[Complications in the use of blood transfusions--alloimmunization in polytransfused patients]. / Komplikacija primanja transfuzija krvi--aloimunizacija politransfundovanih bolesnika.

INTRODUCTION: The objective of this paper was to examine the frequency of red blood cell (RBC) alloantibodies in polytransfused hematologic patients. MATERIAL AND METHODS: Blood samples of 2669 polytransfused hematologic patients were examined on clinical significant alloantibodies using antibody screening and identification according to Standards of AABB Technical Manual (1). Available medical charts were reviewed for sex, age and medical history and total number of given transfusions. RESULTS: During a three year period blood samples of 2669 polytransfused hematologic patients were examined for RBC alloantibodies. Alloantibodies were detected in 48 cases with the incidence of 1.79%. 36 patients (1.35%) developed single antibody while in 12 patients (0.45%) multiple antibodies were detected. Antibodies were registered more frequently in females than in males (37:17). In patients with single antibody next specificity was detected: anti-D (38.89%), anti-K (22.22%), antibodies to antigens MNSs system (22.22%), while anti-Le, anti-Fy and anti-P specificity was detected in 13.89%. Patients with multiple antibodies had specificity to Rhesus, Kell, Duffy, MNSs, Lewis and P blood group systems. All patients received more than 10 RBC transfusions. CONCLUSION: The incidence of alloimmunization was 1.79%. Sensibilization occurred more frequently in females than in males. Usually, the discovered alloantibodies were clinically significant and made problems in pretransfusion testings and required special efforts in blood selection for transfusion. For patients with the risk of frequent transfusions we suggest to include blood transfusion charts with complete phenotyping against antigens in Rhesus, Kell, Kidd and MNSs blood group systems and the data of all received transfusions.

[A simple model of the optimal time for allogenic bone marrow transplantation in chronic granulocytic leukemia]. / Jednostavni model optimalnog vremena za transplantaciju alogene kostane srzi u hronicnoj granulocitnoj leukemiji.

Allogenic bone marrow transplantation is the treatment of choice in chronic granulocyte leukemia patients, while the best results are achieved when it is performed in the chronic phase of the illness. That is why time optimization for bone marrow transplantation in chronic granulocyte leukemia means making priority lists for transplantation according to medical indications. This study comprises a very simple model of optimal time for bone marrow transplantation in chronic granulocyte leukemia. It is based on data of the International Bone Marrow Transplant Registry (IBMTR) on bone marrow transplantation results in different phases of chronic granulocyte leukemia and prognostic model for survival of younger leukemic patients according to which there are three groups of patients. The mathematical method estimated cumulative risks of the final therapeutic results. This model has shown that the time limit for transplantation is the fourth year of the disease in the low risk group; the third year of the disease in the medium risk group and the second year in the high risk group of patients.

[Modern treatment of leukemia and hematopoietic stem cell transplantation]. / Savremeno lecenje leukemija i transplantacija maticne celije hematopoeze.

The paper presents the possibilities of contemporary treatment of acute and chronic leukemia that have been based on new knowledge and experience we have gathered through clinical and scientific work. Contemporary treatment of leukemia is very complex and requires the application of cytostatics, biological therapy and transplantation of hematopoietic stem cells. The treatment of acute leukemia by cytostatics and induction protocols results in a rather high percentage of remissions, but unfortunately most of them cannot be preserved. Allogenic transplantation of hematopoietic stem cells from bone marrow or peripheral blood have given the best results in the treatment of acute and chronic leukemia. Anti-leukemic effect is bound to the previous chemoradiotherapy, particularly to the activity of donor's immunocompetent cells in the transplant, having an effect of a graft against leukemia. The cleansing of the autograft and isolation of stem cells together with the application of IL-2 will be a significant improvement of the efficacy of autologous transplantation in leukemia. It is realistic to expect that the treatment of malignant diseases such as leukemia will in near future, besides the already existing treatment methods, include molecular therapy at various cell levels, which will make possible a correction of the basic disorder in the process of malignant alteration of hematopoietic cells.

[Blood of patients with acute leukemia increases the leukocyte count in the peripheral blood of mice]. / Serum bolesnika obolelih od akutne leukemije povecava broj leukocita u perifernoj krvi miseva.

Serum of 23 patients suffering from acute myeloid leukemia were given to groups of six mice (s.c. 0.6 ml); 3 and 5 days later the total number of leucocytes, granulocytes and lymphocytes was determined in the peripheral blood of mice. Serums of all patients caused significant increase of leucocytes in mice 3 and/or 5 days after the serum's application. In most cases the increase was caused by increased number of granulocytes and lymphocytes, and in 6 cases only by increase of granulocytes or only lymphocytes. This increase can also be thought of as a stimulation of leukocytopoiesis by increased concentration of hematopoetic growth factors in blood of those suffering from acute leukemia.

[Prognosis in patients with myelodysplastic syndromes based on cytomorphologic and clinico-biologic parameters]. / Prognoza obolelih od mijelodisplasticnih sindroma na osnovu citomorfoloskih i klinicko-bioloskih parametara.

