CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES

Magnetic resonance imaging in diagnosis of non-Hodgkin’s lymphomas of the spine with spinal cord compression

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , ,

A.S. Nered, N.V. Kochergina, A.B. Bludov, Ya.A. Zamogilnaya, A.K. Valiyev, K.A. Borzov, and E.R. Musayev

N.N. Blokhin Russian Cancer Research Center, RAMS, Moscow, Russian Federation

ABSTRACT

MRI features of 5 patients with non-Hodgkin’s lymphomas (NHLs) of the spine with spinal cord compression were studied. It was revealed that NHLs of the spine were characterized by the predominantly homogeneous extraosseous component of soft-tissue density tending to spread to the adjacent vertebrae through the ligaments of the spinal column, lytic cortical layer destruction with the «wrap-around» sign, and the geographic pattern within the affected vertebrae. Compression myelopathy was observed in the spinal stenosis greater than 40 % of its anatomic width.

Keywords: non-Hodgkin’s lymphoma, magnetic resonance imaging, spinal cord compression.

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Refernces

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Radiotherapy in combined treatment of patients with diffuse large B-cell lymphoma

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , ,

Yu.N. Vinogradova, N.V. Ilin, D.V. Larionov, M.M. Khodzhibekova, N.A. Kostenikov, and L.I. Korytova

Russian Research Centre for Radiology and Surgical Technologies, RF Ministry of Health, Saint Petersburg, Russian Federation

ABSTRACT

The study included 86 primary patients (age: 18–83) with diffuse large B-cell lymphoma, I to IV stages, who received (R)-CHOP regimen and radiotherapy at the CRIRR (at present RRCRST) over the period 2000–2012. The follow-up period median was 42 months (5–120 months). Positron emission tomography (PET) with 18F-FDG was performed in 45 patients at the various follow-up time-points. In all patients, the changes of hematologic indices were observed using baseline, pre-, and postradiation measurements. After combined treatment completed, remission was achieved in 80 out of 86 (93.0 %) patients, including complete or uncertain complete remission and partial remission in 86.0 % and 7.0 %, respectively. During the initial therapy, disease progression occurred in 6 (7.0 %) patients. After the chemotherapy stage, complete remission was noted in 56 (65.1 %) patients only. Additional radiotherapy promoted the increase in the rate of complete and uncertain complete response by 21.9 %. Disseminated disease relapses developed in 2 out of 80 (2.5 %) patients. The complete response rate in the patients who received radiotherapy using the various fractionation regimens was similar. 5-year overall, relapse-free, and progression–free survival were 89.7 ± 3.9 %, 96.6 ± 2.4 %, and 85.4 ± 4.8 %, respectively. In 20.6 % of the patients examined after chemotherapy, PET gave positive results, while after the radiotherapy stage, all the patients examined at this time-point were PET-negative. Radiotherapy was accompanied by mainly I–II grade hematologic toxicity, and in 16–58 % of patients, no interruption of treatment were required. Neutropenia and thrombocytopenia occurred more frequently at the twice-a-day irradiation.

Keywords: diffuse large B-cell lymphoma, radiotherapy, positron emission tomography, hematologic toxicity.

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Multiple myeloma (management of newly diagnosed patients): literature review and our on data. Part II

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , , , , , ,

S.S. Bessmeltsev

Russian Research Institute of Hematology and Transfusiology, FMBA, Saint Petersburg, Russian Federation

ABSTRACT

Over the last decades, survival rates for young patients with multiple myeloma markedly increased mainly due to the use of autologous stem cell transplantation (ASCT) and new highly efficacious rescue therapies. In patients with multiple myeloma over 65 years of age, a combination of melphalan and prednisone (MP) is traditionally used. Introduction of novel agents such as immunomodulatory drugs (IMiDs) and proteasome inhibitors substantially changed the therapeutic approach to the disease. Many double-, triple-, and quadruple-agent combinations were studied in the patients with newly diagnosed multiple myeloma. It was established that the achievement of complete response (CR) is an independent predictor of prolonged progression-free survival (PFS) and overall survival (OS). The data from prospective trials completed suggest that the best available strategy to achieve high CR rates and prolong its duration includes an induction therapy with a triple-agent bortezomib- or IMiDs-based regimen followed by ASCT and consolidation/maintenance with IMiDs or proteasome inhibitors. The vast majority of elderly patients with MM are ineligible for ASCT. Introduction of novel agents such as thalidomide, bortezomib, or lenalidomide considerably improved the treatment outcomes. MPT (MP + thalidomide), VMP (MP + bortezomib), and MPR-R (MP + lenalidomide) regimens are currently regarded as the new standards of care for elderly patients with multiple myeloma. The prognosis for multiple myeloma is determined by numerous factors, all of which should be considered when choosing the initial therapy. This review covers the new strategies based on the current studies being conducted that are aimed at optimizing treatment outcomes in the patients with newly diagnosed multiple myeloma.

Keywords: multiple myeloma, bortezomib, thalidomide, lenalidomide, treatment, complete remission, overall survival, neuropathy, autologous stem cell transplantation

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Apoptotic markers in CD34-positive cells in acute leukemias

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , , ,

Ye.N. Parovichnikova1, Ye.Ye. Khodunova1, I.V. Galtseva1, S.М. Kulikov1, V.V. Troitskaya1, L.А. Kuzmina1, D.V. Shcheblyakov2, and V.G. Savchenko1

1 Hematology Research Center, RF Ministry of Health, Moscow, Russian Federation

2 N.F. Gamaleya Research Institution of Epidemiology and Microbiology, RF Ministry of Health, Moscow, Russian Federation

ABSTRACT

Objective. To evaluate expression of Bcl-2, Bax, p53, CD95, and ACE on CD34+ cells of peripheral blood and bone marrow during induction chemotherapy in the patients with newly diagnosed acute leukemia.

Materials and methods. Expression of Bcl-2, Bax, p53, CD95, and ACE on CD34+ cells of the peripheral blood and bone marrow in 23 patients with AL (14 AML and 9 ALL) was measured using flow cytometry analysis. Peripheral blood and bone marrow samples were analyzed before chemotherapy and during the induction course: on Days +8, +21 (blood only), and +36–38. The control group consisted of 8 healthy donors.

Results. Bcl-2 expression on CD34+ sells in BM was 34.8 ± 6 % and significantly higher compared to the donors (11.5 ± 1.8 %) at the time of diagnosis. On Days +36–38 after the onset of chemotherapy, no significant difference between the patients and control groups were found. CD34/Bax coexpression in BM cells of ALL patients was significantly higher than in AML patients and donors. ACE and p53 expression on CD34+ cells in AL patients before and during chemotherapy was significantly lower than in the donors. CD34/ACE coexpression in PB and BM cells of AL patients and donors showed no significant differences at any time-points of evaluation.

Conclusion. The above changes suggest the imbalance between the pro- and anti-apoptotic proteins in AL patients. After chemotherapy, the expression profile of these proteins considerably changed, but did not reach the healthy donor values.

Keywords: acute leukemias, apoptosis, expression of Bcl-2, Bax, р53, CD95, and ACE.

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