[Primary mediastinal (thymic) large B-cell lymphoma: review of the literature and author's own data].

AIM: To study morphoimmunological and clinical features of primary mediastinal large B-cell lymphoma (PMLBCL). MATERIAL AND METHODS: We analysed the results of biopsy material study and treatment of 86 PMLBCL patients, effects of different factors on the disease prognosis, efficacy of some therapeutic programs and overall therapeutic efficacy. RESULTS: PMLBCL manifests mainly with massive lesions of anterior upper mediastinum with involvement of adjacent organs and tissues, absence of bone marrow involvement, frequent affection of CNS. Many primary patients have resistance to treatment, sensitive patients have no late recurrences. CONCLUSION: PMLBCL is an independent extranodal variant of non-Hodgkin's lymphoma with special clinical and morphoimmunological characteristics. Criteria are proposed for differential diagnosis of different variants of PMLBCL. New approaches to PMLBSL patients' management are outlined.

[Infectious complications in patients with Hodgkin's lymphoma of unfavourable prognosis].

Analysis of the infectious complications in 48 primary patients with Hodgkin's lymphoma of infavourable prognosis recorded within 1998-2006 is presented. Respiratory tract infections, mucositis and Herpes infection were stated in 43, 24 and 22% of the patients respectively. Bacterial infections predominated (61% of the patients), then followed viral and fungal infections (26 and 43% of the patients respectively). Associations of bacterial and fungal infections were most frequent (50% of the patients). Associations of bacterial and viral infections were less frequent (30%) and fungal and viral infection associations were revealed in 20% of the patients. The structure of the bacterial, viral and fungal infections and the dynamics of the pathogen spectra are presented. The results of the analysis showed that the infections were frequent complications in such patients and could be due not only to obligate but also to opportunistic pathogens, that requires design of the diagnostic algorithm for prediction of the complication process and outcome, thus improving the remote results of the treatment.

[Use of Mabtera (rituximab) in treating patients with refractory courses of B-cell lymphoma, along with high-dose chemotherapy and autologous transplantation of hematopoietic stem cells]. / Primenenie mabtery (rituksimab) u bol'nykh refrakternym techeniem B-kletochnym limfom, poluchaiushchikh vysokodoznuiu khimoterapiiu s autologichenoi transplanttatsiei kletok-predshestvennits gemopoéza.

AIM: To study efficacy of rituximab in patients with resistant B-cell lymphoma on high-dose chemotherapy. MATERIAL AND METHODS: From September 2000 to April 2002 we studied efficacy and tolerance of rituximab at different stages of high-dose chemotherapy. The treatment was given to 10 patients with histologically verified CD20+ non-Hodgkin's lymphoma: diffuse large-cell (n = 4), Berkitt's (n = 2), follicular (n = 3), mantle-cell (n = 1). Five patients with diffuse large-cell lymphoma and Berkitt's lymphoma had a primary resistant course of the disease, one patient with diffuse large-cell lymphoma had a refractory recurrence. Follicular and mantle-cell lymphomas were characterized by a resistant course and large tumor masses. The patients received 1-2 courses of induction chemotherapy with dexa-BEAM with collection of peripheral stem cells followed by high-dose chemotherapy (BEAM-9, CBV + mitoxantron-1) with transplantation of autologous stem blood cells. Rituximab infusion (375 mg/m2) was conducted before the collection of the stem cells, prior to high-dose chemotherapy and in posttransplantation period after recovery of hemopoiesis. RESULTS: 4 patients achieved complete remission, 3-partial remission, 2 had progression and 1-stabilization. In mean follow-up 11 (2-20) months 7 of 10 patients were alive, overall survival being 15 +/- 2.4 months (95% confidence interval 10-19.7), median was not reached. 5 patients are in complete remission: 2 of them without further treatment, 3-after progression and repeat therapy including rituximab and interferon-alpha or rotuximab and CHOP chemotherapy. CONCLUSION: The addition of rituximab can improve the results of high-dose chemotherapy of patients with non-Hodgkin's lymphoma resistant to standard doses of cytostatics. Repeat use of this drug can be effective in some patients with progression after high-dose chemotherapy with rituximab.

[Benzylpenicillin efficacy for neutropenic infection prophylaxis in patients with cancer and postcytostatic neutropenia]. / Effektivnost' naznacheniia benzilpenitsillina dlia profilaktiki neitropenicheskoi infektsii u bol'nykh s opukholevymi zabolevaniiami i posttsitostaticheskoi neitropeniei.

Evaluation of benzylpenicillin (penicillin G) effect for infection prophylaxis at the oncological patients with severe postcytostatic neutropenia was performed. All the patients with neutrophils levels lower than 0.5 x 10(9)/L were recommended to use antibiotics for infection prophylaxis. Test-group (n = 40) used ciprofloxacin (0.5 g twice daily, per os) combined with benzylpenicillin (1.0 g four times daily, i/v); control group was treated by ciprofloxacin in the same dose only. Combination with benzylpenicillin resulted in statistically significant reduction of infections frequency among oncological patients.

