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Merkel cell carcinoma is a very aggressive primary skin tumour with a high risk of local recurrences and lymphatic and distant metastases. The frequent association between this carcinoma and other skin tumour and lymphoid malignancies, its similar cellular morphology with leukocytes, and limited infiltration in bone marrow constituted a challenging diagnosis. We report an unusual case of an 82-year-old male who simultaneously presented Merkel cell carcinoma and acute myeloid lymphoma. The diagnosis was established through flow cytometry, immunohistochemical studies and next generation sequencing (NGS) analysis. Flow cytometry allowed for the differentiation of the two cell populations in bone marrow aspirate, which was crucial to the diagnosis of Merkel cell carcinoma and acute myeloid leukaemia (AML), after confirmed by immunohistochemistry. AML could be classified based on NGS results. Following diagnosis, the patient received palliative care and died 50 days later. immunophenotypic analysis by flow cytometry and Immunohistochemical study was crucial to establish the diagnosis of simultaneous affection of Merkel cell carcinoma and hematologic disorder. [ABSTRACT FROM AUTHOR]

Simple Summary: This study analyzes the use of rituximab (RTX) in the daily clinical practice of several Italian oncohematology centers, with a particular focus on the adoption of biosimilars. The results show that only a minority of patients (22%) switched between different biosimilars, while the majority continued treatment with the biosimilars Rixathon and Truxima. This finding suggests that the proactive sharing of guidelines between regulators and prescribers, from the outset, may be an effective strategy to further promote the adoption of biosimilars. This approach could be particularly useful in those areas where the use of biosimilars is still lower than the national average, helping to free up economic resources that could be redirected towards other healthcare opportunities. The clinical safety and efficacy of rituximab biosimilars compared to the reference rituximab (Mabthera) have been well established in randomized trials. However, concerns persist regarding the safety of changing from the reference product to biosimilars, and particularly between different biosimilars. This prospective multicenter observational study was conducted in 13 oncohematology units of eight Italian regions. The study included 800 patients with non-Hodgkin lymphoma (NHL) or chronic lymphocytic leukemia (CLL) who received rituximab between March 2018 and June 2022. To minimize survivorship bias, only newly diagnosed patients (i.e., those without prior rituximab treatment) were included in the analysis of adverse drug reactions (ADRs). Thus, this study focused on 505 incident cases (79.8% of the initial cohort) from 13 centers. A total of 3681 rituximab infusions were administered, and 16.8% of the patients experienced at least one ADR. These were observed most frequently during the first infusion (44 patients, 52%) and the second infusion (17 patients, 20%). The most frequent reactions were general disorders and administration site conditions (n. 50, 8% serious). These findings support the clinical safety of rituximab biosimilars and suggest that switching between biosimilars does not increase the risk of adverse events. This evidence may alleviate concerns about biosimilar use, potentially leading to broader acceptance and reduced healthcare costs. [ABSTRACT FROM AUTHOR]

Chemotherapy and targeted therapy have significantly improved the prognosis of oncohaematological patients. Antineoplastic treatment can cause adverse cardiovascular effects known as cardiotoxicity, which requires modification, interruption or withdrawal of life-saving drugs. The onset of cardiotoxicity may depend on the class, dose, route, and duration of anticancer drug administration and individual risk factors. Standard chemotherapy exerts its toxic effect mainly by inducing oxidative stress and genomic instability. At the same time, new targeted molecules work by interfering with signalling pathways that are important for tumour cells and cardiomyocytes. For example, Bruton tyrosine kinase (BTK) inhibitors interfere with phosphatidylinositol-3-kinase isoforms involved in cardiac hypertrophy, contractility, and regulation of various proteins. Off-target effects of BTK inhibitors are associated with an increased incidence of atrial fibrillation. This review summarises current knowledge about the cardiotoxic effects of targeted therapies used in haematology. Fig. 2, Tab. 3, Ref. 44, on-line full text (Free, PDF) www.cardiology.sk [ABSTRACT FROM AUTHOR]

