Rejet de greffe et iontophorèse de corticoïdes: à propos de 3 cas [Corneal graft rejection and corticoid iontophoresis: 3 case reports].

This is the first report of three cases of severe acute corneal graft rejection, treated by transscleral methylprednisolone (Solumédrol) iontophoresis. The efficacy of the treatment was evaluated by corneal transparency, visual acuity and corneal inflammation parameters. The patient was treated with Solumédrol iontophoresis once a day for 3 days with a topical corticotherapy reduced to three drops of dexamethasone per day. Iontophoresis was performed, under topical anesthesia, and lasted 3 minutes with a 1.5-mA current. The subjective and objective tolerance of iontophoresis was good. No side-effect was observed. Corneal transparency and visual acuity improved rapidly after the second iontophoresis procedure. These observations show that Solumédrol iontophoresis might be an alternative to pulse therapy in the treatment of corneal graft rejection. Further comparative studies are necessary to confirm these preliminary observations.

Global mass wasting during the Middle Ordovician: Meteoritic trigger or plate-tectonic environment ?

Mass wasting at continental margins on a global scale during the Middle Ordovician has recently been related to high meteorite influx. Although a high meteorite influx during the Ordovician should not be neglected, we challenge the idea that mass wasting was mainly produced by meteorite impacts over a period of almost 10 Ma. Having strong arguments against the impact-related hypothesis, we propose an alternative explanation, which is based on a re-evaluation of the mass wasting sites, considering their plate-tectonic distribution and the global sea level curve. A striking and important feature is the distribution of most of the mass wasting sites along continental margins characterised by periods of magmatism, terrane accretion and continental or back-arc rifting, respectively, related to subduction of oceanic lithosphere. Such processes are commonly connected with seismic activity causing earthquakes, which can cause downslope movement of sediment and rock. Considering all that, it seems more likely that most of this mass wasting was triggered by earthquakes related to plate-tectonic processes, which caused destabilisation of continental margins resulting in megabreccias and debris flows. Moreover, the period of mass wasting coincides with sea level drops during global sea level lowstand. In some cases, sea level drops can release pore-water overpressure reducing sediment strength and hence promoting instability of sediment at continental margins. Reduced pore-water overpressure can also destabilise gas hydrate-bearing sediment, causing slope failure, and thus resulting in submarine mass wasting. Overall, the global mass wasting during the Middle Ordovician does not need meteoritic trigger. (C) 2010 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Geological transect across the Northwestern Himalaya in eastern Ladakh and Lahul (A model for the continental collision of India and Asia)

The detailed geological mapping and structural study of a complete transect across the northwestern Himalaya allow to describe the tectonic evolution of the north Indian continental margin during the Tethys ocean opening and the Himalayan Orogeny. The Late Paleozoic Tethys rifting is associated with several tectonomagmatic events. In Upper Lahul and SE Zanskar, this extensional phase is recorded by Lower Carboniferous synsedimentary transtensional faults, a Lower Permian stratigraphic unconformity, a Lower Permian granitic intrusion and middle Permian basaltic extrusions (Panjal Traps). In eastern Ladakh, a Permian listric normal fault is also related to this phase. The scarcity of synsedimentary faults and the gradual increase of the Permian syn-rift sediment thickness towards the NE suggest a flexural type margin. The collision of India and Asia is characterized by a succession of contrasting orogenic phases. South of the Suture Zone, the initiation of the SW vergent Nyimaling-Tsarap Nappe corresponds to an early phase of continental underthrusting. To the S, in Lahul, an opposite underthrusting within the Indian plate is recorded by the NE vergent Tandi Syncline. This structure is associated with the newly defined Shikar Beh Nappe, now partly eroded, which is responsible for the high grade (amphibolite facies) regional metamorphism of South Lahul. The main thrusting of the Nyimaling-Tsarap Nappe followed the formation of the Shikar Beh Nappe. The Nyimaling-Tsarap Nappe developed by ductile shear of the upper part of the subducted Indian continental margin and is responsible for the progressive regional metamorphism of SE Zanskar, reaching amphibolite facies below the frontal part of the nappe, near Sarchu. In Upper Lahul, the frontal parts of the Nyimaling-Tsarap and Shikar Beh nappes are separated by a zone of low grade metamorphic rocks (pumpellyite-actinolite facies to lower greenschist facies). At high structural level, the Nyimaling-Tsarap Nappe is characterized by imbricate structures, which grade into a large ductile shear zone with depth. The related crustal shortening is about 87 km. The root zone and the frontal part of this nappe have been subsequently affected by two zones of dextral transpression and underthrusting: the Nyimaling Shear Zone and the Sarchu Shear Zone. These shear zones are interpreted as consequences of the counterclockwise rotation of the continental underthrusting direction of India relative to Asia, which occurred some 45 and 36 Ma ago, according to plate tectonic models. Later, a phase of NE vergent `'backfolding'' developed on these two zones of dextral transpression, creating isoclinal folds in SE Zanskar and more open folds in the Nyimaling Dome and in the Indus Molasse sediments. During a late stage of the Himalayan Orogeny, the frontal part of the Nyimaling-Tsarap Nappe underwent an extension of about 15 km. This phase is represented by two types of structures, responsible for the tectonic unroofing of the amphibolite facies rocks of the Sarchu area: the Sarchu high angle Normal Fault, cutting a first set of low angle normal faults, which have been created by reactivation of older thrust planes related to the Nyimaling-Tsarap Nappe.

