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Background: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome with various etiologies. Its treatment is complicated by several important but not immediately obvious issues (e.g., HLH-2004 criteria are the most commonly used for diagnosis, but the recommended therapeutic regimen is HLH-94)., Objectives: The study aimed to assess hematologists' practical knowledge of HLH., Material and Methods: A survey was conducted among physicians treating adult hematological patients. A 10-question paper questionnaire was distributed to physicians from various hematology centers. A total of 126 questionnaires were analyzed., Results: Most respondents had little-to-moderate experience in caring for HLH patients: 59% treated 0-2 patients and 36% treated between 3-5 patients. Among the respondents, the preferred diagnostic criteria were HLH-2004, either in its original form (5 out of 8 criteria) for 70 respondents or its modified version (4 out of 6 available criteria when ferritin exceeds 2,000 ng/mL) for 56 respondents. The preferred treatment regimen was HLH-2004, with a full dose of etoposide in 72 responses or reduced in 39 responses. Fifty percent of respondents incorrectly answered that meeting the HLH-2004 criteria necessitates the use of the HLH-94/2004 regimen in full doses and duration. Sixty-four percent of respondents correctly identified that hemophagocytosis is not necessary for the diagnosis., Conclusions: This survey reveals that the majority of surveyed physicians adhere to international HLH recommendations. However, there are instances where these guidelines are not fully implemented, which underlines the need for further efforts to raise awareness and share clinical experiences about this patient group.

Introduction: Infections represent one of the most frequent causes of death of higher-risk MDS patients, as reported previously also by our group. Azacitidine Infection Risk Model (AIR), based on red blood cell (RBC) transfusion dependency, neutropenia <0.8 × 10 9 /L, platelet count <50 × 10 9 /L, albumin <35g/L, and ECOG performance status ≥2 has been proposed based on the retrospective data to estimate the risk of infection in azacitidine treated patients., Methods: The prospective non-intervention study aimed to identify factors predisposing to infection, validate the AIR score, and assess the impact of antimicrobial prophylaxis on the outcome of azacitidine-treated MDS/AML and CMML patients., Results: We collected data on 307 patients, 57.6 % males, treated with azacitidine: AML (37.8%), MDS (55.0%), and CMML (7.1%). The median age at azacitidine treatment commencement was 71 (range, 18-95) years. 200 (65%) patients were assigned to higher risk AIR group. Antibacterial, antifungal, and antiviral prophylaxis was used in 66.0%, 29.3%, and 25.7% of patients, respectively. In total, 169 infectious episodes (IE) were recorded in 118 (38.4%) patients within the first three azacitidine cycles. In a multivariate analysis ECOG status, RBC transfusion dependency, IPSS-R score, and CRP concentration were statistically significant for infection development ( p < 0.05). The occurrence of infection within the first three azacitidine cycles was significantly higher in the higher risk AIR group - 47.0% than in lower risk 22.4% (odds ratio (OR) 3.06; 95% CI 1.82-5.30, p < 0.05). Administration of antimicrobial prophylaxis did not have a significant impact on all-infection occurrence in multivariate analysis: antibacterial prophylaxis (OR 0.93; 0.41-2.05, p = 0.87), antifungal OR 1.24 (0.54-2.85) ( p = 0.59), antiviral OR 1.24 (0.53-2.82) ( p = 0.60)., Discussion: The AIR Model effectively discriminates infection-risk patients during azacitidine treatment. Antimicrobial prophylaxis does not decrease the infection rate., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mądry, Lis, Sienkiewicz, Drozd-Sokołowska, Biecek, Sośnia, Gołos, Olszewska-Szopa, Obara, Walkowiak, Ściesińska, Subocz, Butrym, Machowicz, Budziszewska and Basak.)

