[Collection of peripheral hematopoietic stem cells for transplantation from volunteer donors--siblings of the patients]. / Odber transplantátu periferních kmenových bunek krvetvorby u dobrovolných dárcu--sourozencu nemocných.

Peripheral stem cells obtained by stimulation of haematopoiesis by administration of so-called growth factors are used for allogenic transplantations of haematopoietic cells only since the mid-nineties of the 20th century. So far however not all potential undesirable effects of growth factor administration to healthy subjects are known. The authors present the results of a programme of allogene transplantation of peripheral blood stem cells from related donors which was started in their department in 1996. From 11/1996 till 8/2000 the authors started 55 mobilizations of peripheral stem cells in donors before transplantation. The mobilization growth factor G-CSF was used for in a total dose of 16 micrograms/kg/day s.c. administered in two daily doses. During administration of G-CSF 19 donors had no complaints, 34 donors (64%) had pain in their bones, subfebrile temperatures and/or symptoms of flu. G-CSF produced dramatic changes in the haemogram--massive leucocytosis with dominant neutrophilia, after collection of the transplant thrombocytopenia developed. The changes of some biochemical parameters were also marked. A peripheral venous approach for collection of the transplant was applied in 23 instances (43%), in the remainder cannulation of a central vein was used. A total of 121 leukaophereses was performed in 53 donors (separator COBE Spectra) which were started on the 4th day of G-CSF administration. An automatic operation of PBSC collection was used in 28 leukaphereses, an operation of mononuclear collection in 93 leukaphereses. In leukaphereses only mild symptoms of hypocalcaemia were observed in 26 donors (48%). The mean total yield of leukaphereses was 9.39 x 10(6) CD34+ cells/kg of the recipient (3.48-23.13) and 76.54 x 10(4) CFU-GM/kg of the recipient (10.02-238.78), no mobilization failed. Of 36 donors 25 (69%) came for a check-up one year after collection of the transplant. No changes in the haemogram nor in biochemical parameters were recorded. In donors with hepatopathies pathological findings persisted in biochemical examinations without a deteriorating trend. Administration of G-CSF to healthy subjects is a new technology associated with certain advantages as well as some questions. Safety of donors holds the first place, detailed information is essential as well as examination and follow up not only on a short-term but also on a long-term basis.

[Comparison of the effectiveness of idarubicin (Zavedos) and mitoxantrone (Refador) in induction therapy of acute myeloid leukemia in elderly patients (55-75) (a prospective multicenter randomized study conducted 1998-2000]. / Srovnání úcinnosti idarubicinu (Zavedos) a mitoxantronu (Refador) v indukcní lécbe akutní myeloidní leukémie nemocných seniorského veku (55-75 let) (prospektivní multicentrická randomizovaná studie 1998-2000).

The presented study compares the efficacy and the toxicity of idarubicine and mitoxantrone in combination with cytosar (3 + 7) in induction treatment of the patients with AML aged 55-75. 31 patients at the age of 55-75 (median 62) were evaluated in the arm with idarubicine and 29 patients at the age of 57-74 (median 64) in the arm with mithoxantrone. Complete haematological remission was achieved in 13 patients (41.9%) in the arm with idarubicine and 15 patients (51.7%) in the arm with mitoxantrone. The medians of overall survival time (OS) and disease free survival time (DFS) were 22 and 44 weeks in the idarubicine arm and 35 and 40 weeks in the mitoxantrone arm, respectively. Statistical analysis did not prove any significant difference in the complete remission rates, in the number of deaths during cytopenia, in the OS or DFS, in the duration of hospitalisation, severe neutropenia and thrombopenia, in the number of days with febrile neutropenia, or in the consumption of platelets and erythrocytes transfusion units between both arms. Despite the fact that these results are not statistically significant in favour of any treatment arm, which is probably influenced also by the small number of evaluated patients, more favourable results were achieved in the arm with mithoxantrone with the respect to the evaluated parameters. From the point of view of cost-effectiveness, the difference could be observed when considering the price of both intercalating cytostatics. The use of mitoxantrone (Refador, Lachema) is 15x times cheaper per course of treatment than the use of idarubicine (Zavedos, Pharmacia). Autologous peripheral blood stem cells transplantation (APBSC) was carried out only in 4 patients younger than 60. No one of them was cured by APBSC but the median of OS of these patients was longer than the median in the other patients of the group. The results achieved are comparable with those of other trials conducted by various foreign groups. The possible causes of our unfavourable treatment results in this high-risk category of aged patients and the ways how to individualize the treatment with the use of prognostic factors analysis and how to improve the quality of life of the patients has been discussed.

