Objective:Multiple myeloma is a common haematological malignancy and immune dysfunction is the hallmark of the disease. It leads to an increased infection risk, which is still a major cause of mortality. The infection spectrum and characteristics have evolved with the introduction of novel agents. An understanding of risk factors that increase susceptibility to infections is critical in fighting them. This retrospective investigation aimed to establish the incidence and main characteristics of infections in non-transplanted hospitalised myeloma patients in our department over a 3-year period, as well as factors associated with infections.Materials and Methods:A total of 240 hospitalised patients with multiple myeloma (120 males and 120 females; average age: 69 years, range: 41-89 years) who were diagnosed or treated in our department from January 2008 to December 2010 were included in this study and their data were retrospectively analysed.Results:Infections were identified in 17.9% of hospitalised patients. The most common pathogen found was Pseudomonas aeruginosa. The frequency of gram-positive and gram-negative pathogens was similar. In 37.2% of cases, the agent was not isolated. The most common sites of infections were the urinary system and the blood (septicemia). The frequency of infection increased with duration of disease and the rate of reinfection was 41.9%. The patients treated with bortezomib had the highest infection occurrence. Fatal outcome occurred in 9.3% of cases.Conclusion:The factors associated with infections in this investigation were female sex, 3B clinical stage of disease, increased serum creatinine and ferritin levels, neutropenia, poor general condition, and presence of catheters. Myeloma patients with one or more of these mentioned risk factors should be monitored with particular care in order to decrease the incidence and severity of infective complications.

Background: Diffuse large B-cell lymphomas (DLBCL) are heterogeneous diseases, and the identification of additional DLBCL risk factors is especially important. Methods: In this pilot study, we determined pretreatment serum levels of vascular endothelial growth factor (VEGF), osteopontin (OPN) and macrophage chemotactic protein-1 (MCP-1) in 67 newly diagnosed DLBCL patients before treatment with standard chemoimmunotherapy and in 30 healthy persons. Results: Serum levels of all three cytokines were significantly elevated in untreated patients compared to controls. VEGF and OPN concentrations were higher in patients with advanced Ann Arbor stage, B symptoms, Eastern Cooperative Oncology Group score ≥2, International Prognostic Index (IPI) ≥3 and partial/no remission. A high MCP-1 level was associated with advanced stage, increased IPI and bone marrow infiltration. In univariate analysis, elevated OPN and VEGF, and concurrent elevation of all three biomarkers, were identified as significant predictors of poor survival. Multivariate Cox analysis revealed that elevated OPN combined with elevated VEGF levels was one of the best parameter subsets predicting poorest survival. Conclusion: According to our preliminary results, serum levels of VEGF and OPN before treatment predict response to therapy and survival after chemoimmunotherapy, and may help to further stratify DLBCL patients into risk groups.

