Currently, lenalidomide is the only immunomodulatory drug (IMiD) approved for maintenance therapy in patients with newly diagnosed multiple myeloma who have received high-dose chemotherapy and autologous stem cell transplantation (ASCT). The maintenance with lenalidomide showed an advantage over placebo or observation for both progression-free and overall survival in a series of phase 3 randomized trials. Salvage ASCT can be performed after disease relapse in case of a long-term response after the first transplantation or if this option has not been performed before. Pomalidomide is a third-generation IMiD approved for the treatment of relapsed and refractory multiple myeloma, which is efficient in patients with resistance to lenalidomide and proteasome inhibitors. Structurally, lenalidomide and pomalidomide are similar, and therefore the latter can also be considered as a drug for maintenance, however, there are no relevant phase 3 randomized trials. In this article, we present a clinical case of a 60-year-old patient with newly diagnosed multiple myeloma who progressed after 2 lines of induction therapy, which included lenalidomide and two proteasome inhibitors (bortezomib, ixazomib). The use of Pd combination (pomalidomide, dexamethasone) made it possible to achieve a repeated response and implement of salvage ASCT. The second ASCT was carried out only 12 months later after the first due to the COVID-19 pandemic. Subsequent long-term maintenance therapy with pomalidomide resulted in a complete response and minimal residual disease negativity. The resulting response has persisted at the time of this writing for over 2 years. To discuss the presented clinical case, the data of the French phase 2 IFM 2013-01 study were used, in which patients with failed first-line transplantation in case of relapse received PCd (pomalidomide, cyclophosphamide, dexamethasone) induction, salvage ASCT, and maintenance by Pd until disease progression. Pomalidomide may be an acceptable substitute for lenalidomide in patients with prior intolerance or refractory to this IMiD.

One possible manifestation of multiple myeloma may be extramedullary plasmacytoma, manifested by infiltration of plasma cells outside the bone marrow. In the debut of the disease, bone plasmacytomas are most often diagnosed, in contrast to extramedullary ones, which are rare. According to the literature, the presence of extramedullary plasmacytoma is an unfavorable factor characterized by an aggressive disease course, the absence of an antitumor response to standard therapy, and low overall survival rates. Therefore, the pathogenesis, clinic, diagnosis and treatment of this variant of the disease require additional study. This article presents a clinical case of an aggressive course of extensive extramedullary plasmacytoma in a patient with multiple myeloma with an assessment of various combination therapy regimens efficacy.

The article presents an analysis of the current state of the problem of the combination of lymphoproliferative diseases associated with pregnancy. Analysis of literature sources has shown that despite the seemingly obvious unfavorable relationship between pregnancy and lymphoproliferative diseases, most studies demonstrate a favorable prognosis regarding the prognosis and outcome of this oncological pathology in combination with pregnancy. The Research Institute of Oncology of the Tomsk SRI has sufficient experience in the treatment of this pathology, including on the background of pregnancy. We have presented two clinical cases in which successful treatment of lymphoproliferative processes in pregnant women has been demonstrated.

Despite the therapy advances, largely due to the study of molecular biology, multiple myeloma remains an incurable disease, and refractory course or relapses significantly worsen the prognosis. In this regard, the development of effective therapeutic agents with fundamentally new mechanisms of action that provide increased survival is currently an urgent task. One potential immunotherapeutic target is signaling lymphocyte activation molecules (SLAMs), and the anti-SLAMF7 monoclonal antibody elotuzumab is used in combination with either lenalidomide and dexamethasone (Elo-Rd regimen) after 1 prior line of therapy, or with pomalidomide and dexamethasone (Elo-Pd regimen) after 2 or more lines of therapy. The results of studies demonstrated a survival benefit in all subgroups of patients with refractory or relapsed multiple myeloma when using elotuzumab. A manageable safety profile and a low frequency of grade III–IV induced myelosuppression were noted, which allows the use of elotuzumab in combination with lenalidomide or pomalidomide and dexamethasone in elderly and debilitated patients. We present our own experience of using elotuzumab in the treatment of patients with refractory/recurrent multiple myeloma. A clinical case of a patient in whom treatment with elotuzumab was initiated at an early stage (after 1 line of previous therapy) is presented; the effectiveness and safety of using the monoclonal antibody are assessed. A significant improvement in the patient’s clinical condition and positive dynamics according to laboratory data were noted already during the 1st cycle of Elo-Rd regimen with a further progressive deepening of the antitumor response along with satisfactory tolerability and the absence of significant adverse events.

