Multiple myeloma is a malignant tumor characterized by the proliferation of clonal plasma cells and currently remains an incurable disease, despite advances in therapy. Resistance and development of double refractoriness represent a significant problem, worsening the prognosis. To overcome double refractoriness, new proteasome inhibitors carfilzomib and ixazomib, the 3rd generation immunomodulator pomalidomide and monoclonal antibodies daratumumab, elotuzumab and isatuximab are used. Based on randomized phase III ICARIA-MM and IKEMA studies results, which demonstrated, along with a manageable safety profile, advantages in increasing the antitumor response depth, the rate of achieving negative minimal residual disease status and survival in all subgroups of patients with refractory/relapsed multiple myeloma, isatuximab is used in IsaPd (isatuximab, pomalidomide, dexamethasone) and IsaKd (isatuximab, carfilzomib, dexamethasone) combination. This article discusses the clinical pharmacology of isatuximab. The results of studies demonstrating the effectiveness and safety of antitumor therapy regimens including isatuximab, which made it possible to use it in clinical practice, are presented. We present a case report of a patient with refractory/relapsed multiple myeloma who received 3 lines of antitumor treatment, including class 2 proteasome inhibitors, lenalidomide and the monoclonal antibody elotuzumab. After 3 cycles of IsaPd (8 injections of isatuximab), partial remission and pain relief were recorded. The achieved antitumor effect, along with the absence of significant adverse events, facilitated the continuation of therapy at recommended doses.

The aim of this work is to assess the capabilities of ultrasound examination as part of the diagnostic algorithm in head and neck tumours. Five clinical cases of patients are presented with masses in the head and neck area, with different diagnostic approaches used. When examining the patients, the following diagnostic methods were employed: ultrasound examination, X-ray computed tomography, magnetic resonance tomography, positron emission tomography combined with computed tomography, endoscopic examination, as well as contrast-enhanced ultrasound examination, endosonographic examination and ultrasound-controlled fine-needle puncture biopsy. The clinical cases described demonstrate the high diagnostic value of the ultrasound method. Ultrasound examination is a highly informative multiparameter examination method that can be used in patients with head and neck tumours.

Treatment of patients with multiple primary malignant neoplasms caused by genetic mutations requires correct priorities from the clinician in selection of the most effective therapeutic tactics. An important aspect in this case is the identification of the neoplasm determining patient’s survival. The main goal is to achieve maximal treatment effect for this tumor and use therapy methods for control of other synchronous and metachronous tumors.The article presents a clinical case of a patient with BRCA1 mutation-associated recurrent ovarian cancer and de novo breast cancer of negative subtype. Combination multidisciplinary and personalized approach to treatment which led to the maximally effective result is described. Personalized approach to prescription of antitumor drug therapy, timing of surgical intervention and subsequent targeted therapy allowed to realize maximal antitumor effect and increase the patient’s lifespan.

Despite the therapy advances, largely due to the study of molecular biology, multiple myeloma remains an incurable disease, and refractory course or relapses significantly worsen the prognosis. In this regard, the development of effective therapeutic agents with fundamentally new mechanisms of action that provide increased survival is currently an urgent task. One potential immunotherapeutic target is signaling lymphocyte activation molecules (SLAMs), and the anti-SLAMF7 monoclonal antibody elotuzumab is used in combination with either lenalidomide and dexamethasone (Elo-Rd regimen) after 1 prior line of therapy, or with pomalidomide and dexamethasone (Elo-Pd regimen) after 2 or more lines of therapy. The results of studies demonstrated a survival benefit in all subgroups of patients with refractory or relapsed multiple myeloma when using elotuzumab. A manageable safety profile and a low frequency of grade III–IV induced myelosuppression were noted, which allows the use of elotuzumab in combination with lenalidomide or pomalidomide and dexamethasone in elderly and debilitated patients. We present our own experience of using elotuzumab in the treatment of patients with refractory/recurrent multiple myeloma. A clinical case of a patient in whom treatment with elotuzumab was initiated at an early stage (after 1 line of previous therapy) is presented; the effectiveness and safety of using the monoclonal antibody are assessed. A significant improvement in the patient’s clinical condition and positive dynamics according to laboratory data were noted already during the 1st cycle of Elo-Rd regimen with a further progressive deepening of the antitumor response along with satisfactory tolerability and the absence of significant adverse events.

Oncological and cardiovascular diseases are the main causes of mortality worldwide. The rate of these pathologies tends to increase as the population ages. The implementation of highly effective therapeutic schemes has led to a significant increase in the survival rate of oncology patients over the last decades. In many cases, the mortality rate in oncology patients who underwent effective treatment is caused by cardiovascular events arising as a consequence of aggressive antitumor treatment or pre-existing chronic cardiovascular diseases. Among cardiovascular complications that developed both during active treatment of the malignant neoplasm and in the longer term, literature most often mentions cardiac insufficiency. We present a clinical case of successful diagnosis and treatment of severe heart insufficiency caused by antitumor therapy with bevacizumab and osimertinib in a patient with cancer of the upper lobe of the right lung and metastases into the brain.

