[Toxicity of different treatment protocols for acute myeloid leukemias in adults: the results of four Russian multicenter studies].

AIM: To comparatively analyze the toxicity of 4 treatment protocols in patients with acute myeloid leukemia (AML), which were used in the Russian multicenter center in 1992 to 2009. MATERIALS AND METHODS: The information obtained in 4 Russian multicenter studies conducted in 33 hematology departments of 26 cities and towns of the Russian Federation in 1992 to 2009 was analyzed. Randomization was made in 243 patients with AML (median age 38 years) in 1992-1995, 396 patients (median age 39 years) in 1995-1999, 392 patients (median age 39 years) in 2001-2006, and 137 patients (median age 40 years) in 2006-2009. The analysis excluded patients with acute promyelocytic leukemias who were recruited in the AML-92 and AML-95 studies. These patients' statutory forms adequately filled in were 60-70% therefore toxicity was analyzed on the basis of the data of 631 patients. RESULTS: The baseline clinical and laboratory parameters in the patients enrolled in the studies in different years slightly differ in the count of leukocytes at the onset of the disease and in the level of lactate dehydrogenase (LDH): the recent studies revealed a larger number of high-risk group patients (leukocytes more than 30 10(9)(/l; LDH more than 500 units) possibly due to the later diagnosis of AML. During the studies, the number of complete remissions remained as before (55%) after the first course and increased from 65 to 78% after the second course using cytosine arabinoside in high doses. Despite treatment intensification, mortality in the induction period remained as before (19-21%). Remission mortality decreased from 18 to 10-13%. The long-term results of using the aggressive therapy did not differ from those obtained during the standard treatment protocols. The duration of leucopenia after standard induction courses during the all studies remained equal (17-19 days); the exclusion was a HAM course as the second induction course after which the duration of neutropenia was much more than that of the standard course (17 and 10 days, respectively). During the study years, there was an increase in platelet transfusion volumes (from 20 to 53 doses during the first course and from 7 to 28 doses during the second course) and a reduction in the percentage of severe hemorrhagic complications. The incidence of pneumonias remained at the same level (40-50%) during the induction courses and that of septic complications and necrotic enteropathy considerably decreased from 40-46 to 17-19%. The incidence of invasive aspergillosis during the current programs from AML treatment was 10% (two induction courses), that of invasive candidiasis was 4.7% (two induction courses). CONCLUSION; The long-term results of treatment for AML were virtually unchanged regardless significant therapy intensification. Mortality remained high during induction treatment and in the postremission period. Its cause is severe infectious complications developing during myelotoxic agranulocytosis. The results of the analysis provide the basis for developing a new AML treatment protocol that should take into account all the merits and demerits of the previous protocols and provide a toxicity-treatment efficiency balance.

[The results of a multicenter randomized trial on the treatment of acute myeloid leukemia of adults].

AIM: Systematization of the results of 20-year multicenter randomized trial of the efficacy of treatment of acute myeloid leukemia (AML) of adults; presentation of the design of the study of the strategy of consolidation and maintenance therapy after high-dose consolidation initiated in 2007. MATERIAL AND METHODS: Treatment outcomes on the protocol AML-01.01 are presented for 354 AML patients from 29 hematological centers located in 22 towns of Russia and 2 towns of Ukraine. The patients were randomized into 3 groups by variant of therapy: 124 patients (62 males and 62 females; age median 42 years) received 4 courses of 7+3+VP-16 and 5 courses of maintenance therapy (7+3 with thioguanin); 130 patients (65 males and 65 females, age median 41 year) received 2 courses of 7+3+VP-16, 2 courses 7+3, maintenance--5 courses 7+3 with thioguanin; 126 patients (57 males and 68 females, age median 40 years) were given 2 courses of 7+3+VP-16, 2 HAD courses, treatment discontinuation. RESULTS: A complete remission after the first course of 7+3+VP-16 was achieved in 55% patients, after the second course--in 30% after the course 7+3+VP-16 or 7+3 with mitoxantron, in 70%--after NAM. Overall and recurrence-free survival were 18 and 35%; 30 and 20%; 36 and 30%, respectively. There was no significant difference in efficacy of the treatment scheme. CONCLUSION: The multivariate analysis has shown that a leading factor having impact on treatment results was the number of randomized patients: the less patients were randomized, the worse were the results.

