No abstract

Summary.Retinal changes are common in adult acute leukaemia patients at presentation, but whether they correlate with the risk of subsequent intracranial haemorrhage is unknown. A 4-year study has been carried out in 82 newly-diagnosed acute leukaemia patients, aged 12-77 years, who were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton-wool spots (CWS) and macular haemorrhages (MH). Groups with and without these features were compared for their risk of intra-cranial haemorrhage (ICH) within the first 30 d following diagnosis.There was no association between the incidence of ICH and the presence of IRH, WCH or CWS. However, 6/13 of those with MH developed ICH, compared to 6/69 of those without MH (relative risk 5 . 0, CI 95% [2 . 03-12 . 33], P¼0 . 003). The only other identifiable risk factor for ICH was the M3 subtype of AML, but if the four cases of M3-AML were discounted from analysis, MH remained a highly significant risk factor for ICH. Patients with MH should be monitored intensively for the development of ICH, and receive priority in the allocation of platelets where these are in short supply.

Fifty-two BMT institutions were sent a questionnaire asking for details of dosing for busulphan, cyclophosphamide (bu-cy), cyclosporin and methotrexate (CSA-MTX). The following data were requested: (a) the method used to determine the body weight for dosage calculations (b) the actual dose per weight and (c) the schedule of administration. Thirty-six (69%) institutions responded and 33 were evaluable. There was substantial variation in the method used to determine weight for bu-cy. No single method was used in more than 30% of units, although most units made some allowance for discrepancies between actual and ideal body weight. There was more uniformity in the method of weight determination for CSA-MTX, with the majority of units using actual body weight. Conversely, there was much more variation in the dose per weight formulae and schedules used for CSA-MTX than for bu-cy. These substantial differences highlight the importance of specifying these criteria when the toxicity and efficacy of chemotherapy regimens is reported and the need for further studies to determine the optimal weight formulae for dosage calculations.