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Important aspects of carbohydrate metabolism disorders development in hematology/oncology patients during therapy with glucocorticosteroids: a review of the literature 糖皮质激素治疗期间血液学/肿瘤学患者碳水化合物代谢紊乱发展的重要方面:文献综述
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-118-131
N. T. Vatutin, E. Sklyannaya, V. V. Gribov
Glucocorticosteroids are highly effective anti-inflammatory and immunosuppressive agents. The drugs were introduced into therapeutic practice from the mid-20th century and are still widely used in the treatment of various diseases. They are an integral part of the treatment of patients with hematological malignancies. One of the clinically significant complications of glucocorticosteroid therapy is steroid-induced carbohydrate metabolism disorders. Diabetes mellitus is one of the main risk factors for the development of cardiovascular diseases, which are the main non-oncological cause of death in the population and a significant treatment complication in patients with malignant neoplasms. Early detection of the disease and improved treatment efficiency increase the survival rate of patients with various types of neoplasms. It is also important to pay attention to quality of life improving in cancer patients after treatment.The aim of this review is to analyze the pathogenesis features, as well as predictors of early detection and prevention of possible complications of persistent hyperglycemia in patients with hematological malignancies.
糖皮质激素是一种高效的抗炎和免疫抑制剂。这种药物从 20 世纪中期引入治疗实践,至今仍被广泛用于各种疾病的治疗。它们是血液恶性肿瘤患者治疗中不可或缺的一部分。糖皮质激素治疗的临床重要并发症之一是类固醇引起的碳水化合物代谢紊乱。糖尿病是心血管疾病发病的主要危险因素之一,而心血管疾病是导致人口死亡的主要非肿瘤性原因,也是恶性肿瘤患者治疗过程中的一个重要并发症。及早发现疾病和提高治疗效率可以提高各类肿瘤患者的生存率。本综述旨在分析血液恶性肿瘤患者持续性高血糖的发病特点以及早期发现和预防可能并发症的预测因素。
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引用次数: 0
Sinonasal diffuse large B-cell lymphoma: own clinical observation and literature review 鼻窦弥漫性大 B 细胞淋巴瘤:临床观察和文献综述
Pub Date : 2024-04-02 DOI: 10.17650/1818-8346-2024-19-2-75-82
M. A. Mingalimov, E. Baryakh, O. Kochneva, E. Misyurina, Y. Y. Polyakov, E. Zhelnova, K. Yatskov, A. B. Makeshova, T. Tolstykh, T. S. Chudnova, D. D. Ivanova, D. V. Lebedev, E. Zotina, D. Gagloeva, M. Beregov, E. A. Mamatturdiev, I. Samsonova, M. A. Lysenko
Diffuse large B-cell lymphoma is the most common immunomorphological variant of lymphoma in adults. Extranodal lesions are observed in a third of patients at the disease onset. The organs most often involved are the gastrointestinal tract, testicles, bones, thyroid gland, and skin. Primary involvement of the nasal cavity and paranasal sinuses occur extremely rarely and cause diagnostic and therapeutic difficulties.The article demonstrates a rare clinical case of newly diagnosed diffuse large B-cell lymphoma with sinonasal tract involvement. It took 6 months to verify the final diagnosis. At the moment, the induction stage of treatment for diffuse large B-cell lymphoma continues, the achieved complete metabolic response is maintained.
弥漫大B细胞淋巴瘤是成人淋巴瘤中最常见的免疫形态学变异。三分之一的患者在发病时会出现结节外病变。最常受累的器官是胃肠道、睾丸、骨骼、甲状腺和皮肤。鼻腔和鼻窦原发受累的情况极为罕见,给诊断和治疗带来困难。本文展示了一例新诊断的弥漫大B细胞淋巴瘤鼻窦受累的罕见临床病例。该病例历时 6 个月才最终确诊。目前,弥漫大B细胞淋巴瘤的诱导治疗阶段仍在继续,已取得的完全代谢反应得以维持。
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引用次数: 0
Expert recommendations for pancreatitis/pancreatic necrosis treatment after L-asparaginase in children with acute lymphoblastic leukemia 急性淋巴细胞白血病患儿使用 L-天冬酰胺酶治疗胰腺炎/胰腺坏死的专家建议
Pub Date : 2024-04-01 DOI: 10.17650/1818-8346-2024-19-2-141-146
T. T. Valiev, E. Kumirova, V. Rozinov, T. R. Panferova, I. Khvorostov, K. L. Kondratchik, O. Y. Fuks, P. A. Kerimov, N. Matinyan, A. N. Belyaeva, A. Efremenkov, A. A. Bystrova, A. P. Kurkin, V. V. Gorev
L-asparaginase is one of the most effective drugs in pediatric and adult acute lymphoblastic leukemia treatment. But drug side effects are an important problem. pancreatitis and pancreatic necrosis are not common (2–18 %) complication, but high chance of severe disease with fatal outcome make to bring in careful attention of pediatric oncologists-hematologists, surgeons, intensivists, radiologists. Recognizing multidisciplinary importance of this problem, at June 21st, 2023 at Morozov Children’s Clinical hospital a Round table on pancreatitis/pancreatic necrosis after L-asparaginase use was organized. This article presents expert recommendations from federal and regional clinics in diagnosis and treatment of such severe complication.
