Improvement in quality of life for cancer patients treated with epoetin alfa.

Anaemia is a common complication of cancer and cancer therapies, and fatigue is one of the most common symptoms of anaemia, disrupting functional performance and reducing overall quality of life. The positive effects of treating renal patients with recombinant human erythropoietin are well documented. This case report series details the specific effects of fatigue on individual patients with cancer and their way of life, and describes their significant improvement in lifestyle following the reversal of anaemia using recombinant human erythropoietin, epoetin alfa.

Haematologists' approaches to the management of adolescents and young adults with acute leukaemia.

Approaches to the management of adolescents and young adults with acute leukaemia were investigated by sending a questionnaire to hospitals identified as having diagnosed or treated patients aged 15-29 years. The responses demonstrated the types of hospital treating these patients, the haematologists' perceived practice for entry of patients to Medical Research Council (MRC) leukaemia trials and reasons for non-entry. Data were linked to MRC trials data to determine the proportion of patients aged 15-29 years at diagnosis in responding hospitals actually treated in MRC leukaemia trials in the 5 years preceding the questionnaire. Eighty-two per cent of haematologists stated that they entered patients 'always' or 'whenever possible' for acute myeloid leukaemia (AML) and 76% for acute lymphoblastic leukaemia (ALL), but actual entry rates from the study hospitals were 46% of 239 AML patients and 36% of 182 ALL patients. The reasons most commonly reported for not entering eligible patients to national leukaemia trials were clinician preference for one arm of an MRC trial, a regional study or non-trial protocol, and concern about workload and ethical approval.

Patterns of care and survival for adolescents and young adults with acute leukaemia--a population-based study.

We report a population-based study of patterns of care and survival for people with acute leukaemia diagnosed at age 15-29 years during 1984-94 in regions of England and Wales covered by specialist leukaemia registries. There were 879 patients: 417 with acute lymphoblastic leukaemia (ALL) and 462 with acute myeloid leukaemia (AML). For ALL, actuarial survival rates were 43% at 5 years after diagnosis and 37% at 10 years. Survival improved significantly between 1984-88 and 1989-94 for those aged 15-19 at diagnosis. Patients entered in national clinical trials and those not entered had similar survival rates. Survival rates were similar at teaching and non-teaching hospitals and at hospitals treating different numbers of study patients per year. For AML, survival rates were 42% at 5 years after diagnosis and 39% at 10 years. Survival improved significantly between 1984-88 and 1989-94. Patients entered in the Medical Research Council AML10 trial had a higher survival rate than those who were in the earlier AML9 trial. Survival did not vary with category of hospital. We conclude that survival has improved for adolescents and young adults with acute leukaemia but that there is at present no evidence that centralized treatment results in a survival benefit for patients in this age group.

Infectious mononucleosis complicated by haemolytic anaemia due to the Donath Landsteiner antibody and by severe neutropenia.

A young man developed infectious mononucleosis complicated by profound anaemia due to haemolysis. The Donath Landsteiner antibody was found in his serum. He was treated successfully by blood transfusion but subsequently developed severe neutropenia. Both complications have been reported previously but not in the same individual. No underlying immune deficiency could be identified.

Survival in adult leukaemia.

The evaluation of treatment and outcome in adult leukaemia requires unselected data. Such data is available from one Health Region in the United Kingdom with an adult population of 3.1 million. In the period July 1982 to December 1989, 676 cases of acute myeloid leukaemia (AML), 136 of acute lymphoblastic leukaemia (ALL) and 141 of chronic granulocytic leukaemia (CGL) were registered. The median survival for AML was 21 weeks and 26% of these patients died within 4 weeks of diagnosis. For ALL, the corresponding figures were 81 weeks and 21%. In CGL, the median survival was significantly different for males and females: 113 weeks and 173 weeks respectively. The 5-year survival in AML was 9%, in ALL, 31% and in CGL, 29% (20% for males, 45% for females). Age at presentation was the single most powerful prognostic factor and probably accounts for survival differences between patients referred to tertiary centres and those treated in district general hospitals. (DGH). Survival may be improving overall as supportive care improves.

Mitozantrone and cytosine arabinoside as first-line therapy in elderly patients with acute myeloid leukaemia.