Cardiotoxicity of anticancer therapy is a severe adverse cardiovascular event affecting the survival of cancer patients. Modern methods for diagnosing cardiotoxicity allow to identify already occurred myocardial transformations, accompanied by symptoms of heart failure and are not predict and detect early changes in the heart tissue during treatment. Recently, increasing attention is paid to the search for molecular genetic markers, a single identification of which before starting treatment will make possible to determining the risks of cardiotoxicity and change treatment taking into account individual genetic characteristics. At the same time, most research on the effect of allelic variants of genes on cardio-vascular complications relate to chemotherapy of solid tumors. The review considered possible prognostic genetic variants of cardiotoxicity induced by chemotherapy in patients with the hematopoietic and lymphatic malignancies.

Introduction/Justification: Lymphomas are neoplasms originating from lymphoid tissue, with Hodgkin's Disease (HD) being noteworthy. HD manifests in two primary types: classical Hodgkin's lymphoma and Nodular lymphocyte-rich lymphoma. The classical types are identified by Reed-Sternberg multinucleated cells, subdivided as nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depletion. The development of HD is linked to various factors, including genetic predisposition, immunosuppression, autoimmune diseases, and exposure to carcinogens. Clinical symptoms commonly observed include pruritus, intermittent fever, nocturnal hyperhidrosis, and lymphadenopathy. Differential diagnosis plays a crucial role in HD identification since clinical symptoms may resemble various other medical conditions, including other lymphoma forms, viral or bacterial infections, and autoimmune diseases, emphasizing the importance of biopsy and thorough investigation. Epidemiological analysis of HD plays a pivotal role in early diagnosis and the implementation of appropriate therapies aiming for eventual patient remission. Objectives: To analyze hospitalization data within the Brazilian Unified Health System (SUS), estimating disease incidence across different regions, demographic disparities, treatment costs, and mortality, aiming to provide insights for public health policies to improve management and access to healthcare services for HD patients within the SUS context. Materials and Methods: A retrospective study using data from the Department of Health Informatics of SUS (DATASUS) from 2013 to 2023. Data included total hospitalizations, region, age, gender, race, deaths, mortality rate, and average hospitalization cost. Results: Brazil recorded 53,297 HD-related hospitalizations from 2013 to 2023. Geographical distribution revealed the Southeast region accounted for the majority of cases (47.64%), followed by the Northeast (24.74%) and South (17.29%). Males comprised the majority of hospitalizations (55.56%), with females representing 44.43%. Regarding race, whites accounted for 43.84% of hospitalizations, followed by mixed race individuals (37.52%). Hospitalizations were most common among individuals aged 20-29 (24.90%), followed by age groups 15-19 (14.85%) and 30-39 (14.34%). There were 2,149 deaths during this period, corresponding to a mortality rate of 4.03%. Based on the average value per hospitalization in SUS, a total of R$135,694,694.97 was spent. Conclusion: The epidemiological study reveals a higher incidence of Hodgkin's Disease in the Southeast region, predominantly among males in the age group between 20-29, along with a mortality rate of 4.03% among the hospitalized. These findings emphasize the public health challenge of HD and the need for comprehensive strategies, including awareness campaigns, screening programs, and improved diagnostic and treatment capabilities. Understanding HD epidemiology is crucial for effective resource allocation and improved clinical outcomes.

ABSTRACT BACKGROUND: There are several illness-specific cultural and system-based barriers to palliative care (PC) integration and end-of-life (EOL) care in the field of oncohematology. OBJECTIVES: This study aimed to investigate the variability in the perceptions of PC and EOL care. DESIGN AND SETTING: A cross-sectional study was conducted in the Hematology Division of our University Hospital in Salvador, Bahia, Brazil. METHODS: Twenty physicians responded to a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies from October to December 2022. RESULTS: The median age of the participants was 44 years, 80% of the participants identified as female, and 75% were hematologists. Participants faced a hypothetical scenario involving the treatment of a 65-year-old female with a poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of the participants chose to follow other chemotherapy regimens, whereas 40% opted for PC. Next, participants considered case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct, and the conduct they thought would be better for the patient. Even though participants were from the same center, we found a divergence from the most probable conduct among 40% of the participants, which was due to personal convictions, legal aspects, and other physicians’ reactions. CONCLUSIONS: We found considerable differences in the perception of PC and EOL care among professionals, despite following the same protocols. The study also demonstrated variations between healthcare professionals’ beliefs and practices and persistent historical tendencies to prioritize aggressive interventions.

