A. Arrighini

Autologous bone marrow transplantation for treatment of isolated central nervous system relapse of childhood acute lymphoblastic leukemia

The purpose of this study was to assess the role of ABMT in children with ALL who are in 2nd CR after an early isolated CNS relapse. All children experiencing an isolated CNS relapse at 10 AIEOP centers (Associazione Italiana Emato-Oncologia Pediatrica) from 1986 to 1992 were eligible for this study. The series included 69 patients who relapsed within 3 years from diagnosis: 19 underwent ABMT, nine patients underwent ALLO-BMT from an HLA-identical sibling, and 41 received conventional chemotherapy (CHEMO). Statistical analysis was performed using a Cox’s regression model, adjusting for the waiting time before transplantation and prognostic factors. The 5 years DFS was 56.3% (s.e. 12.3) for patients in the ABMT group. This compared favorably with the poor result (12.6% (s.e. 5.9)) seen in the CHEMO group. The risk of failures was reduced by one-third in the ABMT group as compared to the CHEMO group in the multivariate analysis (P < 0.01). in the allo group four out of nine patients were in ccr 4–5 years post-transplant. this study suggests that abmt may also represent a valuable therapeutic choice for patients lacking a matched familiar donor in 2nd cr after an early isolated cns relapse.

Outcome after cessation of therapy in childhood acute lymphoblastic leukaemia

A total of 2192 children with acute lymphoblastic leukaemia who had reached cessation of therapy in complete remission were followed for a median time of 52 months after treatment suspension. Of the 485 relapses observed, 62.3% occurred in the first year off therapy and 68.9% involved the bone marrow. Eight relapses were reported more than 5 years (62-143 months) after treatment withdrawal. Males fared worse than females consistently, experiencing 1.5 times more relapses (P < 0.0001). Thirteen patients died in continuous complete remission, 5 because of non-neoplastic central nervous system complications. There were 11 second solid malignancies, 8 of them in the central nervous system; 9 subjects presented an haematopoietic malignancy after ALL. The projected event-free survival at 8 years is 73%. Twenty-two of the 171 young adults (age > 20 years) were married and 16 have had 21 healthy children. Twenty-four per cent of patients experienced an unfavourable event. Relapses accounted for 93% of failures. Central nervous system late effects and second malignancies were the major causes of non-leukaemic morbidity and mortality.

Effect of Ultrasounds Treatment on Alloys for Semisolid Application

Semisolid metallic alloys are commercially produced by means of mechanical or electromagnetic stirring. Among the mechanical devices, the rotating pin immersed in a solidifying alloy seems to be easier to manage in industrial practice although it can induce some porosity, depending on the shape of the pin. As known, ultrasounds are mechanical waves which, when applied to liquid metals, increase the number of solidification nuclei, so that the cast products show superior mechanical performances, as a consequence of the finer grain structure. In this paper the use of ultrasound waves applied to different alloys during solidification was studied in order to obtain feedstock for semisolid die-casting application. A dedicated ultrasound power unit, together with a proper sonicator pin, was designed and manufactured by the authors and, subsequently, the effect of the ultrasonic treatment on the microstructure of A356 aluminum alloy and ZA27 zinc alloy was investigated. All the produced samples were characterized by metallographic analyses to measure the globule size and shape factor, which are main criteria for thixo-microstructure assessment. The results were compared to those obtained with traditional mechanical stirring, showing the higher capability of ultrasound treatment in producing better semisolid microstructure. An optimized combination of process parameters seems to be necessary to get a reasonable thixotropic structure in treating ZA27 alloy. Less severe production conditions are needed in the case of aluminum alloy, revealing the potentiality of ultrasounds as an alternative treatment to traditional mechanical stirring, with the further advantage of alloy degassing and grain refinement, without the use of expensive addictions (TiB2). Trials were finally performed on a continuous casting pilot plant in combination with electromagnetic stirring to produce semisolid billets.

Treatment of Poor-Risk Neuroblastoma with Intensive Chemotherapy and Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor

Advanced neuroblastoma is one of the most lethal pediatric malignancies. Several antitumor compounds are able to induce tumor regression, and a dose-response relationship has been demonstrated for some of them. A significant improvement in both response rate and duration of survival has thus been obtained by treatment intensification [1–4]. In the Italian experience, the median survival time of children treated with aggressive chemotherapy has been doubled compared with historical controls [5]. However, the higher initial response rate and the prolonged remission time has resulted in only a marginal improvement in cure rate, presently not exceeding 25% [6, 7]. Hematopoietic growth factors (colony-stimulating factors, CSFs), by mitigating the myelotoxic effect of chemotherapy, may reduce the treatment-related morbidity and thus permit the delivery of higher dosages and the shortening of intervals between chemotherapy courses [8, 9].