INTRODUCTION: Hypomethylating agents have become a standard therapy for high-risk myelodysplastic syndromes (MDS) and elderly patients with acute myeloid leukemia (AML). AIM:The aim of the study was to assess the efficacy of azacitidine treatment in patients with MDS and AML followed for 18 months. MATERIALS AND METHODS: Twenty-seven patients with MDS and AML treated in theClinic of Hematology at St. Marina University Hospital, Varna were included in the study. Azacitidine was administered subcutaneously at a dose of 75 mg/m 2 for 7 days. Disease assessment was performed on the 3 rd month, 6 th month, and at progression. RESULTS: Twenty-seven patients were analyzed. Their median age was 71.5 years. Nine had refractory anemia with excess of blasts II (RAEB II), 5 had chronic myelomonocytic leukemia II (CMML II), 1 was with unclassifiable MDS (MDS-U), and 12 with AML. The median number of administered cycles was 6 (1-19). Eleven patients completed 6 cycles of azacitidine. Partial response was achieved in 9 patients (33%) (7 MDS and 2 AML), stable disease in 8 (29%) (5 MDS and 3 AML). Progressive disease was observed in 10 patients (37%). The response correlated with the type of the disease (p=0.03), cytogenetic risk (p=0.01), and survival (p=0.000). At 18 months, 60% of MDS patients were alive compared to 41.7% in the AML group. The median time to death in the AML patient group was 2.5 months. The mean overall survival was 10.4 months (12.6 months for MDS patients and 5.4 months for AML patients). CONCLUSION:The therapy with azacitidine is an option for elderly patients with high-risk MDS. In patients with AML a rapid progression is observed during the first two cycles with mortality rate of 58.3%. Scr Sci Med. 2018;50(1):31-35

Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL) is an aggressive disease with poor outcomes. Despite the incorporation of tyrosine kinase inhibitors (TKIs) in the therapeutic strategies, patients who relapse after chemotherapy plus TKI have poor overall survival (OS) and less chance to proceed to hematopoietic stem cell transplantation (HSCT) which remains the only curative approach. Therefore, new drugs, such as antibody-targeted therapies alone or in combination with TKIs, offer new therapeutic options for those patients. However, the combination of inotuzumab plus ponatinib has limited application. We present a case of a patient affected by Ph + ALL with T315I mutation successfully treated after early relapse with inotuzumab plus ponatinib, followed by allogeneic HSCT and ponatinib maintenance.

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AbstractTo analyze the effects of conventional polychemotherapy of acute myeloblastic leukemia (AML) patients on the prooxidants/antioxidants balance in plasma total antioxidant status (TAS) and a single plasma antioxidant — uric acid (UA) were measured. Lipid peroxidation was assessed by malonedialdehyde (MDA) content. Total serum iron was monitored as a potential source of nontransferrin-bound iron with a role in initiation of oxidative burst. A group of patients in the acute phase of AML (group A) and a group of patients in complete remission of AML (group B) were studied. A strong correlation between UA values and TAS (r = 0.8 for group A, r = 0.9 for group B) was revealed in the course of the treatment. Strong negative correlation (r = −0.9) between TAS and MDA was shown for both groups. Total iron significantly increased in the course of chemotherapy. We have established that polychemotherapy leads to the consumption of antioxidants and increased lipid peroxidation in AML patients. An appropriate supplementation with antioxidants at the end of the polychemotherapy treatment could be considered.