evolution | Acta Medica Marisiensis

Interferon Beta-1b for the Treatment of Multiple Sclerosis – More than 10 Years of Experience

Laura Iulia Barcutean1,2, Smaranda Maier1,2, Zoltan Bajko1,1, Anca Motataianu^1,2, Andreea Romaniuc², Sebastian Razvan Andone², Rodica Ioana Balasa^1,2

1. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania,
2. Mures County Emergency Clinical Hospital, Department of Neurology, Târgu Mureş, Romania

DOI: 10.2478/amma-2019-0003

Objective: Interferon beta-1b (IFNβ-1b) was the first disease-modifying agent (DMT) used for the treatment of multiple sclerosis (MS). We aimed to evaluate the first patients with MS that started treatment in our clinic.
Methods: An observational, retrospective study was performed on 78 patients that had continuous treatment with IFNβ-1b for more than 10 years. The collection of the demographical data and periodical clinical evaluation was performed on all patients. The disability was quantified using the Expanded Disability Status Scale (EDSS), creating two groups of patients, G1: EDSS < 4.0 and G2: EDSS ≥ 4.0. The hallmarks of the disability evolution were gathered by direct patient interview, such as the symptoms at onset and relapse frequency.
Results: After more than 17 years of disease evolution, more than half (65.38%) of the patients present a mild disability score. The majority (54.90%) started treatment in the first three years after the onset, while the patients in G2 started treatment after more than 3 years from the onset. The initiation of IFNβ-1b lead to a significant reduction of the relapse rates. A reduced number of patients (<25%) transitioned from RRMS to SPMS.
Discussion: Continuous evaluation of MS patients allows us to assess the possibility of prolonged treatment with IFNβ-1b and to differentiate the responders from non-responders. The clear reduction in relapse rates and disability progression, notably in patients that started treatment early ensure us into continuing administering this medication. Compared to historical cohorts, our lot had a slower disability evolution and a significant proportion hadn’t reach an important disability score.

Acute Myeloblastic Leukemia: Difficulties of Treatment, Complications and Evolution

Tilinca Mariana¹, Benedek Lázár Erzsébet², Köpeczi Judith Beáta², Bacârea Anca³, Bănescu Claudia⁴, Benedek I², Bățagă Simona⁵

1 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Hematology, Bone Marrow Transplantation Compartment, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Physiopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: This paper presents a special case of an acute myeloblastic leukemia accidentally diagnosed on a 57 years old asymptomatic person without occupational exposure, without a medical history, with normal blood count, without thrombocytopenia, as a result of routine hematological tests that reveal the presence of more than 10% blasts on peripheral blood smear.
Material and method: Bone marrow aspirate revealed 80% blasts and flow cytometry confirmed the diagnosis of acute myeloblastic leukemia LAM0. Cytogenetic examination showed normal karyotype 46, XX. The treatment aims to induce, maintain and consolidate remission. Since the classical therapeutical approach with Idarubicine and Cytarabine 3+7 was not tolerated, adjustments were necessary to 2+5, four courses being administered. During the remission period Methotrexate and Purinetol maintenance treatment was administered, it was obtained a tolerable quality of life, the patient resumed his work. The first relapse occurred after approximately one year. Later medical courses were established after chemotherapy protocol with Clofarabine and Cytarabine, but after intolerance, neutropenia, sepsis and death occured.
Results: Because of the severe prognosis and infectious complications the treatment was difficult and dose ajustments were necessary according to patient’s tolerance. Bone marrow transplant was not possible due to the lack of a compatible family donor.
Conclusions: This case of acute myelogenous leukemia treatment reflects the difficulties and complications occurred during the disease evolution. However remission periods with a tolerable quality of life were obtained, duration of treatment was approximately three years until death.