Any variant of acute leukemia is characterized by a severe course of the disease, a high incidence of complications and mortality. For a long time, there was an opinion that when verifying hemoblastoses during pregnancy, its termination is required. Currently, studies and experience accumulated have shown that in most cases, a complete treatment of hemoblastosis can be carried out during pregnancy without the risk for developing any complications for both a mother and a fetus. The entire range of diagnostic studies is also carried out fully. The safety of pregnant women performing such diagnostically significant procedures as bone marrow puncture biopsy has been repeatedly confirmed. In most cases, a lumbar puncture with a study of the cerebrospinal fluid is also feasible to rule out leukemic lesions of the central nervous system. The choice of treatment tactics is carried out by a doctor depending on the type of hemoblastosis and its stage. The main methods of treatment include multicomponent chemotherapy, supportive treatment, replacement transfusion therapy, extracorporeal methods. In the first trimester, there is a high probability of an unfavorable outcome of pregnancy for both the mother and the fetus. But currently, polychemotherapy schemes have been developed that can be used in this period of pregnancy. The delivery period in patients with acute leukemia is determined individually. The resumption of special therapy is recommended not earlier than 3-4 weeks after birth in order to minimize the risk of developing infectious and hemorrhagic complications in the postpartum period. If it is necessary to continue chemotherapy in the postpartum period, lactation should be suppressed in the patient, since most drugs penetrate into mother's milk. The specific chemotherapy carried out does not exclude the possibility of developing various pathological conditions that can be regarded as complications of cytostatic therapy, because these conditions can also occur during a healthy pregnancy as a result of spontaneous mutations and the development of congenital anomalies in the fetus. In the 2ndand 3d trimesters, polychemotherapy is used with the drugs that are not able to overcome the hematoplacental barrier. Thus, the management of pregnancy in patients with acute leukemia is a difficult task, which is addressed by the joint efforts of hematologists and obstetricians and gynecologists.

