Changes of serum prohepcidin, iron status and zinc-protoporphyrin in a random group of patients with malignant diseases.

PURPOSE: To investigate the changes in the serum levels of prohepcidin (pHp) and markers of iron homeostasis for gathering more data on the pathogenesis of anemia in malignancies. METHODS: In 84 patients with advanced solid malignant tumors, but without iron or vitamin B12 and folate deficiency anemia, we measured serum pHp levels and common markers of iron status, erythropoiesis and inflammation. Two months later the same tests were repeated to determine possible changes in the levels of the measured parameters. RESULTS: The first blood sample characterized the group with a moderately low hemoglobin (Hb) and high CRP levels, suggesting anemia in some patients. Two months later higher levels of serum iron (sFe), total iron binding capacity (TIBC), transferrin saturation, ferritin and zinc-protoporphyrine (ZPP) in erythrocytes were found, along with lower pHp and high sensitivity C-reactive protein (hs-CRP). The correlation coefficient (R) between the values of iron-containing substances and pHp were low (R=0.244). Allocations by sex, Hb concentration and pHp showed that the changes in each group were similar, keeping the trend of increased sFe, ferritin and ZPP, decreased hs-CRP and pHp, at a stable hematological state. CONCLUSION: Because of low correlation between sFe and pHp, it seems more likely that the positive two-month change of iron-containing substances in the serum of the studied patients is a result of treatment, impaired liver function or malignant intoxication, rather than of decreased pHp.

Fluoroquinolone prophylaxis for bacterial infections in neutropenic patients with hematologic malignancies.

INTRODUCTION: The use of fluoroquinolones as prophylaxis for bacterial infections in patients with chemotherapy induced neutropenia is debatable. The present study was conducted to assess the prophylactic efficacy of fluoroquinolones in adult neutropenic patients with hematologic malignancies. MATERIALS AND METHODS: For the period 1994 through 2000 a prospective, randomized trial was conducted at the University Clinic of Hematology (Medical University, Plovdiv). Two groups of patients were included--experimental group, consisting of 36 patients with 41 granulocytopenic episodes and a control group of 34 patients with 41 granulocytopenic episodes. Non parametrical and psi methods were used for statistical analysis. Kaplan-Meier test was employed to determine patients' survival rate. Comparison of survival rates between the two groups was performed using the log-rank test. RESULTS: A statistically significant difference between the two groups was found in the number of infection-free neutropenic episodes (P < 0.001), in infection-related mortality rate (p = 0.001) and mortality rate within 1 month of the onset of infection (p < 0.001). Difference in long term survival rates was not statistically significant (p > 0.05). CONCLUSIONS: Prophylaxis with fluoroquinolones reduced the occurrence of infection in adult neutropenic patients without affecting the long-term survival. Moreover, it is especially beneficial for patients with severe neutropenia and during the active phase of the disease.