CT arthrography of the glenohumeral joint: CT fluoroscopy versus conventional CT and fluoroscopy--comparison of image-guidance techniques.

PURPOSE: To compare examination time with radiologist time and to measure radiation dose of computed tomographic (CT) fluoroscopy, conventional CT, and conventional fluoroscopy as guiding modalities for shoulder CT arthrography. MATERIALS AND METHODS: Glenohumeral injection of contrast material for CT arthrography was performed in 64 consecutive patients (mean age, 32 years; age range, 16-74 years) and was guided with CT fluoroscopy (n = 28), conventional CT (n = 14), or conventional fluoroscopy (n = 22). Room times (arthrography, room change, CT, and total examination times) and radiologist times (time the radiologist spent in the fluoroscopy or CT room) were measured. One-way analysis of variance and Bonferroni-Dunn posthoc tests were performed for comparison of mean times. Mean effective radiation dose was calculated for each method with examination data, phantom measurements, and standard software. RESULTS: Mean total examination time was 28.0 minutes for CT fluoroscopy, 28.6 minutes for conventional CT, and 29.4 minutes for conventional fluoroscopy; mean radiologist time was 9.9 minutes, 10.5 minutes, and 9.0 minutes, respectively. These differences were not statistically significant. Mean effective radiation dose was 0.0015 mSv for conventional fluoroscopy (mean, nine sections), 0.22 mSv for CT fluoroscopy (120 kV; 50 mA; mean, 15 sections), and 0.96 mSv for conventional CT (140 kV; 240 mA; mean, six sections). Effective radiation dose can be reduced to 0.18 mSv for conventional CT by changing imaging parameters to 120 kV and 100 mA. Mean effective radiation dose of the diagnostic CT arthrographic examination (140 kV; 240 mA; mean, 25 sections) was 2.4 mSv. CONCLUSION: CT fluoroscopy and conventional CT are valuable alternative modalities for glenohumeral CT arthrography, as examination and radiologist times are not significantly different. CT guidance requires a greater radiation dose than does conventional fluoroscopy, but with adequate parameters CT guidance constitutes approximately 8% of the radiation dose.

U-Pb zircon dating of granitoids from the Dora-Maira massif (western Italian Alps)

Among the large number of granitic intrusions within the Dora-Maira massif, several main types can be distinguished. In this study we report field, petrographic and geochemical investigations as well as zircon typology and conventional U-Pb zircon dating of plutons representing these types. The main results are as follows: the Punta Muret augengneiss is a polymetamorphosed peraluminous granite of anatectic origin. It is 457 +/- 2 Ma old and represents one of the numerous Caledonian orthogneisses of the Alpine basement. All other dated granites are of Late Variscan age. The Cavour leucogranite is an evolved granite of probably calc-alkaline affiliation, dated at 304 +/- 2 Ma. The dioritic and granodioritic facies of the Malanaggio diorite (auct.) are typical calc-alkaline rocks, whose respective age of 290 +/- 2 and 288 +/- 2 Ma overlap within errors. The Sangone and Freidour granite types have very similar alkali-calcic characteristics; their ages are poorly constrained between 267-279 and 268-283 Ma, respectively. The new data for the Dora-Maira granites are in keeping with models of the overall evolution of the Late- to Post-Variscan magmatism in the Alpine area in terms of age distribution and progressive geochemical evolution towards alkaline melts. In a first approximation, granitic rocks across the Variscan belt seem to be increasingly younger towards the internal (southern) parts of the orogen. A Carboniferous, distensive Basin and Range situation is thought to be responsible for the magmatic activity. This tectonic context is comparable to the back-are opening of an active continental margin. The observed southward migration of the magmatism could be linked to the roll-back of the subducting Paleotethyan oceanic plate along the Variscan cordillera.