deskriptori: transplantacija krvotvornih matičnih stanica; Hodgkinova bolest-liječenje; ne-Hodgkinov limfomliječenje; karmustin-nuspojave, terapijska primjena; Bendamustin-nuspojave, terapijska primjena; kombinirani protutumorski kemoterapijski protokoli-terapijska primjena; transplantacijsko kondicioniranje-metode; Mukozitis-etiologija; trombociti-djelovanje lijeka; autologna transplantacija sažetak. unatrag nekoliko godina u hematologiji i onkologiji globalno sve češći problem postaje prikladna opskrba "starijim i manje zanimljivim" kemoterapeuticima. Zbog povremene nestašice karmustina, jednog od osnovnih kemoterapeutika pri kondicioniranju prije autologne transplantacije krvotvornih matičnih stanica (atkS) u oboljelih od limfoma, u našem se centru od 2016. godine on zamjenjuje bendamustinom. u ovom radu retrospektivno analiziramo tijek atkS-a u 41 bolesnika koji su primili bendamustin u sklopu protokola BeeaM te ga uspoređujemo s tijekom atkS-a u 40 bolesnika koji su primili karmustin u sklopu protokola BeaM. Medijan oporavka vrijednosti neutrofila (> 0,5 × 10 9 /l) u skupini koja je primila bendamustin iznosio je 11 dana, dok je u skupini kondicioniranoj karmustinom iznosio 10 dana. Medijan oporavka vrijednosti trombocita (> 20 × 10 9 /l) bio je duži kod skupine koja je primala bendamustin (16 prema 13 dana) te su ti bolesnici bili duže ovisni o transfuzijama eritrocita (7 prema 5 dana). Infektivne komplikacije nisu bile češće nakon primjene bendamustina, ali smo nakon primjene karmustina imali veću pojavu mukozitisa II.-III. stupnja (35% prema 12%). nakon primjene bendamustina zabilježen je jedan slučaj nefrotoksičnosti i kardiotoksičnosti terapije, dok kod primjene karmustina te komplikacije nisu zabilježene. Pri upotrebi bendamustina kod kondicioniranja u naših bolesnika u ovom trenutku nije utvrđena znatnija hematološka toksičnost u odnosu prema karmustinu, ali su prisutni dulji period oporavka vrijednosti trombocita te niža incidencija mukozitisa. descriptors: Hematopoietic stem cell transplantation; Hodgkin disease-therapy; lymphoma, non-Hodgkin-therapy; Carmustine-adverse effects, therapeutic use; Bendamustine hydrochloride-adverse effects, therapeutic use; antineoplastic combined chemotherapy protocols-therapeutic use; transplantation conditioningmethods; Mucositis-etiology; Blood platelets-drug effects; transplantation, autologous summary. Inadequate supply of "old and less interesting" chemotherapeutic agents is becoming a global issue in hemato-oncology today. In 2016 we were faced with occasional carmustin shortage, one of the most commonly used in autologous transplant conditioning regimens for lymphoma in our centre, so we decided to use bendamustin instead. We performed a retrospective analysis of 41 patients treated at our centre who had received bendamustin within BeeaM protocol and compared them with 40 patients who had received carmustin within BeaM protocol. Both protocols were used as conditioning protocols before autologous stem cell transplantation. neutrophil recovery median following...

UVOD: Anemija je stanje koje je definirano smanjenim brojem crvenih krvnih stanica u cirkulaciji i/ili smanjenom količinom hemoglobina. Anemije stečene u bolnici su stanja koja se razvijaju u hospitaliziranih bolesnika s prethodno normalnom koncentracijom hemoglobina te su povezane s lošijom prognozom za bolesnike i povećanim iskorištavanjem bolničkih resursa. Hospitaliziranim se osobama gotovo svakodnevno potražuju laboratorijski nalazi, a dnevna količina izvađene krvi iznosi oko 12mL. Ovakav gubitak bi normalna koštana srž nadomjestila, međutim u bolesnika s različitim bolestima taj nadomještaj može biti smanjen te se povećava mogućnost razvoja anemije. Reed Miller je u svom radu dokazao da je smanjenje koncentracije hemoglobina u korelaciji s dužinom hospitalizacije.CILJ:Cilj ovog istraživanja je ispitati učinak uzrokovanja krvi na koncentraciju hemoglobina u hospitaliziranih bolesnika. METODE:Ispitanici su osobe muškog i ženskog spola (N=100), stariji od 18 godina, različite životne dobi hospitalizirani u Klinici za unutarnje bolesti s centrom za dijalizu Sveučilišne kliničke bolnice Mostar u razdoblju od 01.01.2016. do 01.05.2016. čiji su podatci bili dostupni u Bolničkom Informativnom Sustavu. Izabrani su metodom probira vodeći računa o definiranim uključnim/isključnim kriterijima. REZULTATI: Od ukupnog broja ispitanika 54% (54) su muškarci, a 46% (46) žene. Prosječna dob ispitanika je 68 godina.Prosječna količina uzorkovane krvi je 61,9 mL, a prosječan boj uzorkovanje je 12,4. Najčešće korištena epruveta je od 7,5 mL. Rezultati ovog istraživanja pokazali su da postoji korelacija između broja uzorkovanja krvi za pretrage i pada koncentarcije Hgb, odnosno vrijednosti Erc i Hct. Nije utvrđen utjecaj spola na razliku u koncentraciji Hgb na početku i na kraju hospitalizacije.ZAKLJUČAK: Učestalo uzorkovanje krvi za različite pretrage te veća količina krvi u mL može dovesti do pada koncentracije Hgb kao i različitog stupnja anemije.