Vol 80, No 7 (2008)

Editorial
"Electronic case history"
Zingerman B.V., Shifrin M.A., Shklovskiĭ-Kordi N.E.
Terapevticheskii arkhiv. 2008;80(7):5-8
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High-dose therapy of berkitt's lymphoma in patients over 40 years of age
Kravchenko S.K., Bariakh E.A., Zamiatina V.I., Perestoronina T.N., Fink O.S., Gubkin A.V., Egorova E.K., Zvonkov E.E., Iliushkina E.A., Krasil'nikova B.B., Morozova A.K., Vorob'ev I.A., Kaplanskaia I.B., Kliasova G.A., Obukhova T.N., Kremenetskaia A.M., Vorob'ev A.I.
Abstract
Aim. To analyse efficacy and tolerance of high-dose polychemotherapy (PCT) of Berkitt's lymphoma (BL) in patients aged over 40 years. Material and methods. High-dose PCT was given to 6 BL patients aged 41-56 years (median 48.1 years). Results. Complete clinicohematological remissions were achieved in 4 patients. In two of them the treatment was discontinued after three blocks of PCT because of severe infectious complications. According to 4-12 month follow-up, remission continues. Remission was not achieved in two patients: one patient had primary resistance, the other died of sepsis after the second PCT course before remission. The time to remission did not correlate with age. Duration of myelotoxic agranulocytosis varied from 2 to 24 days. Duration of agranulocytosis did not correlate with age. Infections complicated 19 of 20 PCT blocks. Severity of complications caused withdrawal of three patients. Conclusion. BL is biologically heterogenous as it demonstrates different responses to BL-M-04 program. Causes of slow regression of tumor mass in some patients need further investigations. In spite of a great number of infectious complications high-dose therapy has no alternative.
Terapevticheskii arkhiv. 2008;80(7):9-18
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Efficacy of conservative treatment of gastric lymphosarcoma
Zvonkov E.E., Kremenetskaia A.M., Kravchenko S.K., Makhinia V.A., Kaplanskaia I.B., Obukhova T.N., Samoĭlova R.S., Shevelev A.A., Magomedova A.U., Bariakh E.A., Krasil'nikova B.B., Gubkin A.V., Iliushkina E.A., Mar'in D.S., Morozova A.K., Kulikov S.M., Gemdzhian É.G., Vorob'ev A.I.
Abstract
Aim. To compare efficacy and toxicity of conservative therapy (different programs of polychemotherapy) of gastric lymphosarcoma conducted for the last 10 years in Hematological Research Center of the Russian Academy of Medical Sciences. Material and methods. The study included 63 patients (40 females and 23 males aged 14 to 78 years, mean age 49 years) with primary diagnosis of gastric lymphosarcoma (GL). Of them, 56 (89%) patients had diffuse large B-cell lymphosarcoma (DLBCL) and 7 (11%) had gastric Berkitt's lymphoma (BL). Only detection of t(8;14) with rearrangement of c-myc gene provided accurate diagnosis of gastric BL. By the treatment DLBCL patients were divided into two groups: 44 patients of group 1 received polychemotherapy (PCT) according to CHOP scheme or in combination with radiotherapy and surgical treatment; 12 patients of group 2 were treated according to modified program mNHL-BFM-90, without surgical or radiation treatment. Of 7 patients with gastric BL 5 patients received treatment according to a modified program mNHL-BFM-90 and 2 patients were given CHOP because of DLBCL misdiagnosis without cytogenetic detection of t(8;14). Results. Overall survival in group 1 was 73% in mean follow-up 61 months. The survival depended only on initial factors of poor prognosis (PPF): tumor size over 10 cm, Ann-Arbor stage higher than IE, B-symptoms, elevated level of LDH. Overall survival of 18 gastric DLBCL patients without PPF reached 94%, of 26 patients with PPF - 60%. Lethality due to side effects was 4% (2 patients), primary resistance was 14% (6 patients), recurrence arose in 9% (4 patients). Overall survival in group 2 was 100% in mean remission duration 18 months, was unrelated to PPF (10 of 12 patients) but correlated with high toxicity. 5 BL patients treated with a modified mNHL-BFM-90 program achieved remission (a mean follow-up at present is 1 to 50 months, mean 24 months). 2 BL patients treated with CHOP died for a year. Conclusion. Gastric lymphosarcomas are sensitive to chemotherapy, thereby PCT only is effective in most patients. PPF in gastric DLBCL were responsible for poor outcome in 40% patients in CHOP treatment. The modified program mNHL-BFM-90 can produce up to 100% complete long-term remissions in therapy of gastric lymphosarcoma in adults both in BL and DLBCL patients. A cytogenetic examination of c-myc gene rearrangement is obligatory before initiation of PCT of gastric lymphosarcoma.
