[Drug treatment of acute myelogenous leukaemia. Current options and future perspectives]

Acute myelogenous leukemia is a heterogeneous disease. Recent molecular mutational analysis techniques have shed more light on different, genetically well characterised types of the disease. Treatment approach is uniform except for acute promyelocytic leukemia. Application of the "3 + 7" induction treatment has been the gold standard in the past 40 years. While the dose of cytarabine has not been changed, escalating daunorubicine dose in younger (<60 years) patients with good performance status to 90 mg/m(2) had a positive impact on overall survival. High dose chemotherapy is tolerated poorly in patients older than 60 years of age and, as treatment is not curative in the elderly, improvement of overall survival and quality of life remains the main goal of management in these patients. Low intensity treatment is beneficial and can provide additional advantage over supportive care. Innovative and targeted therapy approaches might give promise to better management of patients with acute myelogenous leukemia.

Incommensurate systems as model compounds for disorder revealing low-temperature glasslike behavior

We show that the specific heat of incommensurately modulated crystals with broken translational periodicity presents similar features at low temperatures to those of amorphous and glass materials. Here we demonstrate that the excess to the constant C_{p}(T)/T^{3} law (or Debye limit) is made up of an upturn below 1 K and of a broad bump at T≈10 K that directly originates from the gapped phase and amplitude modes of the incommensurate structure. We argue that the low-energy dynamics of incommensurate systems constitute a plausible simplification of the landscape of interactions present in glasses, giving rise to their low-temperature anomalies.

[Treatment of acute myeloid leukemia -- a single center experience (2007-2013)]

INTRODUCTION

Mortality of acute myeloid leukemia is still 60-70% in young (<60 years) adults and 90% in elderly (≥60 years) patients.

AIM

The aim of the authors was to analyse the outcome of treatment in their patients with acute myeloid leukemia.

METHOD

From 2007 to 2013, 173 patients with acute myeloid leukemia were treated. Patients were classified according to the European LeukemiaNet prognostic guideline. Association between mortality and the type of acute myeloid leukemia (secondary or primary), dose of daunoblastin at induction of treatment, and the rate of minimal residual disease were investigated.

RESULTS

The 5-year survival probability was 25% in young adults and 2% in the elderly. The survival was significantly influenced by these prognostic factors. The 5-year survival rate was 50% in the young, favorable prognostic group. The 90 mg/m2 daunoblastin dose was found to be beneficial. Addition of bortezomib to the standard induction protocol had an additional beneficial effect.

CONCLUSIONS

The speed and depth of the response to induction therapy, and the initial white blood cell count had an apparent effect on survival.

[Current treatment of acute myeloid leukaemia in adults]

Recent cytogenetical findings and novel molecular biology results of acute myeloid leukaemia have shed new lights of our understanding in the diagnosis and treatment of the disease. Acute myeloid leukaemia is not only represented by the wide variety of morphological and immunophenotypic diversity but also demonstrates cytogenetical and molecular biological heterogeneity of its own. It has an unfavorable prognosis, especially in the elderly. Overall survival of younger patients (<50-60 years) has increased in the past years due to high dose chemotherapy (daunorubicine, cytarabine). But in case of unfavorable prognostic factors (not only cytogenetical but also molecular biological characters of the disease), allogeneic stem cell transplantation is needed for successful overall outcome. Better understanding the biology of acute myeloid leukaemia could establish novel targeted therapies and help us eventually to cure the disease.

[Practical considerations and questions in the treatment of chronic lymphocytic leukemia]

Understanding the pathogenesis and refine the treatment of chronic lymphocytic leukemia have been tremendously improved in the past decade. Treatment outcome and estimated prognosis have become more accurate due to the advanced molecular biological techniques and the classical prognostic markers. Incorporation of fludarabine and rituximab into the standard protocols fundamentally improved treatment outcome in chronic lymphocytic leukemia. Chemoimmunotherapy has improved not only the remission rates but had a significant impact on overall survival, as well. Eliminating residual leukemia and achieving complete hematological remissions at such high rates establish potential background for cure. Still, a great deal of dispute has been emerged regarding everyday clinical practice. Authors present their institutional experiences and review the literature.

[One hundred fifty autologous peripheral haemopoietic stem cell transplantations and their lessons]

Five years ago (in September, 2003), the activity of the 5th Haemopoietic Stem Cell Transplantation Centre of Hungary has begun. This centre has been registered as No 648. by the European Group for Blood and Marrow Transplantation-Centres.

AIMS

To supply the needs of stem cell transplantation regions in north-east Hungary and to develop an active co-operation with the Hungarian and international centres.

METHODS

Transplantations were made according to international criteria.

