[C-reactive protein as a marker of the severity of an infectious process in acute myeloid leukemia patients with neutropenia].

AIM: To determine C-reactive protein (CRP) levels as diagnostic markers of infection in acute myeloid leukemia (AML) patients with neutropenia. SUBJECTS AND METHODS: Sixty-three AML patients (28 men and 35 women) aged 20 to 77 years (median 50 years) were examined. According to the French-American-British (FAB) classification, the types of AML were as follows: M0 (n = 3), M1 (n = 9), M2 (n = 35), M4 (n = 10), and M5 (n = 6). All the patients had chemotherapy-associated neutropenia (granulocytes, less than 0.5.10(9)/l). In different treatment steps, all the patients developed infectious complications (the study analyzed the data of 86 cases). RESULTS: In patients with localized infections (such as mucositis, abscess, pneumonia, etc.) or fever of unknown origin (FUO), the levels of CRP were not statistically significant different, but were significantly higher than in those without infectious complications. The concentrations of CRP did not differ in patients with systemic inflammatory response syndrome (SIRS) and in those with sepsis. At the same time, the level of CRP in systemic infection (SIRS, sepsis) was significantly higher than that in localized infection (p < 0.001). In patients with neutropenia, the median CRP levels were as follows: 7 mg/l (range 0-37; 95% reference interval (RI) 0 to 32) for those without infection 56 mg/l (range 13-104; 95% RI 17 to 104) for those with localized infection or FUO; and 168 mg/l (range 103-399; 95% RI 105 to 362) for those with systemic infection. CONCLUSION: CRP is a marker of the severity of an infectious process in AML patients with neutropenia. The increase of its level more than 32 mg/l serves a valid criterion for the presence of infection and more than 105 mg/l does for that of a systemic inflammatory response in these patients.

[The prognostic indicators of development of ATRA-syndrome under treatment of acute promyelocyte leucosis].

The application of all-trans-retinoic acid (ATRA) in the protocols of treatment of acute promyelocyte leucosis provided the achievement of 95% of full remissions and fast correction of coagulopathy. Besides, ATRA along with positive impact can exert the side effects, among which the most dangerous is the differentiation syndrome. On the basis of analysis of clinical signs, biochemical, hemostasiologic and morphologic blood indicators it is established that among prognostic criteria of differentiation syndrome development are presence of febrile temperature, decrease of content of thrombocytes lesser than 20-109/l (deep degree of thrombocytopenia), prolongation of index of activated partial thromboplastin time relative to norm before treatment start. Apart from this, the following factors also are among such kind of criteria: decrease of hemoglobin after ATRA prescription before differentiation syndrome development, on-going hypofibrinogenemia and deep degree of thrombocytopenia under concurrent increase of content of urea and creatinine as compared with initial values in treatment dynamics.

[Vaccine prophylaxis of viral hepatitis B in patients with acute leukemia].

AIM: To assess efficacy of vaccine against viral hepatitis B (VHB) in adults after achievement of acute leukemia (AL) remission. MATERIAL AND METHODS: Specific prevention of VHB was made in 30 AL patients with recombinant vaccine Engerix B by two schemes: 0-1-2-12 and 0-1-2-6 months with double adult dose 40 mcg. Efficacy of vaccination was evaluated by the titer of antibodies to HBs-Ag (HBs-Ab) 1 month after each injection of the vaccine. The control group consisted of 36 patients. Follow-up was 6 months to 10 years. RESULTS: Vaccine prophylaxis of VHB in AL remission resulted in appearance of the protective antibody titer after the forth vaccine injection in 50% patients. Out of 30 vaccinated patients 2 (6.7%) got infected with HBV 3 and 5 years after onset of the disease. Markers of HBV replication were detected in 8 (22%) of 36 patients. CONCLUSION: Vaccine prophylaxis of VHB in adult patients in AL remission was effective in 93.3% of the vaccinated patients.

[Hemostatic changes during the treatment of acute promyelocytic leukemia with all-transretinoic acid]. / Izmenenie gemostaza pri lechenii ostrogo promielotsitarnogo leikoza polnost'iu trans-retinoevoi kislotoi.

AIM: To study hemostasis in ATRA treatment of acute promyelocytic leukemia (APL). MATERIAL AND METHODS: Hemostasis was studied in 8 newly admitted APL patients treated with ATRA. All of them had hemorrhages, thrombocytopenia 5-15 x 10(9)/l at diagnosis, laboratory signs of the DIC syndrome at induction therapy. RESULTS: Hemorrhage arresting was seen on the ATRA therapy day 14 to 30. Duration of thrombocytopenia under 20 x 10(9)/l was 5.8 +/- 1.8 days. After 7 days of ATRA therapy coagulation tests improved with some hypercoagulation tendency. Subsequent condition of hemostasis was considered as normo/hypercoagulation accompanied by constant thrombin persistence (in the presence of FDP) and depression of hageman-dependent fibrinolysis even in remission. A case of ileofemoral thrombosis followed by fatal thromboembolism of the pulmonary artery is reported. CONCLUSION: It is suggested to use heparin, especially low molecular weight heparin when there are signs of hypercoagulation in APL patients.

[Combination of interferon-alpha and all-trans-retinoic acid as a treatment for maintaining remission in high-risk group patients with acute myeloid leukemia]. / Sochetanie interferona-alpha i polnost'iu trans-retinoevoi kisloty v kachestve programmy terapii podderzhaniia remissii u bol'nykh ostrymi mieloidnymi leikozami iz gruppy vysokogo riska.

AIM: To evaluate the efficiency of combination of interferon-alpha (INF) and all trans-retinoic acid (ATRA) as a treatment for maintaining remission in high risk group patients with acute myeloid leukemia (AML). MATERIALS AND METHODS: Three-day INF + ATRA course was administered every 3 months to 22 patients with AML from high risk group (impossibility of drug therapy during the first complete remission, resistant forms of AML, relapses, secondary AML, acute promyelocytic leukemia after attaining molecular remission). RESULTS: INF + ATRA during remission maintained a long first complete remission (median 18 months) in patients with primary AML after small-volume drug therapy, led to long first and second complete remissions (median 12 months) in patients with resistant AML, and induced and maintained molecular remissions in patients with acute promyelocytic leukemia.