Examining the Agreement of Structural Loss Measured With Heidelberg Retinal Tomograhy and Functional Loss With Standard Automated Perimetry (SAP; Octopus), Pulsar Perimetry (PP), and Moorfields Motion Displacement Test (MDT) Perimetry

Purpose: To examine the relationship of functional measurements with structural measures. Methods: 146 eyes of 83 test subjects underwent Heidelberg Retinal Tomography (HRTIII) (disc area<2.43, mphsd<40), and perimetry testing with Octopus (SAP; Dynamic), Pulsar (PP; TOP) and Moorfields MDT (ESTA). Glaucoma was defined as progressive structural or functional loss (20 eyes). Perimetry test points were grouped into 6 sectors based on the estimated optic nerve head angle into which the associated nerve fiber bundle enters (Garway-Heath map). Perimetry summary measures (PSM) (MD SAP/ MD PP/ PTD MDT) were calculated from the average total deviation of each measured threshold from the normal for each sector. We calculated the 95% significance level of the sectorial PSM from the respective normative data. We calculated the percentage agreement with group1 (G1), healthy on HRT and within normal perimetric limits, and group 2 (G2), abnormal on HRT and outside normal perimetric limits. We also examined the relationship of PSM and rim area (RA) in those sectors classified as abnormal by MRA (Moorfields Regression Analysis) of HRT. Results: The mean age was 65 (range= [37, 89]). The global sensitivity versus specificity of each instrument in detecting glaucomatous eyes was: MDT 80% vs. 88%, SAP 80% vs. 80%, PP 70% vs. 89% and HRT 80% vs. 79%. Highest percentage agreement of HRT (respectively G1, G2, sector) with PSM were MDT (89%, 57%, nasal superior), SAP (83%, 74%, temporal superior), PP (74%, 63%, nasal superior). Globally percentage agreement (respectively G1, G2) was MDT (92%, 28%), SAP (87%, 40%) and PP (77%, 49%). Linear regression showed there was no significant trend globally associating RA and PSM. However, sectorally the supero-nasal sector had a statistically significant (p<0.001) trend with each instrument, the associated r2 coefficients are (MDT 0.38 SAP 0.56 and PP 0.39). Conclusions: There were no significant differences in global sensitivity or specificity between instruments. Structure-function relationships varied significantly between instruments and were consistently strongest supero-nasally. Further studies are required to investigate these relationships in detail.

Structural development of the Tso Morari ultra-high pressure nappe of the Ladakh Himalaya

