Oncohematological Diseases Research Articles

Association of elevated vitamin B12 with oncohematological diseases inacohort of 79,524 patients from Latvia.

Currently there are some large-scale studies of elevated total vitamin B12 in relation to diseases and their prognosis. Aim of this retrospective study was to determine association of increased B12 as an additional diagnostic marker of oncohematological diseases by a statistical analysis of clinical data of 79,524patients. Overall Latvian population representative data on B12 testing in 79,524patients were obtained from laboratory database. The following exclusion criteria were applied: fluctuating B12 results within a three-month period, elevated (> 100U/L) alanine transaminase or aspartate transaminase, hepatitis (HAV, HBV, and HCV) infection, reduced glomerular filtration rate (< 45mL/min/1.73m2). As a control group, individuals with normal B12 level and any oncologic diagnosis (solid cancer or hematological malignancies) were selected. After application of step-by-step exclusion filters, 1,373patients were left with significantly increased level of plasma B12 (> 1,700pg/mL). Odds ratios for oncohematological diseases in total and myeloid leukemia (including acute, chronic and unspecified) in patient group with elevated B12 were found to be 6.0 (95% CI 4.7-7.6; p < 0.0001) and 19.2 (95% CI 13.1-28.0; p <0.0001), respectively, as compared to the control group. Elevated total B12 could be considered as a potential marker for oncohematological disorders.

CARDIOTOXICITY AND METHODS OF ITS DIAGNOSIS IN HEMATOLOGY PATIENTS (REVIEW)

The article is devoted to the modern concept of cardiotoxicity, induced chemotherapy in patients with hematological pathology and methods of its diagnosis. The study of cardiotoxicity is one of the current trends in oncology and oncohematology, as the side effects of chemotherapy drugs on the cardiovascular system affect the quality and life expectancy of patients, regardless of the prognosis associated with oncohematological disease. While modern strategies for the treatment of oncohematological diseases make it possible to achieve stable remissions and increase the duration and quality of life of patients, such successes can be offset by an increase in mortality in this group of patients due to the development of side effects of chemotherapy in relation to the cardiovascular system. In the review problems and prospects of cardiotoxicity diagnosis in patients with hematological diseases on the background of chemotherapy are presented at modern level of medical science development. The use of such methods as three-dimensional echocardiography, echocardiography with determination of global longitudinal myocardial deformation, stress echocardiography with determination of contractile reserve, determination of troponin and natriuretic peptide levels for diagnosis of cardiotoxicity makes it possible to detect manifestations of cardiotoxicity at an earlier stage and thus will reduce mortality in patients with oncohematological profile receiving chemotherapy for non-hematological reasons.

Overcoming Resistance in Relapsed Anaplastic Large-Cell Lymphoma, ALK-Positive (Literature Review and Clinical Experience)

Peripheral T-cell lymphomas (PTCL) are characterized by unfavorable prognosis and poorer survival in comparison with B-cell lymphomas. Probability of remission on first-line PTCL therapy is not higher than 60 % with high relapse rate. Longterm remission in PTCL relapses/progression cases typically fails to be achieved. The present article provides literature review and the authors’ own clinical experience in the management of anaplastic large-cell lymphoma, ALK-positive with primary skin and soft tissue lesions in an 65-year old female patient. After NHL-BFM-90 intensive chemotherapy the first 5,5-year complete remission was achieved in this patient. Afterwards a СНОР therapy-resistant relapse was identified. Chemotherapy-resistance of tumor was successfully overcome by adding of epigenetic drugs to cytostatic antitumor therapy. The duration of second complete remission is 3 years. Oncohematological diseases with either initial chemotherapy-resistance or the resistance acquired during antitumor therapy are most efficiently treated by various drug combinations including monoclonal antibodies, epigenetic drugs, and cytostatic therapy.