Background. Mastocytosis is a heterogeneous group of diseases that are characterized by excessive proliferation and accumulation of clonal (neoplastic) mast cells in one or more organs. Advanced variants of systemic mastocytosis (aggressive systemic mastocytosis, systemic mastocytosis associated with hematological neoplasm, and mast cell leukemia) are characterized by infiltration of organs by mast cells, which leads to organs dysfunction. Such patients require a more active approach and the use of cytoreductive therapy. Available therapeutic options include imatinib, interferon-alpha, cladribine. Only one of the targeted drugs is registered in Russia – midostaurin. Midostaurin is a potent                    multikinase inhibitor that is active against KIT regardless of mutation status. Midostaurin has shown its effectiveness in clinical trials, however, we know that data from real clinical practice often differ from clinical studies due to the characteristics of patients (preserved comorbid status, stable disease parameters) traditionally included in clinical trials.

Aim. To evaluate the effectiveness and safety of midostaurin in patients with advanced variants of systemic mastocytosis in real clinical practice.

Materials and methods. This work analyzed 13 patients (7 (54 %) men and 6 (46 %) women) who received midostaurin therapy for systemic mastocytosis (aggressive systemic mastocytosis – 9 (69 %), systemic mastocytosis associated with a hematological neoplasm – 4 (31 %)). The median age of patients when the diagnosis was verified was 73 (61–87) years, the median age when midostaurin was prescribed was 74 (61–88) years. According to the International prognostic scoring system for mastocytosis (IPSM) based on clinical variables, patients are classified as follows groups: SM1 – 1 (8 %) patient, SM2 – 3 (23 %), SM3 – 8 (61 %), SM4 – 1 (8 %).

Results. As a result of therapy, clinical improvement was achieved in 10 (77 %) patients, and stabilization in 3 (23 %) patients. During midostaurin therapy, grade I–II adverse events were noted from the gastrointestinal tract: nausea in 5 patients (38 %), vomiting in 2 (15 %), diarrhea in 6 (46 %). Hematological toxicity of grade I–II was also observed: anemia in 6 (46 %) patients, thrombocytopenia in 5 (38 %) patients. The median overall survival in the group was not achieved. The 2-year overall survival rate was 75 %.

Conclusion. The study results suggest the potential efficacy and safety of midostaurin in patients with aggressive systemic mastocytosis and systemic mastocytosis associated with hematological malignancies.

Multiple myeloma is a malignant tumor characterized by the proliferation of clonal plasma cells and currently remains an incurable disease, despite advances in therapy. Resistance and development of double refractoriness represent a significant problem, worsening the prognosis. To overcome double refractoriness, new proteasome inhibitors carfilzomib and ixazomib, the 3rd generation immunomodulator pomalidomide and monoclonal antibodies daratumumab, elotuzumab and isatuximab are used. Based on randomized phase III ICARIA-MM and IKEMA studies results, which demonstrated, along with a manageable safety profile, advantages in increasing the antitumor response depth, the rate of achieving negative minimal residual disease status and survival in all subgroups of patients with refractory/relapsed multiple myeloma, isatuximab is used in IsaPd (isatuximab, pomalidomide, dexamethasone) and IsaKd (isatuximab, carfilzomib, dexamethasone) combination. This article discusses the clinical pharmacology of isatuximab. The results of studies demonstrating the effectiveness and safety of antitumor therapy regimens including isatuximab, which made it possible to use it in clinical practice, are presented. We present a case report of a patient with refractory/relapsed multiple myeloma who received 3 lines of antitumor treatment, including class 2 proteasome inhibitors, lenalidomide and the monoclonal antibody elotuzumab. After 3 cycles of IsaPd (8 injections of isatuximab), partial remission and pain relief were recorded. The achieved antitumor effect, along with the absence of significant adverse events, facilitated the continuation of therapy at recommended doses.

