[Results of the treatment of adult acute lymphoblastic leukemia according to ALL-2005 protocol as a basis for new trials].

AIM: To analyse the results of the treatment according to ALL-2005 protocol for adult patients with acute lymphoblastic leukemia (ALL); on the basis of the summarized evidence on ALL treatment to propose principles for development of a new program of ALL treatment in 15-55-year-old patients. MATERIAL AND METHODS: Five hematological centers (in Moscow, Saransk, Volgograd, Tambov, Kirov) participated in ALL-2005 protocol trial initiated in 2005. A total of 71 adult patients with ALL (age median 27 years) were treated. The results of the MB-2002 study with participation of 16 patients aged 16-23 years performed in the State Hematological Research Center (SHRC) were reviewed RESULTS: The results of the induction therapy according to ALL-2005 protocol conducted in Moscow SHRC were good: a complete remission was achieved in 90% patients, early lethality was 6%, resistance was observed in 4%. In regional centers lethality in remission was higher, 5-year overall survival was 28% (in SHRC it was 56%), recurrence-free survival in regional center was 22% versus 51%, respectively. Long-term response by ALL-2005 and MB-2002 in patients aged 19-23 was the same, but toxicity of ALL-2005 treatment was higher (no lethality and 5, 4% in induction and remission, respectively). CONCLUSION: The decision was made on design of a new protocol of treatment of Ph-negative ALL for patients aged from 15 to 55 years the main principles of which are the following: continuous treatment with modification of cytostatic drugs doses depending on myelosuppression severity; assessment of tumor cells sensitivity to prednisolone and its replacement for dexametasone throughout the treatment; prolongation of L-asparaginase treatment with elevation of its total dose; monitoring of minimal residual disease (MRD) for decision on late intensification in patients with MRD at late treatment stages (5 months).

[Preliminary results of a multicenter randomized study on the treatment of acute promyelocytic leukemias]. / Predvaritel'nye rezul'taty mnogotsentrovogo randomizirovannogo issledovaniia po lecheniiu ostrykh promielotsitarnykh leikozov.

AIM: To study efficacy of maintenance therapy of patients with acute promyelocytic leukemia (APL) in the APL treatment Russian multicenter trial. MATERIAL AND METHODS: The trial was made with participation of 18 hematological departments of clinics in Russia. A total of 68 APL patients entered the trial. The maintenance therapy consisted of 5-day courses of cytostatic drugs which alternated or did not alternate with 5-day courses of ATRA. Cytogenetic tests were made in 31 patients, t(15;17) was detected in 26 of them. Molecular examination conducted in 28 patients discovered chimeric transcript PML/RARa in 26 of them. Of 20 patients examined in Hematological Research Center, 7 (35%) had a bcr 1/2 variant of the transcript PML/RARa, 13 (65%)--bcr 3 variant. RESULTS: 65 patients were eligible for assessment. A complete remission was achieved in 90% cases. No resistance was observed. In follow-up within 30 months the recurrence rate was similar on both treatments. The results of the induction therapy and survival in patients with different variants of the transcripts were also similar. Overall 2.5 year survival for all the patients was 77%, recurrence-free--80%. The survival analysis in patients with leukocytosis higher and lower 10 x 10(9)/l found no statistical differences by the survival. Patients with hyperleukocytosis had higher early lethality than patients with leukocytes under 10 x 10(9)/l (25% vs 5.3%, p = 0.03). CONCLUSION: The APL 06.01 protocol showed high efficacy of the relevant maintenance which provides a complete molecular remission in the majority of patients with probable recurrence-free 2.5 year survival 80%.

[Neurologic and mental disorders in patients with migraine and in their children]. / Nervno-psikhicheskie rasstroistva u bol'nykh migren'iu i ikh detei.

