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Objectification of the method for glomerular filtration rate assessing in patients with diffuse large B-cell lymphoma during induction immunochemotherapy 弥漫大 B 细胞淋巴瘤患者在诱导免疫化疗期间肾小球滤过率评估方法的客观化
Pub Date : 2024-04-03 DOI: 10.17650/1818-8346-2024-19-2-67-74
A. Nozdricheva, I. Lysenko, N. Guskova, N. Nikolaeva, Y. Gaysultanova, S. Dimitriadi, O. G. Ishonina
Aim. To study the glomerular filtration rate (GFR) dynamics calculated by creatinine and cystatin C during induction immunochemotherapy in patients with newly diagnosed diffuse large B-cell lymphoma in order to objectify the method for estimation.Materials and methods. The open longitudinal study included 39 patients with newly diagnosed diffuse large B-cell lymphoma who received specialized treatment at the Oncohematology Department of National Medical Research Centre for Oncology (Rostov-on-Don) in 2021. Patients received induction immunochemotherapy according to the R-CHOP regimen (rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisolone) in combination with accompanying therapy (allopurinol 300 mg/day). Blood sampling was carried out at 0, 24, 48, 72, 120 hours and on 21st day of the 1st therapy cycle. Patients were divided into 2 groups depending on the GFR level, calculated by creatinine, before treatment: group A – 27 (69 %) patients with GFR >90 ml/min/1.73 m2, group B – 12 (31 %) patients with GFR <90 ml/min/1.73 m2.Results. During the immunochemotherapy in patients with initially reduced GFR, a further decrease was observed with the restoration of the initial level by day 21 of therapy. When calculating GFR by cystatin C, in contrast to the calculation by creatinine, it revealed the dependence of GFR level on pathological process stage: GFR in group A patients with stages I–II is 20.4 % lower than in patients with stages III–IV, in group B – by 30.5 %. The use of the fisher test at GFR thresholds of 90 and 60 ml/min/1.73 m2 revealed a greater advantage in establishing absolute GFR levels, especially in the range of 60 to 90 ml/min/1.73 m2.Conclusion. The data obtained confirm that the determination of GFR by cystatin C in patients with diffuse large B-cell lymphoma is a more sensitive method that objectively reflects the functional state of the kidneys, especially when values are within the “gray area” – from 90 to 60 ml/min/1.73 m2.
目的研究新诊断弥漫大B细胞淋巴瘤患者在诱导免疫化疗期间通过肌酐和胱抑素C计算的肾小球滤过率(GFR)动态变化,以确定客观的估算方法。这项开放式纵向研究纳入了 39 名新确诊的弥漫大 B 细胞淋巴瘤患者,他们于 2021 年在国立肿瘤医学研究中心(顿河畔罗斯托夫)肿瘤血液学部接受了专业治疗。患者根据R-CHOP方案(利妥昔单抗、多柔比星、环磷酰胺、长春新碱和泼尼松龙)接受了诱导免疫化疗,并同时接受了辅助治疗(别嘌呤醇300毫克/天)。在第一个治疗周期的 0、24、48、72、120 小时和第 21 天进行抽血。根据治疗前肌酐计算的肾小球滤过率水平,患者被分为两组:A 组--27 名(69%)肾小球滤过率大于 90 毫升/分钟/1.73 平方米的患者;B 组--12 名(31%)肾小球滤过率小于 90 毫升/分钟/1.73 平方米的患者。在免疫化疗期间,最初 GFR 降低的患者的 GFR 进一步降低,在治疗第 21 天时恢复到最初水平。用胱抑素 C 计算肾小球滤过率与用肌酐计算肾小球滤过率不同,它揭示了肾小球滤过率水平与病理过程分期的关系:A 组 I-II 期患者的 GFR 比 III-IV 期患者低 20.4%,B 组低 30.5%。在 90 毫升/分钟/1.73 平方米的 GFR 临界值和 60 毫升/分钟/1.73 平方米的 GFR 临界值上使用 Fisher 试验,在确定 GFR 绝对水平方面具有更大的优势,尤其是在 60 至 90 毫升/分钟/1.73 平方米的范围内。所获得的数据证实,用胱抑素 C 测定弥漫大 B 细胞淋巴瘤患者的 GFR 是一种更灵敏的方法,能客观地反映肾脏的功能状态,尤其是当数值处于 90 至 60 毫升/分钟/1.73 平方米的 "灰色区域 "时。