H3K27M-altered diffuse midline gliomas are the most devastating pediatric brain tumors. These tumors are characterized by lesion of central nervous system midline structures, diffuse infiltrative growth and fatal prognosis. The pathogenesis of H3K27M-altered diffuse midline glioma is based on unique epigenetic and genetic changes which are associated with histone 3 (H3) alterations. Clinical disease course usually is non-specific, that could hamper diagnosis establishment and defines high prevalence of disseminated tumor stages. Diagnostic approach includes neuroimaging, various laboratory and molecular methods, including high throughput sequencing, which allows finding potential targets for precise therapy. Despite the availability of anti-tumor technologies, including targeted therapy and immunotherapy, the standard of care for H3K27M-altered diffuse midline glioma is radiation therapy, which does not allow achieving long-term event-free survival. A dismal prognosis and absence of curative options for these tumors determine the necessity of new treatment methods search that could improve patients’ outcome. In this article we present current worldwide data of the diagnosis and treatment trends in H3K27M-altered diffuse midline glioma.

Background. Targeted therapy is the most promising in the treatment of myelofibrosis, but it is necessary to search for the reasons limiting its effectiveness. There are known factors negatively affecting the development of myelofibrosis, but data on their negative impact in the context of targeted therapy are scarce.

Aim. Assessing the impact of cytogenetic and genetic abnormalities on the course and therapy results for primary and secondary myelofibrosis during ruxolitinib therapy.

Materials and methods. The prospective study included 106 patients with myelofibrosis in the chronic phase (53 (50 %) men and 53 (50 %) women) who received ruxolitinib at the Moscow City Hematology Center, S.P. Botkin City Clinical Hospital. The median age of patients was 62 (18–84) years. The median disease duration before initiation of ruxolitinib therapy was 79 (1–432) months. Before therapy, genetic studies were performed, including next-generation sequencing. The median duration of ruxolitinib therapy was 33 (1–111) months. The influence of the cytogenetic landscape, driver mutations, allele burden of JAK2 (over time) and CALR, additional mutations on the dynamics of symptoms, spleen size, achievement of hematological response, overall survival, progression-free survival, survival without blast crisis and without progression of myelofibrosis with targeted therapy was assessed.

Results. The studied genetic factors did not have a significant correlation with hemogram parameters. The hematological response in patients with JAK2 and CALR mutations compared favorably with the response in the groups with the MPL mutation and triple negative status (TNS). Higher hematological response rate was obtained in the group with initially low allele burden <50 % of JAK2 or CALR. Significant differences in 5-year overall survival were found between groups of patients with TNS and JAK2 and CALR mutations (p  <0.05); with CALR  allele burden <50 % and ³50 % before initiation of ruxolitinib therapy (p = 0.01); the presence or absence of positive dynamics of the JAK2 allele burden during treatment (p <0.05); additional mutations assigned to different pathogenicity groups (p <0.05); with different number of pathogenic mutations (1 or ³2), the presence or absence of pathogenic mutations in the ASXL1 (p = 0.002) and SETBP1 (p = 0.00001) genes. The 5-year progression-free survival was significantly different in cohorts of patients with or without positive dynamics of the JAK2 allelic load during treatment (p <0.05); additional mutations assigned to different pathogenicity groups (p <0.05); with a different number of pathogenic mutations (1 or ³2), the presence or absence of a pathogenic mutation of the SETBP1 gene (p = 0.003). Progression-free survival did not correlate with the type of driver mutation or its absence; however, all patients with TNS died from myelofibrosis progression. Significant differences in 5-year blast crisis-free survival were observed between groups with JAK2 and MPL mutations (p = 0.001), JAK2 and TNS (p = 0.002); difference in 5-year survival without progression of fibrosis – between groups with pathogenic and benign (p = 0.031); uncertain and benign (p = 0.001) mutations.