Role of glutathione-dependent peroxidase in regulation of lipoperoxide utilization in malignant tumors.

Glutathione content, the activity of glutathione-dependent enzymes (glutathione reductase, glutathione peroxidase, and glutathione S-transferase), and also SOD (superoxide dismutase) and catalase were studied in human malignant tumors (uterus, breast, and ovaries) and normal tissues. Glutathione level and the activity of glutathione-dependent enzymes were 2-3 times higher in the malignant tumors than in normal tissues. A negative correlation between the level of glutathione and glutathione-dependent enzymes (glutathione peroxidase and glutathione S-transferase) in tumors and the efficacy of postoperative chemotherapy may characterize the degree of tumor resistance to chemotherapy and therefore may have prognostic value. Low SOD and catalase activity and high activity of glutathione-dependent enzymes in tumors suggest that glutathione peroxidase and glutathione S-transferase play a major role in peroxide utilization in malignant tumors.

[The role of high-dose chemotherapy with hemopoietic stem cell transplantation in the treatment of breast cancer with unfavorable prognosis]. / Rol' vysokodoznoi khimioterapii s transplantatsiei kletok- predshestvennikov gemopoèza pri lechenii prognosticheski neblagopriiatnykh form raka molochnoi zhelezy.

High-dose chemotherapy using transplantation of hemopoietic precursor cells offers much advantage for treatment of prognostically unfavorable cancers of the breast. Both experimental and clinical evidence points to a potential of raising antitumor effect by increased dosage of chemical drugs. Clinical studies using high-dose chemotherapy for treating patients with stage II-III tumors or with greater than or equal to 10 positive axillary lymph nodes, and locally-advanced and disseminated tumor established a relative rise in overall and recurrence-free survival, as compared with standard treatment. Hazardous cytopenia and related complications can be significantly reduced when hemopoietic precursor cells are transplanted from peripheral blood.

[Superhigh-dosage chemotherapy with the transplantation of autologous hemopoietic precursor cells in patients with a prognostically unfavorable relapse and resistant course of lymphogranulomatosis]. / Sverkhvysokodoznaia khimioterapiia s transplantatsiei autologichnykh kletok predshestvennikov gemopoéza u bol'nykh s prognosticheski neblagopriiatnym retsidivom i rezistentnym techeniem limfogranulematoza.

Eighteen patients with relapsed or refractory Hodgkin's disease (HD) have been treated with high-dose chemotherapy (BEAM regimen) followed by autologous peripheral stem cells and/or bone marrow rescue. There were no treatment-related deaths. Overall response rate was 82%. With a median follow-up of 10 months (3-24 months) overall survival and freedom from progression were 100 and 94% (95% confidence interval 58-97%), respectively. The use of peripheral stem cells in addition to bone marrow resulted in a significant shortening of the time to engraftment (p < 0.01). The BEAM regimen is an effective conditioning schedule which is well tolerated.

[Use of thermal radiochemotherapy in patients with anal epidermoid cancer]. / Primenenie termoradiokhimioterapii u bol'nykh ploskokletochnym rakom anal'nogo kanala.

The authors have developed a new original procedure for combined and multimodal treatment of patients with anal dermoid cancer, which includes radiation therapy, polychemotherapy (platidiam and bleomycin) by using topical superhigh-frequency hyperthermia and antioxidants. The treatment regimen proposed has turned out to be highly effective. It allows sphincter-preserving therapy to be performed without rectal extirpation in most primary patients with anal dermoid cancer.

[Use of autologous hematopoietic stem cells from peripheral blood for transplantation in patients with hematologic and solid neoplasms after high-dose chemotherapy]. / Primenenie autologichenykh kletok-predshestvennikov gemopoéza ia perifericheskoi krovi dlia transplantatsii u bol'nykh s gematologicheskimi i solidnymi novoobrazovaniiami posle vysokodoznoi khimioterapii.

Peripheral mononuclears under normal hemopoiesis and after chemotherapy or/and cytokin were isolated on blood cell separator and cryopreserved. The cells from 22 patients with different hematological and solid malignancies were examined. Mononuclears with high content of hemopoiesis precursors may be collected rapidly after stimulation. Fast and persistent recovery of hemopoiesis in transplantation of this material after superhigh-dose chemotherapy of prognostically unfavourable patients is demonstrated. Cytokin (granulocytic and granulocytic-macrophagal growth factors) promoted fast and reliable production of sufficient quantities of peripheral blood hemopoiesis cells precursors.

