Development and psychometric validation of a brief comprehensive health status assessment scale in older patients with hematological malignancies: The GAH Scale.

OBJECTIVES: The purpose of this study was to develop a new brief, comprehensive geriatric assessment scale for older patients diagnosed with different hematological malignancies, the Geriatric Assessment in Hematology (GAH scale), and to determine its psychometric properties. MATERIALS AND METHODS: The 30-item GAH scale was designed through a multi-step process to cover 8 relevant dimensions. This is an observational study conducted in 363 patients aged≥65years, newly diagnosed with different hematological malignancies (myelodysplasic syndrome/acute myeloblastic leukemia, multiple myeloma, or chronic lymphocytic leukemia), and treatment-naïve. The scale psychometric validation process included the analyses of feasibility, floor and ceiling effect, validity and reliability criteria. RESULTS: Mean time taken to complete the GAH scale was 11.9±4.7min that improved through a learning-curve effect. Almost 90% of patients completed all items, and no floor or ceiling effects were identified. Criterion validity was supported by reasonable correlations between the GAH scale dimensions and three contrast variables (global health visual analogue scale, ECOG and Karnofsky), except for comorbidities. Factor analysis (supported by the scree plot) revealed nine factors that explained almost 60% of the total variance. Moderate internal consistency reliability was found (Cronbach's α: 0.610), and test-retest was excellent (ICC coefficients, 0.695-0.928). CONCLUSION: Our study suggests that the GAH scale is a valid, internally reliable and a consistent tool to assess health status in older patients with different hematological malignancies. Future large studies should confirm whether the GAH scale may be a tool to improve clinical decision-making in older patients with hematological malignancies.

[Alveolar rhabdomyosarcoma with massive infiltration of the bone marrow as its initial manifestation]. / Rabdomiosarcoma alveolar con infiltración masiva de medula ósea como manifestación inicial.

We report a case of alveolar rhabdomyosarcoma (AR) with massive infiltration of bone marrow at presentation, and initial diagnosis in bone marrow aspirate. A 35 year old man presented with a submandibular mass, and hematomas after mild traumatisms. Peripheral blood showed thrombocytopenia and a normocytic anaemia. Bone marrow film showed diffuse involvement by undifferentiated blasts with rhabdomyoblastic features. Subsequent biopsy of submandibular lymph node confirmed the diagnosis with positivity for specific muscle actin and desmin, and negativity for lymphoid markers. Initial presentation of AR with extensive bone marrow involvement is extremely rare, and it could lead to wrong diagnosis and treatment of acute leukaemia, with the serious consequences that this would have. Immunohistochemical study and morphologic differential features can be of great diagnostic help.

[Alloimmunization in polytransfused patients. Usefulness of selecting erythrocytes compatible with antigens different from ABO and D]. / Aloinmunización en pacientes politransfundidos. Utilidad de seleccionar hematíes compatibles para antígenos differentes al ABO y D.

PURPOSE: Antibody formation against red blood cells' antigen is a very important complication due to transfusions, and it can make the following transfusions difficult. To avoid this, it has been proposed giving identical red blood cells for the antigens more frequently involved in sensitizations. To evaluate this fact, we have accomplished a study with the transfused patients in our Hospital since 1990. MATERIAL AND METHODS: 10,308 transfused patients in the Hospital Nitra. Sra. de Covadonga (Oviedo), between January 1990 and March 1994, were studied. The patients have been included in two groups: The first one was constituted by 4,226 patients from the Haematology and the Nephrology Departments, who received red blood cells units compatible with ABO and CcDEe antigens. The second group was formed by the remainding patients transfused with red blood cells compatible only with ABO and D antigens. RESULTS: All 165 antibodies were detected in 132 patients, which means an incidence of 1.3 percent. In 63 cases, antibodies were present before the first transfusion. In the remaining patients, an allosentitization of 0.2 percent in group 1 and 1 percent in group 2 (p < 0.0001) was shown. This difference cannot be explained only for transfusing red blood cells with the same Rh phenotype in the group 1, because a lower immune response had persisted when we analyzed the other antibodies. More than 70 percent of antibodies appeared before the 10th transfusion. DISCUSSION: A lower sensitization exist in the patients of group 1. This seems to be caused by a state of immunosuppression for their disease or their treatments. However, in some patients, the risk of allosensitization persists, so we think it is a good practice to transfuse red blood cells without the most immunogenic antigens in haematological and nephrological patients who already have one antibody.

[Chronic posttransfusion graft-vs-host disease in a patient with non-Hodgkin's lymphoma]. / Enfermedad de injerto contra huésped postransfusional en un paciente con linfoma no Hodgkin.

We report a case of a graft-versus-host disease (GVHD) in a patient with non Hodgkin Lymphoma who received multiple blood transfusion for anemia and thrombocytopenia. Although WBC-reduction filters were used, the patient developed a transfusion associated graft-versus-host disease. We do not recommend WBC-reduction filters to prevent postransfusional-GVHD.