Omeprazole significantly decreased clopidogrel inhibitory effect on platelet P2Y12 as assessed by VASP phosphorylation test. Aspirin-clopidogrel antiplatelet dual therapy is widely prescribed worldwide, with PPIs frequently associated to prevent gastrointestinal bleeding. The clinical impact of these results remains uncertain but merits further investigation.

The combination of interferon and cytarabine, as compared with interferon alone, increases the rate of major cytogenetic response and prolongs survival in patients with the chronic phase of chronic myelogenous leukemia.

heparin (Fragmin) in patients with venous thromboembolism and contraindications to coumarin. Thromb Haemost 1994; 71: 7-11. 13 Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M, Kelton JG.Heparin-induced thrombocytopenia in patients treated with lowmolecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332: 1330-5. 14 Pini M, Aiello S, Manotti C, Pattacini C, Quintavalla R, Poli T, Tagliaferri A, Dettori AG. Influence of omeprazol on the antiplatelet action of clopidogrel associated to aspirin An association of aspirin with clopidogrel is the reference treatment for prevention of thrombosis secondary to coronary angioplasty [1]. Clopidogrel inhibits platelet activation by blocking the P2Y12 platelet receptor, activation of which is associated with dephosphorylation of intraplatelet vasodilatorstimulated phosphoprotein (VASP). VASP phosphorylation provides an index of platelet reactivity to clopidogrel, which varies between individuals: the greater it is the more frequently thrombosis occurs [2]. Clopidogrel is a prodrug, activated by cytochrome 2C19. We investigated whether interactions with other substances could account for the observed variation in biological response to clopidogrel. The VASP test was performed on 105 consecutive patients (mean age: 63.7 years, 61% male) receiving aspirin + clopidogrel bitherapy in a context of high-risk coronary angioplasty.The mean VASP test result, performed at least 48 h after initiation of treatment, was 52.2 ± 18.7, with a range of 6-89. Platelet response was analyzed by Mann-Whitney U-test according to the different standard accompanying treatments: no significant differences were found for statins, angiotensinconverting enzyme inhibitors, angiotensin II receptor antagonist and beta blockers. Conversely, proton pump inhibitors (PPI) users had significantly higher VASP values than nonusers [61.4 ± 23.2 (n ¼ 24), vs. 49.5 ± 16.3 (n ¼ 81) respectively, P ¼ 0.007].These results are the first to show an association between PPI treatment and diminished biological action of clopidogrel. CYP 2C19, which the 681G>A polymorphism has recently been shown to determine the response to clopidogrel [3], is involved in both clopidogrel activation and PPI metabolism [4]. A competitive effect of PPIs on CYP 2C19 might thus underlie clopidogrel's reduced effectiveness in patients receiving PPIs.Demonstrating an interaction between these two drugs, which are so routinely associated in cardiology, would have major implications for the management of the risk of thrombosis following angioplasty, but will require the results of a randomized study that is currently under way.

Abstract. Eighteen French centers reported 133 autologous stem cell transplantations performed after first remission induction in multiple myeloma. The source of stem cell was marrow (81 cases), blood (51 cases) or marrow plus blood (1 case). The immediate outcome after transplantation was 49 (37%) complete remissions (CR; 13 maintained, 36 achieved), 61 (46%) partial remissions, 17 failures and 5 toxic deaths. With a median follow up of 35 months, the median remission duration was 33 months, the median time to treatment failure was 22 months. The median overall survival was 46 months, 54 months for the 103 patients responding to primary treatment and 30 months for the 30 nonresponders. In univariate analysis, the outcome was influenced by age, Ig isotype, initial P,-Microglohulin level, response to initial chemotherapy, plasma cell marrow involvement a t the time of harvest, albumin and P,-Microglobulin level at the time of transplantation and CR achievement after transplantation. In multivariate analysis, the most important prognostic factor was the quality of response after transplantation.The conditioning regimen and the source of stem cell had no significant impact on immediate and long-term results. Maintenance therapy with