Vol 10, No 3 (2015)

Relapsed and refractory multiple myeloma (MM) is defined as progression during anticancer therapy, or within 60 days of therapy completion. Patients with double resistance to bortezomib and lenalidomide that is two key anti-myeloma drugs are considered to have a very poor prognosis, and new regimens are needed to improve this setting. Pomalidomide is an immunomodulatory drug third generation, studied in combination with low-dose dexamethasone (LDD) as salvage therapy for patients with double refractory. This article reviews the clinical pharmacology, therapeutic efficacy and safety, dosage and administration, peculiar properties of the practical application of pomalidomide. The article is illustrated by the description of a 59-year-old woman with relapsed and refractory MM, who received pomalidomide in combination with LDD. Medical history prior to treatment with pomalidomide was included 8 lines of therapy conducted over 6.5 years, with the formation of the double refractory to lenalidomide and bortezomib. In March 2012, treatment with pomalidomide (4 mg days 1–21 of a 28-day cycle) and LDD (160 mg / cycle) has been started as the ninth line. In total, up to March 2014 the patient received 30 cycles of therapy with pomalidomide. After the first 2 cycles documented partial response (52 % reduction of IgGk), the deepest response is received after 10 cycles (82 % reduction). The patient is alive at the time of this article. The duration of response to pomalidomide is 25 months and overall survival from the time of his appointment is more than 37 months. In addition, this review presents the results of base clinical trials testing pomalidomide and LDD. Problems of development of new treatment regimens based on pomalidomide for relapsed and refractory MM are also discussed.

During therapy with second generation tyrosine kinase inhibitors in patients with chronic myeloid leukemia, a number of patients demonstrate non-hematological toxicity of various degrees. The article contains review of references about second generation tyrosine kinase inhibitors effect on the frequency of cardiovascular and metabolic problems.

Serological methods of Rhesus antigens identification in humans cannot identify D-antigen variants. In this article the serological characteristics of Rhesus antigen D weak type 4.2. (Category DAR) are described.

In the second part we present a review of the existing data about ability of integrated tests, as already introduced in clinical practice, and the new (test of thrombin generation, thromboelastography, thrombodynamics, perfusion chamber) to assess the risk of thrombosis in different pathologies. We can conclude that the existing integrated tests can be an important tool in the diagnosis of hypercoagulation. However, lack of standardization prevents their use: various tests and modifications of each test are different in sensitivity and specificity for each pathological condition. Furthermore, even in situations where the tests can reliably identify a group of patients with different degrees of thrombosis risk, their use in clinical practice is often difficult, since the differences between these groups were statistically significant, but the normal range and patients significantly overlap.