Vol 7, No 1 (2012)

We report the activity of lenalidomide (revlimide – R), lenalidomide plus dexamethasone (Rd), lenalidomide plus bortezomib plus dexamethasone (RVd) in 34 patients with relapsed and refractory myeloma. For patients who received lenalidomide the overall response rate was 70.5 %. 38 % patients achieved very good partial response (VGPR) + complete response (CR). Median overall survival (OS) was 48 months. Lenalidomide may overcome the poor prognostic impact of various factors, particularly elevated beta (2)-microglobulin. Lenalidomide is highly active in elderly patients (> 65 years). Significantly increased OS with a lenalidomide-based induction and lenalidomide maintenance therapy was revealed. The median duration of the overall response without lenalidomide maintenance therapy was 10 months. The median duration of the overall response with lenalidomide maintenance therapy was 20 months (р < 0,05). Median OS with lenalidomide maintenance therapy was not reached. Median OS without lenalidomide maintenance therapy was 36 months (р < 0.05). Side effects were predictable and manageable. The most common adverse events reported were neutropenia (38.3 %) and thrombocytopenia (23.7 %). Serious adverse events were rare.

To allow minimal residual disease (MRD) monitoring using flow cytometry it is needed the optimal combination of monoclonal antibodies (MA), based on a precise knowledge of leukemic cells immunophenotypic features. Multiple immunophenotypic aberrations in leukemic blasts of B-precursors ALL (BII ALL) were revealed. Asynchronous expression of differentiation antigens on tumor cells occurs in more than 50 % cases. Aberrant myeloid markers expression in 42.6 % BII ALL cases was observed. The main differences between tumor and normal bone marrow cells are the expression intensity of CD19, CD10, CD20, CD38, CD45, CD34 and CD58. Thus, expression intensity pattern of CD19, CD10, CD20, CD38, CD45, CD34, CD58 on tumor cells compared with normal B-lymphocyte precursors allow to use these markers combination to MRD monitoring.

Umbilical cord blood (CB) is now an attractive source of hematopoietic stem cells (HSCs) for transplantation in pediatric and adult patients with various malignant and non-malignant diseases. However, its clinical application is limited by low cells numbers in graft, which correlates with delayed engraftment, an extension of time to platelets and neutrophils recovery and increasing risk of infectious complications. Several strategies have been suggested to overcome this limitation, one of which is obtaining a sufficient number of hematopoietic progenitor cells by ex vivo expansion. Literature review about CB HSCs expansion in given article is presented.