Docetaxel and gemcitabine in the treatment of soft tissue sarcoma - a single-center experience.

INTRODUCTION: Advanced stage/metastatic soft tissue sarcoma (STS) has a poor prognosis especially after failure of the established first-line treatment. In patients with relapsed leiomyosarcoma, however, the combination of gemcitabine (G) and docetaxel (D) recently has emerged as a valuable salvage therapy. PATIENTS AND METHODS: A retrospective analysis of G (900 mg/m2, days 1+8) and D (100 mg/m2, day 8) was performed in 34 patients with STS, and response rate (RR), overall survival (OS), time to progression (TTP), and toxicities were evaluated. RESULTS: Analysis of these 34 patients revealed a RR of 15% with no complete remission (CR) and 5 partial remissions (PR). Of note, 4/5 PR were achieved in patients with leiomyosarcoma. In 13 patients (38%) disease stabilization (SD) could be achieved resulting in a clinical benefit rate (CBR), defined as CR+PR+SD, of 53%. Median OS was 12.5 and TTP was 2.4 months for the whole group and 2.8 months for patients with leiomyosarcoma. A progression- free rate at 3 months of 38% and 45%, respectively, was observed in these 2 groups. Major side effects were 47% hematological and 26% grade 3/4 nonhematological toxicity. CONCLUSION: With regard to the observed CBR further use of GD seems to be warranted even in pretreated patients with STS.

Serum free light chain analysis and urine immunofixation electrophoresis in patients with multiple myeloma.

PURPOSE: Retrospective studies have shown that immunoassays measuring free light chains (FLC) in serum are useful for diagnosis and monitoring of multiple myeloma. This study prospectively evaluates the use of FLC assays and, for the first time, investigates the relationship between serum FLC concentrations and the presence and detectability of Bence Jones (BJ) proteins in the urine. PATIENTS AND METHODS: Three hundred seventy-eight paired samples of serum and urine were tested from 82 patients during the course of their disease. The sensitivities of serum FLC analysis and urine immunofixation electrophoresis (IFE) in detecting monoclonal FLC were compared. Serum FLC concentrations required for producing BJ proteins detected by IFE were determined. RESULTS: Abnormal FLC were present in 54% of serum samples compared with 25% by urine tests. In abnormal serum samples for kappa or lambda, the sensitivity of IFE to detect the respective BJ proteins in urine were 51% and 35% and the median serum FLC concentrations required to produce detectable BJ proteins were 113 and 278 mg/L. Renal excretions of monoclonal FLC increased with serum concentrations, but excretions significantly decreased at high serum concentrations combined with renal dysfunction. CONCLUSION: Serum FLC assays are significantly more sensitive for detecting monoclonal FLC than urine IFE analysis. They also have the advantage of FLC quantification and are more reliable for monitoring disease course and response to treatment.

Accuracy of a novel approach to measuring arterial thermodilution cardiac output during intra-aortic counterpulsation.

OBJECTIVE: To assess the agreement between a novel approach of arterial and the pulmonary artery bolus thermodilution for measuring cardiac output in critically ill patients during aortic counterpulsation. METHODS: Eighteen male patients aged 37-80 years, undergoing preoperative insertion of an intra-aortic balloon pump (IABP) and elective coronary artery bypass grafting. A thin 1.3FG thermistor was introduced through the pressure lumen to the tip of an 8FG IABP catheter, and the pump rate was set at 1:1. After arrival in the intensive care unit cardiac output (CO) was measured under haemodynamic steady-state conditions hourly for 8-11 h, and arterial bolus thermodilution (BCO(iabp)) and pulmonary artery bolus thermodilution (BCO(pulm)) were determined after the patients' admission to the intensive care unit. RESULTS: A total of 198 data pairs were obtained: 177 with aortic counterpulsation and 21 without. During aortic counterpulsation, median CO was 6.8 l/min for BCO(iabp) and 6.1 l/min for BCO(pulm), without aortic counterpulsation; corresponding values were 7.1 l/min for BCO(iabp) and 6.5 l/min for BCO(pulm) with aortic counterpulsation. Mean bias was +0.77 l/min, limits of agreement ( +/- 2 SD) were -1.27/+2.81 l/min, and mean error (2 SD/[(BCO(iabp )+ BCO(pulm))/2] was 31.4%. Without aortic counterpulsation, corresponding values were +0.43 l/min, -1.03/+1.87 l/min, and 22.4%. CONCLUSIONS: Agreement between BCO(iabp) and BCO(pulm) was satisfactory for CO values between 2.0 and 10 l/min only without aortic counterpulsation. BCO(iabp) CO measurements during aortic counterpulsation after coronary artery bypass grafting cannot be recommended at the present time.