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Title: PROGNOSIS OF ACUTE LEUKEMIA DEPENDING ON THE IRON METABOLISM PARAMETERS IN CHILDREN AFTER CHORNOBYL NUCLEAR POWER PLANT ACCIDENT.
Author: Bebeshko VG, Bruslova KM, Lyashenko LO, Tsvietkova NM, Gonchar LO, Galkina SG, Zaitseva AL, Reznikova LS, Iatsemyrskii SM, Tsvet LO.
Journal: Probl Radiac Med Radiobiol; 2020 Dec; 25():390-401. PubMed ID: 33361849.
Abstract:
OBJECTIVE: To determine the influence of iron metabolism on the prognosis of acute lymphoblastic (ALL) and (AML)myeloblastic leukemia at the different phases of chemotherapy in children after Chоrnobyl accident. MATERIALS AND METHODS: 333 children (295 - ALL, 38 - AML) were examined at the stages of chemotherapy. Thecomparison group included 93 children without leukemia. Acute leukemia variants, patients survival, relapses, thenature of disease (live child or died), iron methabolism (morphometric parameters of erythrocytes, SI, SF, STf, TS),manifestations of dyserythropoiesis, bone marrow sideroblast and patients radiation dose were taken into account. RESULTS: In 295 patients with ALL the following variants of leukemia were established: pro-B-ALL in 23, «common»type of ALL in 224, pre-B-ALL in 29, T-ALL in 19. Thirty eight patients were diagnosed with AML (11 - M1, 19 - M2,8 - M4). Doses of radiation in patients with AL were (2.78 ± 0.10) mSv and they did not correlate with clinical andhematological parameters, disease variant. Relapse rates and shorter survival were in patients with T-ALL, pro-B-ALLand AML with SF levels > 500 ng/ml (p < 0.05). The amount of children with normochromic-normocytic anemias andmanifestations of dysplasia of erythroid lineage elements was greater in the AML than in ALL. SF content in patientswas elevated during chemotherapy and was lower than the initial one only in the remission period. Transferrin wasreliably overloaded with iron: TS (70.2 ± 2.3) % compared with the control group (32.7 ± 2.1) %. Correlationbetween TS and survival of patients was detected (rs = -0.45). Direct correlation between the number of iron granules in erythrocariocytes and SF level (rs = 0.43) was established, indicating the phenomena of ineffective erythropoiesis. CONCLUSIONS: The negative influence of iron excess in the patients body on the hemopoiesis function, manifestations of ineffective erythropoiesis and the course of acute leukemia in children have been established. Changes inferrokinetic processes in children can be the basis of leukemоgenesis development. Meta: vyznachyty vplyv obminu zaliza na prognoz perebigu gostrykh limfoblastnykh (GLL) ta miieloblastnykh leĭkemiĭ (GML) u diteĭ pislia Chornobyl's'koï avariï na etapakh khimioterapiï.Materialy i metody. Obstezheno 333 dytyny (295 z GLL, 38 z GML) na etapakh khimioterapiï. Do grupy porivnianniauviĭshlo 93 dytyny. Vrakhovuvaly varianty gostrykh leĭkemiĭ, vyzhyvanist' khvorykh, retsydyvy, vypadky smerti, pokaznyky obminu zaliza (morfometrychni parametry erytrotsytiv, kontsentratsiia zaliza, ferytynu i transferynu usyrovattsi krovai, koefitsiient nasychennia transferynu zalizom), proiavy dyzerytropoezu, syderoblasty v kistkovomu mozku ta dozy oprominennia khvorykh.Rezul'taty. U 295 khvorykh na GLL buly vstanovleni taki varianty leĭkemiĭ: pro-V-GLL – u 23, «zagal'nyĭ» typGLL – u 224, pre-V-GLL – u 29, T-GLL – u 19. U 38 patsiientiv diagnostuvaly GML (11 – M1, 19 – M2; 8 – M4). Dozyoprominennia khvorykh na gostru leĭkemiiu stanovyly (2,78 ± 0,10) mZv i vony ne koreliuvaly z kliniko-gematologichnymy pokaznykamy ta variantom khvoroby. Chastota retsydyviv i korotsha vyzhyvanist' buly u patsiientiv, khvorykh na T-GLL, pro-V-GLL ta GML z rivniamy syrovatkovogo ferytynu ponad 500 ng/ml (r < 0,05). Chastka diteĭ znormokhromno-normotsytarnymy anemiiamy i proiavamy dysplaziï elementiv erytroïdnogo riadu bula bil'sha pryGML, nizh pry GLL. Vmist syrovatkovogo ferytynu u patsiientiv pidvyshchuvavsia pry provedenni khimioterapiï i buvnyzhchyĭ za pochatkovyĭ lyshe v period remisiï. Transferyn buv dostovirno perevantazhenyĭ zalizom: koefitsiientnasychennia transferynu zalizom – (70,2 ± 2,3) %, porivniano z grupoiu kontroliu – (32,7 ± 2,1) %. Vstanovleno zvorotnyĭ koreliatsiĭnyĭ zv’iazok mizh koefitsiientom nasychennia transferynu zalizom i vyzhyvanistiu khvorykh (rs = -0,45)Vstanovleno priamyĭ koreliatsiĭnyĭ zv’iazok mizh chyslom granul zaliza v erytrokariotsytakh ta rivnem syrovatkovogo ferytynu (rs = 0,43), shcho svidchyt' pro iavyshcha neefektyvnogo erytropoezu.Vysnovky. Vstanovleno negatyvnyĭ vplyv nadlyshku zaliza v organizmi khvorykh na stan gemopoezu, proiavy neefektyvnogo erytropoezu ta perebig gostrykh leĭkemiĭ u diteĭ. Zminy ferokinetychnykh protsesiv u diteĭ mozhut'lezhaty v osnovi leĭkemogenezu.

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