L-天冬酰胺酶是治疗儿童和成人急性淋巴细胞白血病最有效的药物之一。胰腺炎和胰腺坏死并不是常见的并发症(2%-18%),但严重疾病导致致命后果的几率很高,因此需要儿科肿瘤专家--血液科专家、外科医生、重症监护专家和放射科专家的密切关注。认识到这一问题的多学科重要性,2023 年 6 月 21 日在莫罗佐夫儿童临床医院组织了一次关于使用 L-天冬酰胺酶后胰腺炎/胰腺坏死的圆桌会议。本文介绍了联邦和地区诊所在诊断和治疗此类严重并发症方面的专家建议。
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引用次数: 0
Resolution on the results of the regional conference “Modern view of the multiple myeloma patient treatment in real clinical practice”. February 21, 2024, Irkutsk 关于 "临床实践中多发性骨髓瘤患者治疗的现代观点 "地区会议成果的决议。2024年2月21日,伊尔库茨克
Pub Date : 2024-04-01 DOI: 10.17650/1818-8346-2024-19-2-147-148
A. Editorial
Во время региональной конференции «Современный взгляд на терапию пациента с множественной миеломой в реальной клинической практике» была затронута важная тема, посвященная болевому синдрому. С докладами о проблемах болевого синдрома выступили Али Мурадович Мудунов, Максим Бокманович Пак и Вадим Евгеньевич Груздев.
在题为 "多发性骨髓瘤患者在实际临床实践中的现代治疗观点 "的地区会议上,讨论了有关疼痛综合症的重要话题。阿里-穆拉多维奇-穆杜诺夫(Ali Muradovich Mudunov)、马克西姆-博克马诺维奇-帕克(Maxim Bokmanovich Pak)和瓦迪姆-叶夫根尼耶维奇-格鲁兹德夫(Vadim Evgenievich Gruzdev)就疼痛综合征问题作了发言。
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引用次数: 0
VEGFA, VEGFR1, VEGFR2 serum and cerebrospinal fluid concentration in patients with acute leukemia 急性白血病患者血清和脑脊液中的 VEGFA、VEGFR1 和 VEGFR2 浓度
Pub Date : 2024-04-01 DOI: 10.17650/1818-8346-2024-19-2-34-45
E. Zakharko, V. Dvirnyk, Yuliya Chabaeva, D. Drokova, E. B. Rybkina, K. A. Lavrishinets, A. V. Bulgakov, M. N. Panasenko, Z. Fidarova, I. A. Lukianova, O. A. Aleshina, S. M. Kulikov, T. Gaponova, V. Troitskaya, E. N. Parovichnikova
Background. Vascular endothelial growth factor A (VEGFA) is one of the most important factors for regulation of hematopoietic stem cells differentiation. It is involved in leukemogenesis and central nervous system (CNS) damage in acute leukemia. According to the literature, the VEGFA production by blast cells is increased, but the values of serum concentration and the associations with CNS involvement are contradictory.Aim. evaluate the VEGFA, VEGFR1, VEGFR2 concentration in serum and cerebrospinal fluid of patient with different types of acute leukemia in disease onset and during treatment.Materials and methods. The concentration of VEGFA in serum and cerebrospinal fluid was studied in 74 primary patients with acute leukemia. The comparison group consisted of 67 healthy donors. VEGFR1, VEGFR2 were studied in serum and cerebrospinal fluid in 34 patients at the onset of the disease. The comparison group consisted of 10 healthy donors. For the analysis, an enzyme immunoassay was used on a semi-automatic Personal Lab analyzer (Adaltis) and Affymetrix eBioscience human VEGF-A Platinum ELISA reagents.Results. Serum VEGFA concentration was statistically significantly lower in acute leukemia patients than that of donors (median 149.78 and 432.19 pg/ml respectively; p <0.0001). Factor deficiency was significantly more pronounced in patients with blastemia (p <0.015). During antitumor therapy, there was a tendency to increase the amount of the factor in the blood serum. Serum concentration of soluble VEGFR2 was also lower in patients than that of donors (6949.9 and 8795.9 pg/ml respectively; p = 0.0026). For concentration of VEGFR1 such deviations were not found. The concentrations of VEGFR1 and VEGFR2 in serum were higher than in cerebrospinal fluid (p <0.0001), while VEGFR1 showed a positive correlation between serum and cerebrospinal fluid concentrations. the concentration of VEGFR1 in the cerebrospinal fluid was significantly lower in patients with B-lymphoblastic leukemia/lymphoma compared to other types of leukemia.Conclusion. the concentration of VEGFA in serum decreases in patients with blastemia, this may indicate a lack of secretion and excessive consumption of the factor by blast cells with a decrease in the proportion of leukocytes that normally secrete the factor. In the cerebrospinal fluid, the concentrations of VEGFR1 and VEGFR2 are lower than in serum, with the lowest values being found in patients with B-lymphoblastic leukemia/lymphoma, but no relationship with the development of CNS involvement was found.
