Treatment of bendamustine and prednisone in patients with newly diagnosed multiple myeloma results in superior complete response rate, prolonged time to treatment failure and improved quality of life compared to treatment with melphalan and prednisone--a randomized phase III study of the East German Study Group of Hematology and Oncology (OSHO).

PURPOSE: This randomized phase III study compared bendamustine and prednisone (BP) to standard melphalan and prednisone (MP) treatment in previously untreated patients with multiple Myeloma (MM). PATIENTS AND METHODS: To be included, patients had to have histologically and cytologically proven stage II with progressive diseases or stage III MM. They were randomly assigned to receive BP (n=68) or MP (n=63). The primary endpoint was the time to treatment failure (TTF). Secondary endpoints included survival, remission rate, toxicity and quality of life. RESULTS: The overall response rate was 75% in the BP and 70% in the MP group. A significantly higher number of patients treated with BP achieved a complete remission than did patients receiving MP (32 vs. 13%; P=0.007), and the maximum response was achieved more rapidly in patients treated with BP compared to those receiving MP (6.8 vs. 8.7 cycles; P<0.02). TTF and remission duration were significantly longer in the BP group. Patients receiving BP had higher QoL scores and reported pain less frequently than patients receiving MP. CONCLUSION: BP is superior to MP with respect to complete remission rate, TTF, cycles needed to achieve maximum remission and quality of life and should be considered the new standard in first-line treatment of MM patients not eligible for transplantation.

Chemotherapy for mobilisation of Ph-negative progenitor cells from patients with CML: impact of different mobilisation regimens.

Mobilised peripheral blood stem cells are widely used for autografting in patients with chronic myeloid leukaemia (CML) and it is generally thought that a high proportion of Ph-negative progenitor cells in the graft is desirable. We report here the results of 91 stem cell mobilisations performed with various chemotherapy regimens followed by G-CSF. We show that mobilisation of Ph-negative cells is possible after diagnosis as well as in advanced stages of the disease. The yield of Ph-negative cells is highly dependent on the chemotherapy regimen: while the combination of idarubicin and cytarabin for 3-5 days (IC3-5) mobilised Ph-negative cells in most patients, high-dose cyclophosphamide was ineffective. Mobilisation of Ph-negative progenitor cells after IC3 was at least as effective as after IC5; however, less apheresis sessions were required, and toxicity was much reduced after IC3. Compared to historical controls, IC was equally effective as the widely used ICE/miniICE (idarubicin, cytarabin, etoposide) protocol. No correlation was found between graft quality and the cytogenetic response to subsequent treatment with interferon-alpha. We conclude that IC3 is an effective and well-tolerated regimen for mobilising Ph-negative cells that compares well with more aggressive approaches such as IC5 and ICE/miniICE.

[Use of diagnostic tests in problems of internal medicine. Analysis of 1,667 ambulatory patients attending the first aid unit of a general hospital]. / Impiego dei tests diagnostici nei problemi internistici. Analisi di 1,667 pazienti ambulatoriali afferenti al pronto soccorso di un ospedale generale.

Patients with problems of internal medicine presenting at first-aid units of city hospitals represent a considerable work load. 1667 patients of this type have been examined retrospectively. The most numerous group had cardiocirculatory (22%) and nervous system (21%) problems, 9% had problems linked to their mental state and 11% dermatology complaints in general. 1047 patients underwent further investigation and/or specialist examination (247 neurological and 166 cardiological). Patients with jaundice, diabetes mellitus and cardiac decompensation underwent the highest number of laboratory examinations. The highest percentage of X-rays was done on patients suffering from chronic bronchitis during an acute episode, the highest percentage of ECGs in patients with prethoracic pain or cardiopalmus. In first aid also, some tests seem to be carried out as routine or for legal medicine purposes while for problems where tests are less easy or harder to understand (e.g. loss of consciousness episodes), a specialist is frequently brought in. The work load on the first-aid out-patients structure can be reduced by promoting greater awareness of the problem on the part of the internist and by rerouting users to non-hospital structures.

[Diagnostic aspects of complex blood-protein analyses in screening]. / Diagnostische Aspekte komplexer Serumeiweissanalysen im Screening

During a screening at a testing of 5 different protein parameters (IgG, IgA, IgM, Hp, Tf) different types of distribution were found. While IgG, Hp and Tf have a normal distribution, IgG and IgM are not normally distributed in the uncleansed group. Measures of elimination of suggested sizes of influence ("liver parameters") remained without effect.