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引用次数: 0
Immunophenotyping of blood and bone marrow cells as a way to search for differentiation syndrome risk factors in acute promyelocytic leukemia 通过对血液和骨髓细胞进行免疫分型,寻找急性早幼粒细胞白血病分化综合征的风险因素
Pub Date : 2024-04-03 DOI: 10.17650/1818-8346-2024-19-2-56-66
A. A. Semenova, I. Galtseva, V. Troitskaya, N. M. Kapranov, Y. Davydova, K. Nikiforova, A. G. Loseva, A. A. Ermolaev, V. Surimova, S. M. Kulikov, E. N. Parovichnikova
Background. Differentiation syndrome (DS) is a potentially fatal complication of therapy for acute promyelocytic leukemia (APL) with an incidence of up to 48 %. To date, no reliable DS risk factors have been found, with the exception of leukocytosis at the APL onset.Aim. To determine the risk factors associated with DS in patients with APL during induction therapy with arsenic trioxide (ATO) and tretinoin (ATRA).Materials and methods. The study included 39 patients with APL, 29 (74.4 %) of them were classified as low-risk according to ELN (European Leukemia Net), 10 (25.6 %) were classified as high-risk. At the disease onset, cytological and molecular (chimeric transcript PML::RARα, FLT3-ITD mutation) bone marrow studies were performed, the expression of 28 differentiation antigens by blood and bone marrow blast cells was determined (markers of early precursors, myeloid and lymphoid differentiation, cell adhesion molecules, chemokine receptors, integrins, selectin), body mass index (BMI) and the leukocytes number dynamics during induction course were assessed. All patients received ATRA and ATO therapy. Patients from the high-risk group at the onset received 1–3 injections of idarubicin (12 mg/m2) and dexamethasone (8–10 mg/m2 2 times a day) to prevent DS until leukocytosis reduced. In cases of DS, dexamethasone was prescribed at a dose of 10 mg/m2 2 times a day; in cases of severe DS, the induction course was interrupted.Results. Of the 39 patients, 12 (30.8 %) were diagnosed with DS: 20 % of high-risk patients (2/10) and 34.5 % of low-risk patients (10/29). There was no statistically significant association of leukocytosis more than 10 × 109 /L at onset, microgranular morphology of blast cells, bcr3-variant PML::RARα, FLT3-ITD mutation with DS. In multivariate analysis, the probability of DS was associated with BMI ≥30 kg/m2 and mean fluorescence intensity of CD38 antigen by blast cells, regardless of risk group. based on the results of the ROC-analysis, the threshold value of mean CD38 fluorescence intensity was set at 25,000 cu, if exceeded, DS is highly likely to develop.Conclusion. the high incidence of DS among low-risk patients is probably due to the lack of prophylactic glucocorticosteroids administration for the development of leukocytosis during ATRA and ATO therapy. BMI ≥30 kg/m2 and mean CD38 fluorescence intensity more than 25,000 cu were identified as statistically significant DS risk factors.