Background. Invasive mycoses (IM) are one of the most severe infectious complications in oncohematology. The etiological structure of IM is a rather heterogeneous group of microorganisms and undergoes changes over time. Understanding the IM etiological structure is the basis for choosing an effective IM prevention and treatment strategy.Aim. To conduct a systematic review with a meta-analysis of data on the IM etiological structure in patients of all ages receiving therapy for oncohematological diseases, including patients who underwent hematopoietic stem cell transplantation. The analytical hypothesis was the assumption of an increase in caused by rare pathogens IM proportion in the overall IM structure over the past few years. Clinical manifestations, affected organs, risk factors and outcomes were analyzed using the literature review method.Materials and methods. A systematic search was carried out for publications with data on the IM species structure available for analysis until February 10, 2022 in 3 databases (PubMed (Medline), Embase and eLibrary.ru). All IM were divided into 11 groups. The IM species structure was constructed in several patient subgroups in 2 time ranges – in studies before 2010 and after 2010, and they were compared. Results from individual studies were pooled by metaanalysis. Data from selected publications were reviewed to analyze the IM clinical manifestations, risk factors for their development and outcomes.Results. Thirty-four publications were selected using a systematic search. The meta-analysis included 43 cohorts of patients with 2771 samples of IM pathogens. The time period up to 2010 included 16 cohorts with a total number of IM pathogens of 1158 samples; in the time interval after 2010 – 27 cohorts with a total number of IM pathogens of 1613 samples. Analysis of total group showed that the proportion of rare IM among all patients increased from 29 to 39 %. In the subgroup of patients with oncohematological diseases, it increased from 28 to 33 %. For total group of patients, the in‑ crease in rare IM proportion is due to an increase in rare yeasts (from 3.0 to 4.1 %) and a significant increase in the proportion of unidentified species (from 3.2 to 19.8 %). In children, the frequency of rare IM increased from 26 to 28 % among all nosologies. For total children group, the increase in rare IM proportion is due to an increase in mucormycosis (from 1.3 to 1.6 %), rare yeasts (from 4.7 to 7.9 %) and unidentified species (from 4.5 to 12.2 %). In total adult patients group, the frequency of rare IM increased from 24 to 35 %, in adult patients with oncohematological diseases – from 23 to 40 %. For total adult patients group, the increase in rare IM proportion is due to an increase in cryptococcosis (from 1.3 to 2.4 %), hyalohyphomycosis (from 3.4 to 4.8 %), rare yeast (from 1.6 to 1.9 %) and unidentified species (from 1.9 to 16.6 %); for a group of patients with oncohematological diseases – an increase in cryptococcosis (from 1.3 to 2.1 %), rare yeast (from 1.6 to 2.6 %) and unidentified species (from 1.9 to 23.1 %). There is no specific clinical manifestations characteristic of IM, the symptoms are associated with the affected organ. Febrile fever is the only IM systemic clinical manifestation, independent of localization. The lungs were the most common IM localization. The main IM risk factors are prolonged blood cell deficiency, uncontrolled underlying disease, concomitant conditions: comorbidity, diabetes mellitus, mucositis, graft-versus-host disease, infections caused by other pathogens, and a history of IM. IM increases the risk of death, attributable mortality is variable and ranged from 13 to 72 %. The most common cause of death in oncohematological patients with IM is the progression of the underlying disease, in patients after hematopoietic stem cell transplantation – graft-versus-host disease, cardiovascular complications.Conclusion. In IM structure in oncohematological patients and hematopoietic stem cell transplant recipients, the proportion of rare IM increased markedly, mainly due to an increase in their proportion in adult patients with oncohematological diseases. The increase in rare IM proportion is mainly due to the increase in unidentified species, hyalohyphomycosis, rare yeast and cryptococcosis. Clinical manifestations are due to the localization, the main of which is the lungs. The development of IM increases the risk of death, but attributable mortality is about 50 %.

Background. Assessment of lung injury in oncohematological patients is a relevant problem, since the spectrum of pathological changes is wide and includes pulmonary infections, tumor cell infiltration, cardiogenic and non-cardiogenic pulmonary edema, bronchiolitis obliterans, interstitial pneumonitis, post-radiation and post-inflammatory pneumofibrosis, pulmonary vasculopathy and pleural effusion. At the moment there are no approved recommendations with criteria of differential diagnosis for these conditions, in particular, with differences between the most common therapy complication represented by pulmonary infections and poorly explored drug-induced toxic lesions.Aim. Identification of criteria for pneumotoxicity, allowing for differential diagnosis with pulmonary infections developing during chemotherapy, according to data routinely obtained in real clinical practice.Materials and methods. The study group included 38 patients with cytotoxic and autoimmune lung injury caused by specific therapy (group 1); the comparison group included 38 patients with infectious lesions receiving the same antitumor drugs (group 2). The data of the anamnesis, clinical course, instrumental studies and standard laboratory tests was studied retrospectively. For statistical analysis, the Mann–Whitney, χ2, Kruskal–Wallis tests were used. ROC analysis was performed to assess the sensitivity and specificity of various factors in relation to toxic damage.Results. Patients with lymphomas predominated in group of toxic lung injury (63 %). In patients who underwent allogeneic hematopoietic stem cells transplantation, toxic complications developed in the period from 35 to 1289 days, infectious – from 4 to 43 days. Statistically significant differences were obtained in the presence of a concomitant state of an altered immune response: 32 % of patients in the toxic lesion group versus 5 % in the infectious group had a history of allergy, and, in contrast to the infectious lesion group, in the toxic lesion group autoimmune diseases were detected. The main symptom in patients of the first group was shortness of breath, which was observed in 68 % of cases, of the second – an increased body temperature, observed in 92 % of cases; cough was also a common symptom – in 19 % and 13 % of patients respectively. In 58 % of patients of the second group, concomitant mucositis was detected, while in the first group this complication did not occur in any of them. The most common radiological pattern (71 % of cases in each group) was ground-glass opacities, in patients of the second group often combined with infiltrative changes and thickening of the bronchial walls (in 53 and 42 % of cases respectively). Among laboratory results, the largest differences between groups were observed in the leukocyte levels (with an average level of 2.5 . 109 / L in the infectious group versus 6 . 109 / L in the toxic group), eosinophils (with an average of 3.6 % in the toxic group versus 1.75 % in the infectious group), C-reactive protein (with an average level of 146.7 mg / L in the infectious group versus 52.4 mg / L in the toxic group), and creatinine (with an average of 0.085 mmol / L in the toxic group versus 0.071 mmol / L in the infectious group).Conclusion. The data obtained in this research indicates the value of taking an anamnesis and the importance of performing additional studies in patients with suspected drug-induced lung injury, as well as identifies risk groups. Based on the revealed differences, a scale for the differential diagnosis of drug-induced toxic and infectious lung damage, which includes the results of publicly available research methods, with high sensitivity and specificity, was proposed. Further research for more specific, but, at the same time, universal for various drugs, criteria for toxic lung damage is relevant.

