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Mannova J.,Anesteziologicko resuscitacni Oddeleni | Penka M.,Oddeleni Klinicke Hematologie | Stourac P.,Klinika Detske Anesteziologie A Resuscitace
Anesteziologie a Intenzivni Medicina | Year: 2016

The risk of venous thromboembolic events is high during pregnancy due to both the physiologic changes of pregnancy and the additional impact of inherited or acquired thrombophilias. The women with thrombophilia are at increased risk not only of pregnancy-related venous thromboembolism (VTE), but also other pregnancy-related complications, including early and late miscarriage, intrauterine growth retardation, placental abruption and pre-eclampsia. Depending on the type of thrombophilia, personal and family history of VTE and history of complications during pregnancy, prophylactic treatment with low molecular weight heparin or unfractionated heparin is recommended. For women with thrombophilia and history of complications during pregnancy, a combination of low dose aspirin and heparin can increase the probability of live birth. On the other hand, pregnant women on prophylactic or therapeutic anticoagulation require individualized delivery plans addressing the obstetric, anaesthetic and thrombotic concerns.

Mocikova H.,Oddeleni Klinicke Hematologie
Transfuze a Hematologie Dnes | Year: 2010

Hodgkin lymphoma (HL) is usually cured by first-line therapy: in patients in initial stages with unfavorable features relapses occur in 10-15 % of cases and in up to 20 % of patients in advanced stages of HL. The most important prognostic factor at first relapse is chemosensitivity to salvage therapy. No standard salvage regimen is currently recommended, but cisplatinum or carboplatinum based regimens are most widely used. Autologous stem cell transplantation (ASCT) is superior over conventional chemotherapy and remains the standard of treatment in relapsed/refractory Hodgkin lymphoma patients. Tandem transplantation is indicated in poor-risk patients at relapse. ASCT failures occur in approximately 50% of these patients during the follow-up. Experimental approaches after ASCT failure include new agents. The second ASCT is another experimental method. The role of myeloablative allogeneic SCT in multiple relapses of HL is still unclear due to its high treatment-related mortality. Allogeneic transplantation with reduced intensity regimens reduced transplant-related mortality, but even this therapy did not prevent relapses/progressions in about a half or two-thirds of patients.

Chemotherapy of chronic lymphocytic leukemia (CLL) underwent significant development in last two decades involving new agents, allogeneic stem cell transplantation; finally also monoclonal antibodies were added to the CLL management. Chlorambucil had been gold standard in the treatment of CLL for long time. Fludarabine and other purine analogs entered the therapy including 1 st line in mid 90. Since beginning of the 21st century the combination fludarabine and cyclophosphamide (FC) came as the salvage treatment as the effective therapy of CLL then was successfully tested in the 1 st line. This regimen has been eventually enriched for rituximab and the regimen FCR became widely used for the treatment of CLL in 1st line. Other purine analog cladribine was tested in combination with cyclophosphamide and mitoxantrone. Promising is rediscovered agent bendamustine, especially for combination therapy with monoclonal antibodies. Pentostatine in combination with cyclophosphamide and rituximab was found effective in the treatment of refractory CLL. Radiotherapy and splenectomy is effective approach in the therapy of CLL in certain situations.

Kozak T.,Oddeleni Klinicke Hematologie
Transfuze a Hematologie Dnes | Year: 2010

Chronic lymphocytic leukemia is regarding prognosis a heterogeneous disease. Majority of newly diagnosed patients is in an early stage of the disease. The challenge of search for new prognostic markers in CLL is to define the subgroup of patients that might potentially benefit from early treatment. The standard approach otherwise is to institute the therapy in late stage or rapidly progressing and active disease. Except of clinical stage the lymphocyte doubling time (LDT) belongs to so called classical prognostic factors. In past decade the new biological, prognostic factors for CLL were discovered. They are not routinely used for timing of the therapy but they may be helpful in choice of the appropriate therapy including allogeneic hematopoietic stem cell transplantation, however. The strongest marker is cytogenetics (FISH), 17p- being very poor prognostic factor as well as TP53 mutation. Significant negative impact on survival has presence of either unmutated IgVH or mutation VH3.21. Independent prognostic factors are also the high expression of CD38 and ZAP70, elevated level of β2mikroglobulin, thymidinkinase and some angiogenesis markers. One of the important clinical risk factor is also the response to the therapy.

