Fifty-one patients (55%) achieved complete remission (CR), 8 patients exhibited drug resistance and 33 patients died during chemotherapy or aplasia. Three patients had severe cardiac toxicity. The only prognostic factor significantly affecting CR was the initial leukocyte count. After consolidation using ACLA (80 mg/m2/day x 2) and ARA-C (100 mg/m2/day x 5), 47 CR patients were randomly assigned to 2 different treatment arms: 23 patients (Group A) received intensive sequential chemotherapy consisting of 4 monthly courses of 8 different drugs while 24 other patients (Group B) were given ACLA and ARA-C at regular intervals, associated with continuous chemotherapy consisting of 6-mercaptopurine, methotrexate and androgens. The probability of disease-free survival at 2 years was significantly higher (33 +/- 22%) for Group B patients than for Group A (13 +/- 16%) (P less than 0.05). We conclude that continuous maintenance chemotherapy may be useful in increasing the number of long-term survivors, at least in the elderly who have not received very intense consolidation chemotherapy following CR.

Histology and cytology show us the strong heterogeneity of non-Hodgkin’s malignant lymphomas (NHML). Numerous classifications have been proposed. They contain 6–12 classes [18, 25] which more or less match [5, 9, 10, 12, 17, 18, 20, 25]. If, with luck, a nonsophisticated and reproducible classification could predict the evolution, we would have to take it into account and suit the treatment to it. Nevertheless, none of the present classification systems are able to solve the problem for all the patients with NHML. The aim of a practical classification is to clearly distinguish the morphologic groups with the same predictable evolution possibly to cancel those in which the prognosis is still confused. Such well-defined groups have already been described, e.g., African Burkitt’s lymphoma [1], immunoblastic sarcoma [19], convoluted cell lymphosarcoma [18, 30], nodular well-differentiated lymphomas [4, 16], and histiocytosarcoma [22]. Nevertheless, it is still difficult to compare the potential evolution of the morphologic groups from one center to another. There are several causes: the reproducibility is not easy, the treatments are different, and even the frontiers of the disease are badly separated from the chronic lymphocytic leukemia or the acute leukemia.

Forty-five patients were treated for chronic granulocytic leukemia (CGL) in transformation by intensive chemotherapy (23 patients) or radiochemotherapy (22 patients) followed by autologous transplantation of bone marrow (17 patients) or blood-derived hematopoietic stem cells (28 patients). Hematopoiesis was reestablished in most evaluable patients and was significantly more rapid in previously splenectomized patients or in those receiving more than 10 X 10(8) nucleated cells/kg. However, partial or complete failure of engraftment was observed in 11 patients, in most cases after autografting with marrow cells. The median survival of all patients was 4.5 months. The major cause of death was the rapid recurrence of the blast cells not eradicated by the conditioning regimen. However, 4 of the 11 patients treated during the accelerated phase are still alive in the chronic phase, 17, 23, 35, and 54 months after autografting. These results and the restoration of hematopoiesis without the Philadelphia chromosome in 5 patients suggest that autografting could be used in CGL before the onset of the blast crisis.

An unexpectedly high rate of long-term survivors in acute myeloid leukemia (AML) has been observed in a group of patients who achieved a first complete remission (CR) after induction of a therapeutic regimen including daunorubidomycine, vincristine, prednisone and stanozolol, and anabolizing steroid. The rate of CR was 52%. Maintenance therapy was very simple and the only association with stanozolol during this period suggested to us that an androgen, at low dosages, might be responsible for the unusual long-term survival time (45 months with a 95% confidence limit from 30 to 86 months). On the basis of our first observation, high dosages of the androgen were used during the induction phase of treatment but failed to demonstrate any advantage when associated with a drug regimen, including cytosine arabinoside (ARA-C). The reevaluation of each parameter for our group of patients did not allow selection of patients in terms of their age or the hematologic data obtained at presentation. Effects of androgen on the socalled normal hemopoietic cells and on the leukemic cells are discussed, particularly the possible antagonistic effect with ARA-C. A prospective statement is made concerning the possible condition of the prolongation of the complete remission in AML according to some experimental data which enforce the stimulative activity of androgen on the myeloid proliferation.