Under myelodysplastic syndromes we presume a heterogeneous group of malignant hemopathies with clearly described characteristics of the disease given by a cooperative group of French, American and British authors. Myelodysplastic syndromes most frequently occur at older age. Survival of these patients, after the diagnosis is made, is mostly short because the disease evolves into acute leukemia. Myelodysplastic syndrome is characterized by appearance of refractive anemia, leukemia, thrombocytopenia with signs of expressed dishematopoiesis of the bone marrow. Clear criteria which could define forms with fast or slow course leading to acute leukemia don't exist, so there is a need to group patients into those with good or with bad outcome. The investigation included following parameters important for the outlook of the disease: 1. enlargement of lymph nodes, liver and spleen, 2. biochemical examination of peripheral blood, 3. cytomorphologic changes in the peripheral blood cells and bone marrow. By a follow-up of described parameters a statistically significant influence on survival of the sick concerning the degree of present anemia, absolute number of granulocytes, number of thrombocytes, dishematopoiesis of the peripheral blood and bone marrow, lymphadenomegaly, hepatomegaly and splenomegaly was not found. The percentage of blast in the peripheral blood and bone marrow has a statistically significant influence on patients' short survival.

[Prophylaxis and therapy of infections in allogenic bone marrow transplantation in patients with hematologic diseases]. / Profilaksa i lecenje infekcije kod alogene transplantacije kosne srzi bolesnika sa hematoloskim oboljenjima.

Infection and acute graft versus host disease (GVHD) are the most common complications of allogeneic bone marrow transplantation, which compromise this therapeutical method for hematologic diseases. Beside the appreciation of customary preventive measures and the treatment of infections, it is necessary for every bone marrow transplantation center to analyze the development of bacterial, fungal and viral infections in the patients and to generate the most efficient and most rational program for their prevention and treatment. At the Hematology Department in Novi Sad seven allogenic bone marrow transplantations were performed in patients with malignant hematologic diseases and severe form of aplastic anemia. Prevention of the infection by isolation of the patient in a sterile unit, selective decontamination of the digestive tract with sterile food, skin and mucus hygiene and prophylactic drug administration proved rather beneficial and adequate for patients with the graft accepted, hematopoiesis recovered and immunity reconstructed. Risks of infections were increased by permanent vein catheter, acute GVHD and rejection of the bone marrow graft. Prompt isolation and identification of bacteria and fungi, especially in blood, the establishment of a minimal suppressing and bactericide antibiotic concentration, along with the assessment of their synergism, as well as early diagnosis of cytomegalovirus and administration of specific drugs, can significantly contribute to the more successful treatment of infections in transplanted patients.

[Our experiences in the treatment of myelodysplastic syndromes]. / Nase iskustvo u lecenju obolelih od mijelodisplasticnih sindroma.

From 1987 an abrupt increase of the number of patients presented with MDS has been registered. We present our experiences in the treatment of 42 patients. The number of the male patients was two times larger than of the females. They were most frequently diagnosed as having RAB (43%) and RAEBt (28.5%). RA was found in 14%, RARS in 9.5% and CMML. in only 5% of the cases. The treatment was accomplished with ultralow (3 mg/m2/12h s.c.) and low doses (10 mg/m2/12h s.c.) of ARA-C in 75% of the patients with RAEBt and 44.4% with RAEB, while the CMML group received hydroxyurea. The treatment improved hematologic results but the complete remission lacked. In 23.8% of the cases the disease developed into acute nonlymphoblastic leukemia. Patients excepted from cytostatic therapy were observed by the use of androgens, anabolics, vitamin A+D3 and transfusion of separated erythrocytes. In 38% of the patients with MDS a lethal outcome followed. Life of those in whom the disease developed into acute leukemia in statistically significatly shorter (p < 0.05). There was no statistically significant difference in the survival rate between the treated and nontreated patients (p > 0.05). Further treatment of these patients includes, apart from ultralow doses of ARA-C, the use of retinoic acid, a growth factor (GM-CSF) and bone marrow transplantation.

[Experience in the ambulatory care of patients with hematologic diseases at the Hematology Day Hospital]. / Iskustva u lecenju hematoloskih bolesnika ambulantno, putem "Hematoloske dnevne bolnice".

Upon establishing new out-patient services at the Clinical Centre, Clinic of Hematology has set up a new diagnostic and therapeutic department which is popularly named "Hematologic Daily Hospital". In way, the work at the Clinic of Hematology has been completely changed, since a new activity in the out-patient management of hematologic patients has been initiated. In the course of 8-hour working time numerous various diagnostic and therapeutic interventions are being performed in "Hematologic Daily Hospital", such as: a detailed survey of the patients, biologic material is taken and sent to various analyses, sternal and other functions are performed, cytologic analyses of punctates obtained, patients are referred to radiologic, ultrasonographic, CT and other surveys, administration of parenteral therapy of corresponding solution with or without cytostatics, blood and blood derivate transfusion as well as the application of various forms of apheresis. Data on the number and kinds of services applied are presented in this paper with the insight on the organization of work. Such an organization of work has made diagnostic of hematologic patients faster and has contributed to a simpler employment of therapy.

[Liver injury during combined chemotherapy of acute leukemias]. / Ostecenje jetre u toku polihemioterapije akutnih leukemija.

The authors observed 70 patients with acute leukemia treated by polychemotherapy. In 2 patients the signs of severe liver damage were found. The occurrence, course and results of laboratory tests suggested Purinethol predominantly as the cause of development of these alterations. The complication did not occur frequently in our patients. The changes regressed in a satisfactory way after the withdrawal of the hepatotoxic cytostatic from the therapy.