Hodgkin lymphoma (HL) is one of the best curable malignant diseases. Modern therapeutic strategies can cure 85-95 % of patients. Late effects have become increasingly important, especially cardiotoxicity and second tumors, that cause more deaths than HL 15 years after completion of treatment. The goal of the research is to find the therapy that maximizes tumor control and minimizes acute and longterm toxicity. German Hodgkin Study Group (GHSG) proved the possibility to reduce chemotherapy and radiotherapy without reducing the effectiveness of treatment in the HD10 study for early stages of HL. HD9 study for advanced stages demonstrated excellent results of BEACOPP escalated chemotherapy compared to the conventional therapy ABVD, but BEACOPP escalated induced higher acute and long-term toxicity. The goal of subsequent GHSG studies for advanced stages (HD12, HD15 and ongoing active HD18 study) is to reduce the intensity of chemotherapy and to evaluate the significance of subsequent radiotherapy. The HD15 study tests the significance of FDG-PET for indication of radiotherapy. Current HD18 study tests by FDG-PET the early response of tumor after 2 cycles of chemotherapy. New biological drugs that target receptors on malignant cells (monoclonal antibodies, inhibitors) are awaited.

Positron emission tomography based on fluorine-18-fluorodeoxyglucose (18F FDG-PET) is currently a standard procedure in the initial staging and restaging after treatment in Hodgkin's lymphoma (HL) patients. The complete remission is confirmed by a negative PET examination at the end of treatment and it has a high negative predictive value. Currently the criteria of positive and negative PET results during therapy (interim PET) are thoroughly revised. The possibility of a risk-adapted therapy based on early interim PET results (after 2 cycles of chemotherapy) is tested in several clinical trials. PET in a long-term follow-up after treatment is indicated in HL risk groups only within 24 months. The risk groups include patients with a positive interim PET and patients with a residual massive mediastinal tumor after the end of therapy. Positive PET in relapsed/progressed HL patients after a salvage therapy before an autologous stem cell transplantation is a poor prognostic factor.

Starostka D.,Oddeleni klinicke hematologie | Mikula P.,Oddeleni klinicke hematologie
Onkologie (Czech Republic) | Year: 2014

CD5+ B-lymphoproliferative disorders represent a significant group of the defined diagnostic entities within the framework of the WHO classification of mature B-cell neoplasms. The pathological presence of CD5 antigen is an important diagnostic feature because of the minor expression of CD5 on normal B-lymphocytes. The laboratory diagnostics of the CD5+ B-lymphoproliferative disorders is multidisciplinary and it comprises the morphological methods (cytology, histology), the methods of immunophenotyping (immunohistochemistry, flow cytometry) and the cytogenetic and molecular cytogenetic methods. Based on the morphological features, the immunophenotype and the genetic profile, three groups of the CD5+ B-lymphoproliferative diseases can be recognized: the entities with the bright CD5 expression in a major part of cases (chronic lymphocytic leukaemia, small lymphocytic lymphoma, mantle cell lymphoma), the entities with the CD5 expression in a significant minor part of cases (B-prolymphocytic leukaemia, splenic marginal zone lymphoma) and the entities with rare CD5 expression (other types of marginal zone lymphomas, diffuse large B-cell lymphoma, follicular lymphoma, lymphoplasmacytic lymphoma, Burkitt lymphoma).

Polak P.,Oddeleni klinicke hematologie | Matejovska-Kubesova H.,Oddeleni klinicke hematologie
Interni Medicina pro Praxi | Year: 2016

The work is dedicated to the pathophysiology of inflammatory processes leading to the C-reactive protein (CRP) synthesis and to its immune functions. The understanding of possible infectious and non-infectious causes leading to CRP-synthesis as well as understanding of the dynamics of its synthesis and degradation and of the role of elevated CRP levels in the indication of antibiotic treatment are emphasized.

Kozak T.,Oddeleni Klinicke Hematologie
Transfuze a Hematologie Dnes | Year: 2010

Patients not included to respective clinical study should be advised to start the treatment of their chronic lymphocytic leukemia (CLL) strictly according to the clinical stage and activity of the disease. These criteria have not changed significantly in last decade, the last summary has been published in 2008. Patients with high-risk clinical stage of CLL should be indicated for the therapy as well as patients having clear signs of active and progressive disease even in earlier stages. So-called new prognostic markers do not have direct influence on timing of the therapy at this point, but it cannot be ruled out in the future. A clinical trial regarding this endpoint has not been concluded yet.

Smejkal P.,Oddeleni klinicke hematologie
Interni Medicina pro Praxi | Year: 2012

Hemophilia is a rare hereditary disease with incidence of about 1 patient per 10 000 inhabitants. Caring for these patients is costly and is most effectively provided by specialized haemophilia centers. However every physician may encounter these patients in an acute situation or solve their chronic problems.

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