Vol 18, No 5 (2016)

Articles
Missions and potentialities of municipal oncohematological service
Ptushkin V.V.
Abstract
Hematology, especially oncohematology is one of the most science-intensive medical fields, with increasing precision of diagnostics and efficacy of treatment. It makes the municipal medical service face a variety of problems, including increasing number of patients, high demands to the staff qualification, increasing costs of required diagnostics and drugs, urgent need of continuous medical professional education.
Journal of Modern Oncology. 2016;18(5):5-6
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State and problems of clinical trials in Russian Federation
Kuzmin A.A.
Abstract
The Russian Federation is considered one of the most promising platforms for any phase of clinical trials, the maximum number of which was registered in 2011. The participation in clinical trials is often the only option to get advanced treatment for people, significant budget savings for clinics, and the opportunity to learn to work with new drugs before they enter the practice - for doctors. On average, the number of international clinical trials in our country is 10 times lower than in European countries and the United States, which is associated with a number of problems - legislative, clinical, logistics, diagnostics.
Journal of Modern Oncology. 2016;18(5):7-9
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The regional register of multiple myeloma: significance in the era of new drugs
Kaplanov K.D., Shirokova M.N.
Abstract
Introduction. Trend of improving life expectancy of patients with multiple myeloma (MM) is observed from the second half of the 2000s. The changes occur in the general population of patients with MM for a certain period of the time when emerge new drugs and regimes with them. These changes have a great practical interest in this connection. Material and methods. The material of our study was the data of registration of the all cases of multiple myeloma in 2007-2015 period (n=193). In 2007-2008 some patients began to receive first-line regimes including bortezomib, but after a few Alkeran-containing cycles (MP, VCMP, etc.) due to the availability of bortezomib. Results. Complete remission (CR) and very good partial remission (VGPR) rates were lower in the group of patients who received bortezomib than in the group of patients who received induction therapy PAD - 5 (19%) vs 26 (58%) cases respectively (p=0.01). VMP regime demonstrated high efficacy in the absence of restrictions to prescribe Alkeran in the second line - CR and VGPR - 68% (13 cases). The distribution by stages ISS: I - 42 (23%), II - 64 (34%), III - 81 (43%). Renal failure (RF) was detected in 48 patients (26%). 5-year overall survival (OS) was 58% in the population, 10-year - was 20%, the median OS was 84 months (7 years). The detection of the parameters, which have a negative effect on the duration of the OS, was the result of univariate study. Such factors as the presence of renal failure, the need for hemodialysis, the disease stage and male sex stand out from among them. Multivariate Cox regression analysis identified the independent value of renal failure at the onset of the disease, III stage of disease according to ISS and resistance/progression with the first-line therapy in the adverse factors for OS. Conclusions. An analysis of registration data allows to update some of the factors as the most unfavorable and non-levelling with new drugs using, and at the same time to revise the value of the other factors. Population registers allow to identify accurately the size and characteristics of the groups of patients which are in need of new therapies.
Journal of Modern Oncology. 2016;18(5):10-15
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Current treatment of chronic lymphocytic leukemia. New opportunities and new difficulties
Samoylova O.S.
Abstract
Chronic lymphocytic leukemia (CLL) - the most common subtype of hemoblastoses (22-30%). It can have aggressive or indolent course, with diverse clinical symptoms. The foundation of this diversity is the molecular features of the disease. The incidence of CLL in Russia is 6.67 per 100 000 population. By 2016 several novel therapies for CLL have been registered in Russia, including ibrutinib and obinutuzumab, but the implementation of the novel drugs into daily practice meets certain difficulties. This article describes some of them based on the experience on the N.A.Semashko Nizhny Novgorod regional clinical hospital.
Journal of Modern Oncology. 2016;18(5):16-19
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The clinical relevance of flow cytofluorometry in the diagnosis of malignant non-Hodgkins lymphoma
Fominyh T.L., Simonova N.A.
Abstract
The purpose of the study was in defining of the role of immunophenotyping (IPT) by flow cytometry in the lymphoproliferative diseases differential diagnosis. There was analysis of the results of laboratory studies of peripheral blood and bone marrow hematopoietic punctates of 630 patients. 236 patients were under observation by hematologists previously for chronic lymphocytic leukemia (CLL) - the first group; 394 patients were first directed to excluding the non-Hodgkin's lymphoma (NHL) - the second group. The NHL was first detected in 30 examined patients (12.7%) after IPT in the first group of patients. The NHL was detected in 12 examined patients (3.05%) in the second group of patients. Thus, using of the IPT significantly improves the quality of diagnosis NHL that ensures the efficacy of further therapy.