Adult acute lymphoblastic leukemia (ALL) is associated with poor outcomes. ALL is initiated by primary aberrations, but secondary genetic lesions are necessary for overt ALL. In this study, we reassessed the value of primary and secondary aberrations in intensively treated ALL patients in relation to mutator enzyme expression. RT-PCR, genomic PCR, and sequencing were applied to evaluate primary aberrations, while qPCR was used to measure the expression of RAG and AID mutator enzymes in 166 adult ALL patients. Secondary copy number alterations (CNA) were studied in 94 cases by MLPA assay. Primary aberrations alone stratified 30% of the patients (27% high-risk, 3% low-risk cases). The remaining 70% intermediate-risk patients included BCR::ABL1 pos subgroup and ALL lacking identified genetic markers (NEG ALL). We identified three CNA profiles: high-risk bad-CNA (CNA high / IKZF1 pos ), low-risk good-CNA (all other CNAs), and intermediate-risk CNA neg . Furthermore, based on RAG/AID expression, we report possible mechanisms underlying the CNA profiles associated with poor outcome: AID stratified outcome in CNA neg , which accompanied most likely a particular profile of single nucleotide variations, while RAG in CNA pos increased the odds for CNA high / IKZF1 pos development. Finally, we integrated primary genetic aberrations with CNA to propose a revised risk stratification code, which allowed us to stratify 75% of BCR::ABL1 pos and NEG patients.

Hemophagocytic lymphohistiocytosis (HLH; hemophagocytic syndrome) is a rare syndrome of potentially fatal, uncontrolled hyperinflammation. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is indicated in primary, recurrent or progressive HLH, but information about its outcomes in the adult population is limited. We obtained data about 87 adult (≥18 years of age) patients retrospectively reported to the EBMT. The median survival time was 13.9 months. The three and five-year overall survival (OS) was 44% (95% CI 33-54%). Among 39 patients with a follow-up longer than 15 months, only three died. Relapse rate was 21% (95% CI 13-30%), while NRM reached 36% (95% CI 25-46%). Younger patients (<30 years of age) had better prognosis, with an OS of 59% (95% CI 45-73%) at three and five years vs 23% (95% CI 8-37%) for older ones. No difference in survival between reduced and myeloablative conditioning was found. To our knowledge, this is the largest report of adult HLH patients who underwent allo-HSCT. Patients who survive the first period after this procedure can expect a long disease-free survival. Both reduced intensity and myeloablative conditioning have therapeutic potential in adult HLH., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: Hemophagocytic lymphohistiocytosis is a hyperinflammatory syndrome that often requires critical care support and remains difficult to diagnose. These guidelines are meant to aid in the early recognition, diagnosis, supportive care, and treatment of patients with hemophagocytic lymphohistiocytosis in ICUs., Data Sources: The literature searches were performed with PubMed (MEDLINE)., Study Selection: Keywords and medical subject headings terms for literature search included "macrophage activation syndrome," hemophagocytic lymphohistiocytosis," and "hemophagocytic syndrome.", Data Extraction: The Histiocyte Society developed these consensus recommendations on the basis of published reports and expert opinions with level of evidence provided for each recommendation. They were endorsed by the Society of Critical Care Medicine., Data Synthesis: Testing for hemophagocytic lymphohistiocytosis should be initiated promptly in all patients admitted to ICUs with an unexplained or disproportionate inflammatory response, especially those with rapid clinical deterioration. Meeting five or more of eight hemophagocytic lymphohistiocytosis 2004 diagnostic criteria serves as a valuable diagnostic tool for hemophagocytic lymphohistiocytosis. Early aggressive critical care interventions are often required to manage the multisystem organ failure associated with hemophagocytic lymphohistiocytosis. Thorough investigation of the underlying triggers of hemophagocytic lymphohistiocytosis, including infections, malignancies, and