Severe "Poor Graft Function" after Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients: Incidence, Risk Factors, and Outcomes

Aim. Using strict criteria, to assess incidence, pretransplant risk factors, and outcomes of severe "poor graft function" (sPGF), following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adults. Materials &amp; Methods. The study included 710 adult patients (median age was 31 years, range 18-70 years; 55 % male and 45 % female patients) with different hematological diseases and documented transplant engraftment after allo-HSCT from matched sibling (20 %), unrelated (67 %) and haploidentical (13 %) donors in the period from 2008 to 2016. Myeloablative and reduced-intensity conditioning regimens were administered in 30 % and 70 % of patients, respectively. The analysis was based on the following sPGF criteria: 2 or more lines of cytopenia (platelets &lt; 20 x 10&lt;sup&gt;9&lt;/sup&gt;/L, absolute neutrophil count &lt; 0.5 x 10&lt;sup&gt;9&lt;/sup&gt;/L, and hemoglobin &lt; 70 g/L at any time after documented engraftment), complete or stable mixed donor chimerism &gt; 90 %, and absence of relapse signs, rejection, and severe acute graft-versus-host reaction. The following factors were analyzed: age, sex, diagnosis, presence/absence of remission in acute leukemias, ferritin level, type of donor, HLA-match, blood group and sex match, graft source, number of transplanted CD34+ cells, and conditioning regimen. Multivariate analysis included parameters of univariate analysis with p &lt; 0.05. Results. After allo-HSCT sPGF was identified in 103 patients with 2-year cumulative incidence of 15 % (95% confidence interval [95% CI] 12-18 %). In most cases sPGF developed during the 1&lt;sup&gt;st&lt;/sup&gt; year after allo-HSCT (median 50 days). Bi- and trilineage cytopenia was found in 59 % and 41 % of cases, respectively. In multivariate analysis sPGF risk was associated with myelodysplastic syndrome, myeloproliferative disorders (hazard ratio [HR] 3.403; 95% CI 1.972-5.606; p &lt; 0.0001), and haploidentical donors (HR 3.830; 95% CI 1.545-8.828; p = 0.001). The absence of remission at the time of allo-HSCT in acute leukemias and blood group incompatibility were of borderline significance. In almost half of the cases, sPGF had a poor outcome, including death from cytopenia-related complications, further relapses, and graft rejection. Prognosis of bilineage sPGF was more favorable than that of trilineage sPGF. Conclusion. The present large cohort study yielded the incidence and analyzed the structure of sPGF in adult patients with oncohematological diseases. In addition, the key pretransplant sPGF risk factors were identified. The results of the trial can serve to optimize the choice of therapy after allo-HSCT.

Infectious Complications after Haploidentical Hematopoietic Stem Cells Transplantation in Patients with High-Risk Tumors of Hematopoietic and Lymphoid Tissues: A Single-Center Experience

Aim. To determine the incidence of viral, bacterial, and fungal infections in post-transplant period and to assess the prognostic value of infections and their influence on early and long-term results of haploidentical hematopoietic stem cells transplantation (haplo-HSCT). Materials &amp; Methods. Retrospective study included 61 patients older than 18 years with high-risk oncohematological diseases. In the period from 2015 to 2018 all patients received haplo-HSCT. Median follow-up after haplo-HSCT was 12.5 months (376 days, range 6-1202). Patients were divided into two groups. The first group (n = 26) received haplo-HSCT as salvage therapy. It included patients with refractory tumors without remission by the start of haplo-HSCT and patients with early relapses after HLA-matched related or unrelated allo-HSCT. The second group (n = 35) received haplo-HSCT on reaching the optimal pretransplant status (“non-salvage”). Results. The incidence of cytomegalovirus (CMV) reactivation, invasive mycosis, and bacterial infections was 70.4 %, 11.5 %, and 75.4 %, respectively. CMV reactivation and invasive mycosis did not affect either the 35- or the 100-day overall survival (OS). For the first time bacterial infections were stratified based on severity according to Sepsis 3 consensus, which allowed to identify groups of patients with unfavorable prognosis. Severe bacterial infections (sepsis and septic shock) correlated with worse early and long-term results, especially in patients without remission by the start of haplo-HSCT, whereas febrile neutropenia/bloodstream infection did not affect OS. On the whole, mortality associated with bacterial infections was 26.2 %. Conclusion. The main factor affecting early lethality after haplo-HSCT is a severe bacterial infection. The key risk factor is lack of remission by the start of haplo-HSCT. Sepsis 3 criteria can be applied in the period of postcytostatic cyto-penia to identify the group of patients with most unfavorable prognosis (septic shock). The implementation of current infection control methods (genotyping of multiple drug resistant strains and timely determining the strategy of antimicrobial chemotherapy on the basis of the results obtained) into everyday clinical practice can improve the treatment outcomes in this category of patients.