[The role of immunological mechanisms in the development of the late sequelae of nuclear disasters]. / O roli immunologicheskikh mekhanizmov v razvitii otdalennykh posledstvii iadernykh katastrof.

Effects, both specific and non-specific, were analysed of ionizing radiation in a comparative evaluation of medical sequels of the Chernobyl disaster and of the Semipalatinsk Range nuclear test. A hypothesis is advanced assuming that development of all major bodily morbid conditions is directly related to the dysfunction of certain complex of organs, the thyroid gland in the first place, the thymus gland known to be a central organ of systemic immunogenesis. A breach in the thymus link triggers harmful cascade reactions of neuroimmunoendocrinological regulation, appeared to be responsible for the pathogenesis of practically all pathologies disclosed.

[Experience in introducing the method of placental therapy in vitiligo in Ukraine]. / Opyt vnedreniia metoda platsentarnoi terapii vitiligo v Ukraine.

The preparation "melagenin" stimulating reproduction of melanocytes and synthesis of melanotic pigment was isolated from human placenta in Cuba. As many as 366 pediatric patients with vitiligo who ranged from 4 to 15 years old were followed up for 1 year. In 62 cases the area of depigmentation amounted to 71 to 100%. Treatment with melagenin proved to be effective in 83% of vitiligo patients. Indications and contraindications have been determined.

[The characteristics of the course of digestive organ diseases in patients who are long-term residents in a radionuclide-contaminated area]. / Osobennosti techeniia zabolevanii organov pishchevareniia u bol'nykh, dlitel'no prozhivaiushchikh na zagriaznennoi radionuklidami territorii.

Clinical course of digestive tract diseases was studied in 100 subjects residing for 6 years at radionuclides-contaminated territory of Ovrych District (Zhitomir Province). This kind of pathology when constantly influenced by low-dose radiation acquires unnoticeable beginning, uncommon manifestation, torpidity and is often associated with neuropsychic disorders in form of asthenic, astheno-hypochondriacal and astheno-depressive syndromes. Rate of neuropsychic symptoms depends neither on organic diseases of digestive tracts nor on amount of radionuclides accumulated in the body but correlates well with duration of residence at the contaminated territory.

[Computer technology for the automatic processing of the physician's medical documentation]. / Komp'iuterna tekhnolohiia avtomatyzatsiï obrobky medychnoï dokumentatsiï likaria.

In the authors' opinion for a computerized health documents processing to be attractive for practitioners it should grant them appreciable advantages and not demand special training. When creating such a technology the authors achieved the object by as close as possibly adaptation of case history schemes to concrete diagnosis. The universal schemes are noted to be less convenient for the medical practice.

[The status and means for improvement of the rheumatology service in Ukraine]. / Stan ta shliakhy udoskonalennia revmatolohichnoï sluzhby v Ukraïni.

Morbidity, prevalence, temporary loss of capacity for work and invalidity due to rheumatic diseases for the last 5 years in the Ukraine are analysed. Ways of further improvement of rheumatological service are determined. Aspects of coordinated approach to the solution of urgent rheumatological problems on the part of doctors working in different fields of medicine are discussed.

[The dispensary observation of patients with chronic nonspecific lung diseases who work in a dust-producing industry with a high radionuclide level as a consequence of the accident at the Chernobyl Atomic Electric Power Station]. / Dispansernoe nabliudenie za bol'nymi khronicheskimi nespetsificheskimi zabolevaniiami legkikh, rabotaiushchimi na pylevom proizvodstve s povyshennym soderzhaniem radionuklidov vsledstvie avarii na Chernobyl'skoi AES.

