Aims-To determine a concentration of ferritin below which the possibility of iron deficiency should be considered in elderly patients. Methods-Consecutive new referrals to a geriatric unit (n = 472) were studied prospectively. Full blood count, ferritin, serum vitamin B12 and red cell folate were measured for all patients. A blood film was assessed independently by three haematologists for features of iron deficiency. For those with ferritin of 12-45 nglml, bone marrow aspirates were performed and examined for the presence of stainable iron. When possible, a trial of oral iron was given to those with ferritin of < 45 nglml and response was determined by remeasurement of full blood count and ferritin after a minimum of three weeks of treatment. Results-Bone marrow examination was performed in 32 patients with ferritin of 12-45 nglml, of whom 27 (84%) had absent stainable iron, suggesting that most elderly patients with ferritin in this range have iron deficiency. Compared with those with ferritin of 100-299 ng/ml, in whom iron stores were presumed to be normal, patients with ferritin of nglml had a significantly lower mean haemoglobin and mean red blood cell volume. Furthermore, patients with ferritin up to 75 ng/ml had a significantly higher mean red cell distribution width, and were more likely to have an iron deficient blood film. Conclusion-Iron deficient erythropoiesis can occur in elderly patients with ferritin up to 75 nglml. This is much higher than the lower limit of the "normal" range usually quoted for younger subjects; this difference should be taken into account when ferritin concentrations are interpreted in elderly patients. ( Clin Pathol 1993;46:857-860)
Apart from possibly in the best-prognosis group, where results are equivalent, ChlVPP/EVA hybrid produces significantly better FFP, EFS, and OS than VAPEC-B in patients with previously untreated Hodgkin's disease.
Summary
Whilst infusional vincristine, adriamycin and dexamethasone (VAD) is an effective treatment for patients with multiple myeloma (MM), administration may be complicated by line‐associated infections and thromboses. The oral regime, Z‐Dex (idarubicin and dexamethasone) has been shown to be efficacious in MM. We conducted a randomized study comparing Z‐Dex with VAD as induction therapy in newly diagnosed MM patients. A total of 106 patients (median age, 56 years; range: 37–73; Durie‐Salmon stage II/III) were randomized to receive four to six cycles of Z‐Dex or VAD. Central line complications were reported in 38 patients on 57 cycles, primarily because of infection. Neutropenia (all grades) was more common in the Z‐Dex arm (P = 0·009) although grade III/IV neutropenia was not significantly different between the treatment groups (P = 0·06). Infections (all grades) were more commonly seen in the VAD arm (P = 0·001) although grade III/IV infections were not significantly different between the two groups (P = 0·081). The responses to therapy (complete/partial response) in evaluable patients were: VAD 74% vs. Z‐Dex 58%, with an estimated difference in response of 16% (95% CI −2–33, P = 0·075). VAD recipients (15%) suffered early treatment‐related mortality compared with 12% of Z‐Dex recipients. Overall, 45 patients have died: disease progression (Z‐Dex n = 13, VAD n = 10), regimen‐related toxicity (Z‐Dex n = 2, VAD n = 2), infection (Z‐Dex n = 0, VAD n = 3), other causes (Z‐Dex n = 7, VAD n = 2), unknown (Z‐Dex n = 3, VAD n = 2). This study demonstrated that Z‐Dex might be a suitable oral alternative to VAD for treating newly diagnosed MM patients, although definitive evidence for equivalence is not provided.
The prognostic value of CD34 expression on leukaemic blast cells was assessed in 38 patients with acute myeloid leukaemia. Nineteen patients had more than 10% CD34 positive blast cells. Median survival for the CD34 positive patients was 125 days and for the CD34 negative patients the median survival has not yet been reached at day 575 (p = 0.06). Of those patients who received intensive chemotherapy, CD34 positive patients (n = 13) had a median survival of 150 days while for CD34 negative patients (n = 14) the median survival has not yet been reached (p = 0.01). Adjustment for age and pre-existing myelodysplastic syndrome did not affect the correlation of CD34 positivity with survival (p = 0.02). Over the period of observation (median 10 months, range 2-19 months) the relative risk of death was 5 times greater for the CD34 positive patients. This study suggests that CD34 expression is an adverse prognostic marker, independent of age and pre-existing myelodysplasia.
We thank Ms S Nip-Vlieg and Ms J Jacobs for their skilful technical help. This report is a part of the study on post-transfusion hepatitis, financed b Ethe Prevention Fund of the Netherlands.
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