[Lymphocytosis with large granular lymphocytes: case report]. / Lymfocytóza z velkých granulárních lymfocytu: popis prípadu.

Lymphoproliferative disorders of large granular lymphocytes (LGL) can arise from either CD3+ T cells or CD3- natural killer cells. Polyclonal proliferation of LG lymphocytes is called LGL lymphocytosis, monoclonal proliferation of LG lymphocytes is LGL leukaemia. Prominent clinical manifestations of LGL lymphocytosis and leukaemia are bacterial infections, splenomegaly, and may be connected with rheumatic or autoimmune disorders. Hematologic findings reveal particularly lymphocytosis, and severe neutropenia. The beta chain gene of T cell receptor rearrangement analysis is necessary for distinguishing of T LGL lymphocytosis from T LGL leukaemia. The authors report a case of young woman with T cells LGL lymphroproliferative disorder, bacterial infection, reactive lymphadenopathy, and spontaneous regression of the lymphocytosis within 6 months.

[Diagnosis of cytomegalovirus infection with the polymerase chain reaction and antigenemia in patients after allogenic peripheral stem cell transplantation--comparison of 318 paired samples]. / Diagnostika cytomegalovirové infekce pomocí polymerázové retezové reakce a antigenémie u nemocných po alogenní transplantaci periferních kmenových bunek--srovnání 318 párových vzorku.

BACKGROUND: Cytomegalovirus (CMV) represents a serious infectious complication in patients after allogenic haematopoietic stem cell transplantation. Timely initiation of the therapy at the time of incipient active CMV infection (preemptive therapy) is an important prevention of CMV disease. It is not clear, what is the best indicator of this incipient CMV infection. METHODS AND RESULTS: The significance of the detection of incipient CMV infection by CMV-antigenaemia and DNA-viraemia was compared in this study. DNA-viraemia was detected by the non-nested polymerase chain reaction (PCR). The sensitivity of nested and non-nested PCR was also compared experimentally. We tested 318 blood samples for antigenaemia and DNA-viraemia. Six samples were significantly positive for PCR, no sample was significantly positive for antigenaemia. Timely initiation of therapy resulted in the rapid eradication of the incipient active CMV infection and clearance of DNA-viraemia. CONCLUSIONS: Non-nested PCR is a suitable and more reliable method for the monitoring of incipient active CMV infection and it is a good method for timely initiation of preemptive antiviral therapy.

[Treatment of multiple myeloma]. / Perspektivy v lécbe mnohocetného myelomu.

A new era of multiple myeloma management includes new approaches such as genetic marking and gene therapy, immunotherapy, stimulation of graft versus myeloma effect, etc. Intensive clinical research is also focused on the detection of minimal residual disease and bone marrow purging. Clinical trials have begun and the first results are promising, though preliminary. The combinations of new types of therapeutical approaches with the most efficient regimens used until now could form a new type of MM management strategy that better involves minimal residual disease.

[Evaluation of treatment of anemia with erythropoietin in patients with multiple myeloma]. / Hodnocení lécby anémie erytropoetinem u pacientu s mnohocetným myelomem.