Conclusion. The study identified genetic markers associated with decreased efficacy of ruxolitinib therapy.

Lymphoblastic lymphomas (LBL) are the second most common subtype of non-Hodgkin’s lymphomas in children and adolescents, accounting for 25–35 % of all non-Hodgkin’s lymphomas cases. The majority of all lymphoblastic lymphomas (80–85 %) are T-lymphoblastic origin; 15–20 % origins from B-cell precursors, biphenotypic LBL are extremely rare. Currently, the overall and relapse-free survival of children and adolescents with LBL exceeds 80 %, uses of modern therapy programs. However, the survival rates of patients with recurrent or refractory LBL remain low – 10 %. Optimization of therapeutic approaches in LBL follows the path of clarifying clinical, morpho-immunological and molecular biological risk groups, modification of treatment programs using new drugs (including immunotherapy, inhibitors of multifunctional intracellular signaling pathways (NOTCH, PI3K/AKТ/mTOR, JAK/STAT and MAPK), affecting the cell cycle regulation), and also a reduction in immediate and long-term toxicity. This article presents modern approaches to the diagnosis of LBL, staging and choosing of a treatment method.

Background. In current clinical practice, there are no reliable methods to stratify patients with a high risk of relapse or with a primary refractory form of Hodgkin lymphoma. Quantification of CD30-positive small extracellular vesicles (CD30(+)SEV) in plasma seems to be a possible approach to solve this issue. CD30(+)SEV can be quantified by the AuNP aptasensor technology based on the enzyme-mimetic properties of gold nanoparticles and the CD30-specific affinity of DNA aptamers.

Aim. To quantify CD30(+)SEV in the plasma of patients with newly diagnosed Hodgkin lymphoma; to investigate the links between estimated parameter and clinical/morphological properties of disease and the effect of first two chemotherapy cycles.

Material and methods. A semi-quantitative analysis of CD30(+)SEV in the plasma of patients with Hodgkin lymphoma (n = 55) was performed using the AuNP aptasensor. The relationship between the CD30(+)SEV concentration and the data of standard diagnostic approaches was evaluated through the r-Pearson correlation coefficient, the Mann–Whitney and Kruskal–Wallis criteria.

Results. The plasma concentration of CD30(+)SEV in patients with Hodgkin lymphoma correlates with the quantity of CD30(+) cells in tissues of biopsied lymph nodes (r = 0.8) and the total lesion glycolysis estimated by PET/CT (r = 0.9). Patients with a relatively high concentration of CD30(+)SEV are characterized by an increase of erythrocyte sedimentation rate and leukocytosis compared with patients with a lower concentration of CD30(+)SEV. Two cycles of chemotherapy reduced CD30(+)SEV concentration, and this effect was more pronounced in patients treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) regime than the BEACOPPesc (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, procarbazine).

Conclusion. AuNP-aptasensor can be used for semi-quantitative assessment of CD30(+)SEV in plasma. The estimated CD30(+)SEV concentration correlates with the clinical and morphological parameters of patients with Hodgkin lymphoma and may reflect the severity of the disease. To assess the diagnostic and/or prognostic potential of developed technology, large-scale multicenter studies are required.

Background. Recently, studies have been conducted all over the world to study the role of immune checkpoints in the pathogenesis of chronic lymphocytic leukemia (CLL) and the possibility of their use as prognostic markers. Of greatest interest are PD-1 (programmed cell death-1) and LAG-3 protein (lymphocyte-activation gene 3).