RESULTS

150 autologous stem cell transplantations has been performed so far, including 74 patients with myeloma multiplex, 43 patients with non-Hodgkin lymphoma, 27 patients with Hodgkin's disease, 4 patients with autoimmune disease, and one patient with leiomyosarcoma. The survival rates were similar to the previous Hungarian and international data. The centre played a role in other activities using stem cell therapy at the University of Debrecen (dendritic cell vaccine program, stem cell therapy in myocardial infarction, stem cell therapy in peripheral arterial- and autoimmune diseases). This centre performed the largest quantity of the conditioning protocol Zevalin, Bischloronitrosourea, Etoposide, cytosine-Arabinoside, Melphalan in non-Hodgkin lymphoma in Hungary; ten patients were treated with this protocol.

[Transformation of chronic lymphocytic leukemia to myelodysplastic syndrome: case presentation and review of the literature]

Chronic lymphocytic leukaemia (CLL) may transform to either malignant lymphoid disorder or increase the occurrence of solid neoplasms. However myeloid malignancies seldom develop. We report a case of a patient who has remained untreated for CLL and developed myelodysplastic syndrome (refracter anemia with ringed sideroblasts) six years after the diagnosis of CLL. Development of myelodysplastic syndrome resulted in concurrent attenuation of CLL. Discussion of the pathogenesis of myeloid disorders occurring with CLL and review of the literature are also presented.

[Prognositc value of CD38 cell surface marker in chronic lymphocytic leukemia]

CD38 is expressed on the surface of leukemic cells in a significant percentage of patients with B-cell chronic lymphocytic leukaemia (CLL). From the literature it is known that CD38 expression has prognostic value in CLL, suggesting an association between CD38 expression and the mutational status of IgV genes. Peripheral blood samples from 82 patients with CLL were analyzed by flow cytometry for CD38 expression on CD19+ leukemic cells. CD38 was expressed in 30% or more of leukemic cells in 26 patients (patients with 30% or more B cells coexpressing CD19/CD38 were considered positive). Seven of the 26 patients with high CD38 expression and eight of the 56 patients with low CD38 expression had advanced-stage disease (RAI III-IV). Higher than 4 mg/l levels of beta 2-microglobulin was measured in the serum of nine of 26 CD38+ and seven of 56 CD38- patients. Our analyses showed that the high CD38 expression is associated with other risk factors, identifying an aggressive disease, which require treatment. It will be important to conduct further studies to establish the prognostic value of the high CD38 expression in early-stage disease.

[Experience with fludarabine treatment and review of the literature]

INTRODUCTION

Fludarabine is the most commonly used purine analog, its mechanism of action is complex. Fludarabine inhibits DNA synthesis, acts on non-dividing (G0 phase) cells influencing apoptosis.

PATIENTS, RESULTS, CONCLUSIONS

In our institute 47 patients were treated with fludarabine or fludarabine based combination chemotherapy. Fludarabine was given in 19 patients with chronic lymphocytic leukaemia (CLL), complete remission (CR) was achieved in one case, partial remission (PR) was obtained in 10 patients. Fludarabine was more effective in patients who received less intensive chemotherapy prior to fludarabine therapy and in those patients who had less advanced diseases. Elderly patients (over sixty years of age) also responded to fludarabine therapy. Fludarabine and cyclophosphamide combination (FCy) were used in three lymphocytic lymphoma patients, two of them obtained PR, in the third case the disease progressed. Fludarabine + mitoxantrone (Novantrone) + dexamethasone (FND) regimen was administered in nine patients who were previously heavily treated (one patient with B-CLL, one with T-CLL, one with peripheral T-cell lymphoma and six with indolent B-cell lymphoma). More patients and longer follow up is needed to determine the efficacy of FCy and FND protocol. FLAG-IDA (fludarabine, high dose Ara-C, granulocyte colony-stimulating factor, idarubicin) was applied in 16 acute leukaemia patients with poor prognosis including therapy refractory and relapsing cases. Three CR and two PR, one CR and three PR was achieved in nine patients with acute myeloid leukaemia and in seven patients with acute lymphoid leukaemia, respectively. For this reason, despite the short period of remission, this regimen can be recommended to patients who are candidate for stem cell transplantation.

[Paroxysmal nocturnal hemoglobinuria]

The current knowledge of the history, clinical course, diagnosis and treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH) are summarized in this article.

[Diagnostic possibilities in gastric leiomyoma in relation to two of our cases]

Two cases of rare, benignant gastric tumors are reported. The suggest that while in the diagnosis of tumors with a mucous membrane involvement endoscopy has doubtless a leading role, tumors not infiltrating the mucous membrane are usually better recognizable by radiological (ultrasonography, computer tomography and double contrast x-ray) methods. An appropriate diagnosis followed by surgical removal of the tumor might result in a complete healing of the patient.