背景。分化综合征(DS)是急性早幼粒细胞白血病(APL)治疗的一种潜在致命并发症,发病率高达 48%。迄今为止,除 APL 发病时白细胞增多外,尚未发现可靠的 DS 风险因素。目的:确定在使用三氧化二砷(ATO)和曲妥珠单抗(ATRA)诱导治疗期间,APL 患者出现 DS 的相关风险因素。研究纳入了39名APL患者,其中29人(74.4%)根据ELN(欧洲白血病网)被归类为低风险,10人(25.6%)被归类为高风险。发病时,对骨髓进行了细胞学和分子(嵌合转录本PML::RARα、FLT3-ITD突变)研究,确定了血液和骨髓爆破细胞表达的28种分化抗原(早期前体、髓样和淋巴样分化标志物、细胞粘附分子、趋化因子受体、整合素、选择素),评估了诱导过程中的体重指数(BMI)和白细胞数量动态。所有患者都接受了 ATRA 和 ATO 治疗。高风险组患者在开始时接受 1-3 次注射依达比星(12 毫克/平方米)和地塞米松(8-10 毫克/平方米,每天 2 次),以预防 DS,直到白细胞减少。如果出现 DS,则使用地塞米松,剂量为 10 毫克/平方米,每天 2 次;如果出现严重 DS,则中断诱导疗程。在 39 名患者中,12 人(30.8%)被确诊为 DS:20% 的高危患者(2/10)和 34.5% 的低危患者(10/29)。发病时白细胞超过 10 × 109 /L、囊泡细胞微颗粒形态、bcr3 变异型 PML::RARα、FLT3-ITD 突变与 DS 的相关性无统计学意义。根据 ROC 分析结果,CD38 平均荧光强度的临界值设定为 25,000 cu,如果超过这一临界值,则极有可能发生 DS。结论:低风险患者中 DS 的高发生率可能是由于在 ATRA 和 ATO 治疗过程中未预防性应用糖皮质激素导致白细胞增多。体重指数≥30 kg/m2和平均CD38荧光强度超过25,000 cu被认为是统计学上显著的DS风险因素。
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引用次数: 0
Cladribine chemotherapy of multifocal, multisystemic form of Rosai–Dorfman disease: literature review and case report 罗赛-多夫曼病多灶、多系统形式的克拉利宾化疗:文献综述和病例报告
Pub Date : 2024-04-03 DOI: 10.17650/1818-8346-2024-19-2-46-55
V. Potapenko, D. Abramov, V. V. Baykov, T. L. Grigorieva, M. S. Selinkina, L. O. Nikolskaya, Jean-François Emile
Rosai–Dorfman disease is the most frequent variant of non-Langerhans cell histiocytosis. Local forms can be resected or irradiated. If the process involves multiple organs, systemic chemotherapy can cure some patients. This article includes literature review and a case report of a 34-year-old patient with multifocal, multisystemic form of Rosai–Dorfman disease with bone and pleural involvement. The diagnosis was based on histological, immunohistochemical, and molecular studies of tumor tissue. Since November 2021, 6 courses of chemotherapy with cladribine and 8 infusions of zolendronic acid were carried out with achievement of durable remission. The tolerance was acceptable.
罗赛-多夫曼病是非朗格汉斯细胞组织细胞增生症最常见的变种。局部病变可以切除或照射。如果病变累及多个器官,全身化疗可以治愈部分患者。本文包括文献综述和一例 34 岁患者的病例报告,该患者患有多灶、多系统形式的罗赛-多夫曼病,并累及骨骼和胸膜。诊断基于肿瘤组织的组织学、免疫组化和分子研究。自 2021 年 11 月以来,患者接受了 6 个疗程的克拉利宾化疗和 8 次唑仑膦酸输注,病情得到了持久缓解。耐受性良好。
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引用次数: 0
Complications of thrombopoietin receptor agonists therapy in patients with immune thrombocytopenia 免疫性血小板减少症患者接受促血小板生成素受体激动剂治疗的并发症
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-109-117
S. Zakharov, T. Mitina, A. V. Zakharova, O. P. Madzyara, I. N. Kontievskii, R. Vardanyan, E. Kataeva, Y. Chernykh, L. Vysotskaya, L. V. Ivanitskiy, Y. Chuksina, O. R. Zhuravlev, N. V. Gorgun, Z. M. Kharasova, E. Trifonova, K. Belousov, Z. Tekeeva
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction and decreased platelet production. The formation of antibodies to platelet and megakaryocyte glycoproteins plays a major role in the pathophysiology of ITP. All treatment strategies for ITP attempt to increase platelet count and reduce the risk of bleeding complications. Corticosteroids remain the most commonly used first-line therapy for ITP, but their long-term use is limited due to the development of severe complications. Today the new treatment methods including the use of thrombopoietin receptor agonists (TPO-RA) romiplostim, eltrombopag and avatrombopag with a number of advantages over standard therapy are of great interest. These drugs are recommended for use in the second-line therapy and show high efficacy in patients with ITP, particularly in real clinical practice. In most cases TPO-RA provide stable and long-term remission of the disease, allowing you to reduce or discontinue the use of glucocorticosteroids and avoid splenectomy. Many studies of the mechanism of action, efficacy and toxicity of TPO-RA have been performed. the research results significantly expand our knowledge about these agents. This review provides comparative data of the TPO-RA safety and the main aspects of their clinical use. The features of the new drug avatrombopag, recently approved for use in the Russian federation, are described. the overview presents the advantages and limitations of each drug, possible adverse events and methods for their control.