Experience with the use of daptomycin in patients with infective endocarditis oncohematological and cardiosurgical profile

The study of the effectiveness of antibacterial therapy with daptomycin in the treatment of gram-positive infection in 44 patients with infectious endocarditis was conducted. Primary infectious endocarditis developed in 15 patients, including 3 patients who were observed for oncohematological diseases (acute leukemia, myelodysplastic syndrome). In 29 patients secondary endocarditis was diagnosed, among the secondary forms of the disease endocarditis prevailed after cardiac surgery. In 32 patients, the bacteriological study revealed the pathogen. Among the identified pathogens included: 7 patients - methicillin-sensitive S. aureus,5 - methicillin-resistant S. aureus, 3 - methicillin-resistant S. Epidermidis in 9 - Enterococcus faecalis, 8 - Streptococcus bovis. All patients were prescribed antibacterial therapy with daptomycin, in monotherapy and in combination with beta-lactams, and surgical treatment was also performed. The average dose of daptomycin was 6,9±0,8 mg/kg/ day, the average duration of treatment 26,2±9,4 days. In 20 (45,4%) patients, repeated surgical treatment with a positive result were performed, there were no fatal outcomes among the operated patients. Of the 44 patients treated with daptomycin, 5 died (due to the inability to provide surgical treatment), in 1 case an early relapse of infectious endocarditis developed, in other cases there was a positive dynamics on the background of treatment, the resolution of infectious complications. No cases of resistance of the infectious agent to daptomycin have been reported. Thus, the use of daptomycin in the treatment of gram-positive infections in patients with cardiosurgical and oncohematological profile is justified and shows good results in tolerability and effectiveness both in monotherapy and in combination with other antibiotics.

Spectral model for diagnosis of acute leukemias in whole blood and plasma through Raman spectroscopy.

Acute leukemias are oncohematological diseases that compromise the bone marrow and have a complex diagnostic definition, leading to a high mortality when diagnosed late. This study proposed to determine the spectral differences between whole blood and plasma samples of healthy and leukemic subjects based on Raman spectroscopy (RS), correlating these differences with their resulting biochemical alterations and performing discriminant analysis of the samples (n = 38 whole blood and n = 40 plasma samples). Raman spectra were obtained using a dispersive Raman spectrometer (830-nm wavelength, 280-mW laser power, 30-s exposure time) with a Raman probe. The exploratory analysis based on principal component analysis (PCA) of the blood and plasma sample's spectra showed loading vectors with peaks related to amino acids, proteins, carbohydrates, lipids, and carotenoids, being the spectral differences related to amino acids and proteins for whole blood samples, and mainly carotenoids for plasma samples. Discriminant models based on partial least squares (PLS) and PCA were developed and classified the spectra as healthy or leukemic, with sensitivity of 91.9% (PLS) and 83.9% (PCA), specificity of 100% (both PLS and PCA), and overall accuracy of 96.5% (PLS) and 93.0% (PCA) for the whole blood spectra. In plasma, the sensitivity was 95.7% (PLS) and 11.6% (PCA), specificity of 98% (PLS) and 100% (PCA), and overall accuracy of 97.1% (PLS) and 64.1% (PCA). The study demonstrated that RS is a technique with potential to be applied in the diagnosis of acute leukemias in whole blood samples.

Zastosowanie leków z grupy echinokandyn – w szczególności kaspofunginy w prewencji i leczeniu inwazyjnych zakażeń grzybiczych w populacji dorosłych pacjentów ze schorzeniami onkohematologicznymi, w tym po przeszczepieniu krwiotwórczych komórek macierzystych

Zastosowanie leków z grupy echinokandyn – w szczególności kaspofunginy w prewencji i leczeniu inwazyjnych zakażeń grzybiczych w populacji dorosłych pacjentów ze schorzeniami onkohematologicznymi, w tym po przeszczepieniu krwiotwórczych komórek macierzystych

PARVOVIRUS B19: FEATURES OF PREVALENCE IN ONCOLOGICAL PATIENTS

The review provides information on the prevalence of parvovirus B19 infection, its spread in various regions of Russia is examined in detail. A brief description of various clinical manifestations of parvovirus infection is given. In more detail, the review discusses the role of parvovirus B19 in the development of cancer and, in particular, oncohematological diseases, the percentage of infection among patients; the importance of timely laboratory diagnosis of this infection is shown.

