Long term experience of patients with unresectable or metastatic KIT positive gastrointestinal stromal tumours.

A retrospective analysis of consecutive patients (183 in total, of which 105 were males and 78 females) with gastrointestinal stromal tumour (GIST) was performed. The mean age was 61 years, median age 64 years. The most frequent localization of the tumour was stomach in 74 patients (40.4 %) and the small intestine in 46 patients (25.1 %). Two or more different synchronous or metachronous cancers occurred in 34 (18.6 %) patients with histologically confirmed GIST. Ninety-six patients were treated with imatinib mesylate in palliative setting during the course of their disease. The therapy was finished in 60 patients and 36 patients have been treated so far. The median progression-free survival reached 32.9 months in the group of 96 patients treated with imatinib. The median overall survival in the group of 96 patients treated for metastatic disease reached 77 months. Two-year and 5-year survival was 85.2 % and 63.1 %, respectively. The second-line therapy with sunitinib malate was administered in 37 patients, of which 31 finished and 6 continued in the therapy. The median progression free survival and median survival since the sunitinib therapy initiation reached 8.4 and 22.1 months, respectively (Tab. 2, Fig. 2, Ref. 16).

Significant antitumor effectiveness of imatinib in c- kit negative gastrointestinal stromal tumor -  case report.

Inoperable c- kit negative gastrointestinal stromal tumor (GIST) is commonly considered to be highly resistant to systemic therapy. We present a case of a woman with an abdominal sarcomalike tumor diagnosed at the age of 26. The patient underwent several surgical procedures and courses of cytostatic therapy without any substantial effect. Later, the tumor was reclassified as c- kit negative GIST harbouring the mutation in exon 12 of PDGFRA gene. Hence, the therapy with imatinib mesylate was initiated, resulting in partial remission of metastatic lesions and further stabilization of the disease for five years to date. We therefore consider imatinib mesylate an appropriate therapy for c- kit negative GIST bearing PDGFRA mutations.

[Pneumosurgery in the management of colorectal carcinomas]. / Pneumochirurgie v resení karcinomu kolorekta.

OBJECTIVE: Surgically solved lung involvement in patients after surgery of colorectal cancer. MATERIALS AND METHODS: Altogether 15 patients, 9 men (median age in the time of lung diagnosis 67 years) and 6 women (median age 59 years) underwent classical open pulmonary surgery during 2003-2008 years from the follow-up cohort of 836 persons after operation due to colorectal cancer in the time period of 1996-2008 years. The indication for lung surgery: solitary pulmonary lesion. Procedures distribution: pulmonary lobectomy 7, bilobectomy 2, segmentectomy 4, wedge resection 2. The requirement of the European Society of Thoracic Surgeons (ESTS) guidelines of complete pulmonary resection has been met by 10 operations (66.7%) with lobe specific lymphadenectomy. Histopathology investigation: Formalin fixed, paraffin embedded samples were investigated after hematoxylin-and-eosin staining, supplemented in case of need by immunohistochemistry of CK7, CK20 and TTF1. RESULTS: Eleven pulmonary metastases were found, in two cases with interlobar lymfatics involvement. Two metachronous primary adenocarcinomas of the lung (ADL) were diagnosed, one of them with metastases into hilar lymphatics. In remaining two patients pulmonary chondrohamartoma was discovered. CONCLUSION: Solitary pulmonary opacity in patient after colorectal surgery might not represent simple metastasis explicitly. Complete resection is needed.

Confocal laser endomicroscopy in experimental pigs. Methods of ex vivo imaging.

BACKGROUND: Confocal laser scanning endomicroscopy (CLSE) enables online in vivo cellular surface and subsurface imaging of normal and pathological tissue at high resolution and magnification. The aim of this study was to work out a method of ex vivo in vitro CLSE in experimental pigs and to compare CLSE images with those of "classic" histology. MATERIAL AND METHODS: Five mature female pigs entered the study. CLSE on an ex vivo in vitro basis was started 10 minutes after pharmacological euthanasia and carried out for 30 minutes. Fluorescein was administrated i.v. as a fluorescence substance. RESULTS: CLSE was successful in all tissue samples of all animals (the oesophagus, stomach, small intestine, large bowel). We have succeeded to obtain high quality images within the first 30 minutes that means 40 minutes after the euthanasia of experimental animals. CLSE images corresponded well with those of haematoxylin-eosin staining. CONCLUSIONS: CLSE on an ex vivo in vitro basis in experimental pigs is feasible.