Terapevticheskii arkhiv. 2008;80(7):18-26
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Vaccine prophylaxis of viral hepatitis in patients with acute leukemia
Gurina N.M., Svedentsov E.P., Shardakov V.I., Cherepanova V.V.
Abstract
Aim. To assess efficacy of vaccine against viral hepatitis В (VHB) in adults after achievement of acute leukemia (AL) remission. Material and methods. Specific prevention of VHB was made in 30 AL patients with recombinant vaccine Engerix В by two schemes: 0-1-2-12 and 0-1-2-6 months with double adult dose 40 mcg. Efficacy of vaccination was evaluated by the titer of antibodies to HBs-Ag (HBs-Ab) 1 month after each injection of the vaccine. The control group consisted of 36 patients. Follow-up was 6 months to 10 years. Results. Vaccine prophylaxis of VHB in AL remission resulted in appearance of the protective antibody titer after the forth vaccine injection in 50% patients. Out of 30 vaccinated patients 2 (6.7%) got infected with HBV 3 and 5 years after onset of the disease. Markers of HBV replication were detected in 8 (22%) of 36 patients. Conclusion. Vaccine prophylaxis of VHB in adult patients in AL remission was effective in 93.3% of the vaccinated patients.
Terapevticheskii arkhiv. 2008;80(7):27-29
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Early computed tomography signs in diagnosis of some pulmonary mycoses in myelotoxic agranulocytosis
Gotman L.N., Iatsyk G.A., Kliasova G.A.
Abstract
Aim. To characterize minimal CT signs of initial pulmonary lesion in candidomycosis and invasive aspergillesis of the lungs. Material and methods. A multislice computer tomograph Light Speed+ (GE) was used to examine 67 patients with hematological malignancy in the condition of myelotoxic agranulocytosis (MTA). A CT picture considered as early presentation of fungal lesion of the lungs was seen in 25 (37%) of 67 patients. This diagnosis was made basing on the symptom of bronchiolyte manifesting roentgenologically as a "tree in the kidneys". Results. Eleven (16%) patients in the condition of MTA for 5-7 days had clinical pulmonary symptoms accompanied with fungal lesion of the upper respiratory tract and a positive reaction to mannan, a Candida antigen, signs of diffuse bronchiolyte. In 14 (21%) patients bronchiolyte symptom was detected in some lobules or segments on MTA day 5-12 and was not associated with pulmonary symptoms and an elevated level of Aspergillus antigen - galactomannan in the blood. A "halo" symptom accompanied with a high concentration of Aspergillus antigen was found in 7 (10%) patients untreated with antifungal drugs at the site of local bronchiolitis. Conclusion. A principal differential-diagnostic sign of bronchiolytis in candidomycosis and aspergillesis of the lungs as shown by multislice computed tomography and high resolution computed tomography is the pattern of its distribution. In candidomycosis bronchiolytis is subtotal or total, with small amount of liquid (> 100 ml) in the pleural cavities (37% cases). Invasive aspergillesis of the lungs is characterized by lobular or segmental bronchiolitis.
