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Three male patients aged 52, 49 and 74 years who were treated with hydroxyurea for chronic myeloid leukaemia (CML) or essential thrombocytosis developed severely painful ulcers on the lower legs and feet after an interval varying from 4 months to 2.5 years. These ulcers only healed after discontinuation of the drug. This is an adverse effect of hydroxyurea that is not infrequently seen but is difficult to recognise. The precise pathogenesis is still unclear but micro-circulatory disorders and a direct cytostatic effect on the epidermal cells probably play a role. Often, the drug has already been used for several years before the ulcers develop. They are resistant to treatment unless the hydroxyurea is stopped. Alternatives to hydroxyurea are imatinib for the treatment of CML and interferon alpha-2a or anagrelide for essential thrombocytosis.

Objective: To determine the average cost-effectiveness ratio of treatment of patients with chronic myeloid leukaemia (CML): with first-line interferon alpha-2a (IFN) or with second-line imatinib following IFN failure., Design: Cost-effectiveness analysis., Method: A general cost-effectiveness analysis was performed using a model. This model consists of two phases: an induction phase of eight months, in which newly-diagnosed patients are treated with either IFN or imatinib, and a chronic treatment phase wherein patients are treated according the result of the induction phase. The model calculated the costs and effects of the treatment. Input for this model was derived from literature and expert opinion. Costs were based on real cost prices and tariffs., Results: Treatment with imatinib resulted in 6.67 quality-adjusted life years (QALYs) and treatment with IFN resulted in 4.98 QALYs. Average costs of treatment with 5 million IU/day of IFN were [symbol: see text] 76,969 and [symbol: see text] 53,257 with 3 million IU/day. For imatinib at 400 mg/day the costs were [symbol: see text] 140,765 per patient. Costs per QALY were [symbol: see text] 15,445, [symbol: see text] 10,687 and [symbol: see text] 21,082, respectively., Conclusion: The addition of imatinib to the treatment options in CML resulted in increased quality-adjusted survival, but also higher costs of treatment.

Three patients suffering from chronic myelogenous leukaemia (CML), a 36-year-old woman in blast crisis, and a 64-year-old woman and a 60-year-old man in the chronic phase, participated in a clinical trial with STI571, a recently developed tyrosine kinase inhibitor with relative specificity for the BCR-ABL kinase. In all three patients, complete haematologic remission occurred within 2 months of the treatment being initiated. Subsequently the patient in blast crisis underwent allogeneic stem-cell transplantation. For the second patient, who had experienced many side effects with the standard treatment, STI571 led to a better quality of life. The third patient reached complete cytogenetic remission after 3 months of treatment. The development of STI571 is a major breakthrough in the treatment of CML. There are few side effects and the short-term results are excellent in specific patient categories. Further research is needed to establish the eventual role of STI571 in the treatment of CML.

Objective: To determine the efficacy of a short intravenous course of high-dose methylprednisolone compared with the standard treatment with prednisone for adult patients with idiopathic thrombocytopenic purpura (ITP)., Design: Retrospective., Methods: For all patients diagnosed with ITP between January 1st 1988 and January 1st 1998 in the University Hospital Vrije Universiteit, Amsterdam, the Netherlands, data were obtained until June 1st 1998. These patients had received a brief course of treatment with methylprednisolone i.v. (1 g per day on three successive days in the outpatient department) or the standard treatment (protracted oral treatment with prednisone). A response was defined as a rise in platelet count of > 50 x 10(9)/l. When a remission lasted more than a year a patient was defined as longterm responder., Results: The results concerned 41 patients. The prednisone group comprised 7 males and 20 females, mean age 39 years, the methylprednisolone group comprised 2 males and 12 females, mean age 43 years. Initial treatment with prednisone or methylprednisolone resulted in equal response rates of, respectively, 63% (17/27 patients) and 64% (9/14 patients). The number of longterm responders was 8 of 27 patients in the prednisone group and 2 of 14 patients in the methylprednisolone group. At time of relapse 22 patients were treated with the other treatment modality. The response rate in the group of patients treated with prednisone after first-line treatment with methylprednisolone, was 67% (6/9), for methylprednisolone after first-line treatment with prednisone the response rate was 23% (3/13)., Conclusion: A short intravenous course of high-dose methylprednisolone is effective as initial treatment of adults with ITP. Toxicity of longterm treatment with prednisone can be avoided in a number of patients with ITP. In patients refractory to treatment with methylprednisolone, the response rate to second-line treatment with prednisone was not negatively influenced, since two thirds of these relapsing patients subsequently responded to prednisone.

Haematological malignancies like acute and chronic leukemias, malignant lymphoma and plasma cell disorders may exhibit oral manifestation during their course. In this article the oral manifestation of a number of haematological malignancies presented in the oral cavity as well as the complications of the treatment are described.