An evaluation of factors predicting long-term response to thalidomide in 234 patients with relapsed or resistant multiple myeloma.

The aim of this study was to assess the prognostic value of pretreatment clinical and laboratory parameters in refractory or relapsed multiple myeloma (MM) patients who have a long-term response to thalidomide (THAL), lasting at least 18 months. The study was carried out on 234 patients who received THAL for relapsed/refractory myeloma. Out of the 234 patients, 129 patients (55.1%) responded to THAL with a mean response duration of 11.9 months (ranging from 1 to 48) and an overall survival rate of 20.3 months (ranging 1-55 months). In 64 patients (27.4% of the whole group), the response to THAL lasted > or =18 months with a mean response lasting 24 months. Statistical analysis of the group of nonresponders and patients with long-term response to THAL showed a significantly higher serum albumin level (P=0.0003) and haemoglobin level (P=0.05), as well as a lower beta2 microglobulin (beta2M) (P=0.022), LDH (P=0.045) serum level in patients with long-term response. In this study, the LDH and serum albumin level were predictors for response to THAL therapy. The beta2M serum level was not a predictor for response to THAL. The albumin serum level was the best parameter distinguishing the group of patients with long-term response to THAL from the entire responding group (P=0.02).

[Evaluation of blood morphology in patients with refractory multiple myeloma treated with thalidomide]. / Ocena morfologii krwi u chorych z opornym na leczenie cytostatyczne szpiczakiem plazmocytowym poddanych terapii talidomidem.

Thalidomide, a derivative of alpha-N-phthalimidoglutarimide acid, was withdrawn from the market in the 1960s because of severe birth defects. Recent reports have suggested antiangiogenic and antitumor activity of this drug. We have treated 52 patients with refractory multiple myeloma at age from 32 to 79 years (mean 63) with thalidomide at a dose of 200-400 mg daily. Out of the group of 52 patients, 27 patients (52%) responded to the therapy, in 25 patients (48%) a response was not achieved (decline in monoclonal protein was smaller than 25%). There was a systematic improvement in haemoglobin concentration, erythrocyte count and thrombocyte count during thalidomide therapy. Leukocyte count showed an inclination to decrease, however observed changes were not statistically significant. The improvement in morphotic parameters of blood was observed both in responder and nonresponder patients.

[Laparoscopic splenectomy with a postero-lateral approach in patients with idiopathic thrombocytopenic purpura]. / Splenektomia laparoskopowa z dostepu tylno-bocznego u chorych z maloplytkowoscia samoistna.

UNLABELLED: The aim of the study is presentation of operative technique and early results of laparoscopic splenectomy in 15 cases of idiopathic thrombocytopenic purpura (ITP) patients resistant to typical steroid therapy. There were 7 women and 8 men in age 16-58 years (mean 32.6 years). Preoperative investigations revealed accessory spleens in two patients. Platelets count at the time of qualifying patients to splenectomy varied from 7-35 g/L and after preoperative treatment (prednisone 1 mg/kg--6 patients, methylprednisone 25 mg/kg--5 patients, immunoglobulins 2.0/kg--2 patients, immunoglobulins and methylprednisone--2 patients) varied from 36-205 g/L. Splenic length was from 8-17 cm. The lateral approach and 4-5 ports were utilized in all cases. Pneumoperitoneum with value of 12-14 mmHg of carbon dioxide was created using an open technique. First step of the procedure was to free spleno-colic ligament, then spleno-reno attachment. In all cases the hilus artery, vein and short gastric vessels were clipped and divided by Endo GIA stapler 30 or 60 mm and clips. Spleens were removed from the abdomen cavity in the plastic bag after manual/forceps crushing inside the bag. Intraoperative bleeding occurred in 2 patients (20%). Blood loss was about 800 and 1000 ml respectively. The mean operative time was 170 min (140-300 min). Spleen weight was 210 g average. In 3 cases conversion to open approach was needed because of injury of splenic vessels (2 pts.) and difficulty in removing spleen--in 1 patient. Post operative course was uneventful in every 10 patients. Mean hospital stay was 5.8 days. Increase in platelet count was observed in 14 patients on the second postoperative day to 60-291 g/L. One patient did not response as expected. No early postoperative complications were observed. CONCLUSION: Laparoscopic splenectomy may be considered as a safe and feasible procedure in selected patients with ITP without long-term improvement after typical conservative treatment.

[A case of multiple myeloma with an aggressive course and multiorgan plasmocytic involvement]. / Przypadek szpiczaka mnogiego o agresywnym przebiegu z wielonarzadowym naciekiem plazmatycznym.

A 51 year old female patient has been diagnosed for IgG lambda multiple myeloma. In spite of treatment an aggressive course of the disease has been observed. The autopsy revealed multiorgan plasmocytic infiltrates.

[The level of erythropoietin in patients with anemia and myeloma multiplex treated with erythropoietin]. / Poziom erytropoetyny u chorych ze szpiczakiem mnogim i niedokrwistoscia leczonych erytropoetyna.

6 patients with anaemia associated with myeloma multiplex were treated with human recombinant erythropoietin (rHuEPO, Exprex*) at a dose of 150 units/kg s.c. three times a week for 12 weeks. A good response, defined as an increase of hemoglobin > 20 milligrams above the pretreatment level, was achieved in 4 patients. The erythropoietin serum concentration was measured four times in each patient: twice before commencing and twice after completing the treatment. In patients who responded to rHuEPO therapy the Epo serum concentration decreased whereas in non-responders increased.

2-Chlorodeoxyadenosine treatment of patients with chronic lymphocytic leukaemia associated with autoimmune haemolysis.

7 patients with chronic lymphocytic leukaemia (CLL) associated with autoimmune haemolysis were treated with 2-chlorodeoxyadenosine (2-CdA) in 0.14 mg/kg/day 2 hour infusion for 5 consecutive days. 2 patients had concurrent immune thrombocytopenia. All patients received prior therapy and either failed or the continuation of prior therapy was contraindicated. The median follow up was 8 months. 5 patients responded: 2 patients experienced complete remission (for 3 months), 3 patients experienced partial remission; 2 patients did not respond. However the decrease of haemolysis was achieved in 6 patients. Therapy was well tolerated. Myelosupression associated with severe infections was the main toxicity. Our results show that 2-CdA may induce remission and resolution of haemolysis in some patients with CLL and concurrent autoimmune haemolytic anaemia.