Characterization of beta-tubulin DNA sequences within Candida parapsilosis complex

Background and Purpose: Candida parapsilosis is a common cause of candidemia in children and patients with onco-hematological diseases, septic arthritis, peritonitis, vaginitis, and nail and skin infections. Regarding this, the present study was condcuted to evaluate intra- and inter-species variation within beta-tubulin DNA sequence of C. parapsilosis complex in order to establish the utilization of this gene in the identification and phylogenetic analysis of the species. Materials and Methods: A total of 23 isolates representing three different species of C. parapsilosis complex were used in this study, all of which were identifed by ITS-sequencing. For the successful amplification of beta-tubulin gene, a newly designed set of pan-Candida primers was used, followed by bilaterally sequenc analysis for pairwise comparisons, determination of multiple alignments, evaluation of sequence identity levels, counting sequence difference, and construction of phylogenetic tree.&#x0D; Results: The multiple alignment of 623-629 bp-long nucleotide (nt) sequences reflecting the beta-tubulin gene indicated an inter-species divergence ranging within 0-68 nt in C. parapsilosis, C. orthopsilosis, and C. metapsilosis with a mean similarity of 84.7% among the species. Meanwhile, the intra-species differences of 0-20 and 0-6 nt were found between the strains of C. parapsilosis and C. orthopsilosis, respectively.&#x0D; The phylogenetic tree topology was characterized by a clade made up by C. parapsilosis and C. orthopsilosis, while C. metapsilosis formed a related but separate lineage.&#x0D; Conclusion: Our data provided the basis for further discoveries of the relationship between the species belonging to C. parapsilosis complex. Furthermore, the findigns of the prsent study revealed the efficiency of beta-tubulin DNA sequence data in the identification and taxonomy of C. parapsilosis and other pathogenic yeasts.

Frequency of isolation and drug susceptibility of bacterial strains isolated from child oncohematological patients 2011-2014: A single center study.

Infections in pediatric patients with oncohematological diseases pose a huge therapeutic and diagnostic problem. The aim of the study was to investigate the etiology of bacteremia and the antibiotic susceptibility of pathogenic and colonizing bacterial strains in pediatric oncohematological patients. In the period 2011-2014, 17,209 positive test results, including 1,129 positive blood cultures, were subjected to a detailed analysis. The assessment of drug susceptibility was conducted in accordance with the CLSI (American), EUCAST (European), and KORLD (Polish) recommendations. A high percentage (86-91%) of negative blood culture results was demonstrated. A predominance of Gram-positive bacteria was seen in all years (60-70%) in contrast to Gram-negative strains (30-40%). Coagulase-negative staphylococci (CNS) were the strains most frequently isolated from blood (41-47%) among all bacterial strains. Susceptibility to linezolid and vancomycin was 96-100%, and to teicoplanin 82-96%. Methicyllin-resistant coagulase-negative Staphylococcus (MRCNS) were isolated in 77-86%. All Staphylococcus aureus (S. aureus) strains were susceptible to glycopeptides and linezolid, while Enterococcus spp. was susceptible to linezolid. Apart from the year 2014, no methicillin-resistant S. aureus (MRSA) were isolated. Enterobacteriaceae (EN) were the most susceptible to imipenem and meropenem (91-100%) as well as to amikacin (77-93%). From 2013 to 2014, non-fermentative rods (NF) isolated from blood were less susceptible to imipenem and meropenem (71% and 67-71%, respectively) than to other antibiotics. It has been shown that strains isolated from blood have a statistically significantly different susceptibility to antibiotics (CNS and EN are less and NF is more susceptible) than those existing as colonizing flora. Our results show that choosing appropriate antibiotics for treating infection in children with oncohematological diseases based on antibiograms for colonizing flora may be difficult because they may not take into account the more resistant strains. According to the antibiotic susceptibility of the strains isolated from blood in our center, the most viable active empirical and carbapenem-saving therapy could be conducted with piperacillin/tazobactam or cefepime.