免疫性血小板减少症(ITP)是一种自身免疫性疾病,其特点是血小板破坏增加、生成减少。血小板和巨核细胞糖蛋白抗体的形成在 ITP 的病理生理学中起着重要作用。所有治疗 ITP 的策略都试图增加血小板数量并降低出血并发症的风险。皮质类固醇仍是治疗 ITP 最常用的一线疗法,但由于会出现严重并发症,其长期使用受到限制。如今,包括使用血小板生成素受体激动剂(TPO-RA)romiplostim、eltrombopag 和 avatrombopag 在内的新治疗方法与标准疗法相比具有诸多优势,因此备受关注。这些药物被推荐用于二线治疗,在 ITP 患者中显示出很高的疗效,尤其是在实际临床实践中。在大多数情况下,TPO-RA能使病情得到长期稳定的缓解,从而可以减少或停止使用糖皮质激素,避免脾切除术。对 TPO-RA 的作用机制、疗效和毒性已进行了许多研究,这些研究成果极大地扩展了我们对这些药物的认识。本综述提供了有关 TPO-RA 安全性及其临床应用主要方面的比较数据。综述介绍了每种药物的优势和局限性、可能出现的不良反应及其控制方法。
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引用次数: 0
Hereditary predisposition syndromes to myeloid neoplasms: diseases, genes and mechanisms of development 髓样肿瘤遗传易感综合征:疾病、基因和发病机制
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-88-100
M. Makarova, M. Nemtsova, D. A. Chekini, D. Chernevskiy, O. Sagaydak, E. Kosova, A. A. Krinitsyna, M. S. Belenikin, P. A. Zeynalova
With the development of modern next generation sequencing based DNA diagnostic methods, it has become possible to study hereditary predisposition to oncohematological diseases. Germline variants (mutations) of RUNX1, CEBPA, GATA2, ANKRD26, DDX41, FANC- (Fanconi anemia), etc. genes, associated with the development of hereditary hematological malignancies, have been identified. Timely diagnosis of such diseases will allow for medical genetic counseling and testing of the patient’s relatives to identify or exclude the risk of developing the disease, select a donor for the patient (it is undesirable to use a mutation carrier relative as a donor), and personalize the choice of chemotherapy regimens (for example, patients with Fanconi anemia may experience increased sensitivity to chemotherapy). The aim of this review is to present a modern view of the genetic predisposition to the development of hematological malignancies.
随着以新一代测序技术为基础的现代 DNA 诊断方法的发展,研究肿瘤性血液病的遗传易感性已成为可能。目前已发现 RUNX1、CEBPA、GATA2、ANKRD26、DDX41、FANC-(范可尼贫血症)等基因的种系变异(突变)与遗传性血液恶性肿瘤的发生有关。及时诊断出这类疾病,就可以为患者亲属提供医学遗传咨询和检测,以确定或排除患病风险,为患者选择供体(不宜使用突变携带者亲属作为供体),并个性化选择化疗方案(例如,范可尼贫血症患者对化疗的敏感性可能会增加)。本综述旨在介绍血液恶性肿瘤遗传易感性的现代观点。
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引用次数: 0
Significance of immunophenotypic, cytogenetic, and molecular markers in adult patients with T-cell lymphoblastic leukemia 成年 T 细胞淋巴细胞白血病患者的免疫表型、细胞遗传学和分子标记的意义
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-14-25
A. Vasileva, O. A. Aleshina, E. Kotova, B. Biderman, T. Obukhova, I. Galtseva, V. Dvirnyk, E. Zakharko, A. Sudarikov, E. N. Parovichnikova
Background. Current chemotherapy protocols for T-cell acute lymphoblastic leukemia (T-ALL) allow achieving a 5-year overall survival of 60–90 %, but relapsed and refractory forms remain incurable situations.Aim. To determine the significance of immunophenotypic, cytogenetic and molecular markers in adult T-ALL patients receiving therapy according to the ALL-2016 protocol.Materials and methods. From December 2016 to June 2022, 113 patients with primary T-ALL were included in the study. Cytogenetic study was performed in 104 (92 %) patients; anomalies in the IKZF1 and NOTCH1 genes were investigated in 43 (38 %) patients.Results. The worst prognosis was in patients with ETP and near-ETP variants of T-ALL (3-year disease-free survival was 54 % in ETP group, 33 % in near-ETP group vs TI/II – 79 %, TIII – 89 %, TIV – 75 %). In early T-ALL variants, abnormal karyotype was most common (ETP – 80.7 %, near-ETP – 60 %). Aberrations in NOTCH1 gene were found in 53 % of cases (in 23 out of 43 patients), and no mutations were found in IKZF1 gene in our study. In the group with no NOTCH1 abnormalities, the overall survival was significantly worse than in the group with abnormalities (NOTCH1– – 52 % vs NOTCH1+ –81 %; p = 0.05).