Post-radiation esophagitis occurs fairly rarely, affecting less than 1 % of the patients who underwent a course of radiation therapy. Non-specific complaints of dysphagia and/or painful swallowing are reported by at most 2 % post-radiation-therapy patients (with a total focal dose of ≤50 Gy) and by up to 15 % patients (>60 Gy). Post-radiation esophagitis may develop after irradiation of the thorax for esophageal, pulmonary, breast cancer, lymphoma, or metastatic affection of bones. The prognosis and severity of esophagitis are evaluated according to the FARE criteria (Fukui Acute Radiation Esophagitis). In the event of strictures and symptoms of dysphagia, endoscopic balloon dilation is indicated.

Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure which can occur in people of any age. It comprises about 10 % of all admissions in intensive care units. The cornerstone of treatment of severe forms of this disorder is protective mechanical ventilation but in patients with initial hypoxia and/or hypotension tracheal intubation is associated with the risk of significant hemodynamic abnormalities. Mortality from severe forms of ARDS remains high. COVID-19 pandemic led to worldwide wider use of such techniques of respiratory support as high-flow nasal oxygen therapy and non-invasive ventilation, the necessity of which is proposed to be used as one of classifying signs of ARDS in addition to the Berlin criteria. If the respiratory therapy is ineffective, veno-venous extracorporeal membrane oxygenation is used for gaseous exchange and decreasing undesirable effects of high pressure in the respiratory pathways. The success of its application strongly depends on the optimal timing of its initialization. The performance of this technique is associated with a number of complications (hemorrhage, thrombosis, sepsis, etc.). Effective treatment of ARDS requires utilization of a large amount of resources and educated staff.

Aortic stenosis belongs to the most common acquired cardiac defects in adults, affecting about 2 % of those over 65 years old and 4 % of those over 85 years old. One of the common causes of aortic stenosis is radiation therapy of the mediastinum for malignant neoplasms localised in the thorax. According to the American Society of Clinical Oncology, 10–30 % of patients receiving radiation therapy tend to develop cardiovascular complications, usually after an average follow-up period of 5 to 10 years. About 80 % of cardiovascular complications of radiation therapy are valve diseases, aortic stenosis accounting for a significant part of them. Radiation causes late cicatrisation, fibrous thickening, retraction and calcification of aortic valve cusps, contributing to the restriction of their movement and therefore to the narrowing of the aortic valve orifice. Patients with aortic valve stenosis have an average lifespan of about 3 years after coronary symptoms or syncopal conditions appear, and about 1.5 years after congestive heart failure begins to manifest. Aortic valve prosthetics is the sole effective and radical treatment method for patients with aortic valve stenosis that allows to improve their condition and prolong their life. Transcatheter aortic valve prosthetics are the treatment of choice in this category of patients.

Study of the molecular pathogenesis of multiple myeloma led to development and introduction of antitumor agents with new mechanisms of action and their combinations into clinical practice. According to several trials, use of anti-CD38 monoclonal antibody daratumumab as part of triplet therapies at an early stage leads to deep and long-term antitumor response, achievement of MRD-negative status, and, as a result, increased survival and improved prognosis in all patient subgroups. High effectiveness of daratumumab subcutaneous formulation close to intravenous formulation has favorable safety profile, short administration time and low rate of infusion reactions which improves patients’ quality of life, affects their treatment compliance, and decreases healthcare costs.We present a clinical observation of a 60-year-old patient with newly diagnosed multiple myeloma who previously underwent treatment for another lymphoproliferative disorder which included autologous hematopoietic stem cell transplantation leading to complete and long-term remission. After 9 intravenous daratumumab infusions (with recommended dose of 16 mg/kg) in accordance to the D-Rd regimen, evaluation of antitumor effect and consideration of socially active lifestyle of the patient, daratumumab formulation for intravenous administration was replaced with subcutaneous formulation of fixed dose 1800 mg. Further deepening of the antitumor response was observed along with manageable safety profile and absence of significant adverse events which allowed to maintain intercourse intervals and improve the patient’s quality of life.

The gingiva is often the site of localized growths that are considered to be reactive rather than neoplastic in nature. Many of these lesions are difficult to be identified clinically and can be identified as specific entity only on the basis of typical and consistent histomorphology. Peripheral ossifying fibroma (POF) is one of the inflammatory reactive hyperplasia of gingiva. It is a non-neoplastic entity, which occurs on the gingiva in response to trauma or irritation. A clinical report of a 26-year-old pregnant female with a large peripheral ossifying fibroma in the anterior maxilla showing significant growth is presented. Keywords: Ossifying fibroma, pyogenic granuloma, trimester, osteogenesis, exostoses.