Multiple myeloma is very frequently associated with anaemia which has the character of hypo-proliferative anaemia of chronic diseases. In this type of anaemia the erythropoietin formation is frequently inadequate. According to data in the literature pharmacological doses of erythropoietin lead to an increase of the haemoglobin concentration in blood. Erythropoietin (Eprex Cilag) was administered to 11 patients whose haemoglobin concentration was lower than 100 g/l. The results from 10 patients were finally evaluated. During the first month all patients were given erythropoietin - 150 U/kg three times per week. Unless during the first month of treatment the haemoglobin concentration increased by 10 g/l, the dose was doubled to 300 U/kg. In patients where the haemoglobin value had risen above 120 g/l, the authors assessed an individual maintenance dose. In case three-month erythropoietin treatment did not lead to an increase of haemoglobin by 20 g/l as compared with the baseline value, erythropoietin administration was discontinued. The haemoglobin concentration increased by 20 g/l in a total of 8 (80%) of 10 evaluated patients. In all five patients where the haemoglobin concentration increased by 20 g/l during the first month, the endogenous erythropoietin concentration was less than 60 U/l. In another three patients the mentioned therapeutic response was recorded only during the 2nd or 3rd month of treatment after the erythropoietin dose had been increased. These three patients had higher baseline concentrations of endogenous erythropoietin, 100 to 350 U/l. During treatment no undesirable effects of erythropoietin were observed. Erythropoietin is a useful drug for anaemic patients with the diagnosis of multiple myeloma. According to the results of the authors work and data in the literature it is obvious that in patients with endogenous serum erythropoietin below 100 U/l a rapid riae of haemoglobin can be observed already during the first month. Patients with a higher baseline concentration of endogenous erythropoietin (100 to 500 U/l) respond less frequently to treatment and larger doses of erythropoietin must be administered. In patients with an erythropoietin value above 500 U/l there is a minimal probability that a response will be produced.

[Tolerance and results of treatment of Hodgkin's disease]. / Tolerance a výsledky lécby Hodgkinovy choroby.

At present the accepted standard chemotherapeutic treatment of Hodgkin's disease is therapy according to the MOPP pattern (mustargen, vincristine, procarbazine and prednisone) alternating with the ABVD therapeutic pattern (adriamycin, bleomycin, vinblastine and dacarbazine). It is substantial for achieving optimal results to administer the planned treatment in non-reduced doses and at the scheduled time. In the submitted paper the authors describe the tolerance of chemotherapy and its results in 15 patients and the tolerance of radiotherapy in another four patients suffering from Hodgkin's disease. Complications of chemotherapy (leukopenia and infection) caused an overall average retardation of chemotherapy of 37 days per patient. This interval would be certainly longer if the patients were not given Leucomax Schering Plough. From a total of four patients given radiotherapy Leucomax had to be administered to two, otherwise radiotherapy would have had to be discontinued on account of a decline of leucocytes.

Therapy of anemia in patients with multiple myeloma.

Multiple myeloma is very frequently associated with anemia which has the character of hypoproliferative anemia of chronic diseases. In this type of anemia there is often insufficient production of endogenous erythropoietin. According to literature pharmacological doses of erythropoietin result in the increase of blood hemoglobin concentration. Erythropoietin (Eprex Cilag) was given to 11 patients whose hemoglobin concentration in blood was lower than 100 g/l. 10 patients could be evaluated at the end of the study. Within the first month all patients were given erythropoietin in the dose of 150 U/kg 3 times a week. The dose was doubled, when the blood hemoglobin concentration did not increase by more than 10 g/l within the first month. In patients with hemoglobin level above 120 g/l we were trying to find the individual maintenance dose. In patients who had not reached a blood hemoglobin concentration increase of at least 20 g/l, as compared with the initial level, further erythropoietin administration was stopped. The concentration of hemoglobin increased of 20 g/l in 8 (80%) out of 10 patients evaluated. All 5 patients who responded within the first month, had had pretreatment concentration of endogenous erythropoietin below 60 U/l. Three other patients had not been responding before their dose of erythropoietin was increased in the 2nd and 3rd months of therapy. The therapy response appeared only in the 2nd and the 3rd months of treatment. These 3 patients had higher pretreatment concentrations of endogenous erythropoietin, from 100 to 350 U/l. During the treatment no adverse effects of erythropoietin were observed. Erythropoietin is a useful drug for anemic patients with the diagnosis of multiple myeloma. According to the results mentioned above and also according to the data from literature it is evident that in patients with the endogenous blood erythropoietin value below 100 U/l it is possible to expect a sudden rise in hemoglobin concentration already within the first month. Patients with a higher concentration of endogenous erythropoietin (100 to 500 U/l) respond to the therapy less frequently and for the increase in hemoglobin it is necessary to give higher doses of erythropoietin. Patients with the initial value of erythropoietin above 500 U/l are not likely to respond.