[Improvement of prescriptions for serum tumor markers in a general hospital]. / Amélioration de la prescription de marqueurs tumoraux sériques dans un hôpital général.

OBJECTIVES: Using a standardized prescription sheet we attempted to improve requests for serum tumor markers in a general hospital. METHODS: Over two 35-day periods before and one year after defining a local prescription consensus and introducing a new prescription sheet, we counted the number of orders for five tumor markers (CEA, CA 19-9, CA 15-3, CA 125, alpha FP) and determined their compliance to the defined prescription protocol. RESULTS: Between the two study periods, the number of prescriptions for the designated tumor markers fell by 24%, from 153 requests in 94 patients to 123 requests in 99 patients, despite a 6% increase in the number of admissions. There was a significant reduction in the number of serum markers orders per prescription (from 1.6 to 1.2) although the distribution by tumor marker remained unchanged. Compliance to the prescription protocol improved, rising from 65 to 87% in units where the pre-protocol compliance rate was below 80%. The rate of compliance was not correlated with correct completion of the new prescription sheet (91% vs 86% respectively). The 6-month cost-savings was estimated at 31,104 FF using the general French nomenclature for laboratory tests. Direct cost reduction was estimated at 5,688 FF. CONCLUSION: Long-lasting improvement of serum tumor marker prescriptions can be achieved in a general hospital. Obtaining a local consensus implicating all prescribing units seems more important than a change in the presentation of the prescription sheet.

Activity of fludarabine in previously treated Waldenström's macroglobulinemia: a report of 71 cases. Groupe Coopératif Macroglobulinémie.

PURPOSE: There is no consensus on the treatment of patients with Waldenström's macroglobulinemia (WM) who develop primary or secondary resistance to frontline therapies. We report our experience on the activity and toxicity of fludarabine in 71 patients with WM resistant to prior chemotherapy regimens. PATIENTS AND METHODS: From January 1991 to June 1995, 71 patients were included in this retrospective study. The median age, median time from diagnosis to treatment, median immunoglobulin M (IgM) level, and median number of previous treatments were 68 years (range, 42 to 81), 5.9 years (range, 0.6 to 20), 35 g/L (range, 5 to 126), and two (range, one to four), respectively. RESULTS: Seventy-one patients received a median of six courses of fludarabine. Twenty-one (30%) responded with a partial response and 50 (70%) were considered as treatment failures. Forty-six patients died: 10 in the responder group and 36 in the failure group. Twenty-five patients were alive with a median follow-up time of 34 months. The overall median survival time of all treated patients was 23 months. The time to treatment failure was 32 months. The only factor that favorably influenced the response to fludarabine was a longer interval between the first treatment and the start of fludarabine. Pretreatment factors associated with shorter survival in the entire population were hemoglobin level less than 95 g/L (P = .02) and platelet count less than 75 x 10(9)/L (P = .02). CONCLUSION: The responses rate in this population with a poor prognosis is close to that reported in shorter series. Patients with WM who are resistant to alkylating agents should be identified early, so that salvage therapy with nucleoside analogs can be started without delay.

Autologous blood progenitor cell transplantation in high-risk multiple myeloma.

The aim of the study was to evaluate the feasibility and the efficacy of high-dose chemoradiotherapy followed by autologous hematopoietic stem cell support with peripheral blood progenitor cells (PBPC) harvested after high-dose cyclophosphamide (HDCYC) treatment in patients with high-risk multiple myeloma (MM). Inclusion criteria were: age less than 65 years and high-risk MM defined as stage II MM, stage III MM, refractory or relapsed MM. The design of the study was: 1) HDCYC +/- hematopoietic growth factors followed by PBPC collection, and 2) high-dose melphalan combined with total body irradiation (or busulfan for previously irradiated patients) followed by PBPC reinfusion (ABPCT). All 60 patients completed the procedure except two who died from infection after HDCYC and another of acute cardiac failure after reinfusion of PBPC. Out of the 60 evaluable patients, three failed to respond while the other 57 achieved either a partial (n = 33) or complete (n = 24) response. Thirty-one patients progressed or relapsed after a median duration of response of 15 months (range: 3-43). The median follow-up for the other 26 responder patients was 24 months (range: 2-66). Twenty-one patients died, 18 of MM (2 after failure, 16 after relapse) and three responders of lung cancer (n = 1) and infection (n = 2). In conclusion, this study shows that this therapeutic approach is feasible and efficient.

[Treatment of bacterial endocarditis with oral amoxicillin and intra-muscular gentamicin]. / Traitement des endocardites bactériennes par l'amoxicilline orale et la gentamicine intra-musculaire.

Fourteen patients suffering from bacterial endocarditis due to a streptococcus or staphylococcus were treated using a combination of amoxicillin per os in a dose of 1 gram every 2 or 3 hours and gentamicin in a dose of 60 mg intramuscularly every 6 or 8 hours. Two patients failed to tolerate amoxicillin, which had to be replaced by penicillin G. Two others, after a period of improvement, relapsed and were cured by the substitution of penicillin G given intravenously, in place of amoxicillin. The ten remaining patients were cured after a normal period of time had elapsed. Two of them were even treated at home. Bactericidal powers of serum obtained by the combination were satisfactory at between 1/16 to 1/4096 one hour after the administration of the antibiotics. This therapeutic protocol is thus effective, and has the advantage of improving the patient's comfort. It should nevertheless be reserved for use against sensitive organisms in patients without digestive problems, the bactericidal power of the serum being verified.