[Prevention of hemostatic disorders at different stages of surgical treatment in patients with colonic cancer]. / Profilaktika narushenii sistemy gemostaza na razlichnykh étapakh khirurgicheskogo lecheniia bol'nykh rakom tolstoi kishki.

The status of the hemostasis system was studied in 40 patients with colonic cancer before, during, and after surgery, who were administered no treatment before the operation, and in 30 ones administered depogen with heparin in the preoperative period. Preoperative treatment with depogen had a favorable effect on both coagulation and platelet components of the hemostasis system. Administration of depogen together with heparin reduced the intensity of subacute chronic intravascular blood coagulation during and after surgery in patients with colonic cancer and was conducive to a reduction of the incidence of postoperative complications.

[Regulation of the indices of neuroendocrine status in surgical patients with lung cancer using optimal doses of ascorbic acid]. / Reguliatsiia nekotorykh pokazatelei neiroéndokrinnogo statusa u operiruemykh bol'nykh rakom legkogo optimal'nymi dozami askorbinivoi kisloty.

Blood plasma and urine levels of ascorbic acid (AA) in patients with lung cancer and healthy donors, as well as changes in cortisol, ACTH, STH blood plasma levels have been studied before surgery and on the 1st and 7th day after surgery in patients who were given AA (2g/day) for 7 days preoperatively and postoperatively and patients who were not given AA. A significant decrease in AA blood plasma and urine levels has been observed in patients with lung cancer, as compared to healthy donors. Despite 7-day premedication with AA in patients with lung cancer, cortisol ACTH and STH concentrations remained practically unchanged. The levels of the above hormones depended on the course of the postoperative period and AA intake. A more rapid recovery of cortisol, ACTH and STH levels and uncomplicated postoperative period were observed in the majority of patients with lung cancer given AA before and after surgery, as compared to those who were not given AA, which is indicative of anti-stress AA effect. An increase in stress adaptation capacity in cancer patients due to normalizing effect of AA on the adrenal cortex function confirms the necessity and expediency of AA introduction into complex pre- and postoperative intensive therapy of patients with lung cancer.

[The effect of antioxidants on the hemostasis system in patients with cancer of the lung]. / Vliianie antioksidantov na sistemu gemostaza u bol'nykh rakom legkogo.

Addition of drugs improving blood viscosity to premedication with antioxidants promotes to normalization of platelet function, thus attenuating the intensity of chronic intravascular coagulation syndrome and improving the state of microcirculation in patients with lung cancer. The above premedication decreases the incidence of postoperative complications.

[Intensive therapy using antioxidants in patients with lung cancer and respiratory insufficiency]. / Intensivnaia terapiia s ispol'zovaniem antioksidantov u bol'nykh rakom legkogo s dykhatel'noi nedostatost'iu.

Positive changes of respiratory function parameters and oxidation-reduction processes observed in 55 patients with lung cancer and low functional respiratory reserve indicate the advisability of introducing antioxidants and antiaggregants (cytochrome C, aevitum, Trental, rheopolyglucin) into complex intensive preoperative correcting therapy for the expansion of indications for surgery and attenuation of the operative risk.

[Characteristics of the state of the hemostasis system in patients with lung cancer and concomitant respiratory insufficiency]. / Osobennosti sostoianiia sistemy gemostaza u bol'nykh rakom legkogo s soputstvuiushchei dykhatel'noi nedostatochnost'iu.

The aggregate of disorders of the hemostasis system revealed in patients with cancer of the lung, respiratory insufficiency, and hypoxemia should be evaluated as the presence of chronic disseminated vascular blood clotting. The degree of these disorders requires obligatory use of methods for correction, both before the operation and before the prescription of any special method for the management of cancer of the lung.

[Preoperative correction of lipid peroxidation in patients with lung cancer]. / Predoperatsionnaia korrektsiia perekisnogo okisleniia lipidov u bol'nykh rakom legkogo.

The disturbed lipid peroxidation and oxidation-reduction processes revealed in patients with lung cancer should be regarded as decompensation of intracellular metabolic mechanisms. The degree of the above disturbances demands correction by using antioxidants both in the pre- and early postoperative period, which is directly confirmed by the results of surgical treatment of patients with lung cancer. To predict the course of the postoperative period, one, along with clinical data, can use such indexes as malonic aldehyde content and superoxide dismutase activity.

[Treatment of the pain syndrome in cancer patients by peridural administration of low doses of opiates]. / Lechenie bolevogo sindroma u onkologicheskikh bol'nykh metodom peridural'nogo vvedeniia malykh doz opiatov.

Peridural injections of morphine were given to 180 incurable cancer patients suffering chronic pain. The effectiveness of the said procedure as well as its side-effects were assessed. A relationship between the external respiration parameters, on the one hand, and drug dosage and time postinjection, on the other, was studied. The data obtained point to the effectiveness of the said method and suggest that it be used as a universal procedure for the treatment of intractable pain in incurable patients.