Chronic granulocytic leukemia (CGL), characterized by the Philadelphia chromosomal abnormality [1], is a clonal [2] myeloproliferative disorder with poor prognosis [3]. The main cause of death is blast crisis, which is often preceded by an accelerated phase. Blast crisis is generally refractory to chemotherapy and fatal within a few months. Conventional chemotherapy can improve the quality of life during the chronic phase but cannot delay the onset of blast crisis. Aggressive chemotherapy during the chronic phase gives poor results because cytogenetic conversions are uncommon, incomplete, and usually transient. Expectations that autografting would prolong survival for patients in blast crisis have not been confirmed. Because of these disappointing results, several investigators began to evaluate supralethal chemoradiotherapy followed by bone marrow transplantation (BMT) as a potential therapeutic modality [4–8]. We report here the results of a retrospective analysis of 160 patients who received transplants between 1981 and 1985 in 18 French centers.

On the basis of cytologic studies of 144 patients with non-Hodgkin's malignant lymphomas (NHML), a cytologic classification was established that was composed of three groups (1, 2 and 3) containing nine classes (1A, 1B, 1C; 2A, 2B, 2C; 3A, 3B, 3C). Statistical analyses were carried out using 52 well-defined elementary cytologic characteristics. All the results given by the data-gathering procedures (hierarchical and dynamic clustering methods), by the descriptive analyses (multifactorial and canonical analysis) and by the stepwise discriminant analysis were in agreement with the proposed cytologic classification system. The most discriminating cytologic characteristics of the classes were the cell size, the nuclear-cytoplasmic ratio, the degree of cytoplasmic basophilia, the homogeneity of the cytoplasm and the number of mitoses. The use of these properties renders this classification system reproducible and applicable to clinical practice. A comparison was made between the cytologic classes and the NHML patients as grouped according to their clinical courses. Of the patients in classes 2A, 2B and and 2C, 94% showed acute leukemic characteristics. Of those contained in classes 3A, 3B and 3C, 78% showed poor prognosis or metastatic patterns. Of those contained in classes 1A, 1B and 1C, 76% showed a good prognosis pattern.

Of 14 patients who received an allogeneic bone marrow graft from HLA-compatible sibling donors, 10 have survived for 6 to 34 months posttransplantation (median, 12 months). Four patients have died, two of relapse at extramedullary sites, one of severe acute GVHD, and one from GI bleeding and pericardial effusion. One patient is alive in relapse and four patients have signs of minimal persistent disease. Five patients are well without signs of active disease. Minor improvement in osteolytic lesions on X-ray were seen in three patients, but the X-ray bone structure was mainly unchanged in most patients. Bone marrow transplantation appears promising for treatment of certain patients with multiple myeloma.

Allogenic bone marrow transplantation (BMT) was performed in 8 patients with B chronic lymphocytic leukemia (CLL): 6 males and 2 females with a median age of 41 years (37 to 46). Seven patients were resistant to previous therapy and were grafted in the evolutive phase. Only 1 patient was grafted without any previous treatment. At the time of BMT 5 patients were classified according to the Rai classification in stage IV, 1 in stage III and 2 in stage 1. The delay between diagnosis and BMT was 47 months (5 to 68). Graft versus host disease (GVHD) prophylaxis was methotrexate (1 patient), cyclosporine (2 patients), methotrexate + cyclosporine (3 patients), cyclosporine + physical removal of T cells (2 patients). The conditioning regimen was standard for 5 patients, reinforced for 3 patients with Chlorambucil (1 patient) and etoposide (2 patients). A successful engraftment was obtained in all cases. The lymphocytosis decreased slowly and disappeared from day 0 to day 28. All patients developed an acute GVHD 5 of which resolved. Three patients died: 2 of acute GVHD and 1 of intracerebral hemorrhage. Five patients are alive in persistent complete remission without clinical symptoms and with normal peripheral blood and normal bone marrow. The median follow-up is 27 months (13-53). This small series suggests that allogeneic BMT should be investigated in selected patients as possible curative treatment of CLL.

A simple density-cut separation technique is described for obtaining GM-CFC concentrates from the peripheral blood of patients with chronic granulocytic leukemia (CGL) for autografting at the acute blastic phase of the disease. Large numbers of granulomonocytic colony forming cells (GM-CFC) were recovered from a single procedure (68.4 X 10(6) GM-CFC). The cryopreservation of these concentrates in liquid nitrogen allowed the recovery of 46.6 +/- 33.8% viable GM-CFC. An improved yield of GM-CFC was obtained by avoiding washing the cells (65.2 +/- 41.1%). The separation technique resulted in a concentrated suspension of progenitors in a small volume of medium (mean = 15 ml) allowing a great reduction in the amount of the cryoprotective agent injected into the patient at autografting. Preliminary data obtained in 4 patients transfused in blastic crisis after chemotherapy, with or without TBI, indicated the capacity of stored concentrates to repopulate these patients.

