Introduction:The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous.Aim:To analyze the prognostic parameters of AML at presentation.Methods:The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10/9/l and ≥50x10/9/l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10/9/l and ≥100x10/9/l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high–dose chemotherapy/stem cell transplantation – autologous and HLA matched, related, allogeneic, together and separately).Results:The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10/9/l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10/9/l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10/9/l and ≥100x10/9/l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups.Conclusions:Female sex, the WBC count >50x10/9/l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.
C hronic eosinophilic leucemia (CEL) is a very rare form of leucemia in the western world. Adequate response is seldomly achieved after treatment with corticosteroids, interferon-alfa (INF-alfa) and medications containing hydroxi-urea (Litalir). The study presents a patient with CEL with no initial therapeutic response to the use of corticosteroids, INF-alfa and hydroxi-urea, and with neither clinical nor hematological response. After setting a diagnosis of CEL, patient was ordinated Imatinib (Glivec tabbletes) in a daily dose of 200 mg. Two days afterwards there was an evident withdrawal of subjective and clinical symptoms of disease, and the complete blood count showed significant amendment.
B-chronic lymphocytic leukemia (B-CLL)/Small lymphocytic lymphoma (SLL) is a neoplastic, lymphoproliferative disease, characterized by accumulation of small, mature lymphocytes of the B-cell line in the blood, bone marrow and lymphoid tissues. CLL and SLL are different manifestations of the same disease. The major difference is that in CLL a significant number of the abnormal lymphocytes are also found in the bone marrow and blood, while in SLL the abnormal lymphocytes are predominantly found in the lymph nodes and bone marrow. B-CLL is the commonest leukaemia in adults in the Western countries. The mean age of occurrence is in the range of 64-70 years. Adequate immunophenotyping of peripheral blood is essential for establishing the diagnosis of CLL/SLL. The typical immunophenotype for CLL/SLL is CD5+, CD10-, CD19+, and CD20 dim, surface immunoglobulin dim, CD23+, CD43 +/-, and cyclin D1-. The clinical course of the disease is highly variable. Approximately 2-10% of patients with CLL/SLL will develop histologic transformation to diffuse large B-cell lymphoma or Hodgkin lymphoma. This transformation is called Richter's syndrome and involves a much more aggressive disease and a fatal outcome. During the past decade, numerous prognostic factors were identified and include serum markers such as thymidine kinase and beta-2 microglobulin, genetic markers including IGHV mutational status and cytogenetic abnormalities detected by FISH (e.g., del(13q), del(11q), del(17p), CD38 expression, CD49d and ZAP-70 expression/methylation). During the last few years, recurrent mutations in NOTCH1, SF3B1 and BIRC3 genes with prognostic implications in CLL were also identified. Minimal residual disease (MRD) negativity determined in the peripheral blood after the end of treatment is emerging as an important predictor of treatment efficacy. Ongoing preclinical and clinical studies will unravel newer therapeutic targets and keep on improving patient outcomes and the quality of life.
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