Instytut Hematologii i Transfuzjologii

Warsaw, Poland

Instytut Hematologii i Transfuzjologii

Warsaw, Poland
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Lewandowska A.,Instytut Hematologii i Transfuzjologii | Wozniak A.E.,Instytut Hematologii i Transfuzjologii
Hematologia | Year: 2016

Patients being treated for myeloid and lymphoid malignancies, particularly those by high dose chemotherapy and/or radiotherapy, are vulnerable to malnutrition and any complications so arising. All efforts for ensuring normal nutrition in such patients can benefit their clinical status//outcomes, quality of life and life expectancy. Besides identifying any malnutrition, attention should also be focused on how the body's mechanisms compensate and prevent adverse events from developing as a result of this condition. The most important of these aspects are the extent of patient nutrition before, during and after treatment, (and in defining malnutrition whenever it occurs), together with how nutrients are consumed, digested and absorbed. Determining such factors make it thereby possible to formulate a detailed nutritional plan tailored to the patient needs and thus support their basic cancer treatment. © 2016 Via Medica.

HOUSTON -- A Phase III clinical trial involving 101 centers in 21 countries revealed the monoclonal antibody blinatumomab to be more effective than standard chemotherapy for treatment of advanced acute lymphoblastic leukemia (ALL). Study findings were published in the March 1 online issue of the New England Journal of Medicine. The study, led by The University of Texas MD Anderson Cancer Center, randomly assigned 405 patients 18 years or older to groups receiving either blinatumomab or chemotherapy. Overall survival was significantly longer in the blinatumomab group with median survival of 7.7 months versus four months for those on chemotherapy. Remission rates within 12 weeks after treatment began were higher in the blinatumomab group with complete remission rates of 34 percent reported in this group versus 16 percent for those on chemotherapy. The study also showed that patients treated with blinatumomab had a lower rate of adverse effects. While the prognosis for newly diagnosed ALL has improved over the last three decades with intensive chemotherapy regimens resulting in complete remission rates of 85 to 90 percent and long-term survival rates of 30 to 50 percent, most adult patients with the B-cell precursor ALL, the most common form, ultimately relapse and die from disease complications. The accepted standard of care is to help the patient maintain remission long enough to receive allogeneic or donor stem-cell transplantation, considered the most effective therapy. "Among adults with relapsed ALL, remission rates are18 to 44 percent with standard chemotherapy but the duration of remission is typically short. A major goal for these patients is to induce remission with sufficient duration to prepare for stem-cell transplantation," said Hagop Kantarjian, M.D., chair of the Department of Leukemia, and lead author for the New England Journal of Medicine paper. "In this study, 24 percent of patients in each treatment group underwent allogeneic stem cell transplantation." Blinatumomab, developed by Amgen, works by binding simultaneously to specific cytotoxic T-cells and B-cells, which allows the patient's healthy T-cells to recognize and eliminate cancer stem cells called blasts. "The activity of an immune-based therapy such as blinatumomab, which depends on functioning T-cells for its activity, provides encouragement that responses may be further enhanced and made durable with additional immune activation strategies," said Kantarjian. The study, designed and funded by Amgen, did not include patients who had other active cancers, relevant central nervous system conditions, autoimmune disease, acute or chronic graft-versus-host disease, chemotherapy or radiotherapy within two weeks before the study, donor stem cell transplantation within 12 weeks before the trial or autologous stem cell transplantation within six week preceding the study. Patients who received immunotherapy in the month before the trial or who were undertaking other investigational treatments were also excluded. Authors from the paper include investigators from City of Hope National Medical Center, Duarte, Calif.; Amgen, Thousand Oaks, Calif. and Washington D.C.; Frankfurt am Main University Hospital Schleswig Holstein, Kiel, Germany; Mediziniche Klinik und Poliklinik II, Universitätsklinikums, Wurzburg, Germany; Princess Margaret Cancer Centre, Toronto; Hôpital Maisonneuve-Rosemont, Montreal; Universitat Autonoma de Barcelona and the University of Valencia, Spain; Alfred Hospital and Monash University, Melbourne, Australia; Hôpital Saint-Louis, Paris; Centre Hospitalier Lyon Sud, Pierre-Benite, France; Universitá Sapienza di Roma, Rome; Aziendo Unitá Locale Socio Sanitaria 12 Veneziana Ospedale Dell Angelo, Venice, Italy; Universitá Statale di Milano, Milan; Ankara Universitesi, Ankara, and Dokuz Eylul Universitesi Tip Facultesi, Izmir, both in Turkey; Instytut Hematologii i Transfuzjologii and Centrum Medcyzne Kszta?cenia Podyplomowego, Warsaw, Poland; and the University of Washington Medical Center, Seattle.

