Introduction: Treatment of classical Hodgkin's lymphoma (cHL) in the elderly population remains a challenge. Prevalence of comorbidities, increased toxicity to standard treatments, and the lack of inclusion within clinical trials contribute to this phenomena. Results are often inferior compared to young adults, and there is a paucity of evidence regarding valid treatment approaches. Recently, the GATLA HL-05 protocol has reported the results of a PET/CT-adapted strategy after 3 cycles of ABVD, regardless of stage at presentation and without upper age limit for inclusion1. Methods: In order to evaluate the outcome of elderly patients included in this trial, a retrospective analysis was conducted on the HL-05 database. Patients (pts) equal or older than 60 years with a recent diagnosis of cHL and a negative HIV status were considered. Progression-free survival (PFS) was defined as time from treatment to relapse or death from any cause. Overall survival (OS) was defined as time from treatment to death from any cause. Duration of response (DOR) was defined as time from complete remission (CR) to relapse or death. The Kaplan-Meier and Log-rank test method were used for survival curves. The Pearson test was applied for comparison of variables within charts. An α level of 0.05 was regarded as significant. Results: Of a total 377 pts enrolled within HL-05, 43 met inclusion criteria. With a median age of 66 yeays (range, 60-89 y), 90% had a performance status of 1 to 2. Nodular sclerosis was the most frequent histological subtype (60% of pts), and 72% of pts were early stage (I-II non-bulky disease). These characteristics were similar to the younger cohort. All pts received initial therapy with 3 cycles of ABVD and underwent evaluation with a PET/CT scan: 81% achieved a negative scan (Deauville scores, 1-2). Of the remaining 19% positive scans, 12% were compatible with PR and 7% with PD. No grade III/IV toxicity events or treatment-related deaths were reported. Within a follow-up period of 68 months, median PFS and OS have not yet been reached, and PFS was 88% at 36 months. In comparison to the younger cohort, response rates after 3 and 6 cycles of treatment were statistically similar. Furthermore, there were no significant differences within PFS, OS, and DOR curves. In a multivariate analysis including age, stage, bulky disease, and negative PET/CT after 3 cycles, older age was not a predictive factor related to PFS. Conclusions: With a PET/CT-adapted therapy after 3 cycles of ABVD for 43 pts older than 60 years, 81% of pts reached a negative scan and thus received no further treatment. These pts had an excellent outcome with a PFS of 88% at 3 years, with no statistically significant differences compared to the younger cohort. The implementation of a PET/CT-guided strategy, regardless of stage at presentation, resulted in a reduced exposition to chemo and radiotherapy and may have contributed to the absence of severe morbidity or treatment-related deaths. Keywords: elderly; Hodgkin lymphoma (HL); positron emission tomography (PET)

Background: The present goal for the treatment of HL is to develop a combined modality therapy with high response rate, disease-free survival (DFS) and overall survival (OSV) with minimal toxicity.

Response to single-agent thalidomide and eligibility to undergo autotransplant for patients with multiple myeloma refractory to VAD

Here we describe two Caucasian brothers who developed adult T-cell leukemia/lymphoma (ATLL), within a short period of time. These two patients have never left Argentina. Their parents are dead and according to the family history it is possible that the mother may have been affected by spastic paraparesis. The daughters reported that their mother had suffered from increasing difficulty in walking for many years which finally made it impossible for to her walk. There are no other data to support the presumptive diagnosis. One of the patients presented with acute disease while the other had a lymphoma type disorder. Both were positive for HTLV 1. The first patient died with disease progression ten months after diagnosis and the second is in partial remission 13 months after diagnosis. Immunophenotyping showed CD4+, CD5+, CD3+, CD2+, CD8 (-). Two asymptomatic brothers with positive HTLV 1 serology were detected. This is the first family case that has been reported in Argentina.

Relapse remains the major cause of mortality in haematological malignancies treated with autologous stem cell transplantation (ASCT). Graft versus tumour reaction (GVT) associated to autologous graft versus host disease (GVDH) may contribute to eliminate minimal residual disease (MRD) after ASCT. Eighty patients with several diagnostics were submitted to ASCT. After stem cell infusion, patients randomised in 4 groups. Groups were treated as follows: Group A received either a IFN (alpha Interferon--1,000,000 U/d), Cyclosporine A (CSA--1 mg/-kg/d intravencus) for 28 days, and granulocyte-macrophage colony stimulating factor (GM-CSF-250/m2/d) until engraftment; B: CSA (same dose and way) and GM-CSF; C: CSA (1 mg/kg/d orally) and GM-CSF and D: only GM-CSF. Patients were inspected daily and if skin rash was detected, a skin biopsy was obtained at that moment, otherwise biopsies were obtained at day 21 after ASCT. GVHD was positive in 23 patients (13 from group A and 10 from group B). All cases were grades I and II. A majority of CD4+ T lymphocytes was seen in skin infiltrates. No significant differences were seen in WBC and platelets engraftment times, antibiotic administration or hospitalisation days required among the four groups. With a median follow up of 18 months, there were no differences in disease free survival (DFS) or overall survival (OS) between the patients who developed GVHD and the others. However, considering that myeloma cells do not express antigen MCH II, which is necessary for GVT effect, we excluded patients with multiple myeloma (MM) from survival analysis, thus obtaining a significant difference in OS results between patients who developed GVHD and those in whom this reaction was not observed (81% vs 58% p:0.05). We conclude that pharmacological induction of GVHD in ASCT is possible with CSA administration (1 mg/kg/d i.v.). Development of GVHD showed a better outcome for patients in our study except for those patients with MM. This results must be confirmed by a longer follow up of our patients and further studies.