Short- and long-term outcomes from the upfront high-dose chemotherapy, followed by autologous hematopoietic stem cell transplantation in diffuse large B-cell lymphoma

Introduction. Diffuse large B-cell lymphoma (DLBCL) is the most common (30-35%) type of B-cell lymphomas. Only about 60% of all newly diagnosed advanced-stage DLBCL can be completely treated by x6 CHOP-R only. High dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation in the first remission (upfront auto-HSCT) can serve an option to improve prognosis in these patients (pts).Aim. To improve prognosis in DLBCL IV stage, IPI ≥2 pts by upfront auto-HSCT.Materials and methods. Included 105 pts: DLBCL NOS, age 18-65, stage IV, IPI ≥2, CR/PR after x6 CHOP/EPOCH + R from 2010 to 2019 at NMRC of Oncology named after N.N. Petrov of MoH of Russia were retrospectively analyzed. HSCT group includes pts with upfront HDCT followed by auto-HSCT (n = 35). The control group includes pts with non-invasive follow-up after induction only (n = 70). Primary endpoints were overall (OS) and progression-free survival (PFS). Secondary endpoints were response rate, relapse rate and treatment toxicity.Results and discussion. The 3-yr OS (p = 0.01) and 3-yr PFS (p = 0.018) were significantly higher in HSCT group. The complete response rate was significantly increased after upfront auto-HSCT (p < 0.001). Early relapse served as an independent negative prognostic factor in OS (p < 0.001) and experienced statistically less in HDCT group (p = 0.027). Early (ER) and late relapse (LR) rate were higher in pts with DEL (ER - p < 0.001, LR - p < 0.001 in control group and ER - p < 0.001, LR -p = 0.013 in all pts). The overall relapse rate was higher if pts had >1 extranodal site with lung involvement (p < 0.004 in the control group and p = 0.021 in all pts). Prognostic models suggested DEL and presence of >1 extranodal site with lung involvement as an independent negative prognostic factors for increasing the relapse probability in two years after treatment.Conclusion. Upfront HSCT can serve as a clinical option to consolidate the first remission in IV stage DLBCL pts with DEL and/or >1 extranodal sites with lung involvement

ЛУЧЕВАЯ ДИАГНОСТИКА ИНФЕКЦИОННЫХ ПОРАЖЕНИЙ ЛЕГКИХ У ПАЦИЕНТОВ С ОНКОГЕМАТОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

Radiological imaging is the main diagnostic technique of infectious pulmonary complications in patients with hematological malignancy. Disturbance of the immune system in this group of patients causes uncommon epidemiology, nonspecific clinical manifestation and rapidly progressive development of the infectious process. Modern diagnostic methods allow to reveal inflammatory changes in the lungs with high efficiency. In the current clinical practice, the most actual problem is rapid identification of pathogens using the wide-spread method. This possibility results in faster and more accurate patient treatment. The article reviews different imaging techniques and focuses on the preferable method for diagnosing pneumonia in immunocompromised patients and presents a recent view of russian and foreign researchers on the advantages and limitations of computed tomography in the differential diagnosis of lower respiratory tract infections.Лучевые методы визуализации являются основными инструментами в диагностике инфекционных поражений легких, которые часто развиваются у  онкогематологических пациентов и  ассоциированы с  высокой летальностью. Глубокое нарушение иммунного ответа у данной группы больных обусловливает необычную эпидемиологию, стертую клиническую картину и быстрое, зачастую молниеносное, развитие инфекционного процесса. Современные методы диагностики позволяют выявить воспалительные изменения в легких с высокой эффективностью. В настоящий момент в клинической практике наиболее актуальной задачей является возможность предположить этиологию инфекционного осложнения и своевременно скорректировать этиотропную терапию, используя быстрый и доступный способ. В данной статье обоснован наиболее предпочтительный метод диагностики пневмоний у  иммунокомпрометированных пациентов и  представлен современный взгляд российских и  зарубежных исследователей на  потенциал и  ограничения компьютерной томографии в  дифференциальной диагностике инфекционных поражений нижних дыхательных путей

Эпидемиология и результаты терапии первой линии ВИЧ-ассоциированной лимфомы Ходжкина

