An evaluation of factors predicting long-term response to thalidomide in 234 patients with relapsed or resistant multiple myeloma

The aim of this study was to assess the prognostic value of pretreatment clinical and laboratory parameters in refractory or relapsed multiple myeloma (MM) patients who have a long-term response to thalidomide (THAL), lasting at least 18 months. The study was carried out on 234 patients who received THAL for relapsed/refractory myeloma. Out of the 234 patients, 129 patients (55.1%) responded to THAL with a mean response duration of 11.9 months (ranging from 1 to 48) and an overall survival rate of 20.3 months (ranging 1–55 months). In 64 patients (27.4% of the whole group), the response to THAL lasted ⩾18 months with a mean response lasting 24 months. Statistical analysis of the group of nonresponders and patients with long-term response to THAL showed a significantly higher serum albumin level (P=0.0003) and haemoglobin level (P=0.05), as well as a lower β2 microglobulin (β2M) (P=0.022), LDH (P=0.045) serum level in patients with long-term response. In this study, the LDH and serum albumin level were predictors for response to THAL therapy. The β2M serum level was not a predictor for response to THAL. The albumin serum level was the best parameter distinguishing the group of patients with long-term response to THAL from the entire responding group (P=0.02).

Outcome and prognostic factors in advanced Hodgkin's disease treated with high-dose chemotherapy and autologous stem cell transplantation: a study of 341 patients

BACKGROUND

The reported probability of survival of patients with Hodgkin's disease (HD) following high-dose chemotherapy with autologous stem cell transplantation (HDC/ASCT) is 35-65% at 5 years. The Polish Lymphoma Research Group investigated retrospectively prognostic factors for overall survival (OS) and event-free survival (EFS), and the risk of secondary malignancies in a large series of patients who underwent HDC/ASCT.

PATIENTS AND METHODS

The data of 341 consecutive patients treated in 10 centers from 1990 to 2002 were collected and analyzed.

RESULTS

The actuarial 5-year OS and EFS were 64% [95% confidence interval (CI) 57% to 71%] and 45% (95% CI 39% to 51%), respectively. In the multivariate model, unfavorable prognostic factors for EFS were less than partial response at the time of ASCT [relative risk (RR), 2.92 (95% CI 1.68-5.08); P<0.001] and three or more previous chemotherapy lines (RR, 2.16; 95% CI 1.42-3.30; P<0.001). These two factors were also associated with unfavorable OS (RR, 3.32; 95% CI 1.90-5.79; P<0.001 and RR, 2.34, 95% CI 1.51-3.64; P<0.001). Five-year cumulative risk of secondary malignancy was 8.4% (95% CI 2% to 13%) and the only identified risk factor was splenectomy (P=0.02).

CONCLUSIONS

HDC/ASCT should be considered early in the course of disease for patients with a response after standard therapy.

Addition of cladribine to daunorubicin and cytarabine increases complete remission rate after a single course of induction treatment in acute myeloid leukemia. Multicenter, phase III study

To assess the efficacy of an original DAC-7 regimen: daunorubicine (DNR) 60 mg/m2/day, days 1-3; cytarabine (AraC) 200 mg/m2/day, days 1-7; cladribine (2-CdA) 5 mg/m2/day, days 1-5, 400 untreated adult acute myeloid leukemia patients (including 63 with preceding myelodysplastic syndrome), aged 45 (16-60) years were randomized to either DAC-7 (n=200) or DA-7 (without 2-CdA, n=200). The overall CR rate equaled 72% for DAC-7 and 69% for DA-7 arm (P=NS). After a single course of DAC-7 induction, the CR rate equaled 64% and was significantly higher compared to 47% in the DA-7 arm (P=0.0009). Median hospitalization time during the induction was 7 days shorter for DAC-7 compared to the DA-7 group (33 vs 40 days, P=0.002). Toxicity was comparable in both groups. The probability of 3-year leukemia-free survival (LFS) for DAC-7 and DA-7 group equaled 43 and 34%, respectively (P=NS). There was a trend toward higher LFS rate for patients aged >40 years receiving DAC-7 compared with DA-7 regimen (44 vs 28%, P=0.05). This study proves that addition of 2-CdA increases antileukemic potency of DNR+AraC regimen, thus resulting in a higher CR rate after one induction cycle when compared to DA-7, without additional toxicity. It shortens hospitalization time and may improve long-term survival in patients aged >40 years.