To specify indications for differentiated therapy, a study was made of the characteristic features of the psychopathological picture of the interictal period of migraine in 50 women aged 28 to 60 years suffering from different forms of migrainous attacks. Besides, the neuropsychic disorders were also examined in those patients' children. The first group was made up of migraine patients in whom paroxysmal psychic disorders resembling convulsion-free epileptic attacks ranked first in the clinical structure of the interictal period. In the second group patients, of paramount importance was the hysterical symptomatology. The third group patients suffered from somatized depressions. The differentiated therapy of psychic disorders of the interictal period favoured the deceleration of migrainous attacks in all the three groups patients.

[Seizure-free paroxysms in epilepsy and migraine]. / Bessudorozhnye pariksizmy pri épilepsii i migreni.

Fourty epileptic and 66 migraine patients were examined. The differences in clinical features of headache paroxysms, consciousness disorders, psycho-sensory++, viscero-autonomic++ and affective spells were determined. The elements of confused consciousness, short-lived and local autonomic responses were characteristic of seizure-free epileptic attacks. Migrainous paroxysms were multiform and pronounced in terms of autonomic disorders, had lesser depth and incidence of consciousness disorders with longer lasting vaso-autonomic++ crises.

[Mental disorders in migraine patients]. / Psikhicheskie narusheniia u bol'nykh migren'iu.

The mental state was studied in patients with different forms of migraine. Using experimental psychological, electroencephalographic, rheoencephalographic, echoencephalographic and dermatoglyphic methods patients with simple and associated migraine were examined. Characteristic mental disturbances were identified. The authors emphasize the significance of psychodiagnosis for selection of the correct management of patients and the selection of adequate therapy.

[Several subclinical forms of epileptic dysphoria and their ambulatory treatment]. / Nekotorye subklinicheskie formy épilepticheskikh disforii i ikh ambulatornoe lechenie.

As a result of a clinico-biochemical study covering 58 epileptic patients with dysphoric states, the authors identified 2 clinical groups with the characteristic clinical features and biochemical profile. On the basis of the data obtained, a definite tactics of the treatment for dysphoric states is proposed. Multiple modality treatment with the use of anticonvulsants, neuroleptics, antidepressants and psychostimulants is recommended.

[Neurotic disorders in epilepsy and their treatment by technics of psychotherapy and reflexotherapy]. / Nevroticheskie rasstroistva pri épilepsii i ikh lechenie metodami psikhoterapii i refleksoterapii.

The paper reports on observations of the onset and development of neurotic states in patients (n = 51) suffering from various forms of epilepsy at different stages of the disease. The clinical features of the principal types of neuroses such as neurasthenia, hysteria or neurosis of obsessive states proceeding in the presence of epilepsy are considered and clinical examples are adduced. Recommendations are given on the treatment of such patients using psychotherapy (including hypnotherapy) and acupuncture combined with basic anticonvulsion treatment. Peculiar phenomena resulting from the application of these methods and their therapeutic value are described.

[Prognostication in epilepsy]. / K voprosu prognozirovaniia pri épilepsii.

Using the method of a sequential analysis, the differential diagnosis of favourable and unfavourable forms of epilepsy was attempted. Preliminary results point to considerable difficulties encountered in predicting the course of epilepsy in view of the shortage and inadequacy of the commonly accepted clinical signs of epilepsy and the absence of a sufficient amount of paraclinical tests. They also indicate that the use of the cytochemical method for examining lymphocytes in the peripheral blood of epileptic patients seems to show promise as a prognostic test.

[Therapeutic activity of tryptophan and its effect on serotonin metabolism in epilepsy patients]. / Terapevticheskaia aktivnost' triptofana i ego vliianie na obmen serotonina u bol'nykh épilepsiei.

The therapeutic activity of tryptophan and the serotonin blood level in epileptic patients were studied. A group of patients (24 cases) received tryptophan (a source of serotonin synthesis in the organism per os during three weeks in a dose of 0,25 g thrice daily. The studies demonstrated the decreased initial level of blood serotonin in patients, especially in those with frequent epileptic seizures and with the disease of long standing. The intake of tryptophan even after a week of its administration produced a reliable increase in the level of blood serotonin and suggestive changes in the clinical picture. This was especially noticeable in patients with seizures of the grand mal tupe and personality changes.