Transplantacija autolognih matičnih stanica u liječenju ne-Hodgkinovog limfoma

Substantial number of patients who present with non-Hodgkin’s lymphoma cannot be cured of their disease by conventional dose therapy. New data on treatment results in the past decade elucidate the role of high-dose therapy (HDT) and autologous bone marrow or peripheral blood stem cells in the treatment of malignant lymphomas. There is evidence from randomized studies that high-dose therapy followed by autografting for relapsed chemosensitive patients is superior to conventional chemotherapy in terms of disease-free and overall survival. For this group of patients autografting became a standard approach to therapy. Also the increasing evidences indicate that high-dose therapy and autotransplantation in first remission improves survival in high-risk patients. The toxicity of the procedure is substantially reduced in recent years. Several new methods are under investigation, like various forms of immunotherapy and radioimmunotherapy, with the aim to reduce the incidence of relapse following transplantation.Brojne bolesnike s ne-Hodgkinovim limfomom nije moguće izliječiti terapijom konvencionalnih doza. Novi podaci o rezultatima liječenja u posljednjem desetljeću rasvjetljavaju ulogu terapije velikim dozama i matičnih stanica autlogne koštane srži ili periferne krvi u liječenju zloćudnih limfoma. U randomiziranim je ispitivanjima dokazano da je terapija velikim dozama nakon koje slijedi autotransplantacija primijenjena u kemosenzitivnih bolesnika s relapsom uspješnija od konvencionalne kemoterapije s obzirom na sveukupno preživljenje bez znakova bolesti. Za tu je skuppinu bolesnika autotransplantacija postala standardna terapijska metoda. Sve je više dokaza koji pokazuju da se terapijom velikim dozama i autotransplantacijom kod prve remisije bolesti postiže bolje preživljenje u bolesnika izloženim velikom riziku. Toksičnost postupka posljednjih je godina znatno smanjena. Ispituje se nekoliko novih metoda, poput raznih oblika imunoterapije i radioimunoterapije, s ciljem da se pojavnost relapsa nakon transplantacije smanji

Transplantacija autolognih matičnih stanica u liječenju ne-Hodgkinovog limfoma

Substantial number of patients who present with non-Hodgkin’s lymphoma cannot be cured of their disease by conventional dose therapy. New data on treatment results in the past decade elucidate the role of high-dose therapy (HDT) and autologous bone marrow or peripheral blood stem cells in the treatment of malignant lymphomas. There is evidence from randomized studies that high-dose therapy followed by autografting for relapsed chemosensitive patients is superior to conventional chemotherapy in terms of disease-free and overall survival. For this group of patients autografting became a standard approach to therapy. Also the increasing evidences indicate that high-dose therapy and autotransplantation in first remission improves survival in high-risk patients. The toxicity of the procedure is substantially reduced in recent years. Several new methods are under investigation, like various forms of immunotherapy and radioimmunotherapy, with the aim to reduce the incidence of relapse following transplantation.Brojne bolesnike s ne-Hodgkinovim limfomom nije moguće izliječiti terapijom konvencionalnih doza. Novi podaci o rezultatima liječenja u posljednjem desetljeću rasvjetljavaju ulogu terapije velikim dozama i matičnih stanica autlogne koštane srži ili periferne krvi u liječenju zloćudnih limfoma. U randomiziranim je ispitivanjima dokazano da je terapija velikim dozama nakon koje slijedi autotransplantacija primijenjena u kemosenzitivnih bolesnika s relapsom uspješnija od konvencionalne kemoterapije s obzirom na sveukupno preživljenje bez znakova bolesti. Za tu je skuppinu bolesnika autotransplantacija postala standardna terapijska metoda. Sve je više dokaza koji pokazuju da se terapijom velikim dozama i autotransplantacijom kod prve remisije bolesti postiže bolje preživljenje u bolesnika izloženim velikom riziku. Toksičnost postupka posljednjih je godina znatno smanjena. Ispituje se nekoliko novih metoda, poput raznih oblika imunoterapije i radioimunoterapije, s ciljem da se pojavnost relapsa nakon transplantacije smanji