The structure of viral hepatitis and dynamics of cytolitic syndrome in patients with oncohaematological diseases

The aim of the research. Evaluation of the structure of viral hepatitis in patients with oncohaematological diseases and activity of ALT and AST during various methods of treatment of the main disease. Materials and methods. Retrospective analysis of data from 2000 patients treated during 2001–2014 in Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation Pavlov of the First Saint Petersburg State Medical University was carried out. The dynamics of cytolytic enzymes during therapy (polychemotherapy, transplantation of hematopoietic stem cells, symptomatic) of oncohematological diseases was evaluated between the patients with concomitant chronic viral hepatitis (N=175) and without liver pathology (N=203). Analysis was performed with SAS software. Results . Over a 10-year follow-up period, 9% of the oncohematological patients of the specialized center identified markers of hemocontact viral hepatitis. The results of the study showed that in patients with concomitant viral hepatitis, in contrast to a group without hepatitis the activity of ALT and AST significantly increased compared to baseline values after the treatment of hematological malignancy. It was twofold increase of the activity of enzymes after transplantation of hematopoietic stem cells and 3–4- fold incease after courses of polychemotherapy. In patients without viral hepatitis, changes in enzyme activity after such therapy were not observed. Summary. Thus, the associated effect of concomitant viral hepatitis and toxic effects of treatment methods with the use of polychemotherapy and transplantation of hematopoietic stem cells was proven on the development of cytolytic syndrome in oncohematological patients.

Обгрунтування способу санаторно-курортної реабілітації дітей з онкогематологічними захворюваннями

Обгрунтування способу санаторно-курортної реабілітації дітей з онкогематологічними захворюваннями

Increase the effectiveness of oral hygiene in children with oncological and hematological diseases

In children with hematological, oncological and immunological diseases often causes complications associated with oral lesions (stomatitis, mucositis, etc.) during treatment with chemo- and radiotherapy. One way to reduce the number of such complications is individual oral hygiene and optimal selection. Aim of this study was to optimize oral hygiene based on the study of individual characteristics of patients. 18 Patients included in the study (9 with oncohematological diseases and 9 patients who did not suffer from them), who’s the main indicators of oral health were analyze in 2 stages. It was shown that patients who treated for oncohematological diseases, there is an increased risk of inflammatory changes with loss of teeth. The article presents that personal hygiene means of the oral cavity selected adequately, adherence to the oral care regime significantly improves the condition of the oral mucosa and teeth, and promotes the prevention of loss of teeth.

Diagnosis and differential diagnosis of pulmonary sarcoidosis

Pulmonary sarcoidosis is one of the most common interstitial lung diseases. The prevalence in Russia is 10-20 per 100 thousand population. Overwhelmingly it is found among working age population, and the peak of morbidity is 30-40 years. In half of the cases, sarcoidosis occurs in oligosymptomatic form. According to research conducted by our scientists, the adverse course of the disease with exacerbations and progressive decrease in pulmonary function found in 27,3% of patients. The diagnosis is based on clinical, X-ray and histological examination. Material for histological study was prepared depending on the extent of the process. Preference is given to minimally invasive methods of biopsy: transbronchial puncture of intrathoracic lymph nodes, peripheral lymph nodes, bone marrow aspiration, skin sarcoid items, etc. In the case of the intrathoracic localization of the disease, the treatment of choice is videothoracoscopy. The detection of epithelioid cell granuloma without necrosis confirms the diagnosis of sarcoidosis. First of all it is necessary to exclude tuberculosis, oncohematological diseases, disseminated lung diseases, combined with alveolitis syndrome and mediastinal lymphadenopathy. The primary diagnosis should be carried out under conditions of a multifunctional clinic. The verification of the pulmonary sarcoidosis should be held in close cooperation of different specialists: pulmonologists, radiologists, thoracic surgeons, pathologists, etc. Further treatment of the patient should be implemented by the pulmonologist in the place of residence. A clinical case of late diagnosis of diffuse diseases of connective tissue, which at its beginning started under the mask of sarcoidosis is demonstrated. The main mistake that led to deep disability of the patient, was absence of timely histological verification of the diagnosis.

Clinical and epidemiological profile of alloimmunized and autoimmunized multi-transfused patients against red blood cell antigens in a blood center of Minas Gerais