autoimmune/autoinflammatory diseases, is essential. Early steroid treatment is indicated for patients with familial hemophagocytic lymphohistiocytosis and is often valuable in patients with acquired hemophagocytic lymphohistiocytosis (i.e., secondary hemophagocytic lymphohistiocytosis) without previous therapy, including macrophage activation syndrome (hemophagocytic lymphohistiocytosis secondary to autoimmune/autoinflammatory disease) without persistent or relapsing disease. Steroid treatment should not be delayed, particularly if organ dysfunction is present. In patients with macrophage activation syndrome, whose disease does not sufficiently respond, interleukin-1 inhibition and/or cyclosporine A is recommended. In familial hemophagocytic lymphohistiocytosis and severe, persistent, or relapsing secondary macrophage activation syndrome, the addition of prompt individualized, age-adjusted etoposide treatment is recommended., Conclusions: Further studies are needed to determine optimal treatment for patients with hemophagocytic lymphohistiocytosis in ICUs, including the use of novel and adjunct therapies., Competing Interests: Dr. Horne serves as a speaker for Swedish Orphan Biovitrum (SOBI) and Novartis; Dr. Jordan serves as a consultant for Novimmune and SOBI; Dr. Hines receives research funding from Incyte and the Histiocytosis Association; Drs. K. Beutel, Lehmberg, and Henter serve as consultants for SOBI; Dr. La Rosée serves as a speaker and consultant for SOBI and Novartis. Dr. Hines’ institution received funding from the American Lebanese Syrian Associated Charities and Incyte. Drs. Hines, Beutel, Hays, and Henter disclosed the off-label product use of extracorporeal life support, Etoposide, dexamethasone, anakinra, cyclosporine, cyclophosphamide, alemtuzumab, Tocilizumab, ruxolitinib, plasmapheresis, cytokine adsorption, IV immunoglobulin, and methylprednisolone. Drs. Beutel, Horne, Lachmann, Machowicz, La Rosée, and Henter received funding from SOBI Adboard. Dr. Beutel received funding from Biotest AG. Dr. Horne’s institution received funding from Novartis. Dr. van Laar disclosed government work. Dr. Shakoory disclosed that there is a Cooperative and Development Research Agreements between her section at National Institutes of Health (NIH) and SOBI. Dr. Zinter received funding from the NIH American Thoracic Society grant (K23HL146936); he received support for article research from the NIH. Dr. Henter’s institution received funding from the Swedish Children’s Cancer Foundation and the Stockholm County Council (ALF project). The remaining authors have disclosed that they do not have any potential conflicts of interest. The above competing interests and Histiocyte Society involvement did not influence the content of these guidelines., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: Azacitidine (AZA) is the standard of care for higher-risk myelodysplastic syndrome (HR-MDS) patients ineligible for intensive therapy. Clinical outcome discrepancies reported in clinical trials and real-life settings stimulate the search for new prognostic factors., Methods: We retrospectively evaluated 315 MDS, 20-30% blast acute myeloid leukemia (AML) and chronic myelomonocytic leukemia (CMML) patients treated with azacitidine in 12 centers cooperating within the Polish Adult Leukemia Group (PALG)., Results: The median number of AZA cycles was 7 (1-69) and 24% patients received fewer than 4 cycles (early failure, EF). Serum albumin level was an independent predictor of EF occurrence. Complete remission (CR) was obtained in 20% and partial remission (PR) in 12% of patients. Hematologic improvement - erythroid (HI-E), neutrophil (HI-N), or platelet (HI-P) was achieved in 51%, 36%, and 48% of patients, respectively. No factors significantly predicted CR or PR in the multivariate analysis. For HI-E and HI-P, lower LDH level predicted response. Median survival was 15 (13-19) months. Lower serum albumin level, serious infection and receiving <4 AZA cycles independently predicted a worse overall survival (OS) ( p < 0.05)., Conclusion: Serum albumin assessment before azacitidine treatment can help to identify patients with higher risk of early failure and worse clinical outcome.