A continental subduction-related and multistage exhumation process for the Tso Morari ultra-high pressure nappe is proposed. The model is constrained by published thermo-barometry and age data, combined with new geological and tectonic maps. Additionally, observations on the structural and metamorphic evolution of the Tso Morari area and the North Himalayan nappes are presented. The northern margin of the Indian continental crust was subducted to a depth of >90 km below Asia after continental collision some 55 Ma ago. The underthrusting was accompanied by the detachment and accretion of Late Proterozoic to Early Eocene sediments, creating the North Himalayan accretionary wedge, in front of the active Asian margin and the 103-50 Ma Ladakh arc batholith. The basic dikes in the Ordovician Tso Morari granite were transformed to eclogites with crystallization of coesite, some 53 Ma ago at a depth of >90 kin (>27 kbar) and temperatures of 500 to 600 degrees C. The detachment and extrusion of the low density Tso Morari nappe, composed of 70% of the Tso Morari granite and 30% of graywackes with some eclogitic dikes, occurred by ductile pure and simple shear deformation. It was pushed by buoyancy forces and by squeezing between the underthrusted Indian lithosphere and the Asian mantle wedge. The extruding Tso Morari nappe reached a depth of 35 km at the base of the North Himalayan accretionary wedge some 48 Ma ago. There the whole nappe stack recrystallized under amphibolite facies conditions of a Barrovian regional metamorphism with a metamorphic field gradient of 20 degrees C/km. An intense schistosity with a W-E oriented stretching lineation L, and top-to-the E shear criteria and crystallization of oriented sillimanite needles after kyanite, testify to the Tso Morari nappe extrusion and pressure drop. The whole nappe stack, comprising from the base to top the Tso Morari, Tetraogal, Karzok and Mata-Nyimaling-Tsarap nappes, was overprinted by new schistosities with a first N-directed and a second NE-directed stretching lineation L-2 and L-3 reaching the base of the North Himalayan accretionary wedge. They are characterized by top-to-the S and SW shear criteria. This structural overprint was related to an early N- and a younger NE-directed underthrusting of the Indian plate below Asia that was accompanied by anticlockwise rotation of India. The warping of the Tso Morari dome started already some 48 Ma ago with the formation of an extruding nappe at depth. The Tso Morari dome reached a depth of 15 km about 40 Ma ago in the eastern Kiagar La region and 30 Ma ago in the western Nuruchan region. The extrusion rate was of about 3 cm/yr between 53 and 48 Ma, followed by an uplift rate of 1.2 mm/yr between 48 and 30 Ma and of only 0.5 mm/yr after 30 Ma. Geomorphology observations show that the Tso Morari dome is still affected by faults, open regional dome, and basin and pull-apart structures, in a zone of active dextral transpression parallel to the Indus Suture zone.

Heterogeneous 40Ar* distributions in naturally deformed muscovite: in situ UV-laser ablation evidence for micro structurally controlled intragrain diffusion

Micas are commonly used in Ar-40/Ar-39 thermochronological studies of variably deformed rocks yet the physical basis by which deformation may affect radiogenic argon retention in mica is poorly constrained. This study examines the relationship between deformation and deformation-induced microstructures on radiogenic argon retention in muscovite, A combination of furnace step-heating and high-spatial resolution in situ UV-laser ablation Ar-40/Ar-39 analyses are reported for deformed muscovites sampled from a granitic pegmatite vein within the Siviez-Mischabel Nappe, western Swiss Alps (Penninic domain, Brianconnais unit). The pegmatite forms part of the Variscan (similar to 350 Ma) Alpine basement and exhibits a prominent Alpine S-C fabric including numerous mica `fish' that developed under greenschist facies metamorphic conditions, during the dominant Tertiary Alpine tectonic phase of nappe emplacement. Furnace step-heating of milligram quantities of separated muscovite grains yields an Ar-40/Ar-39 age spectrum with two distinct staircase segments but without any statistical plateau, consistent with a previous study from the same area. A single (3 X 5 mm) muscovite porphyroclast (fish) was investigated by in situ UV-laser ablation. A histogram plot of 170 individual Ar-40/Ar-39 UV-laser ablation ages exhibit a range from 115 to 387 Ma with modes at approximately 340 and 260 Ma. A variogram statistical treatment of the (40)Ad/Ar-39 results reveals ages correlated with two directions; a highly correlated direction at 310 degrees and a lesser correlation at 0 degrees relative to the sense of shearing. Using the highly correlated direction a statistically generated (Kriging method) age contour map of the Ar-40/Ar-39 data reveals a series of elongated contours subparallel to the C-surfaces which where formed during Tertiary nappe emplacement. Similar data distributions and slightly younger apparent ages are recognized in a smaller mica fish. The observed intragrain age variations are interpreted to reflect the partial loss of radiogenic argon during Alpine (similar to 35 Ma) greenschist facies metamorphism. One-dirnensional diffusion modelling results are consistent with the idea that the zones of youngest apparent age represent incipient shear band development within the mica porphyroclasts, thus providing a network of fast diffusion pathways. During Alpine greenschist facies metamorphism the incipient shear bands enhanced the intragrain loss of radiogenic argon. The structurally controlled intragrain age variations observed in this investigation imply that deformation has a direct control on the effective length scale for argon diffusion, which is consistent with the heterogeneous nature of deformation. (C) 2001 Elsevier Science B.V. All rights reserved.