BackgroundThe large diversity of red blood cell antigens favors, especially in multi-transfused patients, the occurrence of autoimmunization and alloimmunization with the risk of hemolytic transfusion reactions. Thus, this study aimed to determine the rates of alloimmunization and autoimmunization in these individuals, as well as the types of alloantibodies and their systems, clinical and epidemiological aspects and the frequency of autoimmunity in alloimmunized and non-alloimmunized patients. MethodsIn a retrospective study, 153 multi-transfused patients from 2006 to 2014 were evaluated. Sixty-eight had onco-hematological diseases, 64 had hemoglobinopathies and 21 had chronic renal failure. Descriptive analyses were carried out with the proportions being compared using the chi-square test, with the significance level set at 5%. ResultsThe Rh system was the most frequently involved (53.11%) and anti-E and anti-K (Kell system) were the most prevalent alloantibodies (21.87% each). Autoantibodies were found in ten patients (6.54%) with the percentages of autoimmunization in alloimmunized and non-alloimmunized individuals being 29.16% and 2.32%, respectively (p=0.0001). There was a significant difference between autoimmunization and the number of transfusions (16.21% in 6–10 vs. 5.26% <6 vs. 2.56% >10; p=0.0203) and diseases (19.04% in chronic renal failure vs. 6.25% in hemoglobinopathies vs. 2.94% in onco-hematological diseases; p=0.0329). ConclusionThe results show a strong correlation between alloimmunization and autoimmunization. Moreover, they reinforce the need for further studies on the clinical and epidemiological profile of multi-transfused patients in relation to alloimmunity and autoimmunity, especially the latter, for a better understanding of its etiopathogenesis and physiopathogenesis.

Characterization of beta-tubulin DNA sequences within Candida parapsilosis complex.

Background and Purpose: Candida parapsilosis is a common cause of candidemia in children and patients with onco-hematological diseases, septic arthritis, peritonitis, vaginitis, and nail and skin infections. Regarding this, the present study was condcuted to evaluate intra- and inter-species variation within beta-tubulin DNA sequence of C. parapsilosis complex in order to establish the utilization of this gene in the identification and phylogenetic analysis of the species.Materials and Methods:A total of 23 isolates representing three different species of C. parapsilosis complex were used in this study, all of which were identifed by ITS-sequencing. For the successful amplification of beta-tubulin gene, a newly designed set of pan-Candida primers was used, followed by bilaterally sequence analysis for pairwise comparisons, determination of multiple alignments, evaluation of sequence identity levels, counting sequence difference, and construction of phylogenetic tree.Results:The multiple alignment of 623-629 bp-long nucleotide (nt) sequences reflecting the beta-tubulin gene indicated an inter-species divergence ranging within 0-68 nt in C. parapsilosis, C. orthopsilosis, and C. metapsilosis with a mean similarity of 84.7% among the species. Meanwhile, the intra-species differences of 0-20 and 0-6 nt were found between the strains of C. parapsilosis and C. orthopsilosis, respectively. The phylogenetic tree topology was characterized by a clade made up by C. parapsilosis and C. orthopsilosis, while C. metapsilosis formed a related but separate lineage.Conclusion:Our data provided the basis for further discoveries of the relationship between the species belonging to C. parapsilosis complex. Furthermore, the findigns of the prsent study revealed the efficiency of beta-tubulin DNA sequence data in the identification and taxonomy of C. parapsilosis and other pathogenic yeasts.

ХАРАКТЕРИСТИКА ПСИХОСОМАТИЧНОГО СТАНУ ДІТЕЙ У ПЕРІОД РЕМІСІЇ ОНКОГЕМАТОЛОГІЧНИХ ЗАХВОРЮВАНЬ В ПРОЦЕСІ КОМПЛЕКСНОЇ РЕАБІЛІТАЦІЇ З ДИФЕРЕНЦІЙОВАНИМ ПРИЗНАЧЕННЯМ МІНЕРАЛЬНОЇ ВОДИ «МАРІЯ»

Результати аналізу даних літератури свідчать, що вживання мінеральної води (МВ) сприяє зменшенню проявів ендогенної інтоксикації, відновленню функції гепатобіліарної системи та адаптаційних механізмів. Однак це потребує додат-кових досліджень.Мета дослідження – оцінити динаміку психосоматичного стану в дітей у період ремісії онкогематологічних захворювань за комплексом реабілітації з диференційованим призначенням питного водолікування нативною МВ “Марія”.Матеріали і методи. Санаторно-курортне лікування (СКЛ) проводили в умовах дитячого санаторію “Джерело” в Трускавці. Алгоритм обстеження дітей включав загальне клінічне обстеження та лабораторні дослідження крові. Для оцінки імунологічної реактивності організму використовували інтегральні гематологічні показники. В діагностиці психологічного стану дітей застосовували спостереження, бесіди, методи психодіагностики.Результати досліджень та їх обговорення. На кінець реабілітації, за оцінкою функціонального стану дітей, відмічали зменшення від 42,5 до 19,1 % скарг на втомлюваність, зниження больового синдрому в гастродуоденальній ділянці та у правому підребер’ї від 21, до 6,4 %, головного болю – від 19,1 до 2,1 %, поліпшення апетиту – в 18,8 % дітей. Після реабілітації позитивна динаміка проявлялась зменшенням проявів бактеріальної інтоксикації: зниження частоти реакцій гіперчутливості миттєвого типу на 18,2 %, зменшення частоти показників бактеріальної інтоксикації на 9 %. Під впливом комплексу реабілітації дітей на кінець СКЛ частота неспецифічних адаптаційних реакцій організму (НАРО) низького рівня збільшилась із 45,4 % до 63,6 %, частота II ступеня напруження – від 45,4 до 72,7 % при збереженні проявів дітей реакцій спокійної активації у 90,9 %.Висновки. Є доцільною порівняльна характеристика отриманих результатів СКЛ із тими, що стосуються іншого комплексу реабілітації дітей у період ремісії онкогематологічних захворювань в санаторії для дітей із батьками, тобто сімейної реабілітації.