Warzocha K.,Instytut Hematologii i Transfuzjologii
Hematologia | Year: 2013

This article describes the project of a national network for oncology in Poland based on comprehensive cancer centres and institutes, in particular the role played by the National Institute of Oncology and Hematology. © 2013 Via Medica.

Classical Hodgkin lymphoma (cHL) is characterized by pathognomonic Reed-Sternberg (R-S) cells, surrounded by an extensive infiltrate of T- and B-lymphocytes, granulocytes, macrophages, plasma cells, eosinophils, mast cells and fibroblasts. This peculiar infiltrate exhibits profoundlocal immunosuppressive properties and extensive network of mutual connections with R-S cells. Chemokines, cytokines and immunomodulatory proteins produced and released by R-S cells directly skew T-cell compartment toward Th2 and Treg cells, and induce infiltration of other cellular components that support R-S cell proliferation. Microenvironment-induced activation of R-S cell surface tumor necrosis factor-family receptors, cytokine receptors and Notch-1 signaling trigger activation of transcription nuclear factor κB (NFκB), JAK-STAT axis and suppression of B-cell transcriptional program. Understanding of these complex relationships led to conceptual design of targeted therapeutic interventions that by selective inhibition of receptor signaling, depletion of microenvironment cellular components or immunomo-dulation can deprive R-S cells from their supportive niche and complement conventional chemotherapy or R-S-cell-targeted drugs. The presented manuscript summarizes current views on the role of microenvironment in cHL, emphasizes its potential therapeutic applications. © 2011 Via Medica.

Kraj M.,Instytut Hematologii i Transfuzjologii | Kruk B.,Instytut Hematologii i Transfuzjologii | Poglod R.,Instytut Hematologii i Transfuzjologii
Nowotwory | Year: 2011

Objectives: Standard methods for the detection and monitoring of monoclonal proteins include electrophoresis and immunofixation (IFE) of serum and urine samples. Recently, automated quantitative immunoassay for serum immunoglobulin free light chains (FLCs) has become available for clinical use. The aim of this study was to assess the efficacy of serum FLC assay in the detection and monitoring of monoclonal proteins in different variants of multiple myeloma. Material and methods: The diagnostic value of serum FLC κ/λ ratios was compared with serum and urine protein electrophoresis and IFE in 100 multiple myeloma patients and 8 patients with monoclonal gammopathy of undetermined significance (MGUS). FLCs were measured using the Siemens BNII nephelometer with the Freelite ™ Kit (The Binding Site Ltd, Birmingham, UK). Results: Of 35 light chain (LC) myeloma patients, 19 were positive for κ LC and 16 for λ LC. All of these patients had monoclonal LC detected by IFE in urine and 29 also detected in the serum. Although 25 of patients had M spike in urine, only 9 had M spike in serum. All patients in the κ subgroup had an increased κ FLCs in serum and an increased FLC ratio. In the λ group all patients had both increased λ FLCs and decreased FLC ratios in serum. In 5/8 patients who had previously been deemed to have non-secretory myeloma FLCs were increased. Among 27 patients treated with autologous transplant in 12 cases normal FLC ratio documented stringent complete response. Discrepancies between IFE and FLC results were found in 5 patients. In all 30 myeloma patients with intact immunoglobulin (G, A, D, E) assessed at diagnosis or in progression the FLC ratio was abnormal, in 3 patients in CR after bortezomib therapy the FLC ratio was normal and in 2 of 3 patients with PR the FLC ratio was abnormal. In all 4 patients with solitary extramedullary plasmacytoma the FLC ratio was normal. 4/8 MGUS patients with a follow-up from 10 to 26 years had an abnormal FLC ratio. Multiple myeloma progression developed in one patient with abnormal FLC ratio and in one patient with normal FLC ratio. Conclusions: Serum FLC assay provides improved detection rates of light chain multiple myeloma and non-secretory multiple myeloma. It also enables the monitoring of these diseases, detecting residual disease and allows for a more precise definition of the remission status.