Hemophagocytic lymphohistiocytosis (HLH; also, hemophagocytic syndrome) occurs when an inflammatory reaction cannot stop on its own but continues to self‑ accelerate with positive feedback loops. If not interrupted, this pathomechanism leads to death. HLH in adults is usually diagnosed based on the HLH‑2004 criteria, but its confirmation should not stop the diagnostic process. Finding the triggering factor (especially malignancy) is of utmost importance. Treatment strongly depends on the established trigger and it is often based on the etoposide HLH‑94 protocol (adjusted for adults). Diagnostic workup should not unnecessarily delay the treatment since patients in severe or quickly deteriorating clinical condition require its fast initiation. Considering the progressive nature of HLH, time is extremely important. Prompt diagnosis and treatment, frequently made by an internal medicine specialist, is life‑saving. The aim of this review is to raise HLH awareness among internal medicine specialists and to provide advice on HLH management tailored for this group of physicians. Suggested approach is based on the latest recommendations by the Histiocyte Society and include novel insights from the authors' experience.

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by aberrantly activated macrophages and cytotoxic T cells. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity and immune regulation, is most common in children, whereas the secondary (acquired) form is most frequent in adults. Secondary HLH is commonly triggered by infections or malignancies but may also be induced by autoinflammatory/autoimmune disorders, in which case it is called macrophage activation syndrome (MAS; or MAS-HLH). Most information on the diagnosis and treatment of HLH comes from the pediatric literature. Although helpful in some adult cases, this raises several challenges. For example, the HLH-2004 diagnostic criteria developed for children are commonly applied but are not validated for adults. Another challenge in HLH diagnosis is that patients may present with a phenotype indistinguishable from sepsis or multiple organ dysfunction syndrome. Treatment algorithms targeting hyperinflammation are frequently based on pediatric protocols, such as HLH-94 and HLH-2004, which may result in overtreatment and unnecessary toxicity in adults. Therefore, dose reductions, individualized tailoring of treatment duration, and an age-dependent modified diagnostic approach are to be considered. Here, we present expert opinions derived from an interdisciplinary working group on adult HLH, sponsored by the Histiocyte Society, to facilitate knowledge transfer between physicians caring for pediatric and adult patients with HLH, with the aim to improve the outcome for adult patients affected by HLH., (© 2019 by The American Society of Hematology.)

Background: Myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) patients, including those treated with azacitidine, are at increased risk for serious infections. The aim of our study was to identify patients with higher infectious risk at the beginning of azacitidine treatment., Patients and Methods: We performed a retrospective evaluation of 298 MDS/CMML/AML patients and included in the analysis 232 patients who completed the first 3 cycles of azacitidine therapy or developed Grade III/IV infection before completing the third cycle., Results: Overall, 143 patients (62%) experienced serious infection, and in 94 patients (41%) infection occurred within the first 3 cycles. The following variables were found to have the most significant effect on the infectious risk in multivariate analysis: red blood cell transfusion dependency (odds ratio [OR], 2.38; 97.5% confidence interval [CI], 1.21-4.79), neutropenia <0.8 × 10 9 /L (OR, 3.03; 97.5% CI, 1.66-5.55), platelet count <50 × 10 9 /L (OR, 2.63; 97.5% CI, 1.42-4.76), albumin level <35 g/dL (OR, 2.04; 97.5% CI, 1.01-4.16), and Eastern Cooperative Oncology Group performance status ≥2 (OR, 2.19; 97.5% CI, 1.40-3.54). Each of these variables is assigned 1 point, and the combined score represents the proposed Azacitidine Infection Risk Model. The infection rate in the first 3 cycles of therapy in lower-risk (0-2 score) and higher-risk (3-5 score) patients was 25% and 73%, respectively. The overall survival was significantly reduced in higher-risk patients compared with the lower-risk cohort (8 vs. 29 months)., Conclusion: We selected a subset with high early risk for serious infection and worse clinical outcome among patients treated with azacitidine., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome requiring aggressive immunosuppressive therapy. Following 2 large international studies mainly targeting pediatric patients with familial disease and patients without underlying chronic or malignant disease, the HLH-94 protocol is recommended as the standard of care when using etoposide-based therapy by the Histiocyte Society. However, in clinical practice, etoposide-based therapy has been widely used beyond the study inclusion criteria, including older patients and patients with underlying diseases (secondary HLH). Many questions remain around these extended indications and published reports do not address several practical issues. To tackle these concerns, the HLH Steering Committee of the Histiocyte Society decided to issue guidance for use of the HLH-94 protocol. The group convened in a structured consensus finding process to define recommendations that are based largely on expert opinion backed up by available data from the literature. The recommendations address all main elements of HLH-94 including corticosteroids, cyclosporin, etoposide, intrathecal therapy, and hematopoietic stem cell transplantation (HSCT) and consider various forms of HLH and all age groups. Aspects covered include indications, applications, dosing, side effects, duration of therapy, salvage therapy, and HSCT. These recommendations aim to provide a framework to guide treatment decisions in this severe disease., (Copyright © 2018 American Academy of Allergy, Asthma & Immunology. All rights reserved.)

