The hematology journal : the official journal of the European Haematology Association最新文献

Fludarabine monotherapy is an established treatment for chronic lymphocytic leukemia (CLL), achieving superior remission rates compared with other treatment regimens containing alkylating agents or corticosteroids. However, CLL remains incurable and research continues into finding new treatments for this, the most common leukemia in the Western world. Recent research has focused on the use of fludarabine in combination with other chemotherapeutic agents. Studies published to date indicate that regimens containing fludarabine plus cyclophosphamide, with or without mitoxantrone, achieve overall response (OR) rates of 64-100% and complete response (CR) rates of up to 50%. Administration of cyclophosphamide at a lower dosage (< or =300 mg) appears to reduce the risk of myelosuppression without compromising efficacy. Combinations of fludarabine with prednisone or chlorambucil have been shown to be no more effective than fludarabine monotherapy (OR 27-79% with these combinations), while the combination of fludarabine plus cytarabine proved to be less effective than fludarabine monotherapy. Further studies are needed to evaluate the combinations of fludarabine plus doxorubicin and fludarabine plus epirubicin, as results to date have been inconclusive. More trials are also needed to examine a fludarabine, cytarabine, mitoxantrone and dexamethasone combination that has achieved a promising CR rate of 60% in the one trial reported thus far. Taken together, the results obtained so far with fludarabine plus cyclophosphamide suggest that this combination is more potent than fludarabine monotherapy and is able to increase the CR rate, the OR rate, event-free survival and progression-free survival in patients with CLL.

Hepatitis B virus (HBV) reactivation is a potentially fatal complication of chemotherapy in asymptomatic HBV carriers. Prophylactic lamivudine has proven effective for its prevention, but the potential emergence of lamivudine-resistant HBV YMMD mutants, as shown in patients treated for chronic hepatitis, may limit its use. To evaluate the frequency of HBV YMMD mutant and its clinical significance, we have analysed 32 courses of primary lamivudine prophylaxis given to HBV carriers with haematologic malignancies, from the start until 1-5 months after the end of chemotherapy. Lamivudine was used for a median of 6 months (range 2-24+) and median follow-up was 19.5 months (range 5-40). Four episodes of HBV reactivation with mild hepatitis and no evidence of mutant strain occurred after chemotherapy completion and after lamivudine withdrawal. At follow-up YMMD mutant was detected in one patient with normal transaminase levels, who had been on continuous lamivudine for 20 months. In conclusion, among HBV carriers treated with chemotherapy for haematologic malignancies, the emergence of HBV YMMD mutant occurred in 3.1% of prophylactic lamivudine courses and was of little clinical relevance.

To evaluate whether the presence of antiphospholipid antibodies in lymphoma patients influences their response to treatment, and their rate of thromboembolic complications, we followed up 100 consecutive patients with different lymphomas, who underwent measurement of lupus anticoagulants and anticardiolipin antibodies at diagnosis. In all, 27 patients had lupus anticoagulants and/or anticardiolipin antibodies. This prevalence was significantly higher than in a group of 100 age- and sex-matched normal control subjects (8%; P=0.0008, odds ratio 4.25, 95% confidence interval, 1.82-9.92). At diagnosis, antiphospholipid-positive and -negative patients were similar with respect to age, sex, type and staging of lymphomas. During follow-up, the rate of thrombosis was significantly higher in patients with (5.1% patients/year) than without (0.75% patients/year) antiphospholipid antibodies. The two groups were similar with respect to relapse and death rate. In conclusion, antiphospholipid antibodies are associated with lymphomas. Their determination is useful to identify patients at high risk to develop thrombotic complications, but not to predict treatment outcome or disease prognosis.

Multiple myeloma (MM) is an incurable hematological malignancy with an average survival of 3 years with conventional therapy. Allogeneic hematopoietic cell transplantation (allo-HCT) may cure some patients, but has been associated with a very high transplantation-related mortality (TRM) of over 40%.(1) In contrast to allo-HCT, autologous hematopoietic cell transplantation (AHCT) has been much safer, with a TRM <3% in the 1990s. Therefore, in the last 15 years AHCT has become a common procedure for MM patients. The widespread use of AHCT has been associated with a median survival of 55-72 months,(2,3,4,5,6) and two large randomized trials have shown that AHCT is superior to conventional chemotherapy for the treatment of MM.(3,7) Approaches to improve the outcome of stem cell transplantation for MM patients include consideration of patient status, efficacy and toxicity of induction therapy, source of hematopoietic rescue, conditioning regimens, and maintenance therapy. Recent attempts to improve outcome include tandem AHCT, AHCT followed by RIC (reduced intensity conditioning) allo-HCT, and allo-HCT with T-cell depletion and subsequent donor-lymphocyte infusions (DLI), while novel therapies and improved supportive care may improve the overall survival (OS) of all MM patients with or without transplantation.

Abnormalities of TP53 in chronic lymphocytic leukaemia (CLL) correlate with aggressive disease and transformation. We studied 115 patients with CLL including 90 untreated, 25 with heavily pretreated/refractory CLL using fluorescent in situ hybridisation (FISH) to detect allelic loss at chromosome 17p and flow cytometry (FC) to test p53 protein overexpression. A total of 17 cases were identified with TP53 deletion and/or protein expression. Both tests correlated in 10 of 17 patients; in six, one or the other abnormality was detected and in one case, with a deletion, flow cytometry failed. Material for direct DNA sequencing was available in 14 of 17 cases. Mutations were found in seven cases. Five of 14 patients with allelic loss and seven of 13 expressing p53 protein had a mutation. These were single-base substitutions and were located in exons 5, 7 or 8. Mutations were not found in 13 of 14 other cases without deletions by FISH or protein expression. The incidence of p53 abnormalities in this series was 15%, with a significant difference between untreated patients (7%) and the pretreated/refractory group (50%; P<0.01). Abnormal p53 was predicted for shorter survival, regardless of the method used. We confirm that p53 abnormalities are more common in refractory CLL and that mutations occur at the known hot spots. Testing for TP53 deletions by FISH and protein expression by FC is an effective and simple way of screening patients who are likely to have aggressive disease. DNA sequencing adds little to these methods in identifying the population at risk.