[Analysis of causes for anemia in patients with multiple myeloma]. / Analiza przyczyn niedokrwistosci u chorych na szpiczaka mnogiego.

UNLABELLED: Pathogenetic mechanism of myeloma (MM) associated anaemia may involve: decreased level of erythropoietin (Epo) production, insufficient response to this hormone, bone marrow replacement by tumour cells, and cytokine mediated suppressive effect on erythropoiesis (ACD type of anaemia). We evaluated some possible causes of MM associated anaemia in a group of MM patients before treatment, using tests of in vitro culture of erythroid precursors and determination of the level of selected cytokines and evaluation of patient sera and media conditioned by patient cells for haematopoietic growth in vitro inhibitory/stimulatory activity. The study group included 15 patients with advanced MM at III clinical stage (according Durie and Salmon classification) prior treatment with a median age 61.8 women and 7 men. Diagnostic work-up included cytogenetics and serum Epo level as well as routine tests. We determined number of CFU-E, BFU-E and CFU-GM in the bone marrow of patients and healthy donors after mononuclear and T cell depletion in serum free culture under different conditions: 1) with conditioned medium (CM) by patients T cells, 2) CM by T cells of healthy donors and 3) without CM. IL-6, IL-1 alpha and TNF-alpha level in the serum and CM was determined. All patients were slightly anaemic--mean Hb 6 mmol/l (9.6 g/dl), transferrin level was increased--mean 1612 pmol/l (732 ng/ml) whereas iron level was normal. The average frequency of erythropoietic cells in myelogram was decreased (12%), however, the frequency of plasmocytes was increased (32%). Epo serum level was decreased in comparison with degree of anaemia (mean 22.2 U/ml). The average number of CFU-E/10(5) was slightly lower--212 and in the cultures containing CM by patient T cell and CM-by T cells of healthy donor decreased significantly to 138 and 183, accordingly. This phenomenon was not observed in cultures containing normal bone marrow cells. IL-6 level was increased in patients' serum and CM by patients T cells (27 ng/ml and 51 ng/ml, respectively). CONCLUSIONS: The results of this study support the notion on the multifactorial origin of anaemia in myeloma patients. The factors specified in this study include 1. defective response of Epo to the degree of anaemia 2. decreased number of committed erythroid cells in the marrow 3. suppression of erythropoiesis by IL-6.

[Erythropoietin in the pathogenesis of anemia in patients with multiple myeloma]. / Erytropoetyna w patogenezie niedokrwistosci u chorych na szpiczaka mnogiego.

UNLABELLED: Anemia is a common symptom in multiple myeloma (MM) patients but the pathogenesis of it is still unknown. The aim of the study was to explain the causes of anemia in MM patients. Peripheral blood count, bone marrow aspirate, iron and ferritin level, serum erythropoietin (EPO) level, T cell subsets and in vitro CFU-E count were analyzed in the group od 31 MM patients. Erythropoietin and iron deficiency in the study group were not observed. EPO serum level was not significantly different in patients with multiple myeloma and in comparison to patients with sideroblastic anemia with solid tumors. Absolute CD8 T lymphocyte count was not significantly increased in the study group. CFU-E colonies count in vitro was not decreased in these patients. CONCLUSIONS: In the study group of the MM patients anemia probably does not depend on EPO production. Diminished proliferative response of erythropoietic cells on normal serum level of EPO and abnormal iron utilisation probably occur in these patients. Replacement of normal erythropoiesis by tumor plasma cells is probably not decisive.

[Zinc protoporphyrin (ZPP) in diagnosis of anemia]. / Protoporfiryna cynkowa (ZPP) w diagnostyce niedokrwistosci.

In iron deficiency, zinc protoporphyrin (ZPP) is produced instead of heme, and the ZPP concentration in erythrocytes increased (normal value < 2.3 micrograms ZPP/g Hb). The ZPP level and comparison with the other normally used tests in iron deficiency in the group of the patients with iron deficiency, ACD, MDS, AML, plasmocytoma was investigated. The ZPP level was determined by hematofluorometry in samples from 96 patients. Thirty five patients with iron depletion showed decreased both serum ferritin (median 5.9 ng/ml), and hemoglobin level (median 9.8 g/dl) with significantly increased ZPP level (median 8.5 micrograms/gHb). An increased level of ZPP (median 3.95 micrograms/gHb) with normal level of ferritin (median 24 ng/ml) and iron (median 50 (g/dl) in the serum of patients with ACD was determined. Measurement of ZPP level in the combination with ferritin and peripheral blood morphology allows to classify the degree of iron deficiency. The ZPP levels higher than 4.55 micrograms/gHb confirms iron deficiency in the group of anaemic patients.

[Preliminary results of erythropoietin treatment of anemia in myelodysplastic syndromes and chronic lymphocytic leukemia]. / Wstepne wyniki leczenia erytropoetyna niedokrwistosci w zespolach mielodysplastycznych i przewleklej bialaczce limfatycznej.