Introduction. The achievement of the goal of the World Health Organization to eliminate viral hepatitis B by 2030 seems to be problematic partly due to the presence of escape mutants of its etiological agent, hepatitis B virus (HBV) (iHepadnaviridae: Orthohepadnavirus: Hepatitis B virus/i), that are spreading mainly in the risk groups. Specific routine diagnostic assays aimed at identification of HBV escape mutants do not exist. The study aimed the evaluation of the serological fingerprinting method adapted for routine detection of escape mutations in 143 and 145 aa positions of HBV surface antigen (HBsAg). Material and methods. HBV DNA from 56 samples of HBsAg-positive blood sera obtained from donors, chronic HBsAg carriers and oncohematology patients has been sequenced. After the identification of mutations in HBsAg, the samples were tested in the enzyme-linked immunosorbent assay (ELISA) kit «Hepastrip-mutant-3K». Results and discussion. Escape mutations were detected mainly in patients with hematologic malignancies. Substitutions in 143 and 145 aa were found in 10.81% and in 8.11% of such patients, respectively. The G145R mutation was recognized using ELISA kit in almost all cases. The kit specifically recognized the S143L substitution in contrast to the S143T variant. The presence of neighbor mutation D144E can be assumed due to it special serological fingerprint. Conclusion. ELISA-based detection of escape mutations S143L, D144E and G145R can be used for routine diagnostics, especially in the risk groups. The diagnostic parameters of the kit can be refined in additional studies. This immunoassay and methodology are applicable for the development and quality control of vaccines against escape mutants.

A patient with acute myeloid leukemia presented various episodes of febrile neutropenia, for which there was no positive response to antibiotic treatments. Following an episode of bacteremia by extensively drug-resistant Klebsiella pneumoniae, amikacin was prescribed, pharmacokinetic analyses of its plasma concentrations were performed and the dosage interval was narrowed to 12 and 8 h in order to counteract the reduced postantibiotic effect due to the patient being immunocompromised. The patient responded positively, with procalcitonin decreasing and body temperature normalizing. Recovery was finally achieved, without renal or auditory damage. This case proposes tightening dosage intervals for aminoglycosides as an effective strategy in immunocompromised patients. Aminoglycosides are given over extended intervals (24 h), considering concentration-dependent effectiveness, nephrotoxicity and postantibiotic effect. Leukocytes appear to play a determining role in the postantibiotic effect, with no proposed dosing strategy for strongly immunocompromised patients. [ABSTRACT FROM AUTHOR]

