A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma

Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures. We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis. The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM. A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0-2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.

Sub-micrometric reflectometry for localized label-free biosensing

In this work we present an optical technique for characterizing sub-micrometric areas based on reflectivity of the light as a function of angle of incidence for the two pure polarizations s and p, covering a range of angles of incidence from -71.80° to 71.80° with a resolution of 0.1°. Circular areas with a diameter in the order of 600 nm can be characterized, and the spectra for the two polarizations can be obtained with a single measurement. For biosensing purposes, we have fabricated several Bio Photonic Sensing Cells (BICELLs) consisting of interferometers of 1240 nm of SU-8 polymer over silicon. An indirect immunoassay is performed over these BICELLs and compared experimentally with FT-VIS-NIR spectrometry and theoretical calculations. The Limit of Detection (LoD) achieved is comparable with standard high resolution spectrometry, but with the capability of analyzing sub-micrometric domains for immunoassays reactions onto a sensing surface.

Reticulated platelets as a screening test to identify thrombocytopenia aetiology

BACKGROUND

Thrombocytopenia is a common haematological abnormality and no simple diagnostic test is available to diagnose thrombocytopenia pathogenesis.

AIM

To evaluate sensitivity and specificity of reticulated platelets (RP) as a diagnostic test for thrombocytopenia with increased thrombopoietic activity.

DESIGN

Prospective observational study in thrombocytopenic patients.

METHODS

A direct, whole-blood, dual-labelling flow cytometric method was used. Direct, whole-blood double coverage was achieved using a monoclonal anti-glycoprotein (GP)-III antibody (CD61 PerCP) for platelet identification and thiazole orange (Retic-count) as platelet mARN stain.

RESULTS

RP were measured in 101 thrombocytopenic patients and 104 non-thrombocytopenic controls. The mean RP percentage in 60 thrombocytopenic patients with no increased thrombopoietic activity was 7.5% (CI for 95%: 5.2-9.7) and RP absolute number was 3.2 x 10(9)/l (CI for 95%: 2.1-4.3). The mean RP percentage in 41 thrombocytopenic patients with increased thrombopoietic activity was 30.3% (CI for 95%: 25.1-35.5) and RP absolute number was 6.2 (CI for 95%: 4.8-7.7). The RP percentage cut-off for a diagnosis of thrombocytopenia with increased thrombopoietic activity was 11% [sensitivity 93%, specificity 85%, positive predictive value (PPV) 83%, negative predictive value (NPV) 95%].

CONCLUSION

RP measurement by flow cytometry, directly from whole-blood, is a useful screening test to differentiate between thrombocytopenia with high or low thrombopoietic activity. A RP percentage in excess of 11%, has a high sensitivity and good specificity for a diagnosis of thrombocytopenia with increased thrombopoietic activity.

Randomized comparison of dexamethasone combined with melphalan versus melphalan with prednisone in the treatment of elderly patients with multiple myeloma

Melphalan-prednisone (MP) has been the gold standard treatment for more than 30 years in elderly multiple myeloma (MM) patients. In order to assess whether the combination of dexamethasone with melphalan (MD) could improve on the efficacy of MP, we have carried out a randomized trial comparing both treatment approaches. A total of 201 patients >/=70 years old were included in the study. The overall response rate was similar after six cycles (MP: 67.9%versus MD: 64.5%) and after 12 cycles (MP: 49.4%versus MD: 46.1%). However, the proportion of complete responses (CR) was higher in the MD arm, particularly after 12 cycles (MD: 22.4%versus MP: 9.1%; P < 0.05). There was no significant difference in event-free survival (MP: 15.9 months versus MD: 23.3 months). The median overall survival in both arms was almost identical (MP: 29.4 months versus MD: 27.2 months; P = 0.63). No significant differences in haematological toxicity were observed, but non-haematological toxicity was significantly higher in the MD arm. According to these results MP remains as the gold standard for treatment of MM and should be the reference for comparison of new therapeutic approaches involving novel agents.

[Prophylaxis with ciprofloxacin in postchemotherapy neutropenia in acute myeloid leukemia]

BACKGROUND

Infection is the most frequent complication in patients with acute myeloid leukemia (AML) following chemotherapy. The new quinolones, among which ciprofloxacin may be found, seem to be effective in the prophylaxis of this complication.

METHODS

Fifty consecutive episodes of neutropenia were studied in patients with AML who received prophylaxis with ciprofloxacin and these were compared with a historic control group of another 50 consecutive episodes of neutropenia in AML patients who did not receive antibiotic prophylaxis. The difference with regard to the prevalence of infection and the characteristics of the same were studied.

RESULTS

Ciprofloxacin significantly decreased the number of febrile episodes following chemotherapy of induction or consolidation with respect to those who did not receive prophylaxis (68% versus 94%; p = 0.002). Likewise, the patients who received ciprofloxacin presented fewer bacteriologically documented infections (26% versus 50%; p = 0.023), bacteremias (10 versus 25, p = 0.03) and infections produced by Gram negative microorganisms (2 versus 13, p = 0.009). Ciprofloxacin led to disappearance of the infections produced by Pseudomonas aeruginosa. Delay in the development of infection was observed in patients who received ciprofloxacin (mean: 11 days, CI: 7-15 days) with respect to those who did not receive prophylaxis (mean: 6 days, CI: 4-6 days) (p = 0.0001).

CONCLUSIONS

Ciprofloxacin is an effective antibiotic in the prevention of infection in episodes of neutropenia after induction or consolidation chemotherapy in patients with acute myeloid leukemia. Not only does it decrease the number of febrile episodes, bacteriologically documented infections, bacteremias and infections produced by Gram negative microorganisms, but it also delays the appearance of the febrile episodes.

[Resistance to antivitamins K]

Resistance to oral anticoagulant is a rare phenomenon. We report the case of a 32-year-old woman who required anticoagulation due to a deep venous thrombosis. She gradually developed resistance to acenocumarol and warfarin. Although the HPLC (high performance liquid chromatography) method proved satisfactory acenocumarol levels in plasma, therapeutic anticoagulation was not achieved. The mechanisms of resistance are discussed.