Journal of Modern Oncology. 2016;18(5):20-21
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Clinical features and therapy of double-hit and double-expressor lymphomas
Baryakh E.A., Misyurina A.E., Kovrigina A.M., Obukhova T.N., Kravchenko S.K., Magomedova A.U., Zingerman B.V., Misyurina E.N., Poteshkina N.G., Lysenko M.A., Vorobev A.I.
Abstract
Purpose. The identifying of the clinical, morphological, immunophenotypic and cytogenetic features of double-hit and double-expressor lymphomas as well as the development of optimal tactics of treatment and evaluation of efficiency of the ASCT were the main purposes of the study. Material and methods. The study included 85 patients: 45 males and 40 females, the median was 46,6 years (15-73). 62 patients with DLBCL and 23 with BCLu were given BL-M-04/ m-NHL-BFM-90 regimes in Hematological Scientific Center and Municipal Clinical Hospital №52, 2001-2015. Results. Stage I was diagnosed in 5 (6%) patients, II - in 13 (15%) patients, III - in 7 (8%) patients, IV - in 60 (71%) patients. Double-hit lymphoma was diagnosed in 6 (7%) patients (5 MYC+/BCL2+, 1 MYC+/BCL6+), single-hit lymphoma was diagnosed in 6 patients. The translocation was detected in 5 of 12 cases t(8;14)(q24;q32), in 1 case of 12 - t(2;8)(p21;q24), in 2 cases of 12 - t(8;22)(q24;q11) (restructuring c-MYC and IGL gene loci have been identified), in 3 cases of 12 - restructuring of c-MYC with non-IG partner [translocation was absent t(8;14)(q24;q32) and restructuring IGK and IGL gene loci], the partner was not identified in one case of translocation with c-MYC gene [restructuring c-MYC gene loci was identified and translocation was absent t(8;14(q24;q32)]. 8 factors had prognostic significance in relation to OS: nosology - BCLu vs DLBCL (p=0.007; RR=4.5), bone marrow lesion (p=0.0004; RR=7.9), B-symptoms (p=0.0002; RR=8.4), BCL2 expression (I=0.01; RR=4.4), MYC/BCL2 coexpression (p=0.017; RR=0.08), double-hit or double-expressor lymphomas (p=0.009; RR=15.1), the absence of rituximab in therapy (p=0.03; RR=0.3), unfulfillment of ASCT (p=0.003; RR=0.06). Two factors were significant in relation to probability of development of recurrence/progression: double-hit or double-expressor lymphomas (p=0.0005; RR=4.0) and IPI (p=0.03; RR=4.9). Conclusions. Thus, complex diagnostic includes the antibody to the BCL2 (clone 124, Dako) and MYC (clone Y69, Epitomics), and the conduct of standard cytogenetic analysis (SCA) and FISH to detect rearrangements of MYC, BCL2, and BCL6 genes in addition to standard immunohistochemical panel for aggressive B-cell lymphomas. It allows not only to establish the correct diagnosis (DLBCL, BCLu or LB), but also to detect the double-hit and double-expressor lymphomas, which require intensive induction with rituximab and high-consolidation ASCT in first remission.
Journal of Modern Oncology. 2016;18(5):22-30
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Autologous stem cells transplantation in the first remission of follicular lymphoma as "rescue therapy" in patients with unfavorable prognosis factors. The first prospective study results
Nesterova E.S., Kravchenko S.K., Baryakh E.A., Misyurina A.E., Mangasarova Y.K., Vorobev V.I., Chernova N.G., Gemdzhian E.G., Savchenko V.G.
Abstract
The purpose of the study was to evaluate high-dose chemotherapy efficacy with the next autologous stem cells transplantation (ASCT) in first-line treatment of follicular lymphoma (FL) patients with unfavorable prognosis factors. 43 FL patients with unfavorable prognosis factors were observed in Hematological scientific center from 2000 to 2016. The patients received R-CHOP regime as induction therapy. ASCT in first-line treatment after inductional R-CHOP regimes was administrated in 23 patients. The results of the first prospective study of high-dose therapy in FL patients in Russia demonstrate that HDCT with followed ASCT in first line therapy allows to achieve complete remission in patients with unfavorable prognosis factors as well as to increase progression-free survival and overall surviva.