Terapevticheskii arkhiv. 2008;80(7):30-33
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Efficacy of therapy of different variants of anaplastic large t-cell lymphomas
Vinogradova I.E., Lutsenko I.N., Kaplanskaia I.B., Vorob'ev I.A., Samoĭlova R.S., Gorgidze L.A., Ryzhikova N.A., Valiev T.T., Giliazitdinova E.A., Dzhulakian U.L., Egorova E.K., Zvonkov E.E., Krasil'nikova B.B., Magomedova A.U., Margolin O.V., Mar'in D.S., Kremenetskaia A.M., Kravchenko S.K., Vorob'ev A.I.
Abstract
Aim. To compare efficacy of NHL-BFM-90 and CHOP-like courses in the treatment of anaplastic large cell lymphoma (ALCL). Material and methods. Twenty-two patients with ALCL participated in the study. The diagnosis was made basing on the findings of clinical, device, morphological, immunohistochemical and molecular-genetic examinations with application of a panel of monoclonal antibodies to CD30, ALK, CD3, CD4, CD8, CD7, CD34, CD15, CD68, CD20, CD45RO, CD45RA, Ki-67. 14 cases of 22 were negative by kinase of anaplastic lymphocytes (ALK-) and 8 were positive (ALK+). Mean age of ALK-ALCL patients was 39.6 + 4.1 years, of ALK+ALCL patients - 23.4 + 2.6 years. 14 patients were treated by the protocol NHL-BFM-90, 8 were initially treated with other schemes (CHOP, MACOP-В, BEACOPP and others). All 14 patients treated according to NHL-BFM-90 had ALCL stages III-IV with B-symptoms. 12 patients who completed treatment by the above protocol achieved complete remission after the forth course, 2 patients failed the treatment. Of 8 ALCL patients treated initially according to other schemes, a complete remission was achieved in 4 patients (2 had stage II). One of 4 patients with remission had recurrence. Four patients who had failed to achieve complete remission died of the disease progression. Conclusion. ALCL occurs more frequently in young and middle-aged patients. The disease has an aggressive course with rapid generalization. For such processes it is more preferable to use a modified protocol NHL-BFM-90.
Terapevticheskii arkhiv. 2008;80(7):33-37
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Somatogenic and somatogenically provoked psychoses in blood diseases
Vybornykh D.É., Ivanov S.V., Savchenko V.G., Gemdzhian É.G.
Abstract
Aim. To detect risk factors (RF) to develop somatogenic psychoses (SP) in blood diseases. Material and methods. A total of 107 SP patients were examined with the disease corresponding to diagnostic points F05 or F06 (IDC-10). Results. The following RF were identified: cytostatic drugs with or without glucocorticosteroids, glucocorticosteroids alone, interferon-alpha, viral encephalitis, neuroleukemia. Single obligatory specific factors which bring manifestation of certain psychoses were not identified. SP in each of the considered hematological malignancies are related with various factors. Conclusion. The findings suggest polyfactor etiology of SP including some schemes of chemotherapy, some type of blood disease, specific premorbid features and mental disease burden. We suggest that the clinical picture, dynamics and prognosis of SP in blood diseases may be caused by a profile of factors typical for each disease.
Terapevticheskii arkhiv. 2008;80(7):38-43
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Pcr definition of b-cell clonality: which electrophoretic method is better
Sidorova I.V., Nikitin E.A., Ryzhikova N.V., Sudarikov A.B.
Abstract
Aim. To compare diagnostic efficacy of B-cell clonality determination in application of different electrophoretic methods. Material and methods. B-cell clonality was determined with different techniques in 89 patients having B-cell lymphoma (n = 48), B-cell lymphoma in remission (n = 11), reactive processes (n = 24), lymphogranulomatosis and T-cell lymphoma (n = 6). Healthy donors served control. Clonality was defined by rearrangements of Ig heavy chain genes with usage of primers to FR2 region of Ig gene. Electrophoretic methods were the following: agarose electrophoresis and SSCP. Results. Clonality was detected in the presence of more than 5.9% clonal cells from total count of mononuclear cells or more than 20% of clonal cells from total number of B-lymphocytes in the sample. We achieved detectability of B-clonality in B-cell tumors 87.5% (42 of 48 cases). False negative tests were also investigated with kits of primers to FR1 and FR3 regions, but clonality was not determined. Among reactive processes, non-B-cell tumors and healthy donors clonality was found in 1 of 41 cases. This patient had acute respiratory viral infection. Agarose electrophoresis and SSCP test results coincided. Conlusion. Determination of B-cell clonality with agarose electrophoresis proved to be a simple, reliable, cost-effective and reproducible method of differential diagnosis of tumor and reactive lymphoproliferation. This method is not suitable for verification of tumor remission or assessment of minimal residual disease because of its low sensitivity.
