PubMed · 14344307
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M F TOLOT. 1965-02-15. [SOME PRACTICAL REFLECTIONS AND CONCLUSIONS].. https://pubmed.ncbi.nlm.nih.gov/14344307/
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The association of rheumatic diseases with common and some of the less common hematological features such as different forms of anemia, leukopenia and thrombopenia are described in this article. In addition, the occurrence of malignancy in rheumatoid arthritis, systemic lupus erythematosus, myositis and scleroderma and possible causes are discussed. On the other hand, this review also focuses on various rheumatological manifestations of hematological diseases such as leukemia and lymphoma. The aim of the article is to give an overview of the various associations between rheumatological and hemato-/oncological diseases that have to be considered in clinical practice.
Renal failure is a common complication in patients with multiple myeloma. It is generally due to tubular light-chain damage, and it is reversible in about 50% of patients. The reversibility rate depends on the degree of light-chain nephropathy. The initial therapy should consist of dexamethasone- or cyclophosphamide-based regimens. High-dose therapy/autologous transplant may be of benefit in selected patients. Early plasma exchange may be useful in patients who have severe renal failure but do not yet require dialysis. Renal replacement with dialysis is a worthwhile measure in patients with end-stage renal failure. Anemia is the most common hematologic complication. About 70% of anemic patients respond to recombinant human erythropoietin (rHuEPO), resulting not only in an increase in the hemoglobin level but also in an improvement in the quality of life. The hemoglobin level should ideally be maintained at around 12 g/dL. Infection is the main cause of morbidity and mortality in patients with myeloma. The highest risk of infection is within the first 2 months of initiation of therapy as well as in patients with renal failure and in those with relapsed and refractory disease.
AIMS: This paper describes a national audit of the indications for, and techniques and toxicity of, palliative splenic radiotherapy in haematological disorders. MATERIALS AND METHODS: A postal questionnaire was sent to consultant clinical oncologists treating haematological malignancies in the UK. RESULTS: The response rate was 76%. The audit shows chronic lymphocytic leukaemia, myelofibrosis and chronic myeloid leukaemia to be the most common underlying conditions in which splenic irradiation is used. Painful splenomegaly and hypersplenism were the most common indications. Dose fractionation schedules vary widely across the UK, and also the level of full blood counts used to interrupt radiotherapy. CONCLUSIONS: Palliative splenic radiotherapy continues to be widely used in the UK in small numbers of patients and seems to be well tolerated. Re-irradiation for further symptomatic progression is also commonly carried out.