Aim. To study the features of PD-1 (CD279) and LAG-3 (CD223) expression on blood B-cells of CLL patients and the possibility of their use as early markers for predicting the hematological response to therapy.

Materials and methods. The blood of 30 patients with CLL in stage C according to Binet and 20 healthy individuals was studied by 10-color flow cytometry.

Results. In patients with CLL, there were significant differences in the initial lymphocytes level, PD-1 and LAG-3 expression on B-lymphocytes, both with persons in the control group and among themselves with different hematological responses to therapy with rituximab according to the results of minimal residual disease monitoring.

Conclusion. PD-1 and LAG-3 can be used as early markers for predicting the response of CLL patients to therapy. The combined use of initial lymphocytes level and PD-1 and LAG-3 expression on CD19+ blood cells has a greater prognostic value. New data obtained from the study of immune checkpoints PD-1 and LAG-3 may be useful in the development of targeted therapeutic agents.

Natural killer cells are a key component of the innate immune system in the fight against tumors. However, in acute myeloid leukemia there is a decrease in the functional activity of these cells. Their activity is under constant control of one or more inhibitory receptors and depends on the balance of inhibitory receptors activation and activating receptors stimulation. This review examines the key inhibitory and activating receptors of natural killer cells and summarizes literature data describing changes in their expression in patients with acute myeloid leukemia.

Background. The using of killer-cell immunoglobulin-like receptor (KIR) composition data is of increasing interest in clinical practice to select an optimal donor for allogeneic hematopoietic stem cell transplantation for treatment of hematologic malignancies to reduce graft versus host disease and the risk of relapse. It is also of interest to study the frequencies of KIR genes and genotypes in different populations. For the Russian Federation, KIR gene and genotype frequencies have been described for only a few relatively small samples and have not been fully studied. The study of KIR gene and genotype frequencies has not been conducted for the Samara region population to date.

Aim. To study the frequencies of KIR genes and genotypes in the population of Samara region and to compare the data with previously described Russian populations.

Materials and methods. To study the frequencies of KIR genes and genotypes, molecular genetic typing of 142 CBUs from the public cord blood bank of the Samara Regional Medical Centre “Dynasty” was performed. Molecular genetic typing of KIR genes was performed by polymerase chain reaction with sequence-specific primers with subsequent visualization of products in agarose gel. 16 KIR genes and pseudogenes were analyzed: 2DL1, 2DL2, 2DL3, 3DL1, 3DL2, 2DS1, 2DS2, 2DS3, 2DS4, 2DS5, 3DS1, 2DP1, 3DL3, 2DL4, 2DL5, 3DP1. KIR gene frequencies were determined by direct counting. Genotypes were determined using Allele Frequencies database. A determination B-content group was performed using the Donor KIR B-content group calculator. Statistical analysis was performed using the χ2 test.

Results. The highest frequency of KIR inhibitory genes was found for KIR2DL1 (98.6 %), KIR3DL1 (98.6 %), KIR2DL3 (96.5 %), KIR2DL5 (46.5 %), and KIR2DL2 (34.5 %). The most frequent among the activating receptor genes was KIR2DS4 (89.4 %), the frequencies of other KIR activating genes were KIR2DS2 – 45.1 %, KIR2DS1 – 35.9 %, KIR2DS3  33.8 %, and KIR2DS5 – 26.1 %. Comparative analysis of KIR gene frequencies in the population of Samara region and other Russian populations revealed certain differences. Significant differences in the frequencies of occurrence were found for KIR2DL3, KIR2DS4, KIR2DL2, KIR2DL5, KIR2DS3, KIR2DS5, as well as KIR2DP1 and KIR3DP1. Examination of 142 samples revealed 45 different genotypes: AA genotypes were detected in 30 % and Bx genotypes in 70 % of cases. AA genotype ID195 with a frequency of 5.6 % was detected, which has not been previously described in Russian populations. Among the Samara region population sample, only 3.5 % had the “best” status, 20.4 % had the “better” status, and 76.1 % had the “neutral” status of the B-content.