Patients working at a small mining institution and suffering of chronic unspecific pulmonary diseases due to high dust and radionuclide contamination levels were examined. Four groups of dispensarization were singled out with the purpose of differential treatment for each group. Such treatment including also antiaggregant agents, nitro-drugs resulted in a good medico-social effect within 2 years.

[The characteristics of the course of acute pneumonia in patients subjected to prolonged exposure to low doses of ionizing radiation as a result of the accident at the Chernobyl Atomic Electric Power Station]. / Osobennosti techeniia ostroi pnevmonii u bol'nykh, podvergavshikhsia dlitel'nomu vozdeistviiu malykh doz ioniziruiushchego izlucheniia v rezul'tate avarii na Chernobyl'skoi AES.

Distinct changes in the clinical picture of acute pneumonia were noted in patients subjected to constant prolonged (1986-1990) effect of small doses of ionizing radiation as a result of residing in the contaminated territory after the Chernobyl atomic station disaster. These changes included increased duration of the disease, frequency of protracted forms, suppression of the immune system. At the same time a general decrease of the incidence of acute pneumonia, increase of the frequency of severe cases of concomitant pathology indicate some stimulating effect of small doses of ionizing radiation on the body with a healthy immune system and suppressing effect on inadequately functioning immune system. Changes of the clinico-laboratory indices of the course of acute inflammatory process depended on the duration of residing in the contaminated locality and to a lesser degree of the dose.

[Urinary amylase activity and debit as indices of the functional status of the pancreas and gallbladder]. / Aktivnost' i debit uroamilazy kak pokazateli funktsional'nogo sostoianiia podzheludochnoi zhelezy i zhelchnogo puzyria.

The functional state was studied of the pancreas and gallbladder by calculation of the activity and yield of uroamylase in 96 persons. Data are compared that were obtained on the basis of this method. There was a clear correlation with results obtained during cholecystography. This simple and precise method may be recommended for wide practical use.

[Iridodiagnosis in the system of the follow-up of the health status of the population living in an area contaminated by radioactive substances]. / Iridodiagnostika v sisteme kontrolia za sostoianiem zdorov'ia naseleniia, prozhivaiushchego na territorii, zagriaznennoi radioaktivnymi veshchestvami.

The authors substantiate the practical employment of the iridodiagnosis screening-test using a system of archiving and visualization of the iris at the first stage of prophylactic medical examination and management. The economical and medical efficacy of the method has been established. Use of iridodiagnosis improved the detectability of pathologic conditions as compared with complex medical examination. Many specialists were freed from mass medical screening. The expenses for prophylactic medical examination became ten times less.

[Experience in the reduction of the primary disability level]. / Opyt raboty po snizheniiu urovnia pervichnogo vykhoda na invalidnost'.

Measures are designed which are undertaken to form a commission of health occupational experts (CHOE) at local and regional levels in connection with entitlement to disability among workers. Organizational issues are described on early identification and adequate treatment of diseases frequently leading to disability, on promoting motivation of health workers in the reduction of disability among workers, raising the quality of medical-labour examination, information supply of physicians and public health administrators of these problems. A recommendation is made of the necessity to place commissions and institutes of health occupational experts under the authority of ministries of public health of the USSR and union republics. Advisability of including the section devoted to disability issues into the progress report of curative and preventive institutions is emphasized.

[Experience in using hemosorption in treating patients with rheumatoid arthritis]. / Opyt primeneniia gemosorbtsii v lechenii bol'nykh revmatoidnym artritom.

Hemosorption was included in the complex treatment of 30 patients (age: 25-50 years) suffering of rheumatoid arthritis. It was found that the most sensitive laboratory tests of treatment efficacy were erythrocyte sedimentation rate, reduction of the level of gammaglobulins. Clinical improvement was pronounced as result of hemosorption treatment.