Multiple myeloma in association with second malignancy.

PURPOSE: To look at the frequency of second primary malignancies (SECMAL) in patients with multiple myeloma (MM). METHODS: The medical files of 332 patients with MM (whole group), diagnosed and treated at the University Multiprofile Hospital for Active Treatment "Sv. Georgi" and the Comprehensive Oncology Hospital (Plovdiv) for a 20-year period (1990-2010) were retrospectively analyzed. MM patients with SECMAL constituted the study group. A control group comprised patients with solid tumors associated with SECMAL. This group derived from a sample of 21768 patients with solid tumors. RESULTS: In the study group, SECMAL was diagnosed in 4.52% (N=15) of the patients, while in the control group this figure was 5.09% (N=1108) (p>0.05). The diagnosis of MM preceded the occurrence of SECMAL in 35.71% of the study group patients, the median interval being 6.6 years (range 5-14). More frequently the diagnosis of the solid tumor preceded the occurrence of MM (66.67%). Breast cancer and gastric cancer were encountered with the highest frequency (26.67% each). The median survival (77.2 months, range 44-129) was significantly longer in the group with MM and SECMAL compared to the whole group with MM (median 38.6 months, range 10-58; p<0.05). CONCLUSION: The rate of MM with other malignant diseases is comparable with the frequency of SECMAL in other lymphoproliferative disorders and solid tumors. The occurrence of SECMAL during the clinical course of MM is not a frequent event and is expected in the rare cases with longer survival.

Non-Hodgkin lymphomas and carrier state of viral hepatitis B and C.

PURPOSE: To establish the characteristics and prognosis of newly diagnosed patients with non-Hodgkin lymphoma (NHL), who were carriers of hepatitis B (HBV) and C (HCV) viral infection. METHODS: 542 patients with NHL, diagnosed and treated in the University Hospital "Sv. Georgi", Plovdiv, were retrospectively analysed. Two NHL patient groups were created - the study group, consisting of 33 patients with NHL positive for HBV and HCV, and the control group, consisting of 40 randomly assigned patients with NHL and negative serology for hepatitis. Study and control groups were compared for basic characteristics and survival. RESULTS: The prevalence of hepatitis B surface antigen (HBsAg) among newly diagnosed patients was 5.72% and of HCV 1.84 %. Association with hepatitis viruses was more frequent in indolent than in aggressive NHLs (p=0.044). Liver dysfunction was registered more often in the study group (p=0.002). Reactivation of HBV infection was registered in 5 patients (12.19%) from the study group. There was no statistically significant difference between survival rate of patients in the study group and in the control group (p=0.738). CONCLUSION: Hepatitis virus carrier state did not alter significantly the clinical course and disease prognosis (remission rates and survival) in our patient group. We recommend the routine testing for hepatitis infection in patients newly diagnosed with NHL in order to collect more data needed for the establishment of a possible causal relationship between hepatitis viruses and NHL. Since antiviral prophylaxis could positively impact the course of lymphoma treatment, national guidelines for the management of patients with hepatitis infection and NHL will prove to be necessary for the clinical practice.

Therapy-related acute promyelocytic leukemia after treatment with radioiodine for thyroid cancer: case report with literature review.

Therapy-related acute promyelocytic leukemia (t-APL) is a rare but known complication of chemotherapy and/or radiation therapy. Approximately 200 cases of t-APL have been reported in the literature up until now. The development of t-APL after radioiodine therapy is very rare, keeping in mind the very low doses of radiation exposure of the patient. We present a case of a 47-year-old woman with t-APL t15;17(q22;q21) developed after radioiodine treatment for thyroid carcinoma. The patient was treated with chemotherapy and achieved complete response lasting for 3(+) years. The patient's excellent response to treatment supports the data of the relevant literature that t-APL is associated with a better therapeutic result than the other subtypes of secondary acute myeloid leukemia (AML).

The prognostic value of clinical and laboratory parameters in patients with chronic lymphocytic leukemia.

