The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits.

A comparative study of some immunologic aspects and hormonal balance was performed on 49 multiple myeloma (MM) patients and 29 healthy persons. Functional immunoregulatory imbalances were evident in the majority of patients with MM, as demonstrated by a significant reduction in the mitogenic response of peripheral blood lymphocytes (PBL) to phytohemagglutinin, increased mean stimulation indices of PBL to pisum sativatum agglutinin, wheat germ agglutinin (WGA) and dextran sulphate. Our results appear to provide important evidence in support of the existence of hormonal imbalance in MM: increased cortisol levels, augmented concentrations of follicle stimulating hormone, luteinizing hormone and 17 beta-estradiol and an increased estrogen to androgen ratio in male patients; decreased estrogen values and estrogen to androgen ratios were evident in female patients. Triiodothyronine and thyroxine mean concentrations were also found to be markedly diminished in MM patients. Our studies suggest some potentially important interactions between the immune and endocrine systems in multiple myeloma.

Summary Helicobacter pylori (H. pylori) infection is associated with peptic ulcer disease and gastric cancer. The eradication of H. pylori is of special interest in patients with congenital bleeding disorders, for whom treatment of gastrointestinal hemorrhage with factor concentrates is costly. The prevalence of H. pylori varies between different populations and identification of high-risk subgroups may allow for more targeted screening and eradication of the infection. We performed a 5-year retrospective study of gastrointestinal bleeding, combined with screening and treatment for H. pylori and a long-term prospective follow-up in 168 Swedish and 23 Estonian patients with hemophilia or von Willebrand disease. The prevalence of seropositivity was lower in Sweden than in Estonia (28 versus 48%, p = 0.03), lower in native Swedes than in non-Nordic immigrants to Sweden (20 versus 76%, p = 0.0001) and lower in patients less than 40 years of age than older patients (16 versus 38%, p = 0.002). The incidence of gastrointestinal hemorrhages among the 35 Swedish patients with active H. pylori infection, confirmed by a urea breath test, was 6.0 per 100 patient-years before eradication therapy versus 1.7 during the prospective followup. A negative urea breath test one month after therapy always remained negative after one year. Screening, followed by treatment of all infected patients, yielded a reduction of direct costs over a 5-year period of 130 US-$ per screened patient. We conclude that screening and eradication therapy for infection with H. pylori in patients with congenital bleeding disorders is an effective and economic strategy.

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