Large-scale evolutionary trends of Acrochordiceratidae Arthaber, 1911 (Ammonoidea, Middle Triassic) and Cope's rule

Directed evolution of life through millions of years, such as increasing adult body size, is one of the most intriguing patterns displayed by fossil lineages. Processes and causes of such evolutionary trends are still poorly understood. Ammonoids (externally shelled marine cephalopods) are well known to have experienced repetitive morphological evolutionary trends of their adult size, shell geometry and ornamentation. This study analyses the evolutionary trends of the family Acrochordiceratidae Arthaber, 1911 from the Early to Middle Triassic (251228 Ma). Exceptionally large and bed-rock-controlled collections of this ammonoid family were obtained from strata of Anisian age (Middle Triassic) in north-west Nevada and north-east British Columbia. They enable quantitative and statistical analyses of its morphological evolutionary trends. This study demonstrates that the monophyletic clade Acrochordiceratidae underwent the classical evolute to involute evolutionary trend (i.e. increasing coiling of the shell), an increase in its shell adult size (conch diameter) and an increase in the indentation of its shell suture shape. These evolutionary trends are statistically robust and seem more or less gradual. Furthermore, they are nonrandom with the sustained shift in the mean, the minimum and the maximum of studied shell characters. These results can be classically interpreted as being constrained by the persistence and common selection pressure on this mostly anagenetic lineage characterized by relatively moderate evolutionary rates. Increasing involution of ammonites is traditionally interpreted by increasing adaptation mostly in terms of improved hydrodynamics. However, this trend in ammonoid geometry can also be explained as a case of Copes rule (increasing adult body size) instead of functional explanation of coiling, because both shell diameter and shell involution are two possible paths for ammonoids to accommodate size increase.

Le mariage à l'épreuve: les défis du partenariat de même sexe et de la procréation médicalement assistée en Suisse

Afin de rendre compte des luttes de?finitionnelles qui visent a? transformer ou a? pre?server le sens du mariage en tant qu?institution de l?he?te?rosexualite?, cet article examine deux de?bats cle?s qui ont re?cemment mis a? l?e?preuve l?institution du mariage en Suisse : l?institutionnalisation juridique des couples de me?me sexe avec l?adoption de la loi fe?de?rale sur le partenariat et la pre?servation du sche?ma familial he?te?rosexuel avec la loi fe?de?rale sur la procre?ation me?dicalement assiste?e. Ce texte de?fend que pour saisir l?e?volution du sens politique accorde? au mariage et a? la famille dans les de?bats sur le partenariat homosexuel, il convient d?e?tudier le processus d?institutionnalisation des couples homosexuels dans une temporalite? longue prenant place sur diffe?rentes sce?nes le?gislatives. This article examines how the heteronormative norm embedded in the institution of marriage has been put into question through the legal recognition of same sex couples and the access to assisted reproductive technologies in Switzerland. The paper shows that assessing the transformation of the meaning scheme attributed to the marriage and the family in the ongoing political debates on same-sex couples is enhanced by a diachronic analytical perspective focused on the different regulatory scenes, where the debate has taken place.

Variscan lamprophyres in the Lower Penninic domain (Central Alps): age and tectonic significance

Lamprophyre dykes have been recently discovered in blocks of gneiss embedded in a calcschist formation of wildflysch type that forms the top of the Mesozoic-Tertiary metasedimentary cover of the Antigorio nappe (the Teggiolo zone) in the Val Bavona (Lower Penninic, NW Ticino, Switzerland). The presence of the lamprophyres gives a clue to the possible source of these blocks. Similar dykes occur in the N part of the Maggia nappe where they are intruded into the Matorello granite and the surrounding gneisses. We studied these lamprophyres at two localities in the Teggiolo zone (Tamierpass and Lago del Zott) and at one locality in the Maggia nappe (Laghetti). Detailed mineralogical and geochemical investigations confirm their great similarity, particularly between the Tamier and Laghetti dykes. They all recrystallized during Alpine metamorphism under amphibolite facies conditions and lost their primary mineral assemblages and textures. The chemistry reveals a calc-alkaline affinity, a limited differentiation range, features of mineral accumulation and intense remobilization in some cases. The lamprophyres are characterized by a high mg# and relatively low contents in REE and other incompatible elements. In situ SHRIMP and LA-ICPMS U-Pb zircon dating yielded ages of 284.8 +/- 1.7 Ma (Tamier), 290.0 +/- 1.3 Ma (Zott) and 290.5 +/- 3.7 Ma (Laghetti). These ages are compatible with the general late- to post-Variscan magmatic evolution of the Helvetic and Lower Penninic domains. The lamprophyres are considered as melts derived from the lithospheric Variscan mantle, variously hybridized and differentiated at the contact with crustal material during late- to post-orogenic extension. These lamprophyres are chemically distinct from earlier lamprophyres of Visean age, emplaced together with their associated granites in transcurrent fault zones during the Variscan orogenic compression. The similarity of these different dykes suggests that the front of the Maggia nappe is a likely source of the gneissic blocks embedded in the calcschists at the top of the Teggiolo zone. They would have been provided by the advancing Maggia nappe during its thrusting over the Antigorio nappe and simultaneous closure of the Teggiolo sedimentary basin.

