Pretreatment prognostic factors for overall survival in primary resistant acute myeloid leukemia.

AIM: Primary resistant acute myeloid leukemia has a very poor prognosis. We assessed pretreatment parameters for their significance as prognostic factors in the overall survival (OS) of 53 acute myeloid leukemia (AML) patients who had failed to achieve complete remission (CR) after first-line standard-dose remission-induction therapy. RESULTS: During the period January 2005-December 2009, 53 with acute myeloid leukemia received two cycles of the 3+7 protocol as a first-line standard-dose remission-induction therapy (ARA-C, days 1-7 and daunorubicin, days 1-3). The HiDAC (5 patients), MiDAC (7 patients), and FLAG-IDA protocols (3 patients) were given as salvage therapy. None of these patients achieved CR. There were 27 (51%) males and 26 (49%) females (median age, 55 years, range 28-76). The median white blood cell count was 53 (range 0.9 -350)×10(9)/L, platelets 44 (range 3-856×10(9)/l) and bone marrow blasts 67%. HCT-IC comorbidity scores were 3 in two (3.8%) patients, 2 in 11 (20.8%), 1 in 12 (22.6%) and 0 in 16 (30.2%) patients. Median OS was 3.9 months (range 1 -20 months). The hepatomegaly, white blood cell count, ECOG PS, serum level of lactate dehydrogenase, dysplastic changes, coexpression of CD64, CD15, CD11b, comorbidities and disease cytogenetics influenced survival. CONCLUSION: This single-center study evaluated the significance of pretreatment factors, and found that patient age, comorbidities, ECOG performance status, leukocytosis, hepatomegaly, LDH, and the disease cytogenetics were factors which influenced the outcomes of primary resistant patients with acute myeloid leukemia. An understanding of these factors may help to predict OS in cases where CR has not been achieved and may help when making further treatment decisions.

Therapy-related myelodysplastic syndrome and acute myeloid leukemia in patients with chronic lymphocytic leukemia treated with fludarabine and cyclophosphamide.

We retrospectively studied four cases of t-MDS/AML among 210 (1.9%) consecutive patients with CLL treated at a single center with fludarabine and cyclophosphamide (FC) either as the first- or second-line therapy. The median follow-up of the whole cohort of patients was 46months (range: 7-60). Two of these patients (2/130, 1.7%) had been treated with FC only, and two more (2/80, 2.3%) with CHOP and CHOP+FND, respectively, prior to FC. The median age was 61.5years (range: 49-71); three were male. They developed t-MDS/AML after a median latency period of 41months (range: 7-56) from the FC completion. Chromosomal aberrations with an adverse prognostic impact were present in the karyotype of all four patients, including abnormalities of chromosome 5 in three of them, and a rare chromosomal translocation in one patient. Median survival after t-MDS/AML diagnosis was 4months (range: 2-8). Although the agents administered prior to FC make it difficult to assess the risk of t-MDS/AML attributable to FC, this report might be a valuable addition to the literature.

Mycophenolate mophetil therapy for chronic immune thrombocytopenic purpura resistant to steroids, immunosuppressants, and/or splenectomy in adults.

Treatment options are limited in patients with chronic immune thrombocytopenic purpura (ITP) which has been unresponsive to corticosteroids and/or splenectomy. Mycophenolate mophetil (MMF) is effective in many autoimmune disorders including severe and refractory ITP through its targeting of T-cell and B-cell lymphocytes. We report on the efficacy of MMF (1.5-2 g/day) in 16 adults with severe steroid-resistant ITP. MMF was administered for at least 12 weeks (median 37 weeks, range 14-64 weeks). Patients comprised of 10 females and six males, with median pre-treatment platelet counts of 8 × 10(9)/L, median age of 55 years, median ITP duration of 58 months and a median of four prior treatments (range 3-8); nine had been previously splenectomized. Eleven patients (69%) responded after 12 weeks of MMF: 6 (55%) achieving complete remission (CR) and five (45%) achieved partial remission (PR). MMF therapeutic responses were better in those patients who had had fewer prior treatments (p<0.05), and were independent of patient age, sex, disease duration, and splenectomy status (p>0.05). Five of the 11 responders (45%; 3CR/2PR) had sustained remissions; however, six responders (55%; 3CR/3PR) relapsed after median of 14 weeks (range 9-20). Three of the six relapsing patients responded to MMF reinstitution achieving stabile PRs; three were left untreated as none had further bleeding and their platelets remained at "safe" levels (median 30 × 10(9)/L). The MMF treatment was well tolerated; one heavily pretreated patient developed a bronchopneumonia and a second had an episode of diarrhea. MMF used as a second-line agent can produce a sustained response in severe ITP which has been unresponsive to steroid and/or splenectomy without major toxicity.

Anaesthesia in colorectal carcinoma surgery at the Clinic for Digestive Surgery from 1997 to 2007.

BACKGROUND: Colorectal cancers are one of the most present neoplasms in human population. This pathology is one of the most frequent ones at the Clinic for Digestive Surgery in Belgrade. AIM: To investigate if there were any changes in both number and structure of patients with colorectal cancers (age, gender, co-morbidity) as well as in both type and duration of surgical procedures and in providing and maintaining anaesthesia in patients with this disease. METHODS: This is a retrospective study. Research materials were anaesthesiological cards written for patients undergoing surgery in order to treat colorectal cancers at the Clinic for Digestive surgery in both 1997 and 2007. Demographics, co-morbidity, ASA score were the parameters we followed in our survey as well as the type of the resection and duration of these surgical interventions. Besides that providing and maintaining anaesthesia and balance of circulatory volume were considered too. RESULTS: The number of the colorectal surgical interventions has been increased up to 489 (13.1% of all) in 2007 comparing to the number of 379 (13.55% of all) in 1997. The percentage has remained the same because the number of all surgical procedures has been increased. The percentage of the rectal resections is increased highly significante in 2007 (50.1% in 1997; 62.6% in 2007). During the same year the duration of the operations was shortened (mean value 176.31 minutes in 1997, 157.5 minutes in 2007). In 2007 highly statistically significant is bigger amount of colloid and crystalloid infusions that were given for supplementation of circulatory volume (mean value 3294.89 ml in 2007; 2552.22 ml in 1997). On the other hand lower amount of blood was given in 2007 than in 1997 (mean value 102.76 opposite to 488.07) what is statisticly significant. The number of the patients with co-morbidities is not statisticly importantly changed in these two followed years. Anaesthesiology technique has been changed and is monitored by higher use of inhalation anesthetics. They were used more in 2007 (29.65%) for these types of surgical procedures than in 1997 when they had been used almost never. CONCLUSION: In these two followed years there have been significant changes in surgical interventions (type and duration of the operation). Surgical teams are higher specialised for the procedures they use modern technology such as stapplers have better equipment for diagnosing the illnes. The use of modern inhalation anaesthetics has been increased along with reduced amount of blood and derivates used for supplementation of circulatory volume.