Atypical chronic myeloid leukaemia (aCML) belongs to myelodysplastic/myeloproliferative neoplasms. Because of its rarity and changing diagnostic criteria throughout subsequent classifications, data on aCML are very scarce. Therefore, we at the Polish Adult Leukemia Group performed a nationwide survey on aCML. Eleven biggest Polish centres participated in the study. Altogether, 45 patients were reported, among whom only 18 patients (40%) fulfilled diagnostic criteria. Among misdiagnosed patients, myelodysplastic/myeloproliferative syndrome unclassifiable and chronic myelomonocytic leukaemia were the most frequent diagnoses. Thirteen patients were male, median age 64.6 years (range 40.4-80.9). The median parameters at diagnosis were as follows: white blood cell count 97 × 10 9 /L (23.8-342) with immature progenitors amounting at 27.5% (12-72), haemoglobin 8.6 g/dL (3.9-14.9), and platelet count 66 × 10 9 /L (34-833). Cytoreductive treatment was used in all patients, and 2 patients underwent allogeneic hematopoietic stem cell transplantation. The median overall survival was 14.1 months (95% CI, 7.2), with median acute myeloid leukaemia-free survival of 13.3 months (95% CI, 3.6-22.6). Cumulative incidence of acute myeloid leukaemia transformation after 1 year in aCML group was 12.5% (95% CI, 0%-29.6%). To conclude, aCML harbours a poor prognosis. Treatment options are limited, with allogeneic hematopoietic stem cell transplantation being the only curative method at present, although only a minority of patients are transplant eligible. Educational measures are needed to improve the quality of diagnoses., (Copyright © 2018 John Wiley & Sons, Ltd.)

Differential diagnosis of hemophagocytic lymphohistiocytosis (HLH; hemophagocytic syndrome) and sepsis is critically important because the life-saving aggressive immunosuppressive treatment, required in the effective HLH therapy, is absent in sepsis guidelines. Moreover, HLH may be complicated by sepsis. Hyperinflammation, present in both states, gives an overlapping clinical picture including fever and performance status deterioration. The aim of this review is to provide aid in this challenging diagnostic process. Analysis of clinical features and laboratory results in multiple groups of patients (both adult and pediatric) with either HLH or sepsis allows to propose criteria differentiating these two conditions. The diagnosis of HLH is supported by hyperferritinemia, splenomegaly, marked cytopenias, hypofibrinogenemia, low CRP, characteristic cytokine profile and, only in adults, hypertriglyceridemia. In the presence of these parameters (especially the most characteristic hyperferritinemia), the other HLH criteria should be assessed. Genetic analyses can reveal familial HLH. Hemophagocytosis is neither specific nor sensitive for HLH., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders characterized by ineffective hematopoiesis, cytopenias and a risk of progression to acute myeloid leukemia (AML). Anemia is the most frequent cytopenia diagnosed in patients with MDS. Regular RBC transfusions are the only treatment option for about 40% of patients. Transfusion-dependent patients develop secondary iron overload. The influence of serum ferritin (SF) concentration on survival and acute myeloid leukemia transformation in MDS patients remains controversial. The data for the Central European population is scarce and so far there is no description for Poland., Objectives: The aim of this study was to perform a retrospective analysis of the relationship of SF concentration with red blood cell transfusion dependency, survival and transformation to acute myeloid leukemia., Material and Methods: We retrospectively evaluated the data of the 819 MDS patients (58% male; median age 70 years) included in the MDS Registry of the MDS Section of the Polish Adult Leukemia Group (PALG)., Results: Analyses were performed on 190 patients diagnosed with MDS, maximal 6 months before inclusion to the registry in order to avoid selection bias (a shorter survival of higher risk MDS patients). Patients with hyperferritinemia higher than 1000 ng/L vs. patients with SF concentration lower than 1000 ng/L had a median survival of 320 days vs. 568 days, respectively (p log-rank = 0.014). The following factors were found to significantly worsen survival: RBC-transfusion dependence (p = 0.0033; HR 2.67L), platelet transfusion dependence (p = 0.0071; HR 3.321), hemoglobin concentration lower than 10 g/dL (p = 0.0036; HR 2.97), SF concentration higher than 1000 ng/L (p = 0.0023; HR = 2.94), platelet count lower than 10 G/L (p = 0.0081 HR = 5.04), acute leukemia transformation (p = 0.0081; HR 1.968)., Conclusions: Taking into account the relatively low number of patients in previous studies exploring hyperferritinemia in MDS, the results of the first Polish MDS Registry provide important insights. Hyperferritinemia higher than 1000 ng/L can be an important indicator of poor prognosis in MDS.

