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  • Title: PROGNOSIS OF THE COURSE OF CHORNOBYL-ORIGINATED ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN IN UKRAINE DEPENDING ON THE REASON OF STANDARD CHEMOTHERAPY INTERRUPTION.
    Author: Bebeshko VG, Bruslova KM, Tsvetkova NM, Lyashenko LO, Pushkariova TI, Gonchar LO, Tryhlib IV, Yatsemirskyi SM, Samson YM, Boyarskyi VG, Grischenko KV, Polyanska VM, Dmytrenko IV.
    Journal: Probl Radiac Med Radiobiol; 2019 Dec; 24():335-349. PubMed ID: 31841478.
    Abstract:
    OBJECTIVE: Estimation of the bone marrow haemopoietic status depending on the reasons and duration of breaks in a standard chemotherapy (BFM-ALL protocol) to predict the course of acute lymphoblastic leukemia (ALL) in chil- dren exposed to low doses of ionizing radiation after the Chornobyl accident. MATERIALS AND METHODS: The ALL patients (n = 34) were examined within 5 stages of a program chemotherapy. The clinical symptoms, hemogram and myelogram data were analyzed. The radiation dose on bone marrow, initial leuko- cyte count, variants and prognosis of ALL course were accounted. Days of the stopped chemotherapy, type and fre- quency of complications (septic processes, febrile neutropenia, toxic hepatitis, granulocytopenia degree), and the prognosis of disease course (child living status, i.e. alive or died) were estimated. RESULTS: There were abnormal differentiation processes and high percentage of lymphoblasts (86.2 ± 3.3) % in bone marrow in the 1st acute period. Hematological remission was established in all patients on the 33rd day of chemothe- rapy. In a half of cases the haematopoietic recovery occurred by a granulocyte-monocyte type. One third of patients presenting an erythroid type of haemopoiesis died later. The inverse correlation was found between the number of myelocaryocytes and disease prognosis (rs = -0.49). Breaks in chemotherapy for various reasons were recorded. The number of patients with granulocytopenia was greater at the phase 1 and 2 of protocol I and protocol M application, coinciding with a higher incidence of complications. An inverse correlations between the prediction of ALL course and sum of days of breaks between the protocol M and phase 1 of protocol II (rs = -0.56), as well as the duration of the phase 2 of protocol II (rs = -0.62) were found. The radiation dose on bone marrow was (5.37 ± 1.23) mSv. No relationship was found between the radiation doses, ALL variants and disease course. CONCLUSIONS: Prognosis of ALL course in children depends on the type of haemopoietic recovery and reasons of breaks in a standard chemotherapy. Interaction between the haemopoiesis functioning and microenvironment and that of their regulation are the key mechanisms of above-mentioned abnormalities, which is the basis for further research. Meta: otsinyty stan kistkovomozkovogo krovotvorennia zalezhno vid prychyn i tryvalosti pererv pry provedenni standartnoï khimioterapiï za protokolom BFM-ALL dlia prognozu perebigu gostrykh limfoblastnykh ley̆kemiy̆ (GLL) u ditey̆, iaki zaznaly vplyvu malykh doz ionizuiuchogo vyprominiuvannia vnaslidok avariï na ChAES.Materialy i metody. Obstezheno 34 khvorykh na GLL na 5 etapakh programnoï khimioterapiï. Vyvchaly klinichnu symp- tomatyku, pokaznyky gemogram i miielogram. Vrakhovuvaly dozy oprominennia na kistkovyy̆ mozok, initsial'ne chys- lo ley̆kotsytiv, varianty ta prognoz perebigu GLL. Otsiniuvaly kil'kist' dniv zupynok pry provedenni khimioterapiï, vyd i chastotu uskladnen' (septychni protsesy, febryl'nu ney̆tropeniiu, toksychnyy̆ gepatyt, stupin' granulotsyto- peniï) ta prognoz perebigu zakhvoriuvannia (zhyva zhytyna chy pomerla).Rezul'taty. V I gostryy̆ period u khvorykh v kistkovomu mozku maly mistse zminy protsesiv dyferentsiiuvannia i vy- sokyy̆ vidsotok limfoblastiv (86,2 ± 3,3) %. Na 33-y̆ den' khimioterapiï u vsikh khvorykh bulo konstatovano gemato- logichnu remisiiu. U polovyny khvorykh krovotvorennia vidnovliuvalos' za granulotsytarno-monotsytarnym typom. Tretyna khvorykh, u iakykh sposterigavsia erytroïdnyy̆ typ gemopoezu, v podal'shomu pomerly. Vstanovleno zvorot- nyy̆ koreliatsiy̆nyy̆ zv'iazok mizh kil'kistiu miielokariotsytiv i prognozom perebigu zakhvoriuvannia (rs = -0,49). Pry provedenni khimioterapiï u ditey̆ buly perervy v likuvanni z riznykh prychyn. Chyslo khvorykh z granulotsytopeniieiu bulo bil'shym na 1-y̆ i 2-y̆ fazi protokolu I ta protokoli M, i tse spivpadalo z bil'shoiu chastotoiu uskladnen'. Vsta- novleno zvorotni koreliatsiy̆ni zv'iazky mizh prognozom perebigu GLL i sumoiu dniv pererv mizh protokolom M ta 1-iu fazoiu protokolu II (rs = -0,56), a takozh tryvalistiu 2-ï fazy protokolu II (rs = -0,62). Doza na kistkovyy̆ mozok u ditey̆ dorivniuvala (5,37 ± 1,23) mZv. Ne vyznacheno zv'iazku mizh dozamy oprominennia khvorykh, variantamy GLL i perebigom zakhvoriuvannia.Vysnovky. Prognoz perebigu GLL u ditey̆ zalezhyt' vid typu vidnovlennia krovotvorennia ta prychyn pererv pry provedenni standartnoï khimioterapiï. V osnovi vyznachenykh zmin lezhat' mekhanizmy vzaiemodiï mizh funktsionuvan- niam gemopoezu, mikrootochenniam ta ïkh reguliatsiieiu, shcho ie pidgruntiam dlia podal'shogo vyvchennia.
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