We report the activity of lenalidomide (revlimide – R), lenalidomide plus dexamethasone (Rd), lenalidomide plus bortezomib plus dexamethasone (RVd) in 34 patients with relapsed and refractory myeloma. For patients who received lenalidomide the overall response rate was 70.5 %. 38 % patients achieved very good partial response (VGPR) + complete response (CR). Median overall survival (OS) was 48 months. Lenalidomide may overcome the poor prognostic impact of various factors, particularly elevated beta (2)-microglobulin. Lenalidomide is highly active in elderly patients (> 65 years). Significantly increased OS with a lenalidomide-based induction and lenalidomide maintenance therapy was revealed. The median duration of the overall response without lenalidomide maintenance therapy was 10 months. The median duration of the overall response with lenalidomide maintenance therapy was 20 months (р < 0,05). Median OS with lenalidomide maintenance therapy was not reached. Median OS without lenalidomide maintenance therapy was 36 months (р < 0.05). Side effects were predictable and manageable. The most common adverse events reported were neutropenia (38.3 %) and thrombocytopenia (23.7 %). Serious adverse events were rare.

Achievement of platelet diagnostic threshold less than 28.0 × 109/l and prothrombin activity less than 40 % with system inflammatory response (SIRS) were considered as high risk for spontaneous bleeding complication development within the next day in cancer patients. If platelets count is more than 28.5 × 109/l in a combination to prothrombin activity ≥ 40 % and absence of SIRS, it is possible to say that coagulations changes cannot be the independent cause of bleeding and does not require correction of coagulation parameters.

To allow minimal residual disease (MRD) monitoring using flow cytometry it is needed the optimal combination of monoclonal antibodies (MA), based on a precise knowledge of leukemic cells immunophenotypic features. Multiple immunophenotypic aberrations in leukemic blasts of B-precursors ALL (BII ALL) were revealed. Asynchronous expression of differentiation antigens on tumor cells occurs in more than 50 % cases. Aberrant myeloid markers expression in 42.6 % BII ALL cases was observed. The main differences between tumor and normal bone marrow cells are the expression intensity of CD19, CD10, CD20, CD38, CD45, CD34 and CD58. Thus, expression intensity pattern of CD19, CD10, CD20, CD38, CD45, CD34, CD58 on tumor cells compared with normal B-lymphocyte precursors allow to use these markers combination to MRD monitoring.

Persistent thrombocytopenia is a frequent complication after allogeneic bone marrow transplantation (BMT). The major causes of thrombocytopenia include accelerated platelet destruction by antiplatelet antibodies, microangiopathy, viral infection, drug toxicity,
graft`s hypofunction with insufficient production of platelets from megakaryocytes. We have evaluated an efficacy of TPO-receptor agonist
romiplostim in treatment of 3 patients with refractory thrombocytopenia after allogeneic BMT. The first 30 years old patient received haploidentical allogeneic stem cell transplantation for refractory AML relapse. He developed graft hypofunction due to CMV infection, acute GVHD and thrombotic thrombocytopenic purpura (TTP) with platelet counts 5 × 109/l and bleeding complications. After bone marrow “boost” the patient received romiplostim 1 mkg/kg weekly during 2 weeks and 4 mkg/kg during another 2 weeks. Upon reaching platelet counts 50 × 109/l the romiplostim was stopped, but platelet count decreased to 5–7 × 109/l and romiplostim was administered in dose of 4 mkg/kg weekly during 5 weeks. Platelet counts have achieved 150 × 109/l and thrombocytopenia during further follow-up was not revealed. The second 19 years old AML patient received haploidentical allogeneic stem cell transplantation for second remission consolidation. He developed thrombocytopenia (10 × 109/l) due to CMV infection and severe TTP. He received romiplostim 4 mkg/kg weekly and 5 weeks later platelet counts was 50 × 109/l. The administration of romiplostim was allowed to avoid bleeding complications and transfusion dependency. The third 18 years old ALL patient received MUD allogeneic stem cell transplantation for second remission consolidation. He developed profound thrombocytopenia (5 × 109/l) with severe hemorrhagic complications and platelet transfusions refractory due to TTP and acute GVHD. He received one dose of romiplostim 1 mkg/kg and two doses of 3 mkg/kg weekly with completion of hemorrhagic syndromes and achieving 20 × 109/l blood platelet counts. Romiplostim was continued in dose 5 mkg/kg/wk during 2 weeks and stable platelet counts > 30 × 109/l was achieved. The romiplostim efficacy in these patients supports the use of TPO-agonists in patients after allogeneic BMT who developed severe thrombocytopenia due to TTP, CMV infections, acute GVHD and other posttransplant complications.

Umbilical cord blood (CB) is now an attractive source of hematopoietic stem cells (HSCs) for transplantation in pediatric and adult patients with various malignant and non-malignant diseases. However, its clinical application is limited by low cells numbers in graft, which correlates with delayed engraftment, an extension of time to platelets and neutrophils recovery and increasing risk of infectious complications. Several strategies have been suggested to overcome this limitation, one of which is obtaining a sufficient number of hematopoietic progenitor cells by ex vivo expansion. Literature review about CB HSCs expansion in given article is presented.