背景。血管内皮生长因子 A(VEGFA)是调节造血干细胞分化的最重要因子之一。它参与急性白血病的白细胞生成和中枢神经系统(CNS)损伤。目的:评估不同类型急性白血病患者在发病和治疗期间血清和脑脊液中 VEGFA、VEGFR1、VEGFR2 的浓度。研究了 74 名原发性急性白血病患者血清和脑脊液中 VEGFA 的浓度。对比组包括 67 名健康供体。研究了 34 名患者发病时血清和脑脊液中的 VEGFR1 和 VEGFR2。对比组包括 10 名健康供体。分析使用了半自动个人实验室分析仪(Adaltis)和 Affymetrix eBioscience 人类 VEGF-A Platinum ELISA 试剂。急性白血病患者的血清 VEGFA 浓度明显低于供体(中位数分别为 149.78 和 432.19 pg/ml;P <0.0001)。因子缺乏在爆裂性白血病患者中更为明显(P <0.015)。在抗肿瘤治疗期间,血清中的因子量有增加的趋势。患者血清中可溶性血管内皮生长因子受体 2 的浓度也低于供体(分别为 6949.9 和 8795.9 pg/ml;p = 0.0026)。而 VEGFR1 的浓度则没有发现这种偏差。血清中 VEGFR1 和 VEGFR2 的浓度高于脑脊液中的浓度(p <0.0001),而血清和脑脊液中 VEGFR1 的浓度呈正相关。结论:白血病患者血清中的 VEGFA 浓度下降,这可能表明白血病细胞缺乏分泌和过度消耗该因子,正常分泌该因子的白细胞比例下降。脑脊液中 VEGFR1 和 VEGFR2 的浓度低于血清中的浓度,其中 B 淋巴细胞白血病/淋巴瘤患者的浓度最低,但未发现与中枢神经系统受累的关系。
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引用次数: 0
Successful treatment of pancreatitis caused by L-asparaginase in clinical practice 在临床实践中成功治疗 L-天冬酰胺酶引起的胰腺炎
Pub Date : 2024-01-27 DOI: 10.17650/1818-8346-2024-19-1-113-124
Y. S. Korkina, M. Shervashidze, T. T. Valiev, N. Batmanova, T. R. Panferova
Treatment intensification of acute lymphoblastic leukemia in children with L-asparaginase (L-ASP) improves therapy effectiveness and shows high survival rates. The unique biological properties of this enzyme make it possible to suppress tumor blasts proliferation by reducing blood asparagine concentration. L-ASP use is limited by toxicity and hypersensitivity reactions observed in 75 % of cases. Although most complications during L-ASP therapy are mild/moderate and are manageable with adequate accompanying therapy, the development of severe side effects leads to forced withdrawal of L-ASP, which significantly reduces the likelihood of a favorable outcome in children with acute lymphoblastic leukemia. One of the most severe toxicity manifestations is the development of asparaginase-associated pancreatitis. It worsens the prognosis and may cause patients’ death. This article presents both current data about asparaginase-associated pancreatitis and treatment experience of this complication at the Research Institute of Pediatric Oncology and Hematology of the N. N. Blokhin National Research Center of Oncology.