[Pulmonary segmentectomy for tumour]. / Plicní segmentektomie pro nádor.

BACKGROUND: An analysis of outcome data of pulmonary segmentectomy focused on local efficacy in primary non small cell lung cancer and true or seeming lung metastasis. PATIENTS AND METHODS: Miscellaneous series of twenty patients treated with classical open procedure involving individuals with primary or metachronous non small cell lung cancer, solitary pulmonary metastasis of extrapulmonary cancer and/or benign pulmonary lesions, lung metastasis mimicing. Thirteen patients after segmentectomy because of malignancy are separated into a group of 7 cases with NSCLC up to 20 mm in diameter, and a group of 6 persons with solitary pulmonary opacity up to 38 mm treated previously surgically for extrapulmonary cancer. Both without enlargement of hilar and/or mediastinal lymphatics proven on preoperative CT imaging. Third part of the group collects benign pulmonary lesions: chondrohamartoma, pneumonitis and pulmonary infarct. Persons involved through a ten years period are followed up at 3 (4)-months intervals. RESULTS: No perioperative and thirty day mortality was registered. Six cases of distant recurrence were recorded, three in NSCLC and three in extrapulmonary cancer patients. Five patients died within the follow-up period, three of them through the general progression of the oncological disease. Two deaths were non-cancer related. One R1 disease was discovered in a patient with primary lung adenocarcinoma. No local recurrence was recorded in both cancer series with median age of 63 yrs (range 45-79 yrs) and median duration of follow up 35 months. CONCLUSION: Lung segmentectomy seems to accomplish local control of early stage non small cell lung cancer and pulmonary metastasis of extrapulmonary cancer in selected patients.

Uncommon EGFR Mutations in Non-Small Cell Lung Cancer and Their Impact on the Treatment.

BACKGROUND: Epidermal growth factor receptor (EGFR) mutations play an important role in the pathogenesis of non-small cell lung cancer. Because these alterations are so-called targetable mutations, their identification is important in daily clinical practice. The diagnostic standard of EGFR mutations is currently based on polymerase chain reaction methods, particularly the quantitative real-time polymerase chain reaction. In recent years, new generation sequencing has become increasingly important. In patients with EGFR mutations, a significant improvement in therapeutic outcomes was achieved with the administration of targeted therapy using tyrosine kinase inhibitors. EGFR is composed of four domains: extracellular with a ligand binding site, a transmembrane domain, a cytoplasmic tyrosine kinase catalytic domain, and a C-terminal domain. The key structures of the tyrosine kinase domain responsible for signal activation and transmission are encoded within exons 18-21 on chromosome 7. EGFR mutations are highly heterogeneous. About 90% of EGFR mutations are deletions of exon 19 and point mutation L858R in exon 21. These are referred to as classic mutations. Approximately 10% of the total number of EGFR mutations is attributable to less frequent alterations in the EGFR gene. Due to the low incidence of non-small cell lung cancer with less frequent EGFR mutations, information on their predictive significance is still incomplete. Most of the data for the treatment of cases with uncommon mutations were gathered from retrospective analyses and evaluations of small cohorts. PURPOSE: The aim of this review is to summarise the current options for diagnosing and treating non-small cell lung cancer patients with uncommon EGFR mutations. This work was supported by the MEYS - NPS I - LO1413 and MH CR - DRO (MMCI, 00209805). The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 2. 6. 2019 Accepted: 26. 8. 2019.

[Treatment of non small cell lung cancer]. / Lécebné postupy u nemalobunecného karcinomu plic.

According to the recent data lung cancer in Czech republic is the most common malignancy in men (incidence 93/100 000) and is the leading cause of cancer death in men (mortality 90/100 000). In women is the incidence of lung cancer 30/100 000. Non-small-cell lung cancer (NSCLC) accounts for 70% to 75% of all lung cancers, while small-cell lung cancer (SCLC) accounts for 25% to 30% of cases. These two types of lung cance have a different biological characteristics which leads to a different approach in the treatment of NSCLC and SCLC. The treatment of NSCLC is based on clinical stage of disease and different treatment modalities alone or in combination are used: surgery, radiotherapy, chemotherapy and recently a novel treatment strategy--targeted therapy with biologic agents.

