Vol 80, No 7 (2008)

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.

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.

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.

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.