背景。目前针对T细胞急性淋巴细胞白血病(T-ALL)的化疗方案可使患者的5年总生存率达到60%至90%,但复发和难治性T-ALL仍然无法治愈。旨在确定根据ALL-2016方案接受治疗的成人T-ALL患者的免疫表型、细胞遗传学和分子标记物的重要性。从2016年12月至2022年6月,113名原发性T-ALL患者被纳入研究。对104例(92%)患者进行了细胞遗传学研究;对43例(38%)患者的IKZF1和NOTCH1基因异常进行了调查。ETP和近ETP变异型T-ALL患者的预后最差(ETP组3年无病生存率为54%,近ETP组为33%,TI/II组为79%,TIII组为89%,TIV组为75%)。在早期T-ALL变异中,核型异常最为常见(ETP-80.7%,近ETP-60%)。53%的病例(43例患者中有23例)发现NOTCH1基因畸变,在我们的研究中未发现IKZF1基因突变。在没有NOTCH1基因异常的组别中,总生存率明显低于有异常的组别(NOTCH1- 52% vs NOTCH1+ -81%;P = 0.05)。
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引用次数: 0
Genetic polymorphisms as predictors of methotrexate toxicity: literature review 预测甲氨蝶呤毒性的基因多态性:文献综述
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-26-33
G. A. Radzhabova, T. T. Valiev, Yu. E. Ryabukhina, M. I. Savelyeva, S. P. Abdullaev, O. D. Gurieva, P. A. Zeynalova
Background. A significant advancement in the treatment of high-grade aggressive non-Hodgkin’s lymphomas and acute lymphoblastic leukemia is the inclusion of high-dose (1000–5000 mg/m2) methotrexate in the treatment protocol. This approach has significantly increased the long-term survival rate, but it has been associated with toxicity, requiring supportive care. Factors that predict toxicity were identified, including genes involved in the metabolism (MTHFR) or transport (SLCO1B1) of methotrexate. The analysis of methotrexate metabolism has identified additional genes responsible for the elimination of this drug, allowing for more effective prevention and treatment of methotrexate-associated toxicity.Aim. To study the genetic polymorphisms of enzymes involved in the methotrexate metabolism and associated toxicity in the treatment of pediatric acute lymphoblastic leukemia and non-Hodgkin’s lymphomas.Materials and methods. Data were analyzed in specialized medical databases such as Pubmed, Scopus, Web of Science, Frontiers, and Google Scholar from 2001 to 2024.Results. The main predictors of high-dose methotrexate-associated toxicity are gene polymorphisms in MTHFR, SLCO1B1, ARID5B.Conclusion. Despite the contradictory data presented in the literature, it is important to consider the detection of polymorphisms during high-dose methotrexate treatment in order to administer timely supportive care and prevent significant toxicity.