Introduction. The risk of developing Hodgkin lymphoma (HL) with HIV infection is higher than in the general population, and the course of the disease itself is more aggressive. Currently, there is no unified approach to the treatment of HIV-related HL, and data on its epidemiology in the Russian Federation are limited.The objective was to study epidemiological characteristics, the used therapeutic tactics and the results of treatment for HIV-related HL.Methods and materials. The multicenter retrospective study included 46 patients with HIV- related HL treated in 9 centers of the Russian Federation. Descriptive statistics methods were used, the analysis of overall survival (OS) and progression-free survival (PFS) was performed using the Kaplan–Meier method.Results. HIV-related HL is more often represented by an advanced stage, B-symptoms, and extranodal lesions. The ABVD regimen was used as the first-line therapy in 60 % for HIV-related HL. The overall response to therapy was 81.6 %, and the 2-year OS and PFS were 85 % and 49 %, respectively. Factors that worsened OS were CD4+˂266 cells/mcL and general somatic status ECOG≥2. Введение. Вероятность развития лимфомы Ходжкина (ЛХ) на фоне ВИЧ-инфекции выше, чем в общей популяции, а течение заболевания имеет более агрессивный характер. В настоящий момент отсутствует единый подход к терапии ЛХ на фоне ВИЧ, а данные об ее эпидемиологии в Российской Федерации ограничены.Цель – изучить эпидемиологическую характеристику, применяемую терапевтическую тактику и результаты лечения лимфомы Ходжкина на фоне ВИЧ-инфекции.Методы и материалы. В многоцентровое ретроспективное исследование были включены 46 пациентов с диагнозом «ЛХ» на фоне ВИЧ, получавших лечение в девяти центрах Российской Федерации. Применяли методы описательной статистки, анализ общей выживаемости (ОВ) и беспрогрессивной выживаемости (БПВ) выполняли с использованием метода Каплана – Мейера.Результаты. ЛХ на фоне ВИЧ чаще представлена распространенной стадией, В-симптомами и экстранодальным поражением. В качестве терапии первой линии ЛХ на фоне ВИЧ в 60 % случаев использовалась схема ABVD. Общий ответ на терапию составил 81,6 %, а 2-летняя ОВ и БПВ составили 85 и 49 % соответственно. Факторами, снижающими ОВ, являлись уровень CD4+<266 кл/мкл и общесоматический статус ECOG≥2. Ключевые слова: лимфома Ходжкина, ВИЧ, CD4+, ECOG, многоцентровое исследование, терапия первой линии>˂ 266 кл/мкл и общесоматический статус ECOG≥2.

Features of nutritional support during stem cell transplantation

This article presented a review of the literature on the features of nutritional support for oncohematological patients who have undergone allogeneic (alloHSCT)/autologous hematopoietic stem cell transplantation (autoHSCT). Bone marrow transplantation associated with a high risk of developing nutritional deficiencies. Nutritional support (NP) is indicated for patients undergoing alloHSCT and autoHSCT in order to reduce the incidence of infectious complications and reduce the risk of developing severe forms of acute and chronic GVHD. Currently, there are recommendations for conducting NP in alloHSCT, while there are no recommendations for patients with autoHSCT. An important task in planning NP is the calculation of the daily energy requirement. Bone marrow transplantation accompanied by a prolonged negative nitrogen balance. The protein requirement for alloHSCT is significantly higher than for patients with chemotherapy alone – 1.5–2 g/kg per day. An effective method of controlling the needs of hematological patients during the analysis of HSCT and alloHSCT is the calculation of the nitrogen balance and the daily protein norm. In this article was analyzed the role of macronutrients and immunonutrients in the recovery of patients during alloHSCT. It has been shown that low levels of vitamin D and vitamin A increase the risk of development and the severity of the transplant versus host reaction. The addition of omega-3 fatty acids helps maintain an optimal proportion of calorie intake from lipids, as well as maintain the necessary level of triglycerides in the blood. The article presents data on reducing the risk of developing acute GVHD with systemic addition of omega-3 fatty acids. For a final assessment of the effect of the neutropenic diet on the development of infectious complications in oncohematological patients, randomized prospective multicenter studies with the development of a unified approach in choosing a diet for HSCT are needed

Prognostic impact of immunohistochemical and molecular genetic markers in Diffuse Large B-cell lymphoma

Aim. To evaluate impact of different clinical features on prognosis in Diffuse Large B-cell lymphoma (DLBCL) patients and to determine potential correlation between IHC markers (double-expression of c-myc, bcl-2 and p53) on unfavorable clinical characteristics in DLBCL patients.Methods. We analyzed 215 patients with DLBCL who received treatment from 2008 to 2016. We assess impact of different clinical features, such as B-symptoms, extranodal involvement, advanced stages and refractory course on PFS. In this study we also access potentially unfavorable impact of double expression of c-myc and bcl-2 and p 53 by immunohistochemical analysis.Results. In both uni- and multivariant analysis B-symptoms, advanced stages and primary-refractory course were identified as negative prognostic factors for PFS rates. We found tendency to correlation between double expression of c-myc and bcl-2 and high International prognostic index as well as expression of p53 and advanced stages (87,5% vs 56,4% respectively, р = 0,095). Сonclusion. Patients with DLBCL aggressive course of the disease (B-symptoms, advanced stages and primary-refractory disease) have lower rates of PFS. Double-expression of c-myc and bcl-2 and p53 can be potentially associated with aggressive course of the disease

Thermovibrational convection in microgravity: Preparation of a parabolic flight experiment

SCOPUS: ar.jinfo:eu-repo/semantics/publishe