Mucormycosis of the lungs is a severe infectious complication in patients with acute lymphoblastic leukemia, which develops at the stage of high-dose cytostatic therapy. It is characterized by an extremely aggressive, rapidly progressive course and, without specific treatment, is fatal in a short time. Reliable verification of mucor is necessary due to its resistance to the most commonly used antifungal drugs, particularly to voriconazole.The article presents a clinical case of pulmonary mucormycosis in a 12‑year-old child at the stage of diagnosis of acute lymphoblastic leukemia. The first symptoms of the disease (headaches, malaise and weakness, pallor), changes in the general blood count (hyperleukocytosis up to 200 thousand cells/μl, single platelets). Based on the results of the examination, the main diagnosis was verified for acute lymphoblastic leukemia L2, IFT T-II, CD1a-. At the stage of diagnosis of acute lymphoblastic leukemia, the underlying disease was complicated by the development of right-sided pneumonia according to X-ray examination. To verify the etiology of infiltration of lung tissue, broncho-alveolar lavage was directed to microbiological diagnostics, which included studies: enzyme immunoassay, microscopic and cultural. On the aggregate of all the results obtained, invasive mucormycosis was diagnosed and antifungal therapy was started immediately.

The article presents a clinical case of pulmonary mucormycosis in a 12‑year-old child at the stage of diagnosis of acute lymphoblastic leukemia. The first symptoms of the disease (headaches, malaise and weakness, pallor), changes in the general blood count (hyperleukocytosis up to 200 thousand cells/μl, single platelets). Based on the results of the examination, the main diagnosis was verified for acute lymphoblastic leukemia L2, IFT T-II, CD1a-. At the stage of diagnosis of acute lymphoblastic leukemia, the underlying disease was complicated by the development of right-sided pneumonia according to X-ray examination. To verify the etiology of infiltration of lung tissue, broncho-alveolar lavage was directed to microbiological diagnostics, which included studies: enzyme immunoassay, microscopic and cultural. On the aggregate of all the results obtained, invasive mucormycosis was diagnosed and antifungal therapy was started immediately.

Machine learning methods to predict the risk of epilepsy, including vascular epilepsy, in oncohematological patients are currently considered promising. These methods are used in research to predict pharmacoresistant epilepsy and surgical treatment outcomes in order to determine the epileptogenic zone and functional neural systems in patients with epilepsy, as well as to develop new approaches to classification and perform other tasks. This paper presents the results of applying machine learning to analyzing data and developing diagnostic models of epilepsy in oncohematological and cardiovascular patients. This study contributes to solving the problem of often unjustified diagnosis of primary epilepsy in patients with oncohematological or cardiovascular pathology, prescribing antiseizure drugs to patients with single seizure syndromes without finding a disease associated with these cases. We analyzed the hospital database of the V.A. Almazov Scientific Research Center of the Ministry of Health of Russia. The study included 66,723 treatment episodes of patients with vascular diseases (I10–I15, I61–I69, I20–I25) and 16,383 episodes with malignant neoplasms of lymphoid, hematopoietic, and related tissues (C81–C96 according to ICD-10) for the period from 2010 to 2020. Data analysis and model calculations indicate that the best result was shown by gradient boosting with mean accuracy cross-validation score = 0.96. f1-score = 98, weighted avg precision = 93, recall = 96, f1-score = 94. The highest correlation coefficient for G40 and different clinical conditions was achieved with fibrillation, hypertension, stenosis or occlusion of the precerebral arteries (0.16), cerebral sinus thrombosis (0.089), arterial hypertension (0.17), age (0.03), non-traumatic intracranial hemorrhage (0.07), atrial fibrillation (0.05), delta absolute neutrophil count (0.05), platelet count at discharge (0.04), transfusion volume for stem cell transplantation (0.023). From the clinical point of view, the identified differences in the importance of predictors in a broader patient model are consistent with a practical algorithm for organic brain damage. Atrial fibrillation is one of the leading factors in the development of both ischemic and hemorrhagic strokes. At the same time, brain infarction can be accompanied both by the development of epileptic seizures in the acute period and by unprovoked epileptic seizures and development of epilepsy in the early recovery and in a longer period. In addition, a microembolism of the left heart chambers can lead to multiple microfocal lesions of the brain, which is one of the pathogenetic aspects of epilepsy in elderly patients. The presence of precordial fibrillation requires anticoagulant therapy, the use of which increases the risk of both spontaneous and traumatic intracranial hemorrhage. [ABSTRACT FROM AUTHOR]

