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The paper presents a retrospective analysis of long-term follow-ups (from 1959 to 2000) of 86 patients with acute pro-myelocytic leukemia, a rare type of hemoblastoses. The specific features of this form of leukemia is that blast cells of the bone marrow and peripheral blood have a specific granularity that plays a decisive role in the development of the severe hemorrhagic syndrome leading to patients' death. The morphological, cytochemical, cytogenetic, electron microscopic, and biochemical features of blast cells in this disease and its pathogenesis, clinical presentation, and treatment are considered. An extract from the records of a female patient who has had a complete clinical and hematological remission for 22 years is given. The follow-up of such a prolonged remission has not been covered in the Russian literature.

The authors present 5-year survival of 64 patients with aplastic anemia (AA) divided into 2 groups. Group 1 received antilymphocytic globulin (ALG) in low doses (1-5 mg/kg), group 2 in high doses (10-30 mg/kg). Survival of patients with severe AA in group 1 made up 28.5%, with mild AA 90.1%. Overall survival in group 1 was 64.4%, in group 2 53.8%. Overall toxicity came to 48.6%. By resultant complications high and low ALG doses did not differ. The authors propose to use low doses of ALG in mild disease whereas in severe condition high ALG doses are thought adequate.

Clinical and laboratory indications of hemocoagulatory disorders (according to the data of electrocoagulograph H-334 and red blood cell deformability) were compared for multiple myeloma patients. They received drugs according to 3 different polychemotherapy schemes involving various combinations and doses of cyclophosphamide, vincristine, rubomycin, paphencyl, sarcolysin and prednisolone. Pretreatment measurements in relevant patients revealed severe hemocoagulative and rheologic shifts responsible for hemorrhages, impaired microcirculation and cardiac failure. The most efficient polychemotherapy was found that gained benefit with addition of plasmapheresis. To control the effect of polychemotherapy, its intensity, individual deviations and duration, it is advisable to combine routine tests with citrated plasma electrocoagulography, assessment of AT-III activity and red blood cell deformability indicating hemocoagulative and rheologic disorders.

Three different programs of polychemotherapy (PCT) of multiple myeloma (MM) were compared. The programs included the use of cyclophosphamide (up to 750 mg/m2), vincristine (1.4 mg/m2), rubomycin (40 mg/m2), sarcolysine (7.5 mg/m2), paphencyl (50 mg/day) and prednisolone (from 30 to 60 mg/m2) in different combinations with regard to the hemocoagulation and rheological blood properties. It has been shown that in patients with MM there occur profound hemocoagulation and rheological alterations playing an important part in the genesis of the syndrome of hyperviscosity and circulation failure. The use of the programs of PCT in conjunction with therapeutic plasmapheresis brought about an appreciable improvement of the patients' general health status and correction of hemocoagulation and hemorheological disorders. To control the efficacy of PCT, its individualization, intensity and duration, it is recommended that in addition to the common tests, the activity of the antithrombin-III-heparin complex may be measured and the test for the presence of fibrin monomer in the plasma be made, since these parameters clearly reflect the changes in the system of hemostasis and enable one to discover the early signs of proliferation activation in MM thereby preventing hemorrhages.

Results of 270 plasmacytophereses performed in 64 patients with different forms of hemoblastoses are presented. Indications for using the method are determined. It is shown that plasmacytopheresis included in the complex therapy of hemoblastoses increases the incidence of remissions, shortens the time of treatment, allows to increase single doses and decrease general dose of the cytostatic preparations used.

The authors described experience in the use of the method of extracorporal hemosorption in patients with grave hemoblastoses. Nineteen of them were given 24 hemosorptions. Though severe disorders of the blood aggregate condition, thrombocytopenia (65%) and signs of disorder of thrombocyte function were present, no hemorrhagic complications during hemosorption were observed. Mean doses of heparin taking account of its consumption for sorbent treatment were 200 I.U./kg of body mass in thrombocytopenia and 300 I.U./kg of body mass with the normal level of thrombocytes. The refusal of protamine-sulfate administration to neutralize residual heparin at the end of operation for fear of possible complications made it possible to restore the initial indices of homeostasis 20 hrs. after sorption. This scheme for examination of the homeostasis system made it possible to control the adequacy of patient's heparinization and to avoid complications of the blood coagulation system.