Six patients with myelodysplastic syndromes (MDS) and two patients with chronic lymphocytic leukemia, all with severe anemia entered the study. Before treatment reasons of secondary anemia were excluded. Concentration of erythropoietin, iron, transferrin, ferritin were measured before, and in the second and the third month of the trial. A r-HuEpo dosage of 80 U/kg was administered intravenously three times weekly for a minimum of three months. Four patients finished the study. The increase in hemoglobin concentration by 6 g% was observed in one patient with MDS subtype RA. In three other patients who apart from r-HuEpo received chemotherapy transfusion requirements decreased by 90%. Together with increase in hemoglobin decrease in ferritin was observed. The correlation between r-HuEpo and endogenous erythropoietin and ferritin was defined.

[Evaluation of treating anemia in patients undergoing chronic dialysis with small doses of human recombinant erythropoietin]. / Ocena leczenia niedokrwistosci u chorych przewlekle dializowanych malymi dawkami ludzkiej rekombinowanej erytropoetyny.

The aim of the study was to assess the efficacy of low dose subcutaneous (sc) recombinant human erythropoietin (rHuEpo) therapy in hemodialysis (hd) patients, with particular emphasis on their quality of life. 25 anemic (Ht < 25%) hd patients with end-stage renal disease were given small sc doses of rHuEpo once or twice weekly for 12 months. During first 4 months of the therapy there was a significant increase of Ht (21.1 +/- 0.5 vs 28.5 +/- 0.6%; p < 0.0001) and serum hb (6.68 +/- 0.12 vs 8.51 +/- 0.18 g/dl; p < 0.0001) at mean induction dose of 52.5 +/- 2.5 IU/kg/week and this was maintained with a mean dose 67.0 +/- 10.5 IU/kg/week. RHuEpo was effective in 24 patients; all of them required no blood transfusions after starting the therapy. In majority of patients an substantial (p < 0.01) improvements in exercise tolerance, well-being, cold tolerance, sexual satisfaction and libido were observed, although sexual hormones profile revealed no significant changes during the treatment. Within first 6 months of the study cardiac index decreased substantially (p < 0.01), mainly because of stroke volume reduction, but after one year this hemodynamic improvement was noted only in patients who maintained a stable blood pressure. Hypertension worsened in 31% of patients. Low-dose s.c. rHuEpo: (1) is effective and safe treatment for anemia in hds patients, sufficient to abolish blood transfusion requirements; (2) produces significant improvements in quality of life; and (3) allows for 50% costs reduction.

[Anemia and erythropoietin level in some hematology malignancies]. / Niedokrwistosc a stezenie erytropoetyny w niektórych chorobach nowotworowych ukladu krwiotwórczego.

UNLABELLED: Pathogenesis of anemia in patients with myeloma, low grade lymphoma and acute leukaemia was the aim of the study. Erythropoietin (Epo) serum level was detected according to ELISA test. Significant increase of Epo serum level in 13 myeloma and 30 low grade lymphoma patients was found. In 21 acute leukemia cases the Epo serum level was significantly increased (disproportional to Hb concentration). CONCLUSION: in the studied myeloma and low grade lymphoma patients anemia did not depend on defective Epo secretion. Significant increase of Epo serum level in acute leukaemia, strongly suggested additional stimulation mechanism for hormone synthesis. Further studies of this mechanism are needed.

[Erythroid stem (CFU-E) cells and erythropoietin levels in certain hematological diseases]. / Erytroidalne komórki macierzyste (CFU-E) i stezenie erytropoetyny w niektórych chorobach hematologicznych.

The aim of this paper is the trial of explanation of anaemia in certain immunological disorders. This approach consists measure of the Epo serum level and clot culture of bone marrow CFU-E cells. In the plasmocytoma patients inversely proportional dependence between number of CFU-E colonies and percentage of plasmocytes in bone marrow was observed. In low grade lymphoma patients the number of CFU-E colonies in vitro was greater than the standard value. Non proportional increase of Epo serum concentration to the level of anaemia in patients with acute leukemia was observed.

[Usefulness of ELISA and radial immunodiffusion tests for evaluation of the degree of purification of influenza diagnostic and vaccine preparations]. / Przydatnosc testów ELISA i radialnej immunodyfuzji dla oceny stopnia oczyszczenia grypowych preparatów diagnostycznych i szczepionkowych.

It is necessary to use new diagnostic tests for careful and rapid evaluation of a degree of purification and immunogenicity of vaccine anti-influenza preparations. In this study in order to obtain this purpose a radial immunodiffusion++ test and immunoenzymatic test (ELISA) were used Recommended by WHO radial immunodiffusion++ test enable to determine a level of haemagglutinin of particular types and subtypes of influenza virus in polyvalent preparations. However, this test is time consuming therefore for hemagglutinin level determination ELISA test was adapted. This test is hundred times more sensitive and can be applied with success for determination of hemagglutinin level of influenza virus A or B. For evaluation of a degree of purification of vaccine preparations ELISA was elaborated, in which as an index of purification of preparation a level of ovalbumin is determined. This test is specific and extremely sensitive, and it is possible to determine ovalbumin level with accuracy of 1ng in 1 ml of preparation.