The review analyzes the global agenda on mutational status of genes associated with adverse cardiovascular events of arrhythmic type. Whole exome sequencing will identify a risk group for the likelihood of early or delayed cardiovascular events of arrhythmic type, especially among patients receiving anticancer therapy with cardiotoxic drugs. The dedicated up-to-date panel of genetic polymorphisms will provide an opportunity to optimize management of patients, based on not only clinical, paraclinical and anamnestic data.

The objective of the study a detailed, systematic review of the world literature data, which includes all aspects of recommendations for vaccination against SARS-COV‑2 in cancer patients.Materials and methods. Information search was carried out in PubMed, MedLine, Scopus, Web of Science, RSCI.The work included data from literature and information sources that were published before February 2021.Results. The data of retrospective and prospective clinical studies are analyzed. This paper reflects considerations and recommendations for the vaccination of cancer patients by Russian and foreign specialists in the context of COVID‑19 pandemic. The review presents current recommendations for vaccination against SARS-COV‑2 in patients with solid tumors, hematological malignancies, recipients of hematopoietic stem cells and cell therapy.Conclusion. To date, groups at increased risk of infection with the new coronavirus have been identified. These groups include patients with cancer. The presence of tumor does not allow a delay in start of therapy, and requires careful monitoring and observation. In this regard, despite the pandemic, the treatment of cancer patients must be continued regardless of the circumstances. Cancer patients should not be deprived of the opportunity to be vaccinated against SARS-COV‑2. Every patient should be decided individually. At the moment, there are no officially approved recommendations for vaccination against SARS-COV‑2 for cancer patients. Before the creation and approval of final recommendations for cancer patients, it is necessary to focus on compliance with sanitary and anti-epidemic measures and the prevention of COVID‑19 infection. The global cancer community continues to actively develop recommendations for the optimal vaccination against SARS-COV‑2 in cancer patients.The most relevant ones are outlined in this article.

Telomeres are protein structures that regulate the process of cellular aging and play the role of a protective “cap” on the end sections of chromosomes. The telomeres of nucleated cells undergo permanent shortening during their lifetime as a result of multiple cycles of DNA replication. The enzyme that provides completion of the missing telomeric repeats at the ends of chromosomes is called “telomerase”. However, recovery of critically short telomeres by telomerase or recombination in somatic cells is limited due to the presence of a large accumulation of unclosed telomeres, which triggers apoptosis. The death of stem cells due to telomere depletion ensures the selection of abnormal cells in which the genome instability contributes to malignant progression. During carcinogenesis, cells acquire mechanisms for maintaining telomeres in order to avoid programmed death. In addition, tumor cells are able to support the telomere's DNA, counteracting its shortening and premature death. Activation of telomere length maintenance mechanisms is a hallmark of most types of cancers. In the modern world, there is an increasing interest in studying the biological characteristics of telomeres. The development of new methods for measuring telomere length has provided numerous studies to understand the relationship between telomere length of human nucleated cells and cancer. Perhaps maintaining telomere length will be an important step, determining the course and prognosis of the disease. The purpose of this review is to provide an analysis of published data of the role and significance of telomere length in patients with hematological malignancies.

