[Prognostic value of a number of blood laboratory parameters in the use of erythropoiesis-stimulating agents in anemic patients with lymphoproliferative diseases].

AIM: To clarify the prognostic value of the baseline blood levels of endogenous erythropoietin (EE) and tumor necrosis factor-a (TNF-a) involved in the key components of the pathogenesis of anemia in lymphoproliferative diseases (LPD), the counts of reticulocytes and platelets (hematopoietic preservation indicators) in the use of erythropoiesis-stimulating agents (ESAs) to correct anemia syndrome (AS) in patients with LPD. SUBJECTS AND METHODS: The results of AS treatment with ESAs were analyzed in 48 patients with LPD. A study group comprised patients with chronic lymphocytic leukemia (n=1 3), indolent lymphomas (n=14), and multiple myeloma (n=21). Their hemograms (hemoglobin concentration, red blood cells, packed cell volume, reticulocytes, and platelets) and blood EE and TNF-alpha levels were examined before using ESAs. The hemogram was monitored during treatment. ESAs (eralfon (epoietin alpha) in 21 patients and epres in 27) were subcutaneously injected in a dose of 150 IU/kg thrice weekly (for not more than 16 weeks). A control group included 21 anemic patients with multiple myeloma who did not receive ESAs. Increasing hemoglobin concentrations up to 120 g/l was regarded as a positive response to ESA treatment. RESULTS: By and large, the efficacy of epoietin alpha was 62.5% (61.9% for eralfon and 63.0% for epres), which was significantly higher than that in the control group (23.4%; p<0.05). A number of blood laboratory parameters were found to be of value in predicting the efficacy of ESAs. The patients with the decreased baseline concentrations o EE ( <130 mlU/ml) and TNF- alfa (,15 pg/ml) were ascertained to show a positive response more frequently (80 and 92.9%, respectively; p<0.05) than those with thepredicting the efficacy of ESAs. The patients with the decreased baseline concentrations of EE (<130 mlU/ml) and TNF-a (<15 elevated concentrations of the enzymes in question. In addition, a positive response was more often recorded in patients with reticulocyte counts of more than 1% (77.4%; p<0.05) and platelets of 100-10(9)/1 (70%; p=0.05). CONCLUSION: Estimating the baseline blood levels of EE and TNF-a and the counts of reticulocytes and platelets prior to the use of ESAs enables prediction of the efficiency of erythropoiesis-stimulating therapy in anemic patients with LPD.

[Clinical significance of lymphocyte subpopulations and cytokine-producing activity of blood cells in patients with primary myelodysplastic syndrome].

Lymphocyte subpopulation composition and spontaneous production of tumor necrosis factor-alpha (TNF-alpha) by blood cells were studied in 22 and 15 patients with myelodysplastic syndrome (MDS), respectively, who were under immunosuppressive therapy (IST). Patients with hematological response revealed a significantly increased cytotoxic CD8+ lymphocyte concentration and TNF-alpha production. A direct correlation between TNF-alpha production rate and CD8+ lymphocyte level was established. Maximum cytokine-producing activity of blood cells was identified in MDS patients with enhanced erythroid response. The study established a great diversity of MDS, its hypoplastic variants and the prognostic value of spontaneous production of tumor necrosis factor-alpha (TNF-alpha) by blood cells as marker of IST efficacy.

[Morphological and pathogenetic aspects of aplastic anemia]. / Morfologicheskie i patogeneticheskie aspekty aplasticheskoi anemii.

A complex study of colony-stimulating properties of cells-precursors of granulomonocytopoiesis, morphological parameters of the marrow histological structures and immunological parameters was carried out in 90 patients to specify pathogenic mechanisms of aplastic anemia (AA) development. 95% of patients appeared to have sharp decrease of the marrow colony-stimulating properties and only 5% had normal initial indexes. In most patients endostal cell number increased, while the content of reticulocytes grew higher in more than 30% of patients. Defect of the marrow stroma functioning was registered in 23% of patients. Increase of the osseous tissue volume and osteocyte number was found. Dysbalance in cellular link of immunity was demonstrated. Only temporal increase of the marrow colony-stimulating properties was marked in some patients on the background of treatment with antilymphocyte globulin, despite the clinic-hematological improvement. Multifactor pathophysiological mechanisms, the main of which is the stem cell defect lies in the base of AA pathogenesis. Hemopoietic microenvironment pathology is not the leading reason of the hemopoiesis depression but it contributes greatly in its development. Immunological alterations in patients with AA are secondary and can be partly corrected with treatment with ALG.

[The treatment results in patients with aplastic anemia using different doses of antilymphocyte globulin]. / Rezul'taty lecheniia bol'nykh aplasticheskoi anemiei razlichnymi dozami antilimfotsitarnogo globulina.

