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An expert panel convened to reach a consensus regarding the optimal use of lenalidomide in combination with dexamethasone (Len/Dex) in patients with relapsed or refractory multiple myeloma (RRMM). On the basis of the available evidence, the panel agreed that Len/Dex is a valid and effective treatment option for most patients with RRMM. As with other therapies, using Len/Dex at first relapse is more effective regarding response rate and durability than using it after multiple salvage therapies. Len/Dex may be beneficial regardless of patient age, disease stage and renal function, although the starting dose of lenalidomide should be adjusted for renal impairment and cytopenias. Long-term treatment until there is evidence of disease progression may be recommended at the best-tolerated doses of both lenalidomide and dexamethasone. Recommendations regarding the prevention and management of adverse events, particularly venous thromboembolism and myelosuppression, were provided on the basis of the available evidence and practical experience of panel members. Ongoing trials will provide more insight into the effects of continuous lenalidomide-based therapy in myeloma. © 2011 Macmillan Publishers Limited All rights reserved.

A 44-month old girl with congenital amegakaryocytic thrombocytopenia, already with pancytopenia, underwent an unrelated allogeneic cord blood transplantation with recovery of normal blood cell counts. The patient was a compound heterozygote for two c-mpl missense mutations inherited from both parents, one of them, a G578A exon 4 mutation leading to a cysteine to tyrosine replacement of codon 193, previously unreported.

4724 Background: Pts with International Germ Cell Cancer Collaborative Group (IGCCCG) “poor prognosis” disease achieve only a 41% 5-year progression-free survival (PFS) with standard chemotherapy. Pts who do not achieve a complete remission with BEP chemotherapy or who relapse after such treatment have a still worse prognosis. The clinical impact of HDC in such pts is still unclear. Methods: Pts with germ cell cancer with IGCCCCG “poor prognosis” disease at diagnosis (or, earlier, with Indiana group C) or with recurrent or refractory (i.e., less than marker negative partial remission) disease after initial BEP chemotherapy were eligible for HDC. Results: Between June 1996 and April 2003, 18 pts underwent one (13 pts) or two (5 pts) cycles of HDC with ICE (ifosfamide 10g/m2, carboplatin 1,500mg/m2 and etoposide 2,400mg/m2); 17 pts), or etoposide (1500mg/m2) plus thiotepa (900 mg/m2); 1 pt), in 6 pts as consolidation after BEP and in 12 pts for recurrent disease (7 pts) or refractoriness to BEP (5 pts). In ...

Fludarabine is a purine analogue with high activity in lymphoid malignancies and a frequent component of reduced-intensity conditioning regimens, due to its immunosuppressive properties. Renal toxicity of fludarabine occurs in less than 5% of patients,1 usually in the context of tumor lysis syndrome.2 In one case report of fludarabine-associated nephrotoxicity occurring after the administration of a cumulative dose of 500 mg/m2 of fludarabine, renal biopsy showed the presence of mesangiocapillary glomerulonephritis.3 Another report described the occurrence of crescentic glomerulonephritis, with p-ANCA positivity, after three courses of treatment with this drug.4 We report a case of acute renal failure developing after the first administration of fludarabine, without associated tumor lysis syndrome.