We have prospectively evaluated a regimen of mitozantrone and cytosine arabinoside (Ara-C) as first-line therapy in elderly patients with acute myeloid leukaemia (AML). One hundred and four patients with a median age of 68 (range 60-81) were studied, in whom 86 had de-novo AML, and 18 had preceding myelodysplasia or secondary AML. Complete remission was achieved in 64% of de-novo cases, in 28% of MDS/secondary cases, and in 58% overall. The incidence of early death within 28 d of chemotherapy was 11%. The median disease-free survival (DFS) was 11 months with an actuarial DFS of 15% at 43 months. The median overall survival was 9 months with an actuarial survival of 10% at 44 months. The incidence of non-haematological toxicity was acceptably low, and usually of mild to moderate severity. Quality of life was improved, or unchanged, in 90% of responders. We conclude that mitozantrone and ara-C is an effective and well-tolerated regimen which produces high remission rates in elderly patients with AML.

A tongue resection in macroglossia due to primary amyloidosis.

A lady of 62 years with longstanding macroglossia from primary amyloidosis had the anterior two-thirds of her tongue successfully resected. She had Factor X deficiency. The surgical, anaesthetic and haematological problems encountered are described.

Lung cancer, immune thrombocytopenia and the lupus inhibitor.

This case report describes the simultaneous occurrence of autoimmune thrombocytopenia and the lupus anticoagulant in a patient with primary adenocarcinoma of the bronchus. Treatment with corticosteroids and plasmapheresis resulted in a return to normal of the partial thromboplastin time and the disappearance of the platelet antibodies. The carcinoma was inoperable.

T activation haemolysis and death after blood transfusion.

A 30 week gestation infant developed necrotising enterocolitis associated with Clostridium perfringens septicaemia at 3 weeks of age. He responded to treatment with intravenous fluids, antibiotics, and blood, but his blood haemolysed. Because of anaemia further blood was given, but, within minutes he died. Examination of his red cells showed an increase in T activation.

Progressive multifocal leukoencephalopathy, myelodysplastic syndrome type II and prostatic carcinoma.

A case is described of progressive multifocal leukoencephalopathy (PML) occurring in a man with myelodysplastic syndrome type II (MDS II) and prostatic carcinoma. This is the first case, to our knowledge, of the association of PML with MDS II.

Positive direct antiglobulin test in normal individuals.

65 normal, healthy people with a positive direct antiglobulin test (DAT) have been identified in a population of blood donors over a period of 14 years. 32 of them have been recalled for detailed study. A strong positive correlation with increasing age was noted, comparable to that seen in hospital patients with a positive DAT. No feature known to cause a positive DAT was identified in the healthy individuals, only 1 of whom went on to develop autoimmune haemolytic anaemia.

The fragility of normal and abnormal erythrocytes in a controlled hydrodynamic shear field.

Fresh human erythrocytes (suspended in a compatible isotonic viscous saline medium containing plasma) were disrupted by the uniform shear stresses generated in the laminar flow field of a conventional cone and plate viscometer. A range of normal fragilities was established and blood samples from patients having certain well-defined haematological abnormalities were found to be partially or completely outside these limits. The present technique is sensitive enough to distinguish between young and old cell fractions isolated from the same original population and also appears to be able to resolve discrete sub-populations having different mechanical fragilities within unfractionated samples from certain patients (e.g. macrocytosis). This technique provides additional information which could aid or facilitate diagnosis and might eventually form the basis of a routine screening test in clinical haematology.

The fragility of normal and abnormal erythrocytes in a controlled hydrodynamic shear field

Fresh human erythrocytes (suspended in a compatible isotonic viscous saline medium containing plasma) were disrupted by the uniform shear stresses generated in the laminar flow field of a conventional cone and plate viscometer. A range of normal fragilities were established and blood samples from patients having certain well-defined haematological abnormalities were found to be partially or completely outside these limits. The present technique is sensitive enough to distinguish between young and old cell fraction isolated from the same original population and also appears to be able to resolve discrete sub-populations having different mechanical fragilities within unfractionated samples from certain patients (e.g macrocytosis). This technique provide additional information which could aid or facilitate diagnosis and might eventually form the basis of a routine screening test in clinical haematology.(AU)

Formaldehyde induced anti-N: a possible cause of renal graft failure.

Treatment of human red cells with low concentrations of formaldehyde induces an antigenic change which makes them react very strongly with the anti-N sera found in certain patients treated by haemodialysis. This supports the idea that formaldehyde sterilisation of reusable home dialysers leads to the development of anti-N in these patients' sera. The clinical problems produced by this antibody are discussed together with ways of overcoming them.