The authors present 5-year survival of 64 patients with aplastic anemia (AA) divided into 2 groups. Group 1 received antilymphocytic globulin (ALG) in low doses (1-5 mg/kg), group 2 in high doses (10-30 mg/kg). Survival of patients with severe AA in group 1 made up 28.5%, with mild AA 90.1%. Overall survival in group 1 was 64.4%, in group 2 53.8%. Overall toxicity came to 48.6%. By resultant complications high and low ALG doses did not differ. The authors propose to use low doses of ALG in mild disease whereas in severe condition high ALG doses are thought adequate.

[Immunologic monitoring and immune reconstitution in recipients of allogeneic bone marrow]. / [Immunomonitoring i immunorekonstitutsiia retsipientov allogennogo kostnogo mozga]

The dynamics of different peripheral blood lymphocyte subpopulations (CD3+, CD4+, CD8+, CD22+, DR+, CD25+ and CD16+) and levels of serum cytokines TNFa and IL1 beta were evaluated in 10 patients with allogeneic bone marrow transplantation (BMT). It was established that initially low levels of practically all the lymphoid subsets studied came back to normal in patients with favorable post-BMT course, while, in unfavorable post-BMT course (GVHD or relapse), the levels of said lymphoid subsets remained unchanged or even dropped. Post-BMT increase in serum TN alpha level can be of prognostic value for GVHD development whereas serum IL1 beta level does not correlate with post-BMT course.

[Immunomodulator Cycloferon in the comprehensive treatment of patients with acute non-lymphoblastic leukemia]. / Immunomoduliator tsikloferon v kompleksnom lechenii bol'nykh ostrimy nelimfoblastichnymi leikozami.

The therapeutic benefit and action of the immunomodulator Cycloferon were evaluated in patients with acute non-lymphoblastic leukemia. When administered in conjunction with chemotherapy during first complete remission, it reduced both early-onset relapse frequency and degree of cytostatic-induced immune deficiency. The drug's action is mediated by changes taking place in cytokine and interferon synthesis.

[Prognostic value of some biochemical and immunologic factors in the management of multiple myeloma]. / Prognosticheskaia tsennost' nekotorykh biokhimicheskikh i immunologicheskikh faktorov pri mnozhestvennoi mielome.

The results of examination of 58 patients in the course of multiple myeloma (MM) are discussed. Prognosis for LDH, beta2-m and FNO-alpha administration was evaluated versus immunochemical pattern, tumor mass and response to different chemotherapeutic regimens. High prognostic value of serum levels of LDH, beta2 and FNO-alpha in MM patients was observed. The method may be useful in carrying out chemotherapy and detecting recurrences and chemoresistance.

[The results of a hematological examination of the population living in an area of intense radiological control in Bryansk Province]. / Rezul'taty gematologicheskogo obsledovaniia naseleniia, prozhivaiushchego v zone usilennogo radiatsionnogo kontrolia Brianskoi oblasti.

As many as 1492 residents of populated areas in Zlynka District of Bryansk Province were studied. There were 628 children and 864 adults in the series. Contamination with radionuclides in the territory of residence was of the order of 40/km2 and above; the level of cesium deposition in the body of the examinees ranged between 0.4 to 3.4. Deviations from the norm in the peripheral blood were detected in 15% of adults and 36% of children. These were manifest by hypochromic anemia, by eosinophil- and lymphoid-type leukemoid reactions, and by other disorders that resulted from nutritional imbalance, deficiency of iron of varying genesis, helminthic invasion, allergic states. Concurrent cellular and humoral immunity shifts coupled with the deviations from the norm in the indices for the thioldisulphide system attest to the need for designing of measures to secure long term observation over health state of the population residing in the contaminated territories.

[Effect of cytostatic and hormonal drugs on the phagocytic activity of neutrophils of leukemia patients]. / Vliianie tsitostaticheskikh i gormonal'nykh preparatov na fagotsitarnuiu aktivnost' neitrofilov bol'nykh leikozom.

Based on the data concerned with blood cells from 12 normal persons and 18 patients with acute leukemia, the action of the clinically applied cytostatics and hormonal drugs (6-mercaptopurine, cytarabine, vincristine, rubomycin) on granulocyte functions was investigated in vitro and in vivo (in patients). The respective characteristics were found to be in a good enough agreement, enabling the prediction of the effect of polychemotherapy on granulocyte functions (the digestion capacity). It has been established that each of the drugs under study changes the characteristics of granulocytes to a different degree. The individual sensitivity of the digestion capacity of phagocytes to the drugs under study does not depend on the disease pattern or initial characteristics of the phagocytic activity of the cells.