Biologic effects of microwave exposure. II. Studies on the mechanisms controlling susceptibility to microwave-induced increases in complement receptor-positive spleen cells

In attempting to evaluate the mechanisms responsible for susceptibility to the inductive increase in splenic complement receptor-positive (CR+) cells following exposure to 2450-MHz microwaves, it was found that sensitivity to microwave-induced CR+ cell increases was under genetic control. In particular, evidence was accumulated suggesting that regulation was under the control of a gene or genes closely associated with but outside of the mouse major histocompatibility complex (H-2). All responsive strains of mice tested were of the H-2k haplotype, while mice of the H-2a, H-2b, H-2d and H-1i5 haplotypes were refractory to the microwave-induced increases in CR+ cells. By utilizing certain H-2k strains of mice that were genetically unable to respond to endotoxin, we were able to show that these strains of mice responded to microwaves, but not to endotoxin, by increasing CR+ cells. Microwave-induced increases in CR+ cells were not mimicked by the intraperitoneal injection of hydrocortisone. Athymic mice responded to microwave exposure, indicating that this event was not regulated by the T-cell population. Mice less than eight weeks old were found not to be susceptible to exposure to 2450-MHz microwaves. These studies indicate that microwaves do induce changes in the population of cells with specific cell-surface receptors, that susceptibility to these changes is under genetic control, and that it is unlikely that endotoxin, corticosteroids, or regulatory T cells play a significant role in the mechanisms regulating these increases.

Investigations of the Hemostasis System in Different Stages of Coronary Heart Disease

Fifty patients with stable coronary heart disease (CHD), 100 patients with unstable CHD, 74 patients on the first day of myocardial infarction (MI), 40 atherosclerotic patients, and 50 subjects without these diseases were investigated. The following tests were performed: activated partial thromboplastin time, thromboelastography (TEG), platelet number, platelet aggregation (PA), heparin-thrombin clotting time (HTCT), anti-thrombin level (AT), fibrinolytic activity (FA), plasminogen level (PLG), FDP, and paracoagulation tests. There were no significant changes in the hemostasis in the group of stable CHD. In unstable CHD we observed a decrease in AT and a shortening of HTCT. During the first day of MI similar changes were noted in addition to shortening of “r” TEG, increases in both PA and PLG. In atherosclerotic patients decreased FA and shortening of “k” TEG were observed. The correlation between CHD risk factors and some of the indices of hypercoagulability suggest that hypercoagulability may represent their functional manifestations. Development of CHD is associated with an increasing number of hypercoagulability indices. Changes in the hemostasis system have small diagnostic importance, but some of them suggest that this system can play a role in the pathogenesis of CHD and MI in some patients. Some indices can also have prognostic value. Selection of patients with hypercoagulability can facilitate more rational, effective methods of treatment of CHD.

Value of the NBT Test in the Diagnosis of Bacterial Infection in Untreated Cancer Patients and in those on Radio- and/or Chemotherapy

As the first step in the study, the results of the NBT test in 83 patients with various untreated neoplasms, including 20 lymphomas, without bacterial infections and in 35 neoplastic patients with this complications were compared with the results obtained in control groups. No significant differences in the results were found between the groups of neoplastic patients without or with bacterial infections and the controls. To evaluate the NBT test during radio- and/or chemotherapy, especially in neutropenia, 45 patients were NBT-monitored. During the study of 102 episodes of neutropenia 43 infections occurred and 30 were NBT-confirmed. In remaining 13 cases it was impossible to perform the test because of extremely low neutrophil count (below 500/mul). All 20 infections in patients with normal neutrophil count were NBT-positive. These results confirm the usefulness of the test for infection screening in untreated with malignancies, as well as in patients receiving radio- and/or chemotherapy. However, the test can be taken only in patients without severe neutropenia.