使用 L-天冬酰胺酶(L-ASP)强化治疗儿童急性淋巴细胞白血病可提高疗效,并显示出较高的存活率。这种酶具有独特的生物特性,可以通过降低血液中天冬酰胺的浓度来抑制肿瘤细胞的增殖。L-ASP 的使用受到毒性的限制,75% 的病例会出现超敏反应。虽然 L-ASP 治疗期间的大多数并发症都是轻度/中度的,并可通过适当的辅助治疗加以控制,但严重副作用的出现会导致被迫停用 L-ASP,这大大降低了急性淋巴细胞白血病患儿获得良好治疗结果的可能性。天冬酰胺酶相关性胰腺炎是最严重的毒性表现之一。它使预后恶化,并可能导致患者死亡。本文介绍了天冬酰胺酶相关性胰腺炎的最新数据,以及 N. N. Blokhin 国家肿瘤研究中心儿科肿瘤与血液学研究所对这种并发症的治疗经验。Blokhin 国家肿瘤学研究中心儿科肿瘤学和血液学研究所的治疗经验。
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引用次数: 0
Monoclonal immunoglobulin as a prognostic factor for the severity of bone damage in paraproteinemic hemoblastoses and Waldenström’s macroglobulinemia 单克隆免疫球蛋白作为副蛋白血母细胞增多症和瓦尔登斯特伦巨球蛋白血症骨损伤严重程度的预后因素
Pub Date : 2024-01-26 DOI: 10.17650/1818-8346-2024-19-1-56-69
O. Pisarevskaya, S. A. Alekseev, O. Rukavitsyn
Aim. Identify risk factors for the development of osteodestructive syndrome. To determine the relationship between the types of secreted monoclonal immunoglobulin (paraprotein) and the severity of osteodestructive syndrome in patients with paraproteinemic hemoblastoses (PH) and Waldenström’s macroglobulinemia (WM).Materials and methods. A retrospective analysis of data from 116 patients with PH and WM was performed. 104 patients (89.6 %) were diagnosed with multiple myeloma. Less commonly observed were WM (in 8 patients – 6.9 %), plasma cell leukemia (in 2 patients – 1.8 %), solitary plasmacytoma and monoclonal gammopathy of unknown significance were diagnosed in one case (0.9 %) each. According to the severity of osteodestructive syndrome, all patients were divided into 4 groups. The first group (0) included patients who did not have osteodestructive changes in the bones. In patients of the second group, a mild degree (I) osteodestructive process was observed, and in patients from the third and fourth groups – moderate (II) and severe (III) degrees, respectively. All patients underwent protein electrophoresis followed by immunofixation to determine the type of paraprotein and its concentration in serum and urine.Results. In the majority of patients, paraproteins were detected in the blood – Gκ (35.1 %), Gλ (24.6 %), Bence Jones protein λ-type (BJλ) (14.9 %); in urine – BJλ protein (14.9 %) and Bence Jones protein κ-type (BJκ) (28.1 %). Secretion of other types of paraproteins in the blood was less frequently detected – Aκ (9.6 %), Aλ (7.0 %), Mκ (3.5 %), Mλ (3.5 %), Dλ (2.6 %), BJκ (4.4 %). Osteodestructive syndrome of I and II severity was diagnosed in 43 (37.1 %) and 40 (34.5 %) patients, respectively; lytic destruction of III degree was less frequently detected in 20 (17.2 %) patients, in 13 (11.2 %) patients osteodestruction was not detected (degree 0). It was noted that a higher degree of destruction (II, III) was observed in patients with multiple myeloma occurring with paraproteinemia Dλ and BJλ in the blood, as well as hypercalcemia. Osteodestructive syndrome of the lowest degree (0, I) was diagnosed in patients with the secretion of monoclonal proteins Ak and Mλ. There was no statistically significant relationship between the type of secretion of paraproteins Gκ, Gλ, Aλ, Mκ, BJκ in the blood, as well as proteins BJκ and BJλ in the urine and the severity of the osteodestructive process.Conclusion. The results obtained in the study make it possible to identify risk groups, and parameters such as the type of paraprotein, the concentration of calcium in the blood serum can be considered as prognostic factors when assessing the severity of osteodestructive syndrome in patients with PH and WM.