Terapevticheskii arkhiv. 2008;80(7):43-47
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Clinical characteristics of velcade cumulative effect in resistant and recurrent multiple myeloma
Mitina T.A., Golenkov A.K.
Abstract
Aim. To assess efficacy of velcade monotherapy in patients with resistent and recurrent multiple myeloma (MM). Material and methods. Velcade was given to 29 patients (11 males and 18 females at the age 41-73 years) with resistant and recurrent MM of stage 3. A standard scheme was used - 1.3 mg/m2 iv jet on day 1, 4, 8 and 11. The cycle was 21 days, a total of 6 cycles. All the patients were examined immunochemically for serum and urine Pig. An antitumor effect was studied. Results. After, on the average, 3 courses of velcade therapy Pig reduction was 31.3%. The response was complete (CR) in 3.4%, partial (PR) in 44.6%, minor response (MR) in 17% and no response (NR) in 35% patients. After 6 cycles of velcade monotherapy given to 23 patients Pig reduction was 59%. CR, PR, MR, NR were seen in 2 (8.7%), 11 (47.8%), 4 (17.4%), 6 (26.1%) patients, respectively. Progression occurred in 8.7%. After 3 cycles of velcade therapy in 29 patients an objective response occurred in 48%, after 6 cycles it increased to 56.5%. The group with poor respose (MR+NR) reduced from 52 (after 3 cycles) to 43.5% (after 6 cycles) patients. Cumulative toxicity of velcade 10 days after the end of cycles 3 and 6 was absent.
Terapevticheskii arkhiv. 2008;80(7):48-50
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Is a three-month therapy with warfarin adequate for effective therapy of patients after an episode of venous thrombosis
Vorob'eva N.M., Ermolina O.V., Balakhonova T.V., Dobrovol'skiĭ A.B., Titaeva E.V., Kirienko A.I., Panchenko E.P.
Abstract
Aim. To evaluate efficacy of 3 month therapy with warfarin in patients after an episode of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE), safety of the treatment. Material and methods. 26patients after DVT/PATE aged 18-74 were treated in the hospital with non-fractionated heparin for 10-14 days followed by warfarin. The dose was selected under the control of INR up to target values 2.0-3.0. Ultrasound angioscanning of the limbs was conducted at hospitalization, on discharge, 1 and 3 months after the discharge. D-dimer was measured at discharge, 1 and 3 months after the discharge. The patients were followed up for 3 months. The following end points were considered: recurrences of deep or surface vein thrombosis, PATE recurrence, death due to PATE, hemorrhagic complications. Results. By ultrasound angioscanning significant positive results were not achieved. The level of D-dimer upon discharge was elevated in 18 (69.2%) patients (0.94, 0.41-1.69 mcg/ml). 3 month therapy with warfarin resulted in complete solution of all floting thrombs, achievement of recanalization of occlusive thrombosed deep vein in 20 (80%) patients, thrombosed vein number reduced from 4.0 to 3.0, p = 0.004. Deep vein thrombs disappeared only in 3 (11.5%) patients in 3 months. Warfarin lowered D-dimer content to 0.23 mcg/ml (p < 0.001) in 1 month and to 0.12 mcg/ml (p < 0.001) in 3 months after the discharge. 23 patients reached target 2.0-3.0 values and maintained them in therapeutic ranges. In DVT recurrence no PATE and PATE-related deaths were registered. Hemorrhagic complications arose in 5 patients, but they did not lead to warfarin discontinuation. Conclusion. Warfarin is effective for secondary prophylaxis of DVT/PAT, but this therapy failed to solve thrombs in the deep veins in many patients.