Epidemiological studies on myelodysplastic syndromes (MDS) in Middle-Eastern Europe are scarce. No data about the demographic, clinical, and laboratory features of Polish MDS patients have been published. The aim of this study was to assess the epidemiological data and toxic exposure of Polish MDS patients and their association with hematological parameters and clinical outcomes. For 15 months, 966 living MDS patients were enrolled at 24 centers (12 university and 12 community hospitals). Follow-up was conducted for the next 55 months. The percentage of patients older than 80 years (16%) was between the values for Eastern and Western countries. In patients younger than 55 years, a female predominance was observed (male/female ratio 0.70:1 vs. 1.29:1; p < 0.001). Female patients had higher platelet counts (160 × 10⁹/l vs. 111 × 10⁹/l; p < 0.001). Patients exposed to chemicals were younger than patients without such exposure; their median age at MDS diagnosis was 66 vs. 70 years (p = 0.037). Smokers had significantly lower hemoglobin concentrations (8.6 vs. 9.1 g/dl; p = 0.032) and lower platelet counts (99 × 10⁹/l vs. 137 × 10⁹/l; p < 0.001) than nonsmokers. We provide the first description of the characteristics of Polish MDS patients. Females predominated in the group aged <60 years and they had higher platelet counts. The course of the disease is affected by toxic exposure and smoking., (© 2015 S. Karger AG, Basel.)

Cigarette smoking is a leading cause of preventable death in the world. Medical students play a role in smoking prevention especially as future physicians, but also as role models in society. Their approach, although influenced by medical education, is based on cultural and socio-economic background. The aim of this study was to analyze smoking habits, prevalence and attitudes towards smoking cessation in medical students from three different countries: Poland, France and Iran. A questionnaire on tobacco smoking was distributed among medical students from three Medical Universities: in Warsaw, Strasbourg and Teheran. The study population consisted of 1,036 students: 499 from Poland, 367 from France and 170 from Iran. The percentage of smokers among medical students was 14% in Warsaw, 14.4% in Strasbourg and 3.5% in Teheran. The prevalence of ex-smokers was 13.6%, 18%, and 1.2% respectively. The use of nicotine replacement therapy or pharmacological aid in smoking cessation was 9% in Warsaw, 7% in Strasbourg, and none in Teheran. In Strasbourg students willing to choose surgical specialization were more likely to be smoking with OR 2.6 (95% CI 1.4-5.0). Never-smokers were more likely than actual smokers to discourage their friends and family from smoking. In Warsaw OR was 3.8 (95% CI 2.0-7.2), in Strasbourg 6.2 (2.6-14.4) and 7.2 (1.0-82.6) in Teheran. In conclusion, similarities in smoking prevalence and attitudes between medical students in Warsaw and Strasbourg were observed, while in Teheran the percentage of smokers reported was much lower. Pharmacological aid or nicotine replacement therapy in smoking cessation was rarely used among medical students.

Background: According to CDC recommendations, medical staff should be vaccinated against influenza each year. The objective of this work was to establish the percentage of medical personnel and students vaccinated against influenza in two Warsaw university hospitals and Warsaw Medical University, to evaluate their level of awareness about the importance of vaccination and to identify reasons for not taking vaccines., Material and Methods: The anonymous questionnaire survey was conducted in the population of 166 physicians, 104 nurses and 254 students., Results: Only 22.3% of physicians, 10.6% of nurses and 13.4% of students regularly take vaccines against influenza. Free of charge vaccination was offered to 19% of physicians, 15% of nurses and 6% of students. Awareness of the need for influenza vaccination and willingness to take free-of-charge vaccination were declared by 42% of nurses. Physicians justified their decisions not to undergo vaccination by no need to vaccinate, laziness and lack of time, nurses by no need to vaccinate and costs, and students by costs and laziness., Conclusions: The percentage of medical staff of Warsaw university hospitals who regularly take vaccines against influenza is low. In view of the reluctance to take influenza vaccines observed in the study population, there is an urgent need to intensify educational efforts to increase awareness of the importance to be vaccinated.