Objective To investigate the clinical significance of serum lactate dehydrogenase (LDH) and its isoenzymes,M or H subunits in the retreated patients with multiple myeloma(MM).Methods 141 medical records of retreated patients with multiple myeloma were collected,and the relationship of LDH and its isoenzymes,subunits with DS staging system,ISS staging system,creatinine,bone marrow plasma cell percentage,immunoglobulin and microglobin was analyzed.Results Serum total LDH activity was not significantly related to DS staging system and ISS staging system.LDH1 percentages was negatively correlated with ISS staging system (P＜0.01),and LDH4 percentages positively associated with ISS staging system (P＜0.05).LDH activity,absolute value of LDH1 ,LDH2,LDH3,LDH4,and H subunits were positively linked to serum creatinine in myeloma kidney disease patients with renal inadequacy (P＜0.05).Both percentage and absolute value of LDH5 were negatively correlated with bone marrow plasma cell percentage (P＜0.01 and P＜0.05 respectively).Conclusion The detection of serum LDH isoenzyme is more valuable than total LDH activity in retreated patients with multiple myeloma.

Objective To analyze the effect of bortezomib together with dexamethsone on the treatment of refractory multiple myeloma.Methods Bortezomib at 1.3 mg/m2 iv drop 1 d,4 d,8 d,11 d.Dexamethasonc 20 mg/d,1～4 d,8～11 d,17～20 d.21 days are used as a course.For bi-course dexamethasone was given by 20 mg/d,at 1～4 d.Results After 2～6 periods,3 cases achieved completely recovery(CR),4 cases are near to completely recovery(CR),3 cases got partially recovery(PR).Conclusion It is a good choice to treat refractory multiple myeloma by Bortezomib together with dexamethagone.

Objective To analyze the clinical manifestation of diffusive alveolar hemorrhage in acute leukemia induction therapy.Methods Clinical data of two diagnosed cases of diffusive alveolar hemorrhage secondary to acute leukemia were collected.Clinical data of eight cases of diffusive alveolar hemorrhage secondary to acute leukemia which were published were also collected by searching in Medline database.The clinical manifestation,diagnosis,strategy of differential diagnosis and treatment of diffusive alveolar hemorrhage secondary to acute leukemia were analyzed.Results Diffusive alveolar hemorrhage was a rare but fatal complication of acute leukemia.The common clinical manifestations included hemoptysis,progressive dyspnea and progressive decrease in concentration of hemoglobin.The analysis of blood gas showed type Ⅰ respiratory failure.The manifestations of chest computed tomography included diffusive ground glass opacity and infiltration of parenchyma.The bronchoalveolar lavage fluid was bloody.And lung biopsy showed congestion of alveoli and capillaritis.The detection for pathogens,vasculitis related antibodies,brain natrium peptide were negative.The mortality of those cases was 40 ％ (4/10).Corticosteroids therapy was effective.The mortality of patients received corticosteroids therapy was 25 ％ (2/8).Conclusion Diffusive alveolar hemorrhage is a rare but fatal complication of acute leukemia.The mortality is high.The key points of therapy are early diagnosis and corticosteroids therapy.