背景。在治疗高级别侵袭性非霍奇金淋巴瘤和急性淋巴细胞白血病方面取得的一项重大进展是将大剂量(1000-5000 毫克/平方米)甲氨蝶呤纳入治疗方案。这种方法大大提高了长期存活率,但也存在毒性,需要支持性治疗。研究发现了预测毒性的因素,包括参与甲氨蝶呤代谢(MTHFR)或转运(SLCO1B1)的基因。对甲氨蝶呤代谢的分析发现了更多负责消除这种药物的基因,从而可以更有效地预防和治疗甲氨蝶呤相关毒性。研究在治疗小儿急性淋巴细胞白血病和非霍奇金淋巴瘤的过程中,参与甲氨蝶呤代谢和相关毒性的酶的基因多态性。对2001年至2024年期间Pubmed、Scopus、Web of Science、Frontiers和Google Scholar等专业医学数据库中的数据进行了分析。大剂量甲氨蝶呤相关毒性的主要预测因素是MTHFR、SLCO1B1和ARID5B的基因多态性。尽管文献中提供的数据相互矛盾,但在大剂量甲氨蝶呤治疗期间考虑检测多态性以及时采取支持性治疗并预防重大毒性是非常重要的。
{"title":"Genetic polymorphisms as predictors of methotrexate toxicity: literature review","authors":"G. A. Radzhabova, T. T. Valiev, Yu. E. Ryabukhina, M. I. Savelyeva, S. P. Abdullaev, O. D. Gurieva, P. A. Zeynalova","doi":"10.17650/1818-8346-2024-19-2-26-33","DOIUrl":"https://doi.org/10.17650/1818-8346-2024-19-2-26-33","url":null,"abstract":"Background. A significant advancement in the treatment of high-grade aggressive non-Hodgkin’s lymphomas and acute lymphoblastic leukemia is the inclusion of high-dose (1000–5000 mg/m2) methotrexate in the treatment protocol. This approach has significantly increased the long-term survival rate, but it has been associated with toxicity, requiring supportive care. Factors that predict toxicity were identified, including genes involved in the metabolism (MTHFR) or transport (SLCO1B1) of methotrexate. The analysis of methotrexate metabolism has identified additional genes responsible for the elimination of this drug, allowing for more effective prevention and treatment of methotrexate-associated toxicity.Aim. To study the genetic polymorphisms of enzymes involved in the methotrexate metabolism and associated toxicity in the treatment of pediatric acute lymphoblastic leukemia and non-Hodgkin’s lymphomas.Materials and methods. Data were analyzed in specialized medical databases such as Pubmed, Scopus, Web of Science, Frontiers, and Google Scholar from 2001 to 2024.Results. The main predictors of high-dose methotrexate-associated toxicity are gene polymorphisms in MTHFR, SLCO1B1, ARID5B.Conclusion. Despite the contradictory data presented in the literature, it is important to consider the detection of polymorphisms during high-dose methotrexate treatment in order to administer timely supportive care and prevent significant toxicity.","PeriodicalId":518071,"journal":{"name":"Oncohematology","volume":"16 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Persistence of a new coronavirus infection in a patient with primary central nervous system large B-cell lymphoma with assessment of the humoral immune response against SARS-CoV-2 评估原发性中枢神经系统大 B 细胞淋巴瘤患者对 SARS-CoV-2 的体液免疫反应,发现新冠状病毒感染持续存在
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-101-108
Y. Y. Polyakov, E. Baryakh, E. Misyurina, E. Zhelnova, M. A. Mingalimov, S. A. Kardovskaya, M. Y. Smolyarchuk, T. Tolstykh, T. S. Chudnova, D. D. Ivanova, O. Kochneva, D. V. Lebedev, A. U. Abueva, A. M. Chistov, E. Zotina, I. Samsonova, M. A. Lysenko
Treatment of immunocompromised patients with novel coronavirus infection (COVID-19) presents significant challenges. Currently, there are no unified approaches to the treatment of persistent COVID-19 in hematological malignancies. There is a need to develop recommendations for the management of such patients, chemotherapy protocols, as well as therapy for COVID-19 in case of SARS-CoV-2 virus persistence. Doctors are faced with cases of virus persistence, clinical manifestations during a long course of the infectious process and are not provided with methodological recommendations for patient supervision. As scientific data on the persistent COVID-19 course in patients with lymphoproliferative diseases accumulates, it is planned to create recommendations for the treatment of COVID-19 for patients in this group. This article describes a clinical case of persistent COVID-19 course in a comorbid patient with primary central nervous system large B-cell lymphoma during chemotherapy.
