[Empiric antibiotic therapy for treatment of infection in patients with severe neutropenia]. / Empiryczna antybiotykoterapia w leczeniu infekcji u chorych w okresie glebokiej neutropenii.

Infection is the most frequent cause of death in patients with severe neutropenia. Fever and other signs of infection with neutrophil count below 0.5 G/L require an early and rapid treatment--the empiric antibiotic therapy. This treatment comprises various combinations of bactericidal broad-spectrum antibiotics such as ureidopenicillins, cephalosporins, quinolones and aminoglycosides. If defervescence is not attained within 3 days, modification of the treatment scheme should be done. The addition of vancomycin or teicoplanin, antibiotics active against Gram + cocci, and changing of the beta-lactams should be considered. In the case of persistent microbiologically not recognized infection after 7 days of therapy, empiric antimycotic treatment with amphotericin B is indicated. Duration of the empiric antibiotic therapy is dependent on the granulocyte recovery and the resolution of infection.

[Effectiveness of empirical antibiotic therapy in the control of infections in patients with acute leukemia during severe neutropenia]. / Skutecznosc antybiotykoterapii empirycznej w zwalczaniu zakazen u chorych na ostre bialaczki w czasie glebokiej neutropenii.

The clinical efficacy of empiric antibiotic treatment regimen for infection in 38 neutropenic patients with acute leukemia during induction and intensification therapy was evaluated. The therapy, which was applied in 74 episodes of fever in patients with neutrophil count less then 0.5 G/l, consisted of three sets of antibiotics (gentamycin + carbenicillin or azlocillin, amikacin + cephradine++ or cefuroxime, netilmicin+cefotaxime or ceftazidime) used one after another in case of persistence of fever in spite of 72 hours of treatment: In addition, flucytosine was applied in case of stable fever after 72 hours of antibiotic therapy. Flucytosine was replaced by amphotericin after 72 hours of ineffective treatment. The response rate of 68% and 96% was observed for patients during induction and intensification chemotherapy respectively. Low clinical efficiency of gentamicin and carbenicillin/azlocillin during induction treatment indicates that the therapy with antibiotics of broader range of activity is needed for this group of patients.

[Effects of alternating as well as long-term intensive polychemotherapy in the remission-maintaining treatment of patients with acute myelocytic leukemia]. / Wyniki naprzemiennie powtarzanej oraz dlugotrwalej, intensywnej polichemioterapii w leczeniu podtrzymujçym remisje u chorych na ostre bialaczki szpikowe.

The paper presents the results of 2 year maintenance treatment of patients with acute myeloid leukemias using cyclic, rotating and intensive polychemotherapy. Complete remission (CR) was achieved in 22 out of 33 patients with doxorubicin (60 mg/m2; 1-3 days) and cytosine arabinoside (100 mg/m2; 1-7 days). All patients in CR entered into the authors' programme of intensification therapy consisting of two consecutive polychemotherapy cycles, using various combinations of amsacrine, doxorubicin, cytosine arabinoside, etoposide and 6-thioguanine repeated every 3-4 months. The mean survival so far is 18 months (range, 1-52 months). The projected 3-years survival rate in complete remission concerns 33% of the patients treated. Relapses occurred in 50% of the patients, within 10 months (range 1-35 mos.) after CR. Our results indicate that intensive cyclic polychemotherapy markedly prolongs the survival of AML patients. The high frequency of relapses during the first year after CR indicates the necessity to enhance the degree of aggressiveness of treatment shortly after a complete remission has been obtained.