Azacitidine Use After Allogeneic Stem Cell Transplantation-Results From the Polish Adult Leukemia Group.

BACKGROUND: Relapse of primary hematologic disease constitutes an important reason for failure of allogeneic hematopoietic stem cell transplantation (alloHSCT). There are very few treatment modalities for this indications. Therefore, there is a need for novel effective therapies and even more for the prevention of relapse. There are scarce data that azacitidine can be used for these purposes. METHODS: At the Polish Adult Leukemia Group, we retrospectively analyzed the results of azacitidine treatment after alloHSCT. Relapsing patients, patients with minimal residual disease/mixed chimerism, and patients in complete remission with high risk of relapse were analyzed separately. There were 17 patients, 6 with myelodysplastic syndrome, 11 with acute myeloid leukemia, 8 male, and overall median age of 56 years (range, 15-78); 7 patients received donor lymphocyte infusion (DLI). RESULTS: Patients treated because of relapse received a median of 3 (range, 1-6) cycles of azacitidine, patients receiving preemptive treatment received a median of 4 cycles (range, 2-6), and those on maintenance received a median of 5 cycles (range, 3-5). Toxicity was considerable, especially in relapse-neutropenia (67%), anemia (67%), thrombocytopenia (100%), serious infections (78%)-and preemptive settings. Median overall survival of patients treated for relapse reached 6.8 months (95% confidence interval [CI], 0.7-∞), with better survival observed in patients with temporary disease control (7.7 vs 4.7 mo) and without previous exposure to azacitidine (7.7 vs 3.4 mo). One-year overall survival reached 75% (95% CI, 13%-96%) for preemptive and 50% (95% CI, 0%-91%) for maintenance treatment. DLI did not aggravate graft-versus-host disease. CONCLUSIONS: Effectiveness of azacitidine in relapsing patients is disappointing. Azacitidine seems to be promising in preemptive and maintenance settings. Toxicity is considerable. Further research is needed.

Moderate hemodilution technic in surgical procedures. Blood electrolyte balance in patients undergoing operation for gastric and duodenal ulcer.

Studies to determine selected blood electrolyte concentrations showed no disturbances in serum sodium, chloride, and copper concentrations during and after moderate hemodilution to 30 per cent of hematocrit. Sudden significant decreases in serum potassium, magnesium, and total calcium concentrations at ten minutes after hemodilution were the result of physical dilution only and did not have negative effects on organs, especially the heart. We observed a significant decrease in serum iron concentration with a gradual return to the control value; we cannot explain this phenomenon because it resulted neither from dilution nor blood loss. Our results require that caution be exercised and that the dilution fluid employed be changed when more significant hemodilution (below 30 per cent of hematocrit) is intended, so that suspected, more intensive sudden alterations in electrolyte concentration are prevented.

[Magnesium in the cerebrospinal fluid of patients with chronic uremia]. / Magnez w plynie mózgowo-rdzeniowym u chorych z przewlekla mocznica.

The levels of magnesium were determined in the cerebrospinal fluid if healthy subjects and patients with uraemia. The effect of plasma alkalization with sodium bicarbonate on possible changes of magnesium concentration in the CSF was studied. It was found that in healthy subjects magnesium concentration of the CSF was higher than in plasma, and was increased further in chronic uraemia. Plasma alkalization in uraemia with sodium bicarbonate reduced the concentration of magnesium in the CSF.

Lipid composition of plasma obtained from various parts of the vascular system of the rabbit.

Lipid concentrations were compared in the arterial blood, peripheral venous blood (pinna), and blood from the portal vein, hepatic vein, inferior caval vine and both renal veins (right and left). Greatest differences were found between the arterial blood and venous blood from a peripheral vein and hepatic vein. For assessment of the degree of lipid assimilation by the peripheral tissues simultaneous determination of triglycerides and non-esterified fatty acid concentrations in arterial blood and peripheral venous blood was found to be most useful. Liver ability of lipid synthesis can be measured on the basis of difference in the concentrations of cholesterol, non-esterified fatty acids and phospholipids in the arterial and venous blood leaving the liver. Blood passage through the kidneys had no influence on changes in the lipid concentration.

Acute lymphoblastic leukemia in elderly: the Polish Adult Leukemia Group (PALG) experience.

This is a retrospective, multicenter study to evaluate biological features and outcome of elderly patients diagnosed with acute lymphoblastic leukemia (ALL) during the last 10 years in ten hematological centers in Poland. Eighty-seven patients aged 60 years or older were studied. To our knowledge, this is one of the largest group of elderly patients with ALL evaluated. We have not observed differences in immunological subtypes and Ph chromosome incidence as compared with younger adult ALL presented in the literature. Induction chemotherapy was administered in 75 patients. We observed complete remission (CR) in 34 (45%, 95% CI: 33-56%) patients. Induction death occurred in 11 (15%) patients. Thirty patients (40%) showed primary resistance to chemotherapy. Median overall survival (OS) of all patients was 150 days. Median disease-free survival (DFS) of responding patients was 180 days. We observed four long-term survivors (DFS longer than 3 years) in our group of patients. Factors influencing OS were CR achievement, female gender, and WBC below 30 x 10(9)/l. Male gender was the only prognostic factor negatively affecting probability to achieve CR. We have not observed any differences in either biology or outcome between patients aged 60-69 years and those aged more than 70 years. ALL of the elderly is a rare disease with poor prognosis. Further clinical trials evaluating the disease features, outcome, and new therapeutic approaches are warranted.