Conclusion. The results obtained in this sample on the frequencies of KIR genes and genotypes differ from the previously published data for the Russian Federation. Of interest is the finding of a greater diversity of genotypes among a rather small study group, the detection of an atypical ID195 genotype, and the difference in the representation of B-content groups. The analysis of KIR genotypes in the population of Samara region can be used in the selection of optimal CBU and hematopoietic cell/bone marrow donors in addition to HLA typing. Studying the frequency distribution of KIR and HLA genes and genotypes can play a role in the study of fundamental aspects of human immunology and population genetics.

Aim. To study the prognostic significance of gene mutations and intracellular signaling pathways involved in lymphomagenesis in patients with follicular lymphoma using next generation sequencing (NGS).

Materials and methods. The prospective study included 26 patients with a median age of 51.5 years. Mutational screening was performed for cohort using custom NGS Panel of 118 genes. Gene set enrichment analysis (GSEA) was performed using Metascape. The data was analyzed in SPSS Statistics 26 and R 4.2.2.

Results. The highest mutation frequency was noted in the genes: KMT2C – 50 %, KMT2D – 50 %, CREBBP – 31 %, NOTCH2 – 31 %, GNAS – 23 %. Missense mutations occurred with a frequency of 84.3 %. ARID1A gene mutation is an unfavorable prognostic factor according to progressive-free (p = 0.014) and event-free (p = 0.029) survival analysis. Tumor mutation burden (TMB) was defined as the number of mutations per megabase (Mb) of the coding sequence, the median TMB was 5.0 (3.3–8.3) mutations/Mb. The TMB threshold of 6 mutations/Mb divided patients into groups with high (44 %) and low (56 %) TMB. In the high TMB group, 2-year event-free survival was 27.3 % (95 % confidence interval 6.0–61.0), which was significantly lower than in low TMB group – 72.7 % (95 % confidence interval 41.9–91.6; p = 0.037). The most enriched cellular pathways according to GSEA results were regulation of cell activation (–log₁₀(q-value) = 6.357), chromatin remodeling (–log₁₀(q-value) = 5.707), histone modification (–log₁₀(q-value) = 4.569). We have also demonstrated other possibilities of GSEA using follicular lymphoma as an example.

Conclusion. TMB is a significant prognostic factor in patients with follicular lymphoma. We have shown that mutations in the MYC, CREBBP, EZH2, KMT2D genes lead to dysregulation in several intracellular processes, mediating complex molecular changes. The most enriched intracellular pathways in follicular lymphoma are those of chromatin remodeling, regulation of cell activation and histone modification.

Background. Professional burnout (PB) among medical staff, namely hematologists, is of major importance, especially given the current shortage of personnel. It is of extreme value during the COVID-19 pandemic.

Aim. To determine the degree of PB development among hematologists and nursing staff of hematological departments of federal and regional medical institutions in the context of the COVID-19 pandemic and to identify the associated factors.

Materials and methods. The study was conducted in the period from July 2022 to September 2022 in the form of a onetime online survey of hematologists and nursing staff of hematology departments of federal and regional medical institutions in different cities of the Russian Federation. To interview specialists, a special checklist based on an Internet resource (Google forms) was used. It included burnout questionnaire Maslach Burnout Inventory (MBI) and questions related to factors that may be associated with the formation of PB. Statistical analysis included pairwise and multiple comparisons, as well as χ2 test, correlation and logistic regression analysis.

