Особенности формирования онкогематологических заболеваний в отдаленные сроки после перенесенной острой лучевой болезни

Abstract

Purpose: To clarify the frequency, nosological forms, the timing of development and the features of the clinical course of developed oncohematological diseases on the basis of a retrospective analysis of the results of long-term follow-up of patients who underwent acute radiation syndrome (ARS).
 Material and methods: An analysis of clinical histories from archives of A.I. Burnasyan Federal Medical Biophysical Center of 157 patients who underwent ARS of varying severity, and some scientific publications. Various oncohematological diseases developed in the long-term period in 8 patients with ARS I–III severity: in 5 patients – myelodysplastic syndromes (MDS), in 2 – chronic myeloid leukemia (CML) and in 1 – acute myelomonoblastic leukemia (OMML).
 Results: The excess absolute risk of developing MDS and leukemia in the group is 7.2×10–4 man-years/Gy. All patients underwent relatively uniform irradiation. MDS developed in 5 patients who underwent ARS as a result of a single acute gamma-beta- and gamma-neutron irradiation at doses of 1.2–5.0 Gy. Nosological forms of MDS: with unilinear dysplasia, with multilinear dysplasia (2 cases), with ringed sideroblasts, with excess blasts. The latency period lasted from 3 to 31 years. Age at the time of irradiation was 28–55 years. CML, Ph-positive form, was detected in 2 patients. Doses of gamma-beta-radiation were 2.0 and 4.3 Gy. Age of patients at the time of irradiation was 22 and 25 years. Diseases developed 3 and 15 years after the undergone ARS and were characterized by a long period of inactive phase (10 and 7 years), which resulted in a blast crisis. OMML in the patient, who suffered during the Chernobyl accident and since 1990 was observed in the URCRM, developed 11.8 years after irradiation at a dose of 3.0 Gy. An analysis of available clinical data makes it possible to question the diagnosis of acute leukemia, and to suppose that chronic myelomonocytic leukemia developed in this patient.
 Conclusion: The obtained data indicate that chronic leukemia forms are characteristic for radiation leukemia, often with a long preceding cytopenic stage (MDS). An essential factor in the realization of the leukemogenic effect is the uniformity of the whole body exposure undoubtedly. In addition, it can’t be ruled out that the carriage of hepatitis B and C viruses also played a role in the formation of MDS.