Ladislav Slováček

Aplastic Anemia as a Cause of Death in a Patient with Glioblastoma Multiforme Treated with Temozolomide

Background:Standard treatment of glioblastoma multiforme consists of postoperative radiochemotherapy with temozolomide, followed by a 6-month chemotherapy. Serious hematologic complications are rarely reported.Case Report and Results:The authors present the case of a 61-year-old female patient with glioblastoma multiforme treated with external-beam radiation therapy and concomitant temozolomide. After completion of treatment, the patient developed symptoms of serious aplastic anemia that eventually led to death due to prolonged neutro- and thrombocytopenia followed by infectious complications.Conclusion:Lethal complications following temozolomide are, per se, extremely rare, however, a total of four other cases of aplastic anemia have been reported in the literature so far.ZusammenfassungHintergrund:Die Standardbehandlung des Glioblastoma multiforme ist die postoperative Radiochemotherapie mit Temozolomid, gefolgt von einer 6-monatigen Erhaltungschemotherapie. Schwerwiegende hämatologische Toxizitäten werden selten berichtet.Fallbericht und Ergebnisse:Die Autoren präsentieren den Fall einer 61-jahrigen Patientin mit Glioblastoma multiforme, die mit externer Strahlentherapie und begleitender Temozolomidchemotherapie in Standarddosierung behandelt wurde. Nach Abschluss der Behandlung zeigte die Patientin Symptome einer schweren aplastischen Anämie, die infolge prolongierter Neutro- und Thrombopenie durch infektiöse Komplikationen zum Tode führte.Schlussfolgerung:Letale Komplikationen einer Temozolomidchemotherapie sind selten, bislang wurden insgesamt vier Fälle einer aplastischen Anämie in der Literatur berichtet.

Quality of life in oncological and hematooncological patients after hematopoietic stem cell transplantation: The effect of selected psychosocial and health aspects on quality of life: A review of the literature

Summary Haematopoietic stem cell transplantation is a therapeutic method which is not only used for the treatment of haematooncological diseases but also as a therapy for solid tumours and non-malignant diseases. Haematopoietic stem cell transplantation influences the further course of the disease and therefore the quality of life for patients in the same way as other therapeutic methods. The authors describe the evaluation possibilities for the quality of life and effect of selected aspects on quality of life of patients undergoing haematopoietic stem cell transplantation in the form of a review of the literature.

Psychosocial, health and demographic characteristics of quality of life among patients with acute myeloid leukemia and malignant lymphoma who underwent autologous hematopoietic stem cell transplantation.

CONTEXT AND OBJECTIVE This study evaluated the effect of selected psychosocial, health and demographic characteristics of quality of life (QOL) among patients treated with autologous hematopoietic stem cell transplantation (HSCT). DESIGN AND SETTING This was a retrospective study at Charles University Hospital, Hradec Kralove. METHODS The Czech version of the international generic European Quality-of-Life questionnaire (EQ-5D) was applied to evaluate QOL among patients with acute myeloid leukemia (AML) and malignant Hodgkins and non-Hodgkins lymphoma (ML). The total number of respondents was 36: 12 with AML (seven males and five females) and 24 with ML (11 males and 13 females). The mean age of AML respondents was 46 years and the mean age of ML respondents was 44.5 years. RESULTS Age, smoking status and education level had statistically significant effects on QOL among AML respondents (p < 0.05), and age had a statistically significant effect on QOL among ML respondents (p < 0.05). The overall QOL among AML and ML respondents was generally good: the mean EQ-5D score among AML respondents was 71.5% and among ML respondents it was 82.7%. CONCLUSION The QOL among AML and ML respondents treated with autologous HSCT was good. However, patients more than 50 years old, smokers and patients with lower education levels presented worse QOL. These findings need to be better evaluated in longitudinal studies, using large samples.

Quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation: The effect of selected psychosocial and health aspects on quality of life: A retrospective analysis

Summary Background Quality of life (QoL) is defined as “a patients subjective evaluation of his life situation”. QoL evaluation is carried out by means of generic and specific questionnaires. Generic QoL questionnaires generally evaluate a patients overall condition regardless of his disease. Specific QoL questionnaires are designed to evaluate a patients overall condition for a particular type of disease. Aim The study analyses the effect of selected psychosocial and health aspects on quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation. Materials/Methods The total number of respondents undergoing transplantation between 2001 and 2003 was 56:32 respondents (18 male and 14 female) with multiple myeloma, and 24 respondents (11 male and 13 female) with malignant lymphoma. The average age of patients with multiple myeloma was 60 years and the average age of patients with malignant lymphoma was 44.5 years. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial and health aspects (age, sex, level of education, marital status, number of associated diseases, smoking abuse, religion, type of disease and time since the transplantation) on quality of life in patients was determined by means of analysis of variance. Results The above-mentioned aspects proved statistically significant dependence of quality of life on age, smoking abuse in patients with multiple myeloma and on type of disease. EQ-5D score (dimensions of quality of life) and EQ-5D VAS (subjective health condition) significantly decrease with increasing age in both groups of patients and with smoking abuse in patients with multiple myeloma, and are significantly higher in patients with malignant lymphoma. The effect of other aspects on quality of life was not proven as statistically significant. The quality of life in patients with multiple myeloma undergoing autologous progenitor stem cell transplantation is at a lower level (mean EQ-5D score 68.9%, mean EQ-5D VAS 66.6%) than in patients with malignant lymphoma after the transplantation (mean EQ-5D score 82.7%, mean EQ-5D VAS 76.7%) at the Department of Clinical Haematology of the Department of Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. Conclusion The global quality of life in our patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation is at a good level.

Cutaneous Recurrence of Malignant Mesothelioma of the Tunica Vaginalis Testis: a Rare Case Report

Background: Mesothelioma of the tunica vaginalis testis is a rare and aggressive cancer; fewer than 90 cases have been reported. It occurs in all age groups, but its highest incidence appears between 55 and 75 years of age. Less than 5% of all malignant mesotheliomas arise from the tunica vaginalis testis. Case Report: The authors present a rare case of localized malignant mesothelioma of the tunica vaginalis testis. Diagnosis and treatment are described. Conclusion: Mesothelioma of the tunica vaginalis testis can be asymptomatic for a long time. In more than half of the cases, the clinical manifestations imitate a hydrocele or a tumor mass in the scrotum. Despite treatment, this tumor has a very poor prognosis with a median survival of 23 months.

Sexuality of men treated with haematopoietic stem cell transplantation: a review of the literature

Summary Haematopoietic stem cell transplantation (HSCT) is a therapeutic modality used in anti-tumour treatment of haematological malignancies as well as solid tumours. Apart from that it is also used in therapy of non-malignant and hereditary diseases. As well as all the other treatments, HSCT also affects the disease process and with that also the patient’s quality of life (QoL). In the last decade of the 20 th century several studies about QoL in patients after HSCT were undertaken and the infl uence in particular dimensions of QoL was observed. One of the closely observed aspects was sexuality in patients after HSCT. Sexuality and its expression is a very important aspect of human behaviour. It is also a very sensitive aspect, so without doubt it is affected by diagnosis of neoplasm and cancer treatment. Physical and psychosocial factors of HSCT affect patients’ sexuality and sexual functioning, and with that also their QoL. They remain in focus because of the complex care concerning patients after HSCT.

Health-related quality of life in acute myeloid leukaemia and multiple myeloma survivors undergoing autologous progenitor stem cell transplantation: a retrospective analysis