Results. A total of 162 specialists took part in the online survey. More than half of the specialists (52 %) had high degree of emotional exhaustion, high level of depersonalization was detected in 39.5 % of specialists, and low level of personal accomplishment – in one third of specialists (32.1 %). It was shown that physicians, compared with nurses, had significantly higher indicators of PB. The level of problems for all PB components was significantly lower among specialists working in federal health facilities than among specialists working in regional clinics. The specialists who worked in the “red zone” showed a greater degree of emotional exhaustion and depersonalization than the specialists who did not work in the “red zone” during the pandemic. The formed PB syndrome was observed in 16 % of specialists, and its signs – in 42 %. The risk of PB was significantly greater in hematologists than in nurses, as well as among specialists with increased levels of depression and anxiety and dissatisfaction with the level of personal protective measures.

Conclusion. The high importance of PB and the need for preventive measures among specialists of hematological centers and hematology departments in the Russian Federation is shown.

Background. Despite the progress achieved in the treatment of acute leukemia (AL) in children, complications, both at the disease onset and those resulting from antitumor therapy, remain the main cause of early mortality, which varies from 3 to 20 %.

Aim. To assess the frequency, severity, etiology, risk factors, and outcomes of AL complications in children at the disease onset and during induction chemotherapy (ICT).

Results. The study analyzed 92 cases of AL in children aged from 5 months to 17 years. 75 patients had acute lymphoblastic leukemia (ALL), 17 had acute myeloid leukemia (AML). In 1 (1.3 %) patient with ALL and in 5 (29.4 %) with AML, a concomitant diagnosis was Down syndrome. At the AL onset, 34 (36.9 %) patients were diagnosed with infection, of which 27 (36 %) and 7 (41.2 %) patients had ALL and AML, respectively. In both cohorts, febrile neutropenia (55.5 %; n = 15 vs. 14.3 %; n = 1), pneumonia (25.9 %; n = 7 vs. 71.4 %; n = 5), enterocolitis (7.4 %; n = 2 vs. 14.3 %; n = 1) predominated in both cohorts for AML and ALL, respectively. Due to uncontrolled infection in 5 (29.4 %) patients with AML and 13 (17.3 %) with ALL, ICT was delayed until the condition stabilized and the infection was controlled. During ICT, the incidence of infectious complications was 81.3 % (n = 61) and 100 % (n = 17) in patients with ALL and AML, respectively. The most common types were enterocolitis (41.2 %; n = 7 vs. 34.4 %; n = 21), febrile neutropenia (29.4 %; n = 5 vs. 37.7 %; n = 23), pneumonia (47.1 %; n = 8 vs. 29.5 %; n = 18), catheter-associated bloodstream infection (11.8 %; n = 2 vs. 8.2 %; n = 4) in AML and ALL, respectively. By etiology, bacterial infections predominated, accounting for 32 % (n = 8) and 36.8 % (n = 35) in the AML and ALL groups, respectively. More cases of invasive mycoses were reported in AML patients – 23.5 % (n = 4) versus 14.8 % (n = 11). Non-infectious complications were diagnosed in 32.6 % (n = 30) of patients with a predominance in ALL group (34.6 %; n = 26 vs. 23.5 %; n = 4). Hyperleukocytosis at the leukemia onset caused such complications as leukostasis (11.8 %; n = 2) and acute tumor lysis syndrome (11.8 %; n = 2). The most common post-cytostatic complications in ALL were vincristine polyneuropathy (61.5 %; n = 16), hemorrhagic syndrome (15.4 %; n = 4), methotrexate-induced encephalopathy (15.4 %; n = 4), acute tumor lysis syndrome (11.5 %; n = 3). In AML cases, the most common type of non-infectious complications were hemorrhagic (75 %; n = 3). Induction mortality in the ALL group was 2.6 % (n = 2), in the AML group it was higher – 11.8 % (n = 2), however, it should be noted that all deaths were registered in children with Down syndrome. The main cause of mortality in both groups was severe infections secondary to chemotherapy-induced hematopoietic aplasia. There were no deaths associated with non-infectious complications or chemotherapy-induced toxicity.

