A prospective observational study of anaemia management in cancer patients - results from the German Cancer Anaemia Registry.

The use of erythropoiesis-stimulating agents (ESA) in cancer patients is still under debate. However, little is known about rationales, strategies, objectives, and effectiveness of anaemia treatments in common practice. The Cancer Anaemia Registry prospectively surveyed about 2000 cancer patients with anaemia throughout Germany. The main objectives of anaemia treatment regardless of modality were to improve quality of life (QOL) and to correct haemoglobin (Hb) levels. The Hb threshold for any anaemia treatment (means ± SD: 9.4 ± 1.2 g/dL) but not for blood transfusions (8.7 ± 1.0 g/dL) depended on cancer type and treatment strategy. Physicians preferred ESA as first-line treatment to prevent transfusions in patients with solid tumours, if they thought that chemotherapy caused the anaemia. If they suspected other causes or patients had lymphoproliferative malignancies, physicians preferred transfusions or attempted to correct underlying disorders; both mainly to improve QOL or prognosis. Effectiveness of all strategies was comparable. However, ESA most effectively prevented transfusions; primary transfusions appeared less suitable for correcting Hb or improving QOL. Using supportive treatments for QOL improvement was common whereas diagnostic measures and intravenous iron therapy were underused. Prospective clinical trials using QOL as end point and evaluating diagnostics in cancer-associated anaemia are warranted.

Hemoglobin levels that trigger erythropoiesis-stimulating agent treatment decisions for cancer-associated anemia--examination of practice in Germany.

OBJECTIVE: Given the safety concerns regarding off-label use of erythropoiesis-stimulating agents (ESAs) in the treatment of cancer-associated anemia, data from the German Cancer Anemia Registry (CAR) were analyzed to examine whether current practice in Germany adheres to treatment guidelines. RESEARCH DESIGN AND METHODS: CAR was a web-based registry gathering patient data for 12 weeks following anemia diagnosis or until the primary treatment objective was achieved. RESULTS: Of over 2000 patients surveyed, 783 were treated with ESAs. Treatment was primarily aimed at improvement of quality of life (37.3%), hemoglobin correction (32.7%), and prevention of transfusions (24.4%). The average hemoglobin level triggering ESA treatment was 9.7 g/dL (6.0 mmol/L), however, starting levels varied with cancer type. For 67.8% of patients, transfusions could be avoided. ESA treatment was stopped at 11.2 g/dL (7.0 mmol/L) and maximum hemoglobin levels during the study averaged 11.8 g/dL (7.3 mmol/L). In 4.8% of the women and 6.0% of the men, maximum hemoglobin levels were >14 g/dL (8.7 mmol/L); in 15.6% and 9.1%, respectively, levels were between 13 and 14 g/dL. The median hemoglobin level triggering transfusion was 8.3 g/dL (5.2 mmol/L), irrespective of the malignant disease. CONCLUSION: Current use of ESAs for the treatment of cancer-associated anemia in Germany appears to be in good compliance with treatment guidelines. Similar results obtained from other studies in Europe and the US indicate this to be true beyond Germany.

Epidemiological study on the hepatotoxicity of occupational toluene exposure.

In a cross-sectional study of 181 male workers of a rotogravure printing plant, most of whom were exposed to toluene levels well above the GDR threshold limit values, 55 subjects revealed pathological liver screening values (activities of serum aspartate aminotransferase, alanine aminotransferase, gamma glutamyltransferase; liver size). The differential diagnostic examination showed in 51 out of these 55 subjects an association with competing factors such as alcohol abuse (78%) and overweight (40%), to a slight extent disorders of fat and carbohydrate metabolism and of the gallbladder. Drug intake did not play any role. The variance and regression analyses of the biochemical data have shown that alcohol significantly and considerably increases the activities of all three enzymes tested. Bodyweight had a similar, but less pronounced, significant effect. On the other hand, in subjects with a higher alcohol intake the activities of liver enzymes in highly toluene exposed subgroups were significantly and clearly lower than among slightly toluene exposed workers.

[Tumor marker diagnosis in non-seminomatous testicular tumors using human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP)]. / Tumormarkerdiagnostik bei nicht-seminomatösen Hodentumoren mittels Humanchoriongonadotropin (HCG) und Alpha-Fetoprotein (AFP).

In 28 patients with non-seminomatous testicle tumour the tumour markers human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) were determined radioimmunologically and enzymeimmunologically, respectively. While tumours with chorionic carcinoma (n = 8) always were marker-positive, in the embryonic carcinoma in 2 out of 10 cases falsely negative findings appeared. On 5 patients the biochemical monitoring of the course of the testicle tumour disease is demonstrated in detail by means of HCG and AFP and estimated as very helpful method. Advantages and problems of the marker diagnostics are shown and discussed. The positive marker findings were absolutely evident for a metastasation. On the other hand, marker negativation was not always to be equated with absence of a tumour and demanded a further control of the patient by means of all other available methods of diagnostics up to the second-look-operation.

[Treatment of non-seminomatous testicular tumors in combination with vinblastine/bleomycin and adriamycin/cisplatin]. / Behandlung nichtseminomatöser Hodentumoren mit einer Kombination von Vinblastin/Bleomycin und Adriamycin/Cisplatin.

Following orchiectomy and retroperitoneal lymph node dissection (RND) 11 patients with non-seminomatous testicular cancer were treated alternately with combination chemotherapy consisting of vinblastine/bleomycin and adriamycin/cis-dichlorodiammineplatinum (II) (DDP). A total of 39 course of vinblastine/bleomycin and 36 course of adriamycin/DDP were administered. The two patients with disseminated testicular cancer came into complete and partial remission respectively. 1 patient with stage N3 and minor residual disease after RND, 7 patients with stages N1-2 and complete RND and 1 patient with stage N0, but chorio-carcinomatous portions in the testicular tumour show not sign of recidivation at present. The period of observation after orchiectomy ranges from 4 to 21 months, the median being 13 months. The side effects of chemotherapy are discussed in detail and both combinations are judged to be aggressive. The avoidance of DDP-nephrotoxicity by forced diuresis and the distinct and rapidly beginning intensification of the effect of phenprocoumon due to both regimens are stressed.

[Comparative volumetric studies of the lateral geniculate body of mammals]. / Vergleichende volumetrische Untersuchungen am Corpus geniculatum laterale von Säugetieren.

Volumetric investigations of the dorsal and ventral nucleus of the lateral geniculate body (dLGN and vLGN) in 16 mammalian species showed that forms with a high level of neocorticalization are characterized by a high quotient of dLGN and vLGN volumina. This result may be explained by the very different fibre connections of these two nuclei and the close relationship of the dLGN to the visual cortex. Compared with terrestric forms of the same body size tree living forms belonging to the same mammalian order have a larger LGN. The dLGN of these arboreal species exhibits additionally a higher level of histological differentiation (lamination). So we can conclude that there is a correlation between LGN volumina and the occurrence of dLGN lamination in members of the same order. This rule cannot be applied generally to species belonging to different orders.