Autofluorescence (safe) bronchoscopy and p21/ki-67 immunostaining related to carcinogenesis.

Archival biopsy materials from 20 randomly selected asymptomatic volunteers from the Czech uranium miners (CZ UM) risk group (n=98) were examined for p21 and ki-67 immunostatning. There were 16 areas with normal respiratory epithelium and 22 areas with bronchial intra-epithelial neoplasia (IEN). Normal and IEN areas were identified by autofluorescence (System Autofluorescence Endoscopy, SAFE-1000) and monitored during 1998-2002. The majority of specimens from areas with normal autofluorescence intensity with ciliated columnar bronchial epithelium showed strong predominantly cytoplasmic p21 positivity. The SAFE monitoring divided areas of decreased autofluorescence intensity with early stage IEN lesions into two groups. Persistent lesions (P)-showing a spectrum of p21 cytoplasmic staining ranging from negative or isolated negativity to weak or moderate positivity combined with higher proliferative capacity proved by ki-67 nuclear staining. Disappearing lesions (D)-showing strong cytoplasmic p21 positivity and negative ki-67 staining. The IEN lesions were classified into three groups based on p21/ki-67 immunostaining: proliferative lesions at risk (R) with low or without p21 plasma immunostaining combined with high ki-67 nuclear reactivity; ambiguous lesions (A) including cases combining strong p21 cytoplasmic positivity with high ki-67 nuclear reactivity or p21 cytoplasmic negativity with ki-67 negativity staining patterns; the quiescent lesion group (Q) was characterized by strong p21 cytoplasmic positivity and negative ki-67 immunostaining.

[Influences on radiocesium retention in minipigs]. / Ovlivnení retence radiocesia u miniprasat.

The efficiency of an active substance (AL) prepared in our laboratory as a composite sorbent on the basis of hexacyanoferrates (II) bound on pearl cellulose, in affecting the radiocesium (Cs-137) retention in white miniature pigs was investigated. The function of the composite sorbent in dependence on the way of administration, i.e. its effect on a decrease of primary resorption and its ability to interrupt the enteral cycle was studied, too. The efficiency of stable cesium administration in the form of CsCl in the same process was also determined. It was proved that AL accelerated significantly the excretion through its effect both on primary resorption causing an approx. 11-fold reduction of resorption when administered simultaneously with radiocesium and on the enteral cycle, causing an approx. 3.5-fold increase of excretion of Cs-137 when administered daily. Thus the composite sorbent (AL) administered at long-term along with contaminated feed reduced the equilibrium concentration of radiocesium in meat 30-40 times. This might be of great importance in the time of nuclear emergencies. On the other hand, administration of non-active Cs at a level up to 1 mg Cs/1 kg of liveweight had no significant effect on Cs-137 elimination.

[Effect of fibrin on osseointegration of bioactive glass-ceramic materials--experimental study]. / Ovlivnení osteointegrace bioaktivních sklokeramických materiálu fibrinem--experimentální práce.