Conclusion. The main type of toxicity in children at the AL onset and during ICT remains infectious complications of various etiologies, while in AML patients a higher frequency of invasive mycoses is registered (23.5 % vs. 14.8 %). Despite the high incidence of chemo-induced toxicity, the mortality rate in ALL remains low, amounting to 2.6 % in our cohort. In the AML group, mortality was higher – 11.8 %, but it should be noted that all cases occurred in patients with Down syndrome. There were no deaths due to non-infectious complications in any of the study cohorts.

Background. The problem of hemostasis system pathology in patients with AL amyloidosis (AL-A) is of great practical importance. Currently, there are no recommendations concerning indications and methods of prevention of thrombotic complications.

Aim. To study the main parameters of blood coagulation system in patients with AL amyloidosis, to determine the indications for anticoagulant therapy, to evaluate the efficacy and safety of apixaban prophylactic use during antitumor therapy.

Materials and methods. A prospective single-center study included 65 patients with newly diagnosed systemic AL amyloidosis. The median age was 58 (34–74) years. Induction therapy according to the program BorCyDex (bortezomib, cyclophosphamide, dexamethasone) was given to 59 (90 %) patients, of which 5 patients received the combination of BorCyDex with a monoclonal antibody to CD38 – daratumumab. The remaining 6 (10 %) patients were treated with melphalan. Patients with laboratory signs of hypercoagulability or thrombotic complications were treated with apixaban in therapeutic or prophylactic dose. Indications for apixaban therapy in therapeutic dose (10 mg/day): atrial fibrillation, arterial thrombosis or pulmonary embolism less than 1 year ago. Indications for apixaban therapy in prophylactic dose (5 mg/day) were considered the presence of one or more factors: hypoalbuminemia less than 20 g/L; increase in D-dimer level more than 500 ng/mL without instrumentally verified arterial or venous thrombosis; increase in D-dimer level more than 500 ng/mL within 3 months after resolved episode of thrombosis; increase in fibrinogen level more than 4 g/L; increase in FVIII activity more than 150 %. When two or more factors were present, an antiplatelet agent (acetylsacylicylic acid) was added to apixaban therapy. The follow-up period was 4–9 months (median 6 months).

Results. Before the start of antitumor therapy, thrombotic complications were diagnosed in 15 (23 %), bleeding – in 3 (5 %) patients. Hemostasis study revealed an increase in one or more laboratory parameters reflecting hypercoagulability in 92 % of patients. Increase in fibrinogen level was found in 70 %, D-dimer – in 72 %, FVIII activity – in 92 % of patients. 3 (5 %) patients received a therapeutic dose of apixaban, 58 (89 %) patients ‒ a prophylactic dose. Therapy with apixaban and antiplatelet agent was performed in 10 (15 %) patients. During the follow-up 3 patients developed complications related to hemostasis system disorders: 1 (2 %) patient had thrombosis (ischemic stroke), 2 (3 %) – gastrointestinal bleeding of mild severity. All these patients received a prophylactic dose of apixaban due to the presence of 1 thrombosis risk factor: an increase in FVIII activity of more than 150 %.

Conclusion. Clinical signs of hemostasis system pathology were observed in 28 % of AL amyloidosis patients, and laboratory signs of hypercoagulability were detected in 92 %. Our developed indications for thrombosis prophylaxis in AL amyloidosis were effective. The issue of FVIII activity increase as the only indication for anticoagulant therapy in AL amyloidosis patients requires further research.

Glucocorticosteroids (GCS) are the first-line treatment for idiopathic thrombocytopenic purpura (ITP). Despite their high efficacy in patients with newly diagnosed ITP, an adequate level of platelets remains after GCS withdrawal in only less than 20 % of patients. Additionally, GCS use is associated with an increased risk of different adverse reactions, including serious and life-threatening ones. Thrombopoietin receptor agonists represent a relatively new class of drugs for treating ITP as a second-line therapy. This paper reviews the risks of GCS pharmacotherapy, as well as the evidence supporting the use of thrombopoietin receptor agonists as both first-line and second-line treatment for patients with ITP.