An eceriferum locus, cer-zv, is associated with a defect in cutin responsible for water retention in barley (Hordeum vulgare) leaves.

Drought limits plant growth and threatens crop productivity. A barley (Hordeum vulgare) ethylene imine-induced monogenic recessive mutant cer-zv, which is sensitive to drought, was characterized and genetically mapped in the present study. Detached leaves of cer-zv lost 34.2 % of their initial weight after 1 h of dehydration. The transpiration was much higher in cer-zv leaves than in wild-type leaves under both light and dark conditions. The stomata of cer-zv leaves functioned normally, but the cuticle of cer-zv leaves showed increased permeability to ethanol and toluidine blue dye. There was a 50-90 % reduction in four major cutin monomers, but no reduction in wax loads was found in the cer-zv mutant as compared with the wild type. Two F(2) mapping populations were established by the crosses of 23-19 × cer-zv and cer-zv × OUH602. More polymorphisms were found in EST sequences between cer-zv and OUH602 than between cer-zv and 23-19. cer-zv was located in a pericentromeric region on chromosome 4H in a 10.8 cM interval in the 23-19 × cer-zv map based on 186 gametes tested and a 1.7 cM interval in the cer-zv × OUH602 map based on 176 gametes tested. It co-segregated with EST marker AK251484 in both maps. The results indicated that the cer-zv mutant is defective in cutin, which might be responsible for the increased transpiration rate and drought sensitivity, and that the F(2) of cer-zv × OUH602 might better facilitate high resolution mapping of cer-zv.

Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era.

PURPOSE: Salvage chemotherapy followed by high-dose therapy and autologous stem-cell transplantation (ASCT) is the standard treatment for relapsed diffuse large B-cell lymphoma (DLBCL). Salvage regimens have never been compared; their efficacy in the rituximab era is unknown. PATIENTS AND METHODS: Patients with CD20(+) DLBCL in first relapse or who were refractory after first-line therapy were randomly assigned to either rituximab, ifosfamide, etoposide, and carboplatin (R-ICE) or rituximab, dexamethasone, high-dose cytarabine, and cisplatin (R-DHAP). Responding patients received high-dose chemotherapy and ASCT. RESULTS: The median age of the 396 patients enrolled (R-ICE, n = 202; R-DHAP, n = 194) was 55 years. Similar response rates were observed after three cycles of R-ICE (63.5%; 95% CI, 56% to 70%) and R-DHAP (62.8%; 95 CI, 55% to 69%). Factors affecting response rates (P &lt; .001) were refractory disease/relapse less than versus more than 12 months after diagnosis (46% v 88%, respectively), International Prognostic Index (IPI) of more than 1 versus 0 to 1 (52% v 71%, respectively), and prior rituximab treatment versus no prior rituximab (51% v 83%, respectively). There was no significant difference between R-ICE and R-DHAP for 3-year event-free survival (EFS) or overall survival. Three-year EFS was affected by prior rituximab treatment versus no rituximab (21% v 47%, respectively), relapse less than versus more than 12 months after diagnosis (20% v 45%, respectively), and IPI of 2 to 3 versus 0 to 1 (18% v 40%, respectively). In the Cox model, these parameters were significant (P &lt; .001). CONCLUSION: In patients who experience relapse more than 12 months after diagnosis, prior rituximab treatment does not affect EFS. Patients with early relapses after rituximab-containing first-line therapy have a poor prognosis, with no difference between the effects of R-ICE and R-DHAP.