PURPOSE: Chronic lymphocytic leukemia (CLL) is heterogeneous in its clinical course. The aim of the present study was to identify some clinical and laboratory parameters with prognostic value in relation to survival of patients with CLL. PATIENTS AND METHODS: One hundred thirty one patients with CLL, treated in the Clinic of Hematology, Plovdiv, between 1992 and 2003 were studied. The patients' survival was analyzed by using the Kaplan-Meier method. Log-rank test was used to compare cumulative survival functions between different groups of patients. The parameters studied were: age, sex, Rai clinical stage, ECOG Performance status (PS), FAB morphological type, mediastinal lymphadenopathy, abdominal nodal mass, extranodal localization, absolute lymphocyte count, autoimmune hemolytic anemia, and response to therapy. RESULTS: The mean survival of patients was 76 months (95% Confidence Interval, 64-87). The following factors were found to carry significant prognostic value in relation to survival: Rai clinical stage, ECOG PS, mediastinal lymphadenopathy, extranodal localization, FAB morphological type and response to initial standard treatment. CONCLUSION: The prognostic factors identified in the present study can be easily applied in the clinical practice and may be used as a basis for creating mathematical prognostic models.

Survival of patients with surgery for lung cancer.

INTRODUCTION: Lung cancer is the leading cause of death in oncological diseases all over the world. It is a major health problems in Bulgaria. Early diagnosis is of great significance for improving survival in this group of patients. OBJECTIVE: The aim of this study was to analyze survival of patients with surgery for lung cancer. MATERIALS AND METHODS: Retrospective information for all 86 patients with surgery for lung cancer during the period 1995-1998 was obtained from the surgery protocols in the Clinic of Thoracic and Abdominal Surgery at the Higher Medical Institute (Plovdiv, Bulgaria). However, relevant follow-up data were found only for 50 patients. Medical histories were provided by the Plovdiv Oncological Center. Kaplan-Meier analysis was applied to study survival of patients. The log rank test was used to compare cumulative survival functions between groups of patients with different stage at diagnosis. Univariate Cox regression analysis allowed the development of a model to assess the influence of the stage at diagnosis on cumulative survival. RESULTS: Survival was assessed till June 1998. Mean survival period was 15 months (95% CI 13, 18). Patients were divided into two sub-groups: group A (stage I and II) and group B (stage III and IV). The analysis showed a marginally significant difference in cumulative survival between two groups (p = 0.0599). The mean survival period of patients from group A was 18 months (95% CI 14, 22) while for group B it was 12 months (95% CI 9, 16). Univariate Cox regression model showed that the relative risk of patients in group B to patients in group A is 3.2 (95% CI 1.11, 9.06). Early diagnosis of lung cancer is of crucial importance for surgery management and prognosis in such patients.

Diagnostic strategies for evaluation and prognosticating the outcome of jaundice among patients with cholestasis caused by neoplastic diseases of the hepatobiliary system and the pancreas.

The purpose of the present study was to assess the diagnostic approach and the outcome of neoplastic diseases of the hepatobiliary system and the pancreas that develop cholestasis. 84 patients over 40 years of age treated in our Department between January 1994 and January 1998 were included. The etiological cause of jaundice was established by ultrasonography, computed tomography, thin needle biopsy with cytological and histological examination of the obtained material or ERCP. 11 of the 84 patients died, 9 underwent surgery and 64 were referred to the Oncologic Center for further treatment.

Estimation of trends of morbidity of colorectal cancer in Plovdiv district for the period from 1985 to 1996.

The present study concerns the incidence rate of colorectal cancer (CRC) in Plovdiv region (population 1,269,464). The study was carried out over a 12-year period and aimed at establishing the increase rate of this disease. Results show that incidence rate of CRC increased progressively for the mentioned period from 22.14 to 34.98 per 100,000 people and was almost twice as high as that for the country. It is a particularly disturbing fact that the morbidity and mortality rates due to colorectal cancer is rising--2.36 times for 12 years. We propose screening for asymptomatic and high risk patients with considerable results for opportune diagnostics.

Trends in the incidence of colorectal carcinoma in three regions of south Bulgaria for the period 1985-1998.

The purpose of the present study was to evaluate the increase of colorectal carcinoma incidence in three regions of South Bulgaria (a total population of 1,269,464 persons) over a 14-year period (1985-1998). The data about the incidence rate are retrieved from the oncological hospital records of the patients and Bulgarian National Oncological Register. The census data are provided by the National Institute of Statistics, Sofia. The results show that the incidence rate of colorectal carcinoma for the studied period increased steadily from 22.14/100,000 to 37.18/100,000 (an increment of 15.04/100,000) which is almost twice the average for the country. Compared to the baseline year of 1985 the increase in these three regions is 67.93% or approximately 5% annually. The incidence rate in Plovdiv region was almost twice that of Smolyan region. The incidence rate of colorectal carcinoma in both genders was greater than that of stomach cancer. The highest incidence rate was found in the 70-79-year-age group (193.5/100,000). A major part of our study was to find the stage in which colorectal carcinoma (CRC) is detected. In 1985 only 0.57% of the patients were diagnosed as being in the I-st clinical stage, 37.76%--in the II-nd, and 61.67%--in III-IV clinical stages. This unfavorable trend was preserved in 1998, when only 3.17% were diagnosed as having the first clinical stage, 38.62%--the II-nd and 58.21%--the III-IV clinical stages. The 14-year pronounced trend of increase of the prevalence rate (a 2.91 times increment) and the mortality rate (a 2.50 times increment) of colorectal carcinoma is especially alarming. We propose screening of the asymptomatic patients and high-risk persons which gives considerable results in the timely diagnostics of colorectal carcinoma.

