Autoimmune Phenomena in Patients with Solid Tumors.

INTRODUCTION: Autoimmune disorders have been documented in solid tumors and malignant hematological disorders. They are very common and well studied in lymphomas which are associated with immune imbalance. They are less common in solid tumors and are categorized as paraneoplastic syndromes with unclear pathogenesis. AIM: The aim of the present study was to find the frequency of autoimmune phenomena in solid tumors of various origin, location and status of the tumor. PATIENTS AND METHODS: Between 2000 and 2014 we studied 1083 patients with solid tumors that were diagnosed and treated in St George University Hospital, Plovdiv. RESULTS: We found higher incidence of these phenomena in prostate and ovarian carcinomas (9.01% and 5.6%, respectively) than in other solid tumors. Their distribution by type of autoimmune disease showed that vasculitis, polyneuritis and autoimmune hemolytic anemia have the highest frequency of all. Immune thrombocytopenia, seronegative arthritis, psoriasis, polymyositis are less commonly documented. The autoimmune paraneoplastic phenomena manifest themselves metachronously, less commonly synchronously, with the tumor. In most cases, their clinical manifestation is a progressive disease or metastatic malignant disorder which respond favourably to therapy. CONCLUSION: Paraneoplastic autoimmune phenomena are found very commonly in prostate and ovarian carcinomas. They occur in the course of the evolvement of neoplasm and can regress with medicamentous or surgical treatment of the malignoma.

Familial study of chronic lymphocytic leukemia: aggregation of different malignant processes in families with individuals affected with chronic lymphocytic leukemia.

UNLABELLED: There has been evidence that familial factors play a certain role in some cases of chronic lymphocytic leukemia. It is possible in one or more family members to observe chronic lymphocytic leukemia alone, other malignant disorders or combination of both of them. THE AIM: of our study was to analyze the association of family history of malignances with the onset of chronic lymphocytic leukemia. PATIENTS AND METHODS: We conducted a case-control study through direct inquiry of the families of 126 patients with chronic lymphocytic leukemia. The control group consisted of 124 patients with benignant disorders. For statistic data processing we used Fisher's exact test in 2x2 table and Kaplan-Meier survival analyses. RESULTS: 35.71% of the investigated individuals had first degree relatives with malignant disorders, while in the control group their percentage was 17.7%. Significant correlation between positive family history of malignancy and the onset of chronic lymphocytic leukemia was found (P = 0.0016). The risk of development of chronic lymphocytic leukemia in individuals with family history of malignant disorders was 1.69 times higher than in individuals with negative family history RR = 1.697, 95% C.I. [1.177; 2.448]. There was no significant difference in the general survival between groups with positive and negative family history of malignancy. Stomach cancer was particularly often diagnosed in families with individuals affected with chronic lymphocytic leukemia. Other lymphoproliferative disorders were also registered in 3.9% of the families from the control group. CONCLUSION: Our data show that there is a high risk of getting chronic lymphocytic leukemia in close relatives of affected individuals with malignant disorders. There was no data for greater aggressiveness of chronic lymphocytic leukemia in patients with positive family history of malignancy.

A helping computer system prognosing the survival of patients with Hodgkin's disease.

INTRODUCTION AND AIMS: Hodgkin's disease is an uncommon form of lymphoma occurring mainly at 15-35 years of age. Prognostic evaluation plays an important role by supplying a rational working linkage between the wide complexity of disease presentations and available therapeutic resources. Improved prognostic evaluation able to identify the likely outcome of a given patient would be of considerable clinical importance. The aim of this study was to develop and present a computer system and tools that will allow physicians to make more precise prognosis of the survival in such patients. MATERIAL AND METHODS: Several mathematical models were developed using multivariate statistical survival analyses. Data on 116 patients with Hodgkin's disease treated in the Clinic of Hematology (Plovdiv, Bulgaria) between 1974 and 2001, were collected. The patients' database consisted of general information for each patient (name initials, age, sex, date of diagnosis, etc.) as well as of specialized clinical information. RESULTS: The present system has provided different options for calculation of survival probabilities and prognosis using deterministic models for each patient. CONCLUSIONS: The use of the present system in routine practice has allowed physicians to facilitate the process of making more precise prognosis of survival. In this way, they have been able to optimize the treatment scheme and improve the quality of life of their patients.

Treatment with fluorated quinolones of febrile neutropenia in patients with hematologic malignancies.

UNLABELLED: The use of fluoroquinolones in the treatment of cytotoxic therapy-induced febrile neutropenia is controversial. AIM: The aim of the study was to compare the therapeutic effect of fluoroquinolones with that of standard antibiotic regimens in patients with hematologic malignacies and febrile neutropenia following antineoplastic chemotherapy. PATIENTS AND METHODS: This is a prospective randomized study including 129 patients with 141 neutropenic episodes divided into two groups. Fluoroquinolones are used in the trial group and broad-spectrum beta-lactam antibiotics in the control group. The data are analyzed using alternative analysis, non-parametrical chi-square test and Student-Fisher t-test. RESULTS: The febrile neutropenic episodes were classified as fever of unknown origin (50.4%) and documented infection (49.6%). In the category "fever of unknown origin" no statistically significant difference was found in the clinical effect, patient survival, general and infectious lethality between the trial and control group. In the category "documented infection" the trial group showed significantly lower therapeutic effect and lower infection-free survival of the patients. The clinical effect and infection-free survival after treatment with fluoroquinolones were significantly lower in the category "documented infection" than in the category "fever of unknown origin". CONCLUSION: Fluoroquinolones can be alternative drugs to the standard antibiotic regimens in the treatment of febrile neutropenia in cases of fever of unknown origin. Fluoroquinolone monotherapy is not recommended in cases of febrile neutropenia with documented infection.