治疗感染新型冠状病毒(COVID-19)的免疫功能低下患者是一项重大挑战。目前,治疗血液恶性肿瘤中持续存在的 COVID-19 还没有统一的方法。有必要为这类患者的管理、化疗方案以及在 SARS-CoV-2 病毒持续存在的情况下治疗 COVID-19 提出建议。医生们面临着病毒持续存在的病例,在漫长的感染过程中出现临床表现,但却没有为病人的监护提供方法建议。随着淋巴组织增生性疾病患者 COVID-19 持续病程的科学数据不断积累,我们计划为这类患者制定治疗 COVID-19 的建议。本文描述了一例合并原发性中枢神经系统大 B 细胞淋巴瘤的患者在化疗期间出现 COVID-19 持续病程的临床病例。
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引用次数: 0
Pathogenesis and therapy of anemia in patients with inflammatory bowel diseases 炎症性肠病患者贫血的发病机制和治疗方法
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-132-140
O. Rybina, V. Sakhin, A. V. Gubkin, O. Rukavitsyn
Background. Anemia represents one of the most frequent complications in inflammatory bowel disease and severely impairs the quality of life of affected patients. The etiology of anemia in inflammatory bowel disease patients can be multifactorial, often involving a combination of iron deficiency anemia and anemia of chronic disease. The choice of therapy, focused on the leading cause of anemia, allows for individualized therapy, minimizing the risk of side effects and the cost of therapy.Aim. A comparative analysis of blood parameters before and after treatment was performed.Materials and methods. For 5 years, 47 patients (15 women, 32 men) with inflammatory bowel disease with a median age of 48 years (from 28 to 65 years) were studied. Two groups were formed: patients with iron deficiency anemia and patients with anemia of chronic disease. Patients with combination of iron deficiency anemia and anemia of chronic disease D (n = 21) were not included. A division was also made according to the type of treatment performed.Results. In the iron deficiency anemia group, a statistically significant increase in hemoglobin level was revealed as a result of the use of intravenous iron. During therapy with oral iron and B vitamin therapy, as well as therapy aimed only at correcting gastrointestinal tract pathology, no reliable dynamics of the studied parameters was observed. In the anemia of chronic disease group, there were no significant changes in red blood cell parameters with any of the treatment options (p >0.05).Conclusion. The effectiveness of various therapeutic approaches to correct anemia is controversial. Further follow-up and an increase in the sample size are needed, which will help individualize therapy and improve the patients’ quality of life.
背景:贫血是炎症性肠病最常见的并发症之一,严重影响患者的生活质量。贫血是炎症性肠病最常见的并发症之一,严重影响患者的生活质量。炎症性肠病患者贫血的病因可能是多因素的,通常涉及缺铁性贫血和慢性病性贫血。针对贫血的主要病因选择治疗方法,可实现个体化治疗,最大限度地降低副作用风险和治疗成本。对治疗前后的血液参数进行对比分析。研究人员对 47 名炎症性肠病患者(15 名女性,32 名男性)进行了为期 5 年的研究,他们的中位年龄为 48 岁(从 28 岁到 65 岁不等)。研究分为两组:缺铁性贫血患者和慢性病贫血患者。缺铁性贫血和慢性病 D 型贫血合并患者(21 人)不包括在内。此外,还根据治疗方式进行了划分。在缺铁性贫血组中,由于使用了静脉注射铁剂,血红蛋白水平有了统计学意义上的显著提高。在使用口服铁剂和 B 族维生素疗法以及仅以纠正胃肠道病理为目的的疗法期间,未观察到所研究参数的可靠动态变化。在慢性病贫血组中,任何一种治疗方案都不会使红细胞参数发生显著变化(P>0.05)。各种治疗方法对纠正贫血的效果存在争议。需要进一步随访和增加样本量,这将有助于个体化治疗和改善患者的生活质量。
{"title":"Pathogenesis and therapy of anemia in patients with inflammatory bowel diseases","authors":"O. Rybina, V. Sakhin, A. V. Gubkin, O. Rukavitsyn","doi":"10.17650/1818-8346-2024-19-2-132-140","DOIUrl":"https://doi.org/10.17650/1818-8346-2024-19-2-132-140","url":null,"abstract":"Background. Anemia represents one of the most frequent complications in inflammatory bowel disease and severely impairs the quality of life of affected patients. The etiology of anemia in inflammatory bowel disease patients can be multifactorial, often involving a combination of iron deficiency anemia and anemia of chronic disease. The