Outcome of malignant lymphoma in Ukraine. Analysis of 563 cases registered in the Ukrainian Lymphoma Registry in 2019-2021.

We report the outcome of 563 cases of newly diagnosed lymphoma registered in 2019-2021, including 176 cases (31.2%) of Hodgkin lymphoma (HL), 130 (23.1%) of diffuse large B-cell lymphoma (DLBCL), 28 (5%) of follicular lymphoma (FL), 16 (2.9%) of mantle cell lymphoma (MCL) and 20 (3.5%) of peripheral T-cell lymphoma (PTCL). After a median follow-up of 30.1 months (95% CI: 28.8-31.3), the 3-year overall survival rates were 95%, 83%, 86%, 100%, 61% and 42% for HL, DLBCL, CLL, FL, MCL and PTCL respectively. These data offer valuable information on the curability of lymphoma patients in Ukraine, in a real-world setting.

Outcome of clinical experience of introducing a patient with secondary systemic AL-amyloidosis associated with multiple myeloma.

This research is relevant, as AL-amyloidosis refers to a systemic type of disease characterized by aggregation of an improperly folded light chain of an immunoglobulin, mainly in the heart and kidneys, causing organ failure. This study describes the clinical experience of introducing a patient with cardiac amyloidosis associated with multiple myeloma (MM). A clinical case of a patient diagnozed with amyloidosis was considered. Magnetic resonance imaging signs of cardiac amyloidosis were confirmed due to the presence of concentric biventricular hypertrophy without dilation, atrial septal hypertrophy, a tendency to atrial dilation, thickening of valve flaps and atrial walls. Upon admission to the research institute, the patient had an anasarca. More accurate recognition of AL-amyloidosis by cardiologists allows for prescribing earlier treatment and improving results. Conventional treatment of MM and AL-amyloidosis includes a combination of dexamethasone with bortezomib and endoxan. Haematopoietic stem cell transplantation after taking high doses of melphalan has become another treatment option and has led to remission in some patients. The novelty of the study is that an example of a timely complete diagnosis and treatment of a combination of these two diseases was presented, as a result of which the patient has achieved a complete haematological and partial organ response to the underlying disease.

Current overview and special considerations for second breast cancer in Hodgkin lymphoma survivors.

Second breast cancer (SBC) is the most common solid cancer among Hodgkin Lymphoma (HL) female survivors. We reviewed the related modifying risk factors, radiation-induced carcinogenesis, tumors characteristics, management specificities, prevention and surveillance modalities based on current evidence. The risk of developing SBC may be influenced essentially by the age at HL treatment, follow-up latency, dose of irradiation received and the extent of irradiated field. SBCs generally develop at younger age, they are often bilateral, and exhibit more aggressive biological features and worse prognosis. No firm answer about the benefits of breast surveillance is provided by literature, but compelling evidence tends toward a clinical benefit in early detection. Increasing awareness among health providers' care and current survivors as well as the implementation of screening measures is crucial. Great efforts are ongoing in individualizing treatment strategies for future HL patients and response-adapted approaches are holding promise in prevention of these second malignancies.

A Ukrainian multicenter prospective study of the value of PET/ CT prognostic role in primary patients with Hodgkins lymphoma in a real-life cohort.

INTRODUCTION: In recent years, the positron emission tomography combined with computed tomography (PET/CT) has changed and the treatment approaches in Hodgkins lymphoma (HL) patients have entirely improved. The main idea in several studies is the use of PET/CT and the International Prognostic Score (IPS) protocols in identification of patients within a high-risk group and potential early relapse/refractory disease. MATERIALS AND METHODS: This study was based on PET/CT evaluation and treatment strategies of patients from eight Centers of Hematology in Ukraine. The patients included were newly dia-gnosed with HL and were aged 67 years or younger. They received a treatment with ABVD or BEACOPP-14/esc or “switched-regimens” (ABVD + BEACOPP-esc/14, BEACOPP-esc/14 + ABVD). The primary endpoints were to assess a correlation between PET/CT findings at the time of dia-gnosis, response to the therapy and clinical outcome (relapse/death) for patients with early and advanced stages of HL. The secondary endpoints were to evaluate the relationship between IPS and PET/CT findings. RESULTS: The study group included 106 patients. The overall response rate (ORR) was 90.5%. The ORR for patients with stages I-II was 96.5% (55/57) vs. 91% (41/45) for stage III-IV patients. In total, the disease progression occurred in 58.3% (7/12) of PET2+ patients and in 13.3% (12/90) of PET2 patients (P < 0.05). No significant difference was found between the event free survival (EFS) rate and IPS for patients with PET2+ vs. PET2, (log-rank test; P = 0.4). The PET3 status was found in 88.8% (79/89) of the study group patients and 1.2% (10/89) had a PET3+ status (P < 0.05). Using the Cox regression, we confirmed a significant correlation between EFS with PET3 Deauville scale (DS) and IPS. Patients with DS 1-2, DS 3 and DS 4-5 had a 1-year event-free survival of 94.4%, 100% and 33%, respectively (HR 0.56; 95% CI 1.07-2.8; P < 0.02). Our multivariable analysis showed no statistically significant correlation between PET2+ and PET3+ status and extranodal involvement or large tumor burden. CONCLUSION: The results of using PET/CT in patients with primary HL demonstrated a high prognostic value of PET at the end of the treatment. In addition, we confirmed the predictive role of IPS prognostic model in the treatment outcome depending on PET status.

MAPK/ERK signal pathway alterations in patients with Langerhans Cell Histiocytosis.

BACKGROUND: Clinical outcomes of Langerhans cell histiocytosis (LCH) are highly variable. It has been suggested that mitogen-activated protein kinase (MAPK) /extracellular signal-regulated kinases (ERK) signaling pathway might be activated in LCH patients. MATERIALS AND METHODS: We investigated KRAS, BRAF and NRAS mutations in patients with LCH by qPCR. RESULTS: Eight adult patients with LCH were treated at the National Cancer Institute, Kiev, Ukraine. Five patients received chemo plus radiation therapy and three patients received only chemotherapy, resp. (p < 0.05). All patients received LCH-I study protocol, six cycles in average. A BRAF c.1799T > A, p. V600E mutation was detected in 25% (2/8) of cases - 1 patient had an early relapse in 6 months, and 1 patient - stable disease. We did not find any BRAF, KRAS or NRAS mutations in three patients with late relapses (in 15, 24 and 46 months). Notably, KRAS mutations were not revealed in any LCH samples. The NRAS c.182A > G, p. Q61R mutation was found in two cases - one patient had LCH transformed to Hodgkins lymphoma, one patient had a refractory disease. Time to relapse rate (TTR) in patients with and without BRAF V600E gene mutation was 13 vs. 28 months, resp. (p < 0.05). TTR was 31.3 vs. 6.41 months in patients with absence and presence of NRAS mutation, p < 0.05. Multivariate analysis showed the presence of NRAS Q61R mutation was associated with poor event-free survival in LCH patients with HR of 6.1 (95% CI 0.2-12.6; p = 0.008). CONCLUSION: BRAF and NRAS mutations in LCH suggest a possibility of the disease being driven by the activation of the MAPK/ERK pathway. These oncogenic mutations provide new opportunities in understanding LCH pathogenesis and may be a potential target of therapy.Key words: Langerhans cell histiocytosis - mutations - prognostic factors - relapse - survival.