Terapevticheskii arkhiv. 2008;80(7):50-54
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Treatment of diffuse large b-cell lymphosarcoma with involvement of bone marrow in an old female patient
Zamiatina V.I., Kravchenko S.K., Giliazitdinova E.A., Magomedova A.U., Vorob'ev I.A., Gotman L.N., Kaplanskaia I.B., Kesel'man S.A., Obukhova T.N., Sakhibov I.D., Shevelev A.A., Kremenetskaia A.M.
Terapevticheskii arkhiv. 2008;80(7):54-57
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Intensive chemotherapy of diffuse large b-cell lymphosarcoma in a female patient with chronic renal failure and afunctional left kidney
Egorova E.K., Mar'in D.S., Shutova N.A., Galstian G.M., Savenko T.A., Kremenetskaia A.M., Kravchenko S.K., Magomedova A.U., Kovalenko A.V., Kaplanskaia I.B., Samoĭlova R.S., Kliasova G.A., Kozlova S.I.
Terapevticheskii arkhiv. 2008;80(7):57-59
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A case of unclassified B-cell lymphosarcoma
Vorob'ev V.I., Vorob'ev I.A., Lorie I.I., Zvonkov E.E., Kremenetskaia A.M., Obukhova T.N., Kravchenko S.K.
Terapevticheskii arkhiv. 2008;80(7):60-62
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Fatal complications of long-term immunosuppressive therapy in a renal transplant recipient
Rekhtina I.G., Biriukova L.S.
Terapevticheskii arkhiv. 2008;80(7):62-64
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A chronic recurrent course of moschcowitz disease
Kalinina I.I., Stalina O.V., Ryzhko V.V., Tsvetaeva N.V., Vasil'ev S.A., Petrova V.I.
Terapevticheskii arkhiv. 2008;80(7):65-67
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Infectious-septic complications in acute intermittent porphyria aggravated by chronic renal failure
Pustovoĭt I.S., Glasko E.P., Iatskov K.V., Karpova I.V., Shulutko E.M., Petrova V.I., Kozlova S.I., Korolev A.V., Kremenetskaia A.M., Biriukova L.S., Kravchenko S.K., Vorob'ev A.I.
Terapevticheskii arkhiv. 2008;80(7):67-70
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A complex approach to treatment of patients with multiple myeloma
Kobzeva I.V., Tepliakov V.V., Karpenko V.I., Bukharov A.V., Tiurina N.G.
Terapevticheskii arkhiv. 2008;80(7):70-72
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One-stage spleen- and gastrectomy in a female patient with subleukemic myelosis with massive splenomegaly and gastric cancer
Karagiulian S.R., Kovaleva L.G., Danishian K.I., Grzhimolovskiĭ A.V., Sorkina O.M., Bulanov A.I., Kolosova L.I.
Terapevticheskii arkhiv. 2008;80(7):72-74
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Thrombocytopeny in hiv infection
Pivnik A.V., Korovushkin V.G., Tuaeva A.O., Petrova E.V., Gruzdev B.M., Likunov E.B., Tumov I.S.
Terapevticheskii arkhiv. 2008;80(7):75-80
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Limitations in application of imanitib in hematologic malignancies: are there new principal solutions?
Rukavitsyn O.A., Pop V.P.
Terapevticheskii arkhiv. 2008;80(7):80-84
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Leukemic dendritic cells
Gal'tseva I.V., Pashin L.E., Savchenko V.G.
Terapevticheskii arkhiv. 2008;80(7):84-88
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Blood coagulation: mechanisms of regulation
Panteleev M.A., Kotova I.N., Tokarev A.A., Ataullakhanov F.I.
Terapevticheskii arkhiv. 2008;80(7):88-91
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Erythrocytes as carriers of anthracycline antibiotics
Tikhonova A.G., Aleksandrovich I.G., Vuĭmo T.A., Sinauridze E.I., Ataullakhanov F.I.
Terapevticheskii arkhiv. 2008;80(7):91-94
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