PURPOSE OF THE STUDY: The aim of the experimental study is to find out how fibrin influences the speed of osteiontegration of bioactive glass-ceramic materials BAS-O, BAS-HA, BAS-R (LASAK Prague, Czech Republic) and how it influences the response of live tissue at the implant-bone interface in the interval of 1-8 weeks. MATERIAL: Dense materials BAS-0 (glass-ceramics), BAS-HA (hydroxyapatite) and BAS-R (beta tricalcium phosphate) in the form of 0.6-1 mm granules were implanted in artificially created defects in tibia of an experimental animal with the addition of 0.1 ml of fibrin adhesive system Beriplast. Control implantation was performed with the addition of physiological solution. Materials BAS-HA and BAS-R were implanted in the same way in the ratio of 7:3, 8:2 and 9:1. Duration of exposure was 1-8 weeks. Radiographs of samples were taken by Mammograph and decalcified sections were coloured by toluidine blue and examined at 60 times and 120 times magnification. RESULTS: Surgical wounds were healed per primam. Radiographs of materials with the fibrin system showed clearly after one week defects and implants, after the third week part of the materials penetrated above the bone surface, after the fourth week there were evident signs of bone tissue formation between particles of BAS-HA, BAS-R and their mixtures. The most marked bone formation took place in the seventh and eighth weeks. With the use of glass-ceramics without fibrin the particles were after three weeks less clear, after the fourth week BAS-HA and BAS-R penetrated above the surface. A significant bone formation was obvious after the sixth and seventh weeks. There were no signs of resorption or fibrous encapsulating. Microscopic examination proved enveloping of particles of BAS-0 by fibrous tissue which was evident partially also after the eight week. With the use of fibrin the situation was analogical. In BAS-HA and BAS-R the finding in the first week was similar. With fibrin, there was after the third week a mature lamellar bone in the vicinity of granules and the fibrous interlayer disappeared. Neither positive nor negative impact of fibrin on the process of healing was found. With the application of BAS-R and fibrin system the bone tissue was after the third week more significant and trabeculae more bulky. The final result after eight weeks was the same: Ingrowth of the mixtures of the given materials proceeded in the same way. DISCUSSION: The applied glass-ceramic materials are used in the clinical practice. The speed of osteointegration depends on the quality of the bone bed, and on the tolerance of these materials by live tissue. Osteintegration can be accelerated by the use of growth factors or stem cells cultivated in the tissue culture. Fibrin which creates a network along which osteoblasts can migrate should have a similar quality. It seems that of decisive importance is the thickness of the fibrin layer around the implants. If this layer is thick glass-ceramics is enveloped more probably to fibrous tissue. In a thin layer the process is accelerated within the first three weeks. After a longer exposure the differences are not evident. Samples of BAS-HA and BAS-R, both applied separately and in a mixture, showed a marked bioactivity in the experiment. During eight weeks no signs were found of resorption which is typical of tricalcium phosphate in a longer time interval. CONCLUSION: In the experiment on an animal the fibrin adhesive system accelerated osteointegration of bioactive materials BAS-HA, BAS-R and their mixtures until the third week after the implantation. Small differences with the use of fibrin were adjusted within six weeks. Materials BAS-HA, BAS-R and their mixtures were completely osteointegrated. Glass-ceramics BAS-0 was partially enveloped by fibrous tissue, even with the use of fibrin adhesive system. During eight weeks no resorption of materials was found. The process of ingrowth can be seen on radiographs. X-ray picture of bone formation in BAS-HA, BAS-R correlates with the histological finding. The fibrin adhesive system facilitates manipulation with fine granules.

Neoadjuvant treatment for locally advanced rectal adenocarcinoma with concomitant radiotherapy and oral capecitabine.

PURPOSE: Concomitant chemoradiotherapy prior to surgery of locally advanced rectal carcinoma (clinical T3- 4, and/or N+) might improve the therapeutic results. We report on our clinical experience with 34 patients receiving concurrent preoperative radiotherapy and capecitabine. PATIENTS AND METHODS: Between September 2001 and March 2003, 34 patients with a median age of 62 years (range 18-75 years) were treated for adenocarcinoma of the rectum. Capecitabine was administered orally at a dose of 825 mg/m(2) twice-daily concomitantly every day during pelvic irradiation. The planned total dose of radiotherapy was 50.4 Gy, given with daily fractions of 1.8Gy, 5 days a week, over a period of about 5.5 weeks. Large pelvic dose (PTV-1) was 45.0 Gy/25 fractions in 5 weeks. Higher dose up to 50.4 Gy in further 3 fractions was given using boost fields (PTV-2). Radiotherapy was performed with high-energy photon beam (18 MV) linear accelerator using 3-dimensional (3D) treatment planning for 3 or 4 fields technique. RESULTS: Toxicity was low: grade (G) 3 local dermatitis in 2 (6%), G3 diarrhea in 3 (9%) and G3 leucopenia in 1 (3%) patients. However, 2(6%) patients required drug dose reduction by 80%. Sphincter-sparing surgery was possible in 25 (76.5%) patients while 9 (26%) patients had radical surgery with removal of all macroscopic disease. Tumor mass downstaging by TNM criteria has been achieved in all of the treated patients. Pathological (p) complete response (CR) was verified in 7 (21%) patients and minimal microscopic residual cancer was found in 6 (17%) patients, for a total of 13 (38%) patients with substantial disease remission. CONCLUSION: Preoperative concomitant radiotherapy and oral capecitabine chemotherapy for locally advanced rectal adenocarcinoma appears to be an effective and safe therapeutic choice, improving the chance for rectal-sparing surgery. The follow-up time is rather short to evaluate time to progression and survival.