Anemia and Other Manifestations of Iron, Vitamin B12 and Folate Deficiencies

Deficit željeza, vitamina B12 i folata dominantni je uzrok anemije i velik je zdravstveni problem u zemljama u razvoju, ali i u razvijenim zemljama diljem svijeta. Ovaj pregled posvećen je prevalenciji, metabolizmu i posebno uzrocima i dijagnostici deficita ovih triju nutritivnih činitelja. Anemija je dobro poznata i često opisivana posljedica njihova deficita, stoga će znatan dio prostora biti posvećen novim spoznajama o ulozi folata i vitamina B12 u kardiovaskularnim, neurološkim, psihijatrijskim i malignim bolestima, kao i u poremećajima razvoja. Napredak u istraživanju ovih nutritivnih činitelja otkrio je nove aspekte hematoloških poremećaja, ali i mnoge nehematološke manifestacije te posebno blaga, pretklinička stanja deficita. Niz osjetljivih testova omogućava ranu dijagnozu deficita vitamina i željeza. Visoka prevalencija deficita otvorila je pitanje profilaktičke terapije i obogaćivanja hrane ovim vitaminima i mineralima, što je od posebne važnosti za stariju populaciju i populaciju s niskim socioekonomskim statusom.Deficiences of iron, vitamin B12 and folate are the dominant causes of anemia and represent the major public health problem in developing but also in developed countries worldwide. This review is restricted to prevalence, metabolism, and especially to causes and diagnosis of deficiency of these three nutritients. Anemia is very well known and frequently described consequence of their deficiency, and consequently, more attention is paid to recent understanding of the role of folate and vitamin B12 in cardiovascular, neurologic, psychiatric and malignant diseases as well as developmental abnormalities. Advances in the study of these nutritients have revealed new aspects of hematological disturbances, but also of many nonhematologic manifestations of deficiency and especially mild, preclinical deficiency states. A battery of sensitive tests allows for early detection of vitamin and iron deficiency. The high prevalence of deficiency opened a question of prophylactic therapy, and of food fortification with these vitamins and minerals, especially in the elderly and in people with low socioeconomic status

Fizioterapija bolesnika liječenih transplantacijom krvotvornih matičnih stanica

Fizioterapija ima svoje mjesto u gotovo svim granama medicine, pa i kao dio liječenja bolesnika s malignim bolestima. U ovome se radu razmatra uloga fizioterapije u bolesnika s hematološkim malignim bolestima liječenih transplantacijom krvotvornih matičnih stanica. Prikazan je tijek liječenja transplantacijom krvotvornih matičnih stanica od pripreme za transplantaciju do razdoblja nakon transplantacije te problemi i komplikacije koje se pritom javljaju. Liječenje transplantacijom praćeno je nizom komplikacija kao što su promjene na muskoloskeletnom sustavu te na kardiovaskularnom i respiratornom sustavu. Posebno je izražen problem akutne i kronične reakcije transplantata protiv primatelja (graft versus host disease, GvHD). Način liječenja kojem je bolesnik podvrgnut i sve komplikacije rezultiraju raznolikim ozbiljnim tjelesnim promjenama koje utječu na fizičko stanje i kvalitetu života bolesnika, pa i na krajnji ishod liječenja. Fizioterapija tih bolesnika iznimno je važna u svakom trenutku liječenja, a njezini učinci na kvalitetu života bolesnika, smanjenje komplikacija i konačni ishod liječenja relativno su slabo istraženi. Zbog specifičnoga stanja i komplikacija nakon transplantacije hematološkim je bolesnicima potreban jedinstven i složen pristup u fizioterapijskim procedurama. Međutim, ne postoje jasna uputstva i protokoli koje bi fizioterapeuti nužno slijedili i provodili u bolesnika liječenih transplantacijom krvotvornih matičnih stanica. Opisana su dosadašnja iskustva i navedeni mogući pristupi fizioterapiji tih bolesnika

Adsorption of Arsenic on MgAl Layered Double Hydroxide

Groundwater in the Eastern Croatia, as well in the South-eastern Hungary, contains relatively high concentrations of arsenic that can cause chronic toxicity to humans. Therefore, the aim to find an ef-fective composite adsorbent that can be applied for arsenic water remediation by introducing it in the groundwater treatment is very important. The presented results were obtained using layered double hy¬droxide (LDH) as a sorbing system. MgAl LDH samples with a Mg:Al molar ratio of 2:1 were synthe¬sized. Adsorption of arsenic anions from groundwater samples from Eastern Croatia, as well as adsorption of model aquatic arsenic sample solutions, on MgAl layered double hydroxide was investigated. Induc¬tively coupled plasma atomic emission spectrometry (ICP-AES) was used for determination of arsenic concentration after adsorption. It was shown that in both cases the adsorption process could be interpreted in terms of Kroeker adsorption isotherm regardless to the presence of other ions in the groundwater. Addi¬tionally, the influence of phosphate concentration on adsorption of model arsenic samples was examined and it was shown that (at least in examined range of arsenic and phosphate concentration) there is no sig¬nificant influence of phosphate on adsorption of arsenic. (doi: 10.5562/cca2283

