Expression IRF/MUM1>25% Predictor to Three-year Survival of Diffuse Large B Cell Lymphoma in the Immunochemotherapy Era.

INTRODUCTION: Non Hodgkin lymphoma-Diffuse large B cell lymphoma (DLBC) is composed of more varieties of one disease. Analysis and understanding of a wide range of characteristics of the disease, which include: clinical, immunohistochemical, cytogenetic and molecular characteristics may improve treatment results. AIM: achieving the estimated three-year survival and influence of IRF/MUM1 expression to three-year survival. MATERIAL AND METHODS: A study was retrospective-prospective, patients were followed for seven years a period of dine. The study included 60 patients de novo DLBCL. Age was 18-72 years old, the average age 45 years, male 31 (51,7%) and female 29 (48.3%). Median follow-up was 47 months (3-91 months). To determine differentiation immunophenotype antibodies those were used anti-CD20, anti-CD10, anti-Bcl-6, IRF-4/MUM1, CD 138. RESULTS: Included the GCB type was 65%. Impact prognostic index IPI>2 GBC vs non GBC p=0,038 X2. Statistically significant difference was confirmed compared to the IPI> 2 to 3 year OS p<0,0005 X2. Significantly longer three-year survival was provided in the group GCB 36 (92,3%) vs. non GCB 8 (38,1%) p=0,003 X2. Clinical and immunohistochemical factors showed a significant impact to three-year survival by univariate: LDH p=0,005, MUM1 p=0,003, while CD10 p=0,069 was confirmed on the level of borderline impact. Using multivariate analysis, expression MUM1 has the greatest impact p<0.0005 OR=0.083 (95% CI 0.23-0.303) on the disease outcome - three-year survival. CONCLUSION: expression MUM1 >25% has the greatest impact on the disease outcome - three-year survival.

Dilemma: Correlation Between Serum Level of Hepcidin and IL-6 in Anemic Myeloma Patients.

INTRODUCTION: Anemia occurs in 60% to 80 % of patients with newly diagnosed myeloma multiplex (MM). The cause of anemia in MM is probably multi factorial and involved among the others hepcidin and some cytokines, especially interleukine-6. Anemia in MM is one of the risk factor used in Durie-Salmon classification for staging and prognostic score. Treatment options are set according to this score with most significant impact on survival. AIM: To estimate baseline level of serum hepcidin, IL-6 and iron metabolism markers in anemic MM patients, possible role of hepcidin and its interaction with IL-6. METHODS: 27 patients with newly diagnosed MM were enrolled in this observational, prospective study and age, gender matched 60 healthy controls. Erythrocyte count, hemoglobin, serum hepcidin, interleukin-6, iron, ferritin and transferrin were measured. RESULTS: Anemia was diagnosed in 70% of MM patients. Serum hepcidin was significantly higher in MM group (55.5 ng/mL) than in control 5.9 ng/mL (p=0000). In myeloma patients serum IL-6 was 3.59 pg/mL, anemic 3.80 pg/mL, non-anemic 0.33 pg/mL, without significant difference. It was not found significant correlation between hepcidin and IL-6 in anemic myeloma patients. CONCLUSION: High level of hepcidin probably causes anemia in MM but its high expression is not due only to IL-6.

Characteristics of autologous peripheral blood stem cells collection over a one-year period.

Aim To present characteristics of collecting autologous peripheral blood stem cells over a one-year period with an emphasis on efficiency and safety. Methods A retrograde analysis of 24 leukapheresis in 20 adult patients with malignant haematological diseases in the Blood Transfusion Institute of the Federation of Bosnia and Herzegovina in Sarajevo, was done. Cell separators Amicus and Spectra Optia were used for collection procedures. Results The patient's age ranged from 27 to 65 years. Target cells were collected in one procedure in sixteen patients, while in four patients they were collected in two procedures. The mean CD34+ collection efficiency was 57.7%. The median number of CD34+ cells and percentage of CD34+ cells in the products were 5.52x10e6/kg (range 3.28-9.00) and 1.57% (range 0.96-2.91). A strong positive correlation was found between the number of CD34+ cells in peripheral blood on the apheresis day and the amount of CD34+ cells collected in the products (rs =0.73). A total of 95% of patients collected the amount of ≥3x10e6/kg and 55% of ≥5x10e6/kg CD34+ cells for a single transplant. A decrease in platelet count, haemoglobin and haematocrit values after the procedure was not significant. Potassium decrease showed statistical significance (p<0.000). Adverse events occurred during one procedure (4.2%). Conclusion A low number of adverse events and good collection efficiency with adequate patient monitoring, indicate that leukapheresis is a safe procedure that is successfully used in the autologous transplantation process in the treatment of malignant haematological diseases.

Initial values of donor hematocrit and efficiency of plateletpheresis.

CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: The collection of platelets by apheresis is considered as a very great progress in transfusion medicine. A larger yield (total number of collected platelets) is obtained if the donor has a greater number of initial platelets and if the separation is done in a shorter time. One of the parameters is also the efficiency of the platelet collection (expressed in percentage) on the value of which different factors may have direct or indirect influence. AIMS: To calculate the efficiency of platelet collection with the separator Fenval Baxter AMICUS and to compare the efficiency of platelet collection with this separator in relation to the initial value of donor hematocrit. DONORS AND METHODS: The donors who participated in this study were divided into groups according to the value of the donor's 'hematocrit before separation. Group C consisted of donors whose initial value of the hematocrit was lower or equal to 46%. Group D consisted of donors whose initial value of the hematocrit was higher than 46%. The process was carried out on Fenval Baxter AMICUS. The expected efficiency of the collection was obtained by dividing the total number of collected cells by the expected total number of processed cells, i.e. the total number of cells passed through the equipment. RESULTS: In the 258 separations which satisfied the fixed criteria were men in 226 cases (87.6%) and women in 32 (12.4%). There is a statically significant difference in the platelet value between the groups and this value is higher in group D than in group C. The average value of platelets before separation was 46.66. The range of minimal and maximal value is from 38.8 to 52.4 ±2.78. The initial value of hematocrits of the donor does not intervene in the length of the separation, but it has a significant effect on the efficiency of the platelet collection. Increases in the number of hematocrits significantly decrease the efficiency of platelet collection. In practice it means that we can base on this fact make a better selection of donors. In this kind selection, one should prefer a donor with a higher number of initial platelets and lower levels of hematocrits. In that way we can collect a more important yield, have a shorter length of separation and increase the efficiency of platelet collection. Its advantage is as well medical because of a more important yield but also financial because of the decrease of the length of the separation and the increase in efficiency. Key words: value of hematocrits, donors, apheresis, platelets, efficiency.

[The influence of initial values of donor platelets count on the efficiency of plateletpheresis with the cell separator Fenval Baxter Amicus s.v.2.51]. / Utjecaj pocetne vrijednosti trombocita donora na efikasnost afereze trombocita na celijskom separatoru Fenval Baxter AMICUS s.v.2.51.

INTRODUCTION: The collection of platelets by apheresis is considered as a very great progress in transfusional medicine. A larger yield (total number of collected platelets) is obtained if the donor has a greater number of initial platelets and if the separation is done in a shorter time. One of the parameters is also the efficiency of the platelet collection (expressed in percentage) on the value of which different factors may have direct or indirect influence. AIMS: To calculate the efficiency of platelet collection with the separator Fenval Baxter AMICUS s.v.2.51 and to compare the efficiency of platelet collection with this separator in relation to the initial value of donor platelets. DONORS AND METHODS: The donors who participated in this study were divided into groups according to the value of the donors' number of platelets before separation. Group A consisted of donors whose initial value of the platelet number was higher than 200 but lower than 300 x 109/L Group B consisted of donors whose initial platelet number was higher than 300 but less than 450 x 109/L. The process was carried out on Fenval Baxter Amicus s.v.2.51. The expected efficiency of the collection was obtained by dividing the total number of collected cells by the expected total number of processed cells, i.e., the total number of cells passed through the equipment. RESULTS: In the 258 separations which satisfied the fixed criteria the donors were men in 226 cases (87.6%) and women in 32 (12.4%). The efficiency of platelet collection in our material gave 64.14 +/- 7.92 in the range of minimal and maximal value from 36.65 to 85.22. There is no relation in the correlation between the efficiency of the initial value of the number of platelets. There is no statistical significance in the difference in efficiency of the collection of platelets in the groups A and B. The separations lasted for 44.72 (+/- 9.35) minutes, in group A 49.40 (7.30) minutes and (+/- 8.27) in group B. There is a significant statistical difference (p 0.050; Equal Variance Test P = 0.527). DISCUSSION: The values we have obtained from our material are similar to results from other studies of this procedure with one important difference which is that our results were obtained from a larger number of samples. We did not find any relation in the correlation in the variables, the efficiency of platelet separation or in the value of initial number of platelets. The efficiency of platelet collection is almost the same in groups A and B (64.65 +/- 7.99 in group A and 63.50 +/- 7.83 in group B and there is no statistically significant difference). The difference in time of the separation is statistically significant in the groups A and B. CONCLUSION: The initial value of the number of the donor's platelets has no effect on the efficiency of platelet collection by apheresis but they have effect on the duration of the separation and the value of the yield. With a higher number of the value of platelets we can cut the time of the separation and obtain a greater yield. It is preferable to choose donors with a greater value of the initial number of platelets. In this way it is possible to obtain a greater yield, cut the time of separation and improve the efficiency of platelet collection. This is beneficial both from the medical point of view because of the greater yield and from the financial point of view because of the shorter time of separation and greater efficiency.