Summary Background Haematopoietic stem cell transplantation (HSCT) is a specific therapeutic method used for biomodulation antitumour therapy of haematological malignancies and of solid tumours. It is also used for the therapy of non-tumour and hereditary diseases. Aim To analyse the selected psychosocial, health and demographic aspects of quality of life (QoL) in acute myeloid leukaemia (AML) and multiple myeloma (MM) survivors undergoing autologous progenitor stem cell transplantation (PSCT). Materials/Methods The total number of AML survivors was 12 (7 male, 5 female). The total number of MM survivors was 32 (18 male, 14 female). The average age of AML survivors was 47.5 years old. Average age of MM survivors was 60 years old. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial, health and demographic aspects of QoL was determined by means of analysis of variance. The descriptive analysis was used for evaluation of QoL questionnaires. Results The above-mentioned aspects proved statistically significant dependence of QoL (EQ-5D score and EQ-5D VAS) on age in both cohorts (p Conclusions Low QoL correlates with increasing age of survivors treated with autologous PSCT. QoL in survivors who underwent autologous PSCT and believed in God was higher than in survivors who were non-believers. Low QoL correlates with smoking abuse. In both cohorts of survivors we proved lower QoL in smokers in comparison with non-smokers or former smokers. Low QoL in AML survivors with low level of education, meaning survivors with elementary and apprentice level education, has been proved. Low QoL correlates with increasing number of associated diseases in both cohorts of survivors.

Palliative care among elderly cancer patients: Own experience

BACKGROUND Annually, more than 27,000 persons die of cancer in the Czech Republic. It is known that in addition to the demographic aging of the Czech population, the cancer burden is increased. AIM These data clearly demonstrate the need for affordable and good follow-up care for patients, especially for older patients and/or patients with no other cancer treatment due to irreversible progression of tumor. MATERIALS AND METHODS We are talking about so-called palliative cancer care, which can be provided at different levels. One of the most common forms of palliative cancer care is hospice care. RESULTS Our clinic in the years 2008-2010 received a total of 446 patients. 288 of them were women and 158 men. The average age of women was 61 years (age range 20-81 years). The average age of men was 56 years (age range 18-96 years). The performance status was in the fitness category PS-0 (8%), PS-1 (54%), PS-2 (33%) and PS-3 (5%). CONCLUSION Currently the outpatient palliative cancer care are coming more into the forefront. This type of care allows patients to stay as long as possible at home among their close relatives. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies.

Somatostatin analog and mTOR inhibitor treatment of Merkel cell tumor.

Sir, I read with great interest the article by author Fakiha et al.[1] devoted to the issue of remission of Merkel cell tumor after somatostatin analog treatment. I would like this case added to my own experience with somatostatin analog and mTOR inhibitor treatment of Merkel cell tumor in a 70-year-old female patient. The patient underwent radical right elbow surgery, followed by adjuvant radiotherapy to a total dose of 54 Gy in 27 fractions in January 2008. After three months, there was tumor progression -new bearings on the right arm. Palliative chemotherapy based on cisplatin and etoposide was indicated. Patient received five cycles of chemotherapy and we achieved a regression of the disease. Another local disease progression on the right arm occurred at intervals of approximately nine months, we indicated re-irradiation of right arm and then five cycles of palliative chemotherapy based on cisplatin and etoposide in reduced doses of both chemotherapy by 25% due to hematological toxicity (pancytopenia) was given in addition, which led to stable disease. About three months later, there was a significant local tumor progression not only on the right arm, but also on the right side of the neck and chest wall. Due to exhaust the possibilities of cancer therapy, the patient was considered for a biological treatment. Somatostatin analog treatment (lanreotide 120 mg intramuscularly at intervals of two weeks) was indicated because of the positive octreoscan. There was clinically significant progression in the number of active sites on the right upper extremity and right chest wall after three applications of lanreotide. It was therefore resorted to a combination lanreotide with mTOR inhibitor (everolimus at a dose of 10 mg daily). After one month of combined biological therapy, there was another tumor progression. Cancer treatment was finally stopped.The patient died at an interval of one month from the completion of cancer treatment.

Tamoxifen and arrhythmia

Tamoxifen is an orally active selective estrogen receptor modulator that is used in the treatment of breast cancer and is currently the world’s largest selling drug for that purpose. However, it has some side effects including hot flashes, menstrual irregularity, vaginal discharges, uterine bleeding, uterine endometrial cancer, hypercoagulability, steatosis hepatis, risk of trombembolism. Long-term data from clinical trials have failed to demonstrate a cardioprotective effect and beneficial effects on serum lipid profiles. Arrhythmia secondary to tamoxifen is very rare.