Proliferative activity of plasma cells is the most relevant prognostic factor in elderly multiple myeloma patients.

Although multiple myeloma (MM) is predominantly a disease of the elderly, few studies have focused on the identification of prognostic factors in this group of patients. Four hundred twenty five MM patients >65 years were uniformly treated with chemotherapy (MP or VCMP/VBAD). Multivariate analysis identified 4 factors with independent unfavorable prognostic influence: high percentage of S-phase bone marrow plasma cells (>2.5%); elevated beta(2) microglobulin (B2M) (>4 mg/L); age >80 years old; and LDH serum levels (above normal limit). The S-phase value was the most powerful independent prognostic factor to discriminate subgroups of patients with different prognosis. Thus, 3 main risk categories could be identified according to S-phase values: 3%, with median survivals of 34, 22 and 12 months, respectively (p < 0.0001). Our study also proved the value for elderly patients of the recently developed International Score System (ISS) based on B2M and albumin. Furthermore, the number of S-phase cells helped to subdivide the ISS III Group identifying a subset of patients with very poor prognosis defined by an additional high S-phase, who displayed a median survival of only 8 months. These results demonstrate that elderly patients can be accurately classified according to prognosis, which may be particularly valuable when comparing the efficacy of new treatment strategies. Moreover, our results underline the high prognostic value of proliferative activity of PC, a parameter that should be considered in routine laboratory investigations of MM.

Cidofovir treatment of human polyomavirus-associated acute haemorrhagic cystitis.

We report the case of an 18-year-old patient who received an allogeneic bone marrow transplant from an HLA-identical unrelated donor for a Ph+ acute lymphoblastic leukemia, in his third complete remission. Cyclophosphamide and busulfan were used as conditioning treatment. Acute graft-versus-host disease developed on day +9, and the response to adequate treatment (steroids) was favourable. On day +45 the patient developed an acute severe haemorhragic cystitis, and BK polyomavirus was demonstrated in urine samples using electron microscopy and polymerase chain reaction. Urinary symptoms did not improve in spite of palliative treatment, but a response was evident after 2 weeks of cidofovir treatment.

Complicaciones de la esplenectomía. Análisis de nuestra casuística / Complications in splenectomy. An analisys of our case history

La esplenectomía es una técnica quirúrgica común en los servicios de cirugía general, y sus indicaciones habituales son médicas, traumáticas e iatrogénicas. Las correspondientes al primer grupo han aumentado a pesar de la mejora de los medios diagnósticos. Las segundas han disminuido con el control en los servicios de cuidados intensivos y el uso de técnicas conservadoras. Se ha revisado la casuística de nuestro hospital, comparándola con la del resto de la bibliografía, y se ha comprobado que las complicaciones postoperatorias fundamentalmente han sido las respiratorias y el absceso subfrénico. Se corrobora, también, cómo esta última ha tenido gran incidencia en las esplenectomías iatrogénicas, siendo un factor esencial en la morbimortalidad, de tal modo que muchos autores llevan a contraindicar la esplenectomía en el transcurso de cirugía contaminada. Nuestros resultados han sido escasos en relación con la infección grave postesplenectomía, al igual que en otras series; por tanto, la profilaxis correcta (inmunoterapia y antibioterapia) ejerce un papel esencial en la disminución de su incidencia (AU)