choice of therapy, focused on the leading cause of anemia, allows for individualized therapy, minimizing the risk of side effects and the cost of therapy.Aim. A comparative analysis of blood parameters before and after treatment was performed.Materials and methods. For 5 years, 47 patients (15 women, 32 men) with inflammatory bowel disease with a median age of 48 years (from 28 to 65 years) were studied. Two groups were formed: patients with iron deficiency anemia and patients with anemia of chronic disease. Patients with combination of iron deficiency anemia and anemia of chronic disease D (n = 21) were not included. A division was also made according to the type of treatment performed.Results. In the iron deficiency anemia group, a statistically significant increase in hemoglobin level was revealed as a result of the use of intravenous iron. During therapy with oral iron and B vitamin therapy, as well as therapy aimed only at correcting gastrointestinal tract pathology, no reliable dynamics of the studied parameters was observed. In the anemia of chronic disease group, there were no significant changes in red blood cell parameters with any of the treatment options (p >0.05).Conclusion. The effectiveness of various therapeutic approaches to correct anemia is controversial. Further follow-up and an increase in the sample size are needed, which will help individualize therapy and improve the patients’ quality of life.","PeriodicalId":518071,"journal":{"name":"Oncohematology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nijmegen syndrome in childhood: a clinical case 儿童奈梅亨综合征:一个临床病例
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-83-87
N. Malyuzhinskaya, M. A. Morgunova, I. V. Petrova, O. V. Polyakova, V. V. Samokhvalova, A. V. Bayurov, G. Klitochenko
Nijmegen syndrome is a rare monogenic pathology with an autosomal recessive type of inheritance. The disease is manifested by congenital developmental anomalies and microcephaly, primary immunodeficiency, frequent recurrent viral and bacterial infections, retardation in physical and neuropsychic development. In the medical literature, 150 cases of the syndrome are described; pathology occurs more often among the Slavic population. Nijmegen syndrome belongs to a group of diseases with chromosomal instability. The pathogenetic feature of the syndrome is congenital immunodeficiency of the humoral (B-lymphocytes) and cellular (T-lymphocytes) components. According to statistics, 40 % of children with Nijmegen syndrome are diagnosed with malignant neoplasms. lymphoid tissue is more often affected (non-Hodgkin’s B and T-cell lymphomas, acute lymphoblastic leukemia), and the development of solid neoplasia is also possible. To diagnose Nijmegen syndrome, in addition to assessing the patient clinical status, it is necessary to conduct an extended immunological examination with the determination of immunoglobulins A, M, G and molecular genetic studies.The article presents a clinical case of diagnosis and treatment of Nijmegen syndrome in childhood.
奈梅亨综合征是一种罕见的单基因病,为常染色体隐性遗传。该病表现为先天性发育异常和小头畸形、原发性免疫缺陷、频繁的反复病毒和细菌感染、身体和神经心理发育迟缓。医学文献中描述了 150 例该综合征病例;病理变化多发生在斯拉夫人口中。奈梅亨综合征属于染色体不稳定疾病。该综合征的发病特点是体液(B 淋巴细胞)和细胞(T 淋巴细胞)先天性免疫缺陷。据统计,40% 的奈梅亨综合征患儿被诊断出患有恶性肿瘤。淋巴组织更常受到影响(非霍奇金 B 细胞和 T 细胞淋巴瘤、急性淋巴细胞白血病),也有可能发展为实体瘤。要诊断奈梅亨综合征,除了评估患者的临床状况外,还必须进行免疫学检查,测定免疫球蛋白 A、M、G 和分子遗传学研究。
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Oncohematology
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