Vol 20, No 1 (2018)

Relevance. The distribution of patients of the oncohematological department according to the main nosological units reflecting the main hematological diseases of the elderly and senile patients, Hodgkin's lymphoma young patients of and HIV-infected patients of the hematologic profile is shown. These indicators are necessary for statistical processing and profile for doctors of the city and the country. Aim. There are shown diagnostic methods and treatment programs for major hematological diseases of elderly and senile patients, young patients with Hodgkin's lymphoma and HIV-infected patients with hematological malignancies. Materials and methods. Data on 535 persons entered the department 1351 times are summarized. Mortality was 6.1%. Results. Hospitalized: acute leukemias - 22 patients, chronic myeloproliferative diseases - 61, myelodysplastic syndrome - 42, chronic lymphoproliferative diseases - 63, anemia - 22, others - 38 HIV-infected - 45 patients. Conclusion. These nosologies reflect the structure of hematological diseases in the population of elderly and senile patients, the frequency of Hodgkin's lymphoma and the composition of HIV-infected patients. Diagnosis and therapy were carried out in accordance with generally accepted programs with achievement of average results of treatment. Young patients with HIV infection in the stage of secondary diseases suffered mainly from aggressive lymphomas with effective treatment of about 50%.

Classical Hodgkin's lymphoma (cHL) is one of the many malignant tumors associated with the Epstein-Barr virus (EBV). It is shown that EBV-positive cases of cHL are distributed with different frequencies among all cases of the disease. The frequency of EBV-positive cases of cHL is influenced by the demographic characteristics of the studied population and other factors. Russia belongs to geographical regions with a low incidence of this form of tumor. The aim of the study was to estimate the humoral response to EBV and the level of viral DNA in the blood plasma of children with cHL and to evaluate the significance of both EBV markers for clinical manifestations of the disease. The data obtained have shown that the level of EBV persistence in children with cHL practically does not differ from that in healthy children, however, the activity of the humoral response to EBV was significantly lower. The study of the composition of the elements of the leukocyte germ, responsible for cellular and humoral immunity, did not make it possible to explain the observed phenomenon. In particular, the number of circulating leukocytes in the patients' blood before the treatment corresponded to normal values, but it turned out to be below the normal values after the treatment. Conversely, the percentage of lymphocytes in patients before treatment turned out to be lower than normal values, but it reached normal values after the treatment. The percentage of neutrophils and monocytes in patients before and after the treatment was almost the same as in healthy individuals. The data obtained suggest that the reduced humoral response in patients with cHL is not associated with the altered composition of the leukocyte germ cells, but due to their reduced functional activity. The search for copies of virus DNA in plasma and oral cavity swabs made it possible to detect them only in some patients before the therapy and to state their complete absence after the treatment. Dynamic observation of the EBV DNA concentration in blood plasma and humoral response to EBV in 3 patients showed increased values viral DNA copies before treatment, and their decrease to zero after successful therapy, while antibody titers remained at the same level and did not reflected the clinical state of patients. It can be assumed that the increased concentration of plasma viral DNA detected in cHD patients can become a marker that allows indirectly estimating the degree of minimal residual disease and the probability of recurrence of the disease.

Background. Gastric cancer is the fifth most common malignancy worldwide with diagnosis often occurring at an advanced stage. For the majority of advanced gastric cancer patients, chemotherapy typically is used as first-line treatment, although many patients will also require second-line treatment. Ramucirumab (Cyramza®, Eli Lilly and Company, Indianapolis, Indiana, USA) recently has received worldwide and United States Food and Drug Administration approval for gastric cancer in the second-line setting. Case reports. A series of five advanced gastric cancer cases is presented, outlining each patient’s diagnosis and treatment. All patients were treated with intravenous ramucirumab (8 mg/kg on days 1 and 15) plus paclitaxel (80 or 100 mg/m2 on days 1, 8, and 15 of a 28-day cycle) after disease progression on or after first-line chemotherapy. Patient outcomes are described including an outline of treatment-related adverse events and quality of life. All patients were able to achieve a clinical response and stable disease. Conclusion. Our case series demonstrates that ramucirumab, in conjunction with paclitaxel, is an effective and well-tolerated treatment option for advanced gastric cancer patients who have disease progression following first-line chemotherapy.

The article presents the clinical cases of complex approach to the treatment of patients with advanced hepatocellular carcinoma in everyday clinical practice. The use of targeted therapy with sorafenib and regorafenib lead to the long-term disease control even among the patients with massive liver lesions and among the patients with poor performance status.

Aim. A comparative analysis of the impact of derivatives of 3-hydroxypyridine and succinic acids on depressive symptoms, the pain intensity and quality of life after surgical treatment of breast cancer. Materials and methods. A short-term prospective placebo-controlled simple «blind» randomized study of the effect of 14 - day course of application of Emoxipin (150 mg daily intravenously), Reamberin (400.0 ml - 1.5% per day intravenously) and Mexidol (300 mg/day daily intravenously) for severity of depression, the dynamics of postoperative pain and quality of life was conducted. Results. Two-week application of Emoxipin, Reamberin, Mexidol on the background of standard therapy reduces the intensity of nociceptive pain with a simultaneous increase in generic and oncospecific parameters of quality of life in the postoperative period of oncomammologic intervention. Antinociceptive effect of Mexidol and its positive impact on quality of life were accompanied by the development of a significant antidepressant effect. Conclusion. Mexidol, which improved the quality of life due to the parallel development of antinociceptive and antidepressant effects, should be considered the most effective drug in the series of studied derivatives of 3-hydroxypyridine and succinic acid.

Background. Nowadays there are no any standards of treatment for patients with locally advanced and metastatic breast cancer resistant to treatment with anthracyclines, taxanes and capecitabin. Ixabepilone has proved successful as a single agent for treatment of these patients. Methods. Eribulin was chosen as an alternative strategy. Efficacy criteria were overall and progression-free survival. Cost-effectiveness analysis is performed on the basis of published data and Markov modeling for 1.5 year time horizon. Results. Total expenditures for ixabepilone strategy were 18.2% less than those for eribulin treatment. Administration of ixabepilone instead of eribulin will allow treating additionally up to 222 patients per year. Price elasticity analysis revealed that total expenditures on ixabepilone will be 20% less than on eribulin treatment at a price of ixabepilone equal to 63 000 rubles per 45 mg vial and 21 691.23 rubles per 15 mg vial of ixabepilone. Conclusion. Ixabepilone as a single agent appeared to be economically reasonable as compared to eribulin in case of ineffective pretreatment with taxanes, anthracyclines and capecitabine.