A rare case of fibrosarcoma of the inferior vena cava expanding into the right atrium.

The authors report in detail a case of fibrosarcoma of the inferior vena cava. A 53-year-old female presented with echographic and computed tomographic evidence of a solid formation in the porta hepatis that fused with the inferior vena cava. Because of appearance and rapid development of symptoms of right cardiac failure, the patient was transferred to the Clinic of Cardiac Surgery and underwent an emergency operation. A solid formation arising from the inferior vena cava and expanding into the right atrium was found during the operation. The operation performed was not a radical one. Fibrosarcoma of the inferior vena cava was proved on histological examination. A single therapeutic course with vincristine and farmorubicin was administered. The patient died from recurrence of the malignancy 26 months after the operation. The epidemiologic, diagnostic, and therapeutic aspects of the case are discussed in relation with the literature data.

A population-based study on the prevalence of Hodgkin's disease in the region of Plovdiv.

The authors present the results of a ten-year cross sectional population-based epidemiologic study on the incidence-specific patterns of Hodgkin's disease. During the period 1986-1995 there were 259 new cases diagnosed with Hodgkin's disease in Plovdiv region which accounts for 26 new cases per year (range 16 to 37). There was a strong tendency towards steady increase in the HD incidence-specific rate with a median increase of 0.13 cases per year, rising from 1.05 in 1986 to 2.18 per 100.000 in 1995. The HD morbidity-specific incidence rate also increased with 1.07 new cases per year, rising from 12.41 to 21.80 cases per 100.000 in ten years. The age-specific incidence pattern shows a bimodal distribution, with the first peak occurring between the ages of 20 and 29, and the second--between 60 and 79 years of age and with a nadir of morbidity between 40 and 49 years of age. There is a strong male predominance with a male:female ratio of 1.3:1. The most common pathohistologic pattern was the nodular sclerosis type (56.75), followed by the mixed cellularity (32.05%), the lymphocyte predominance (6.18%) and the lymphocyte depletion patterns (5.02%).

Female sex organs malignancies incidence in Plovdiv district for the period 1986-1996.

The aim of the recent survey is to investigate the dynamics of female sex organs malignancies (carcinoma of the uterine corpus, cervical carcinoma and ovarial carcinoma) incidence and to make a structural analysis. The incidence of female sex organs malignancies increases every other year from 37.7 cases in 1986 to 58.64 cases per 100,000 women in 1996. The cervical carcinoma incidence for that period increases from 8.1 cases in 1986 to 14.65 cases per 100,000 women in 1996. For the same period endometrial carcinoma incidence increases from 16.2 cases to 24.74 cases per 100,000 and ovarial carcinoma incidence--from 13.0 cases to 19.64 cases per 100,000. Malignancy staging is an important part of the study. Clinical stage I is diagnosed only in 25.28% of the new cases, stage II--in 46.02%, stage III--in 17.75% and, stage IV--in 10.95% of the cases. The incidence of female sex organs malignancies in the examined, regions and locations shows that there are some differences between the three regions of Plovdiv district (Plovdiv, Pazardjik and Smolyan). The region of Plovdiv has a highest incidence. There are also a differences in the incidence between the citizens of the town and the villages.

[Kidney morbidity in Smolyan District based on out-patient-polyclinical network data for the period 1967-1973]. / Bubrechnata zabolevaemost v Smolianski okrug po danni na ambulatorno-poklinichnite zvena za perioda 1969/1973 g

The renal morbidity data in Smoljan district for seven years (1967-1973) are analyzed according to the documentation of the out-patient links. Internal diseases with a total number of 229 704 are covered, 17 261 out of them being diseases of the kidneys. Increased renal morbity was established. The highest increase found is for the urolithiasis group. With respect to appropriate prophylactic measures, the necessity of complex investigations on the causes of the high urolithiasis percentage is stressed upon.