Clinical Significance of the PRAME Gene Expression in Oncohematological Diseases

Although the PRAME activity was first discovered in solid tumors, this gene is very frequently expressed in oncohematological diseases. PRAME can be regarded as a reliable biomarker of tumor cells. Determination of PRAME transcripts is used in residual disease monitoring and molecular relapse diagnostics. Experimentation with PRAME expressing lines of leukemia cells yielded controversial results. Therefore, it is hardly possible to estimate the prognostic value of PRAME activity in oncohematological diseases. In chronic myeloproliferative disease and chronic myeloid leukemia, however, PRAME activity proves to be a predictor of negative prognosis, and on the contrary, it can be regarded as a positive prognostic factor in acute myeloid or lymphoid leukemia. Despite many clinical studies prognostic value of PRAME expression in some diseases requires further investigation. The present literature review contains the data concerning PRAME expression in oncohematological diseases.

Correction of Anemia and Evaluation of Efficacy of Red Blood Cell Transfusion in Patients with Oncohematological Diseases

Aim. To study the quality of life (QL) of patients with oncohematological diseases and anemia with respect to hemoglobin level and to evaluate the efficacy of red blood cell transfusion (RBCT). Materials &amp; Methods. QL of patients (n = 326) was studied using FACT-An questionnaire. RBCT efficacy was evaluated in two groups. The first group included patients (n = 28; 13 men and 15 women) with oncohematological diseases and chronic anemia aged 23-80 (median 65) years, the second (control) group included patients (n = 12; 11 men and 1 woman) after severe blood loss after injury (acute anemia) aged 25-43 (median 36) years. The baseline levels of hemoglobin (Hb) and hematocrit (Ht) were &lt; 80 g/L and &lt; 25 % in all patients, respectively. The target levels of Hb and Ht were &gt; 80 g/L and &gt; 25 %, respectively. Results. The association between the severity of anemia and QL was shown. The lowest QL was observed in patients with grade III-IV anemia (Hb &lt; 80 g/L). Each patient in both groups received 1-8 units of blood cells (median 2) during the hospital stay. After RBCT the levels of Hb and Ht increased from 64.1 ± 2.7 g/L to 90.2 ± 1.7 g/L and from 20.1 ± 0.8 % to 28.9 ± 0.7 %, respectively. The levels of Hb and Ht in the second (control) group increased from 65.9 ± 3.0 g/L to 88.3 ± 3.2 g/L and from 19.6 ± 0.9 % to 26.7 ± 1.4 %, respectively. Venous blood oxygen saturation (SvO&lt;sub&gt;2&lt;/sub&gt;) increased in the first group from 42.0 ± 3.3 % to 57.6 ± 4.1 %, and in the second group from 51.3 ± 1.9 % to 69.0 ± 1.3 %. However, after RBCT the SvO&lt;sub&gt;2&lt;/sub&gt; level reached &gt; 60 % only in 67.9 % of patients in the first group and in all the patients (100 %) in the second group. In 32.1 % of patients with various forms of hematologic cancer and chronic anemia tissue hypoxia was still observed after RBCT despite increased Hb &gt; 80 g/L and Ht &gt; 25 %. Therefore, it was proposed to raise the target Hb and Ht threshold levels for patients with low SvO&lt;sub&gt;2&lt;/sub&gt;. Conclusion. The effect of the severity of anemia on QL was demonstrated. The patients with Hb &lt; 80 g/L were shown to have low quality of life.