目的确定发生骨破坏综合征的危险因素。确定副蛋白血母细胞增多症(PH)和瓦尔登斯特伦巨球蛋白血症(WM)患者分泌的单克隆免疫球蛋白(副蛋白)类型与骨破坏综合征严重程度之间的关系。对 116 名 PH 和 WM 患者的数据进行了回顾性分析。104名患者(89.6%)被诊断为多发性骨髓瘤。较少见的是WM(8例患者,占6.9%)、浆细胞白血病(2例患者,占1.8%)、单浆细胞瘤和意义不明的单克隆丙种球蛋白病各1例(占0.9%)。根据骨破坏综合征的严重程度,所有患者被分为 4 组。第一组(0)包括骨骼没有发生骨质破坏性改变的患者。第二组患者的骨破坏过程为轻度(I),第三组和第四组患者的骨破坏过程分别为中度(II)和重度(III)。所有患者均接受了蛋白质电泳和免疫固定检查,以确定副蛋白质的类型及其在血清和尿液中的浓度。大多数患者的血液中检测到副蛋白--Gκ(35.1%)、Gλ(24.6%)、本斯-琼斯蛋白λ型(BJλ)(14.9%);尿液中检测到副蛋白--BJλ蛋白(14.9%)和本斯-琼斯蛋白κ型(BJκ)(28.1%)。血液中其他类型副蛋白的分泌较少:Aκ(9.6 %)、Aλ(7.0 %)、Mκ(3.5 %)、Mλ(3.5 %)、Dλ(2.6 %)、BJκ(4.4 %)。43(37.1%)和 40(34.5%)名患者被诊断为 I 级和 II 级严重骨质破坏综合征;20(17.2%)名患者被诊断为 III 级溶解性破坏,13(11.2%)名患者未被诊断为骨质破坏(0 级)。值得注意的是,多发性骨髓瘤患者血液中出现副蛋白血症 Dλ 和 BJλ 以及高钙血症时,骨质破坏程度(II、III 度)较高。分泌单克隆蛋白 Ak 和 Mλ 的患者被诊断为最低程度(0,I)的骨质破坏综合征。血液中副蛋白Gκ、Gλ、Aλ、Mκ、BJκ以及尿液中蛋白质BJκ和BJλ的分泌类型与骨质破坏过程的严重程度之间没有统计学意义上的显著关系。研究结果有助于确定危险人群,在评估 PH 和 WM 患者骨破坏综合征的严重程度时,可将副蛋白类型、血清钙浓度等参数视为预后因素。
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引用次数: 0
The experience of relapsed Burkitt lymphoma treatment with targeted drugs and autologous/allogeneic stem cell transplantation 使用靶向药物和自体/异体干细胞移植治疗复发伯基特淋巴瘤的经验
Pub Date : 2024-01-25 DOI: 10.17650/1818-8346-2024-19-1-40-50
T. T. Valiev, A. A. Khachatryan, S. V. Goryacheva, N. Batmanova, K. Kirgizov, S. Varfolomeeva
The use of high-effective, multicomponent, risk-adopted chemoimmunotherapy schemes in children with Burkitt lymphoma reached advanced long-term progression-free survival over 90 % even for high risk patients. Unfortunately, conventional therapeutic strategy for relapsed/refractory disease is not accepted, and the effectiveness of carboplat‑in- and gemcitabine-containing regimens is unsatisfactory. Clinical experience of rituximab, ibrutinib and nivolumab in combination with polychemotherapy and own clinical case of successful relapsed Burkitt lymphoma treatment with targeted therapy and following autologous and allogeneic hematopoietic stem cell transplantation are presented. Proposed program could achieve a complete remission of Burkitt lymphoma, but short-term after allogeneic hematopoietic stem cell transplantation diagnosed T-cell precursor acute lymphoblastic leukemia became fatal for the patient.
在儿童伯基特淋巴瘤患者中采用高效、多组分、风险适应性化疗免疫疗法方案后,即使是高危患者的长期无进展生存率也超过了90%。遗憾的是,复发/难治性疾病的传统治疗策略并不被接受,含卡铂和吉西他滨方案的疗效并不令人满意。本文介绍了利妥昔单抗、伊布替尼和尼沃单抗联合多化疗的临床经验,以及用靶向疗法和自体及异体造血干细胞移植成功治疗复发伯基特淋巴瘤的临床病例。所提出的方案可使伯基特淋巴瘤完全缓解,但在异基因造血干细胞移植后短期内,诊断出的T细胞前体急性淋巴细胞白血病对患者来说却成为致命的疾病。
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引用次数: 0
Review of the Expert Council “Multiple myeloma: the era of monoclonal antibodies in the treatment of patients with multiple myeloma” 专家委员会 "多发性骨髓瘤:治疗多发性骨髓瘤患者的单克隆抗体时代 "综述
Pub Date : 2024-01-25 DOI: 10.17650/1818-8346-2024-19-1-14-20
M. I. Akhmedov, P. A. Zeynalova
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{"title":"Review of the Expert Council “Multiple myeloma: the era of monoclonal antibodies in the treatment of patients with multiple myeloma”","authors":"M. I. Akhmedov, P. A. Zeynalova","doi":"10.17650/1818-8346-2024-19-1-14-20","DOIUrl":"https://doi.org/10.17650/1818-8346-2024-19-1-14-20","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":518071,"journal":{"name":"Oncohematology","volume":"49 5-6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140530724","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
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Oncohematology
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