Collection and composition of autologous peripheral blood stem cells graft in patients with acute myeloid leukemia: influence on hematopoietic recovery and outcome [Skupljanje i sastav transplantata autolognih krvotvornih matičnih stanica periferne krvi u bolesnika s akutnom mijeloičnom leukemijom: utjecaj na hematološki oporavak i ishod]

Hematopoietic stem cell (HSC) transplantation is a standard approach in the treatment of hematological malignant diseases. For the last 15 years the main source of cells for trasplantation have been peripheral blood stem cells (PBSC). With the availability of hematopoietic growth factors and understanding the advantages of treatment with PBSC, the application of bone marrow (BM) was supplanted. The aim of this survey was to explore the success of PBSC collection, the factors which influence the success of PBSC collection, the composition and the quality of graft and their infuence on hematopoietic recovery and outcome after transplantation in patients with acute myeloid leukemia (AML). PBSC were collected by the method of leukapheresis after applying a combination of chemotherapy and growth factors or only growth factors. The quality of graft was determined with the clonogenic progenitor cell assay and with the flow citometry analysis. Of the total 134 patients with AML, who were submitted to HSC mobilization, the collection was successful in 78 (58.2%) patients. The collection was more successful after the first than after the second attempt of HSC mobilization (49% vs. 11%). The criteria for effective mobilization were the number of leukocytes >3´109/L and the concentration of CD34+ cells >20´103/mL in the peripheral blood on the first day of leukapheresis. The number of CD34+ cells infused had the strongest impact on hematopoietic recovery. We noted significantly faster hematological recovery of neutrophils and platelets, fewer number of transfused units of red blood cells and platelets, shorter duration of the tranfusion support, shorter treatment with intravenous antibiotic therapy and shorter hospitalization after PBSC compared to BM transplantation. These advantages could provide their standard application in the treatment of patients with AML

Smjernice za dijagnostiku i liječenje primarne imunosne trombocitopenije u odraslih [Guidelines for diagnostics and treatment of primary immune thrombocytopenia in adults]

Working Group for Diseases of Hemostasis and Thrombosis of the Croatian Cooperative Group for Hematologic Diseases (CROHEM), Referral Center for Hereditary and Acquired Disorders of Hemostasis of the Croatian Ministry of Health, and Croatian Hematology Society of the Croatian Medical Association developed the Croatian guidelines for the diagnosis and treatment of primary immune thrombocytopenia (ITP). Detailed clinical and laboratory examination should be performed to exclude common secondary causes of thrombocytopenia. An individualized therapeutic approach is ­proposed, and decision to start active treatment depends on the severity and risk of bleeding, platelet count, patient’s life style, age and comorbidities. Glucocorticoids with or without intravenous immunoglobulines are recommended as the first line treatment. The second line treatments are splenectomy or thrombopoietin receptor agonists as suggested options. Thrombopoietin receptor agonists are recommended treatment for splenectomized patients with relapsed ITP. Alternatively rituximab or other immunosuppressive agents are suggested in second or later treatment lines

