Immune thrombocytopenia in the aspect of multiple primary neoplasms

   Multiple primary malignant neoplasms (MPMNs) is a complex process in which the development of 2 or more neoplasms simultaneously or after a certain interval is observed. MPMNs develop independently from each other within one or more organs. Many etiopathogenetic factors can cause MPMNs. Numerous studies have been conducted to study the effect of T-cell immunity on the development of this pathology. Today, there is a steady upward trend in the prevalence of mpmns, which, on the one hand, is due to more effective methods of early diagnosis, an increase in patient overall survival, and early antitumor therapy (chemotherapy, radiation therapy), on the other hand, this trend may be associated with pathology of T-regulatory cellular immunity. T-regulatory cells play a strategic role in the development of immune homeostasis, and their function is closely related to the occurrence of a wide range of pathologies, including autoimmune diseases and malignant neoplasms. The article presents a clinical case of a patient with a confirmed diagnosis: mpmn, immune thrombocytopenia (idiopathic thrombocytopenic purpura). On prednisolone therapy, remission was achieved for 2 metachronous tumors and a complete hematological response for immune thrombocytopenia was obtained. there were no signs of hemorrhagic syndrome and complications during prednisone therapy. It is planned to continue monitoring the patient for metachronous tumors by a hematologist, an oncologist at the place of residence, as well as at the center for orphan diseases of the Moscow Regional Research Clinical Institute named after M. F. Vladimirsky with control of platelets and general condition.

1. Gantsev Sh.Кh. Oncology Practical Training Guide. Moscow: MIA, 2007. 406 p. (In Russ.).

2. Lv M., Zhang X., Shen Y. et al. Clinical analysis and prognosis of synchronous and metachronous multiple primary malignant tumors. Medicine (Baltimore) 2017;96(17):е6799. DOI: 10.1097/MD.0000000000006799

3. Wang Y., Jiao F., Yao J. et al. Clinical features of multiple primary malignant tumors: a retrospective clinical analysis of 213 chinese patients at two centers. Discov Med 2021;32(166):65–78.

4. Li X., Kang J., Pan Q. et al. Genetic analysis in a patient with nine primary malignant neoplasms: a rare case of Li­Fraumeni syndrome. Oncol Rep 2016;35(3):1519–28. DOI: 10.3892/or.2015.4501

5. Cancer. Principles & Practice of Oncology. 7^th edn. Lippincott Williams & Wilkins, 2004. 3120 p.

6. Kazubskaya Т.Р., Belyaev N.F., Nefedov M.D. et al. Clinical and genetic analysis of primary polyneo­plasia. Rossiyskiy onkologicheskiy zhurnal = Russian Journal of Oncology 2007;(2):4–9.

7. Testori A., Cioffi U., De Simone M. et al. Multiple primary synchronous malignant tumors. BMC Res Notes 2015;8:730. DOI: 10.1186/s13104-015-1724-5

8. Tanaka A., Sakaguchi S. Regulatory T cells in cancer immunotherapy. Cell Res 2017;27(1):109–18. DOI: 10.1038/cr.2016.151

9. Takeuchi Y., Nishikawa H. Roles of regulatory T cells in cancer immu­nity. Int Immunol 2016;28(8):401–9. DOI: 10.1093/intimm/dxw025

10. Vogt A., Schmid S., Heinimann K. et al. Multiple primary tumours: challenges and approaches, a review. ESMO Open 2017;2(2):e000172. DOI: 10.1136/esmoopen-2017-000172