[Some aspects of advances in the chemotherapy of bronchogenic carcinoma]. / Nekteré aspekty pokroku v chemoterapii bronchogenního karcinomu.

Bronchogenic carcinoma is in the Czech Republic the most frequent malignant tumour in males. For practice the classification into non-small cell bronchogenic carcinoma (NSCLC) and small cell bronchogenic carcinoma (SCLC) is most useful. Views on chemotherapy of NSCLC were before 1980 rather pessimistic. In untreated patients with advanced NSCLC the median survival is 6 months and one-year survival in 10 %. In the nineties, due to the introduction of cytostatics of the IIIrd generation into treatment of NSCLC, the median survival was prolonged to 10 - 12 months and one-year survival is reported in 40 - 50 % patients. The importance of chemotherapy in SCLC was never doubted. By concurrent chemotherapy and radiotherapy the total period of treatment of patients with SCLC was reduced and the percentage of objective responses increased. Introduction of cytostatics of the third generation is important in particular in treatment of line II SCLC. Basic prognostic factors of successful chemotherapy in patients with bronchogenic carcinoma are the stage of the disease, body weight loss, presence of paraneoplastic symptoms, immune state and clinical and sociodemographic characteristics.

[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.

[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.

[Treatment of inoperable non-small cell bronchogenic carcinoma with a combination of cisplatin and vinorelbine--preliminary evaluation]. / Lécba neoperabilního nemalobunecného bronchogenního karcinomu kombinací cisplatiny a vinorelbinu--prubezné hodnocení.

The optimal therapeutic approach to patients with inoperable non-small-cell carcinoma is still a matter of discussion. The reason is that chemotherapy improves the quality of life only in some patients. It prolongs their life only by several weeks. In recent years in this indication a new cytostatic is tested--vinorelbine which when used in monotherapy achieves a therapeutic response in 16--30%. In clinical trials of phase 2 a combination of vinorelbine and cisplatinum was most effective and therefore it was selected for the third phase of clinical trials. In the Czech Republic a clinical investigation was made with the objective to verify published data on the success of treatment, evaluate undesirable effects and consider whether it is suitable for routine use. Cisplatinum (Platidiam Lachema) was administered--80 mg/m2 on the first day, vinorelbine (Navelbine Pierre Fabre)--30 mg/m2 on the first and eighth day. The cycle was repeated on the 22nd day. All patients were treated for 12 weeks. Then followed the first evaluation and treatment was continued only in patients with regression or stabilization of the disease. In the group of 126 patients in 44 (35%) partial and in 3 (2.3%) complete therapeutic responses were obtained. In 35 (27%) the disease was evaluated during treatment as stabilized, in 38 (30%) of the patients the disease progressed despite treatment. The tolerance of treatment was, when effective antiemetic treatment was used (ondansetrone or granisetrone), relatively satisfactory.

The limits of surgical treatment of non-small cell lung cancer.

Between January 1, 1991 until December 31, 1996, 286 patients with non-small cell lung cancer were diagnosed and treated in the Department of Tuberculosis and Respiratory Diseases and Palliative Care Unit in Babice nad Svitavou, Czech Republic. There were 251 (87.8%) males and 35 (12.2%) females. The mean age of the whole group was 63.8 years. According to TNM staging (regarding the locoregional extension of the disease) as the only criterion 112 patients (39.2%) were eligible for surgical resection of primary lung tumour. However lung surgery was performed in 57 patients (19.9%) with successful radical resection in 49 cases (17.1%) out of 286. Surgical procedure was contraindicated in 55 (49.1%) out of 112 potentially resectable patients mostly because of limited cardiopulmonary function. The strategy of neoadjuvant treatment before the resection of lung tumour was used for 12 (4.2%) patients. Chemotherapy, radiotherapy or the combination of both treatment modalities was used in 121 (42.3%) patients. Symptomatic therapy alone was chosen in 104 (36.4%) cases. The performance of radical resection of lung tumours resulted in a significant influence on the overall survival in the subgroup of all patients with potentially locoregionally operable disease according to the TNM staging. The median survival period reached 17 months if radical resection was done compared to 8.5 months if radical resection was not performed. This difference is statistically significant, p = 0.05.

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.