GUIDELINES FOR DIAGNOSTICS AND TREATMENT OF PRIMARY IMMUNE THROMBOCYTOPENIA IN ADULTS

Radna skupina za bolesti hemostaze i tromboze Hrvatske kooperativne grupe za hematološke bolesti (KROHEM), Referentni centar Ministarstva zdravlja Republike Hrvatske za nasljedne i stečene bolesti hemostaze te Hrvatsko hematološko društvo Hrvatskoga liječničkog zbora izradili su Hrvatske smjernice za dijagnostiku i liječenje odraslih bolesnika s primarnom imunosnom trombocitopenijom (ITP). Detaljnim kliničkim i laboratorijskim pregledom treba isključiti niz čestih uzroka sekundarne trombocitopenije. Predlaže se individualizirani pristup liječenju, gdje se odluka o početku aktivnog liječenja temelji na ozbiljnosti i riziku od krvarenja, broju trombocita, životnom stilu, dobi bolesnika i komor­biditetima. Prva linija terapije ITP-a jesu glukokortikoidi, s primjenom intravenskih imunoglobulina ili bez nje. U drugoj terapijskoj liniji predlaže se splenektomija ili liječenje agonistima trombopoetinskih receptora. Kod splenektomiranih ­bolesnika s relapsom ITP-a preporučuje se liječenje agonistima trombopoetinskih receptora. Alternativno se sugerira mogućnost primjene rituksimaba i drugih imunosupresiva u drugoj ili kasnijoj terapijskoj liniji.Working Group for Diseases of Hemostasis and Thrombosis of the Croatian Cooperative Group for Hematologic Diseases (CROHEM), Referral Center for Hereditary and Acquired Disorders of Hemostasis of the Croatian Ministry of Health, and Croatian Hematology Society of the Croatian Medical Association developed the Croatian guidelines for the diagnosis and treatment of primary immune thrombocytopenia (ITP). Detailed clinical and laboratory examination should be performed to exclude common secondary causes of thrombocytopenia. An individualized therapeutic approach is ­proposed, and decision to start active treatment depends on the severity and risk of bleeding, platelet count, patient’s life style, age and comorbidities. Glucocorticoids with or without intravenous immunoglobulines are recommended as the first line treatment. The second line treatments are splenectomy or thrombopoietin receptor agonists as suggested options. Thrombopoietin receptor agonists are recommended treatment for splenectomized patients with relapsed ITP. Alternatively rituximab or other immunosuppressive agents are suggested in second or later treatment lines

Glycoprotein YKL-40: a novel biomarker of chronic graftvs- host disease activity and severity?

Aim To investigate whether increased YKL-40 levels positively correlate with graft-vs-host disease (cGVHD) activity and severity and if YKL-40 could serve as a disease biomarker. Methods This case-control study was conducted at the University Hospital Centre Zagreb from July 2013 to October 2015. 56 patients treated with hematopoietic stem cell transplantation (HSCT) were included: 35 patients with cGVHD and 21 without cGVHD. There was no difference between groups in age, sex, median time from transplant to study enrollment, intensity of conditioning, type of donor, or source of stem cells. Blood samples were collected at study enrollment and YKL-40 levels were measured with ELISA. Disease activity was estimated using Clinician’s Impression of Activity and Intensity of Immunosuppression scales and disease severity using Global National Institutes of Health (NIH) score. Results YKL-40 levels were significantly higher in cGVHD patients than in controls (P = 0.003). The difference remained significant when patients with myelofibrosis were excluded from the analysis (P = 0.017). YKL-40 level significantly positively correlated with disease severity (P < 0.001; correlation coefficient 0.455), and activity estimated using Clinician’s Impression of Activity (P = 0.016; correlation coefficient 0.412) but not using Intensity of Immunosuppression (P = 0.085; correlation coefficient 0.296). Conclusion YKL-40 could be considered a biomarker of cGVHD severity and activity. However, validation in a larger group of patients is warranted, as well as longitudinal testing of YKL-40 levels in patients at risk of developing cGVHD

Which questionnaires should we use to evaluate quality of life in patients with chronic graft-vs-host disease?

Aim To investigate the ability of two standard quality of life (QOL) questionnaires – The Short Form (36-item) Health Survey (SF-36) and The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire- Core 30 (EORTC QLQ C30) to evaluate QOL in patients with chronic graft-vs-host disease (cGVHD) graded according to National Institutes of Health (NIH) consensus criteria. Methods In this cross-sectional study, QOL was assessed in patients who underwent allogeneic stem cell transplantation (allo-SCT) at the University Hospital Centre Zagreb and were alive and in complete remission for more than one year after allo-SCT. Results The study included 58 patients, 38 patients with cGVHD and 20 controls, patients without cGVHD. Patients with cGVHD scored according to the NIH criteria had significantly lower scores of global health status and lower QOL on all SF-36 subscales and most of QLQ C30 functional subscales (P < 0.050 for all comparisons). Furthermore, patients with active cGVHD had significantly lower QOL scores than patients with inactive cGVHD, and this difference was most evident in physical functioning subscale of SF-36 (P = 0.0007) and social functioning subscale of QLQ C30 (P = 0.009). Conclusion cGVHD scored according to the NIH criteria is correlated with patient-reported QOL, particularly in the physical domains as detected by SF-36. QLQ C30 questionnaire adds more information on social functioning and should be used as a valuable tool in the evaluation of social domains in cGVHD patients