Eighty-three patients with Hodgkin's disease were treated with a combination of chemotherapy and radiotherapy. 43 were included in protocol 1 (from january 1970 to january 1974) and 40 in protocol 2 (february 1974 to december 1977). In protocol 1, staging laparotomy was not systematically performed (20 cases). Treatment consisted of 2 intravenous injections in Vinblastine and total nodal irradiation. In protocol 2, laparotomy was systematic in patients over 50 (35 cases). Patients with stages 1 and II treated as mentioned above. Patients with stage III received two Mopp courses followed by total nodal irradiation. Patients older than 50 with stages I and II and poor prognosis factors received chemotherapy only. Laparotomy was associated with a 0% mortality rate and a 3,6% morbidity rate. No myelitis or pericarditis were observed. Herpes zoster occurred in 24% of the patients, pulmonary apex fibrosis in 6%, hypothyroiditis in 2,4%, and leucopenia in 3,6%. Two late infectious complications were fatal. No solid tumor was apparent. Acute leukemia and non-Hodgkin malignant lymphoma developed in two patients. Good tolerance, shortness of treatment, and remission rate, warrant the pursuit of protocol 2 in which systematic laparotomy for patients under 50 allows total nodal irradiation and therefore reduction of chemotherapy.

Addition of a daily dose of androgen in the form of 0.15 mg/kg of Stanzolol, given without interruption, gave an average survival of more than 4 years in patients suffering from granulocyte series acute leukaemias after complete remission was obtained. The simplicity of this treatment is apparent only from the appearance of marked manifestations of androgen impregnation in women from the 8th month of treatment onwards. These results, superior to those obtained up to the present time in the survival of myeloid leukaemias (non-lymphoblastic) were also better in terms of the stability and X "quality" of the remission in comparison to those obtained in acute lymphoblastic leukaemias. Confirmation of these results by controlled clinical trial will open up interesting perspectives, along side immunotherapy which remains of unproven effectiveness in myeloid leukaemias. The effectiveness of androgen stimulation of haematopoiesis as a stabilising factor of complete remissions in acute leukaemias has, in addition, interesting implications with regard to the theory of the leukaemic process.

Forty-five patients were treated for chronic granulocytic leukemia (CGL) in transformation by intensive chemotherapy (23 patients) or radiochemotherapy (22 patients) followed by autologous transplantation of bone marrow (17 patients) or blood-derived hematopoietic stem cells (28 patients). Hematopoiesis was reestablished in most evaluable patients and was significantly more rapid in previously splenectomized patients or in those receiving more than 10 X 10(8) nucleated cells/kg. However, partial or complete failure of engraftment was observed in 11 patients, in most cases after autografting with marrow cells. The median survival of all patients was 4.5 months. The major cause of death was the rapid recurrence of the blast cells not eradicated by the conditioning regimen. However, 4 of the 11 patients treated during the accelerated phase are still alive in the chronic phase, 17, 23, 35, and 54 months after autografting. These results and the restoration of hematopoiesis without the Philadelphia chromosome in 5 patients suggest that autografting could be used in CGL before the onset of the blast crisis.

This study took place between February 1984 and February 1985 in 76 febrile neutropenic patients. We evaluated the whole mycological and serological results, in 91 febrile episodes. We separated two groups: group I (acute leukemia, chronic myeloïd leukemia, medullar aplasia, lymphomas) and group II (chronic lymphoïd leukemia, Hodgkin disease, myelomas, solid tumors). Patients were included in this study if they developed a temperature of 38.5 degrees C or greater and if they had less than five hundred neutrophils per mm3. They were treated with mono or bi-antibiotherapy. If the patient remained febrile more than 72 hours, an antifungal therapy was added (Amphotericin B IV). Through these weekly results, we conclude: the high frequency of digestive tract candidiasis in such patients; disseminated candidiasis occurs only in the first group patients with fungal digestive colonization; the overall response rate in this study was 77 per cent. This underlines the interest of empiric treatment with amphotericin B IV.

Out of 66 febrile neutropenic patients, 33 were treated with a ceftazidime-vancomycin combination (group A) and 33 with a ticarcillin-vancomycin-amikacin combination (group B). There was no significant difference in satisfactory results between the two groups (group A 79 per cent, group B 88 per cent), and both regimens were equally active in all febrile episodes. Reversible side-effects (renal and cutaneous toxicity) were observed in 15 per cent of the cases. Two cases of superinfection and one case of resistance occurring during treatment were noted in group B patients. At a time when Gram-positive infections are increasingly frequent among febrile neutropenic patients, the ceftazidime-vancomycin combination seems to be as effective as the ticarcillin-vancomycin-amikacin triple drug combination.