Internal hernia results from viscus protrusion into a retroperitoneal fossa or foramen in the abdominal cavity. The condition is rare but when it occurs the patient usually manifests symptoms of alimentary tract obstruction. In this paper we present a very rare case of post-operative incarcerated internal hernia. On post-operative day four we diagnosed small bowel obstruction in a patient subjected to left side nephroctomy from retroperitoneal access. Emergency surgical procedure followed. The incarcerated intestinal hernia was released from the inferior ileocecal recess and absorbable sutures were applied. The post operative complications (pneumonia in right lung and bacterial wound infection) subsided as result of antibiotic therapy and wound dressing Following successful medical treatment, the patient was discharged (postoperative day 20). Diagnosis of incarcerated hernia of the interior ileocecal recess is not easy and often occurs incidentally during exploratory laparoscopy for intestinal occlusion.

Kraj M.,Instytut Hematologii i Transfuzjologii | Kruk B.,Instytut Hematologii i Transfuzjologii | Prochorec-Sobieszek M.,Instytut Hematologii i Transfuzjologii
Acta Haematologica Polonica | Year: 2012

Immunoglobulin (Ig) heavy/light chain (HLC) is a novel antibody based assay that separately measures in pairs the light chain types of each Ig class generating ratios of monoclonal Ig/background polyclonal Ig concentrations. Free light chain (FLC) assay measures unbound κ and λ chains. The aim of the present study was to assess the prognostic impact of HLCand FLCassays in multiple myeloma (MM) and IgM malignant lymphoma (ML) patients with real long term survival. Measurements of serum HLCand FLCconcentrations were performed in 23 MM and 12 ML patients with survival exceeding 10 years and 43 (19 MM, 24 ML) patients with survival not exceeding 5 years. HLC and FLC ratios at diagnosis were less abnormal in patients with survival exceeding 10 years than in patients with survival up to 5 years (p=0.03). The differences in median values were manifold. However, in patients with survival over 10 years highly abnormal HLC ratio (<0.022 or >45) was found in 3 MM patients and 7 ML patients and highly abnormal FLC ratio (<0.1 or >30) was found in 5 MM patients and in 1 ML patient. In conclusion, serum HLCand FLCmeasurements at MM diagnosis provide prognostic information, despite that even in MM patients with survival exceeding 10 years in 15% of them at diagnosis serum HLC and FLC ratios may be highly abnormal. © by Polskie Towarzystwo Hematologów.

Transfusion-related acute lung injury (TRALI) is the leading cause of mortality following transfusion of blood components. Characteristic for TRALI is acute hypoxemia during or up to 6 h after transfusion provided that cardiogenic respiratory failure and transfusionassociated circulatory overload (TACO) are excluded. In this article we present: 1) Etiology and pathomechanism of TRALI syndrome including the numerous issues that are still unresolved. Currently accepted is the multipleevent model which involves both the patient and the transfused blood components. The TRALI syndrome may be either immunological or nonimmunological dependant on the various factors that activate neutrophils - the main cells in TRALI pathogenesis. 2) TRALI diagnosis should be based mainly on the clinical presentation due to the variety of pathomechanism of the syndrome; however testing of anti-leukocyte antibodies in transfused blood components, according to ISBT guidelines, is recommended in order to prevent TRALI incidence. 3) Different strategies of TRALI prevention, although up to date no ultimate provisions have been accepted. Transfusion of plasma collected only from men seems to be a promising solution as in many countries that adapted this preventive measure the number of TRALI cases has substantially decreased. 4) Different methods of proceeding with donors who donated blood components that were the cause of TRALI in transfused patients. It still remains an open question whether to defer donors with antileukocyte antibodies or multi pregnant women. © 2013 Polskie Towarzystwo Hematologów i Transfuzjologów, Instytut Hematologii i Transfuzjologii. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Warzocha K.,Instytut Hematologii i Transfuzjologii
Nowotwory | Year: 2014

This article describes an operational model for the national oncology network in Poland based on standardised diagnostic and treatment working practices performed accordingly to defioned levels of referentiality and competence, at certified medical centres that are covered by the national health fund.

On the 22nd July 2014, the Polish Parliament amended legislation in the provision of state-financed public healthcare services which had previously assumed an oncological treatment package based on a queuing system. The detailed regulations to this law are currently being formulated to permit such required changes to be implemented. Essentially, they concern rules that govern coordinating the various avenues of cancer patient diagnosis and therapy, along with a standardization of services provided at medical centres according to their levels of referentiality, ranges of available competencies as well as the ability to effectively monitor their quality; all integrated into the national oncology network of institutions that coordinate and oversee this process. Such reforms are thus focused on individually treating cancer patients and their healthcare needs in order to achieve the maximum possible effectiveness and benefit for both their therapy and in ensuring the safety of procedures that may be potentially life-threatening. These are therefore important steps to significantly improve the health care system for treating cancer patients in Poland. © 2014 Via Medica.

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