Journal of Modern Oncology. 2016;18(5):31-32
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Prospective analysis of efficacy and safety of BR regime in the first-line treatment of chronic lymphocytic leukemia
Stadnik E.A., Strugov V.V., Andreeva T.O., Virts Y.V., Mirolyubova Y.V., Butylin P.A., Zaritskiy A.Y.
Abstract
This trial has evaluated a systematic prospective analysis of the efficacy and safety of BR in CLL patients in the routine clinical practice. It included 179 patients with verified CLL diagnosis and the presence of the indications for initiation of therapy according to the guidelines iwCLL who received BR regimen. The trial has shown that BR regime has high efficiency and relatively low toxicity in first line therapy of CLL and also is well tolerated in patients with comorbidity and impaired renal function. The efficiency of BR is lower in patients with IGHV-unmutated type of CLL. The achieving of the eradication of MRD in BM is the best predictor of PFS.
Journal of Modern Oncology. 2016;18(5):33-35
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On the question of the treatment of chronic hepatitis C with HIV co-infection in patients with lymphoma
Chistyakova A.V., Stuklov N.I., Tumanova M.V., Dubnitskaya M.G., Mukhin O.V., Shtyrlina E.P., Pivnik A.V.
Abstract
Due to the use of HAART, the efficacy of the treatment of AIDS-related lymphomas and indicators of survival in patients are close to those in the general population of lymphoma patients without HIV. According to the data of department of hematology and secondary immunodeficient conditions of Moscow Clinical Research Center 176 patients with lymphomas associated with HIV were treated for the period 2011-2015. The percentage of patients with hepatitis virus co-infection (C, B or C+B co-infection) is nearly 50%. Co-infection viral hepatitis, particularly hepatitis C virus (HCV) causes certain difficulties that, such as a more rapid progression of liver failure (development of cirrhosis and/or hepatocellular carcinoma). Use of new highly active drugs in viral infections treatment allows to increase the efficacy of the treatment of lymphomas associated with HIV and viral hepatitis. The treatment of HCV in HIV co-infected patients must be prioritized due to the rapid progression of liver failure.
Journal of Modern Oncology. 2016;18(5):36-38
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Characteristics of approach to the treatment of chronic pain in terminal cancer patients
Nevzorova D.V., Ibragimov A.N., Bakunina E.A.
Abstract
The main purpose of the trail was to evaluate the number of oncological patients experiencing from moderate to severe chronic pain observed by the First Moscow Hospice in 2015. Of 1157 patients who were observed by the hospice ambulance service, 53.6% received opioids as pain killers in severe to moderate pain when second grade medicines were proved to be ineffective. It should be note that 735 of 1157 patients were admitted to the hospice to continue their treatment as inpatients due to various factors. It’s shown that there is an influence of religious, cultural, social, educational, political, geographical, legal and logistical reasons on inadequate assessment and management of pain in acute as well as in chronic period in Russia.
Journal of Modern Oncology. 2016;18(5):39-40
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Regulatory T-cells (Treg) in lymphoproliferative diseases
Kuzmina E.G., Mushkarina T.Y., Konstantinova T.V.
Abstract
To purpose of the study was to research the level of regulatory T-lymphocytes (Treg) in lymphoproliferative diseases, and to evaluate their response to chemoradiotherapy. 71 studies of peripheral blood in patients with Hodgkin's lymphoma - HL (7), non-Hodgkin's lymphoma - nonHL (33) and chronic lymphocytic leukemia - CLL (31) were carried out. The phenotype of Treg cells was determined by flow cytometry as a CD45+CD4+CD25+CD127-. The increased levels of regulatory T-cells in lymphoproliferative diseases (HL, NHL and CLL) are detected, as well as their relative resistance to the components of chemoradiation therapy.
Journal of Modern Oncology. 2016;18(5):41-42
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Difficulties of diagnosing of the Langerhans histiocytosis
Shatokhin Y.V., Snezhko I.V., Kuzub E.I., Shatokhina O.N., Matsionis A.E., Pavilaytite P.E., Nagornaya G.Y., Gerasimova O.V., Burnasheva E.V., Ryabikina E.V.
Abstract
A variety of clinical symptoms significantly impedes to diagnose of Langerhans cell histiocytosis. Both presented clinical cases demonstrate patients, who were treated by dermatologists with different diagnoses for a relatively long time. This indicates show a small awareness of physicians about histiocytosis, which leads to late diagnosis verification and the development of severe visceral lesions, most of which are already irreversible.
Journal of Modern Oncology. 2016;18(5):43-44
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