Background: In recent years, the incidence of neoplastic diseases in children has increased significantly. Immunodepression triggers undesirable effects in the oral cavity such as mucositis, opportunistic infections, oral bleeding, xerostomia, dysgeusia, decay, dental malformations and pain. Objective: We aim to assess, through salivary tests, the quality of saliva in pediatric patients affected by oncohematological diseases and treated with chemo/radiotherapy compared to non-treated subjects. Methods: A total of 20 subjects aged between 5 and 18 years, with oncological pathologies undergoing radio and/or chemotherapy, were evaluated. The control group consisted of 20 healthy children of the same age. The two groups of subjects were asked to undergo salivary tests. Descriptive statistics were computed for each item. Fisher's exact test was conducted to compare case and control groups. Results: Subjects treated with chemo/radiotherapy had a lower pH and therefore a higher salivary acidity that predisposes to caries and the oral hygiene of children with oncohematological diseases was more deficient than that of the control group. Conclusions: The early detection of these indicators, and the prevention carried out to limit their severity, is an important aspect of the comprehensive care of oncohematological subjects. Pediatric dentists can play a crucial a role enabling good quality of life during cancer therapy. [ABSTRACT FROM AUTHOR]

Detailed, systematic review of the world literature data, including all aspects that reflect the impact of the COVID-19 pandemic on the oncological practice was conducted. The information sources were taken from Pubmed, MedLine, Scopus, Web of Science, and RSCI systems. The data from retrospective and prospective clinical trials have been analyzed. This review presents current data on the impact of COVID-19 on cancer patients, mortality and prognosis of cancer patients infected with COVID-19, treatment options for COVID-19, as well as the case report of the cancer patient with rare atypical COVID-19 course of disease. To date, the groups of increased risk of being infected with a new coronavirus have been identified. These groups include cancer patients. Despite the pandemic, treatment of cancer patients must be continued, since the presence of a tumor process does not allow the therapy to be delayed. The world cancer community is actively continuing to develop recommendations for optimal management of cancer patients in the context of the pandemic. The most relevant of them are described in this article.

Background. Infectious complications cause significant mortality in children with oncological diseases during chemotherapy-induced neutropenia. The absence of sensitive and specific signs and symptoms of infectious conditions as well as its microbiological identification, leads to inappropriate antibiotic exposure. The use of laboratory biomarkers (procalcitonin (PCT) and C-reactive protein (CRP)) may be helpful for differential diagnostics of inflammatory conditions and for rational antimicrobial therapy.Objective: to assess the current value of PCT as an additional marker for differentiating inflammatory conditions in children with chemotherapy-induced neutropenia.Materials and methods. We presented the analysis of infectious complications in pediatric patients with oncological and onco- / hematological diseases between 2017–2020 (54 patients from 2 mnths – 17 years). PCT and CRP with clinical and instrumental diagnostic data were used for differential diagnosis of fever and development of antimicrobial therapy decision rules. Literature review concerning the discussed theme from 2006–2018 was done.Results. Eighty-five infectious episodes in 36 months were registered, among them 42 in pts with onco- / hematological diseases and 43 – with solid tumors. In the group of bacterial infectious complications mean CRP and PCT values were significantly higher than in group of nonbacterial, moreover the discriminative value was higher for PCT. We revealed the correlation between severity of infectious complications and values of markers of acute-phase reactions. In case of non-severe bacterial complications and other types of infections significant difference was revealed only for PCT mean values.Conclusion. Specificity of PCT concentration in bacterial infections exceeds that of CRP, which confirms the hypothesis of advantages in using PCT as differential marker of inflammatory conditions in children with malignancies.

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Background. Children and adolescents undergoing treatment in the hospital for blood diseases are at risk of thrombotic complications. However, to date no major studies of the prevalence of thrombosis in this category of patients have been conducted in Russia. The objective: to determine the incidence of symptomatic and asymptomatic deep vein thrombosis (DVT), as well as their distribution by gender and age in children with various blood disorders. Materials and methods. Medical records of 1962 patients, aged from 0 to 17 years, were retrospectively analyzed. All DVT cases were confirmed by visualization methods. The presence of thrombosis clinical signs detected during physical examination, allowed identifying symptomatic DVT. Results. DVT was diagnosed in 429 patients; the symptomatic (n = 110) and asymptomatic (n = 337) DVT were considered as two independent groups with cases of thrombosis. The highest incidence of thrombotic complications was found in children with acute lymphoblastic leukemia (ALL) – 30.77 %, non-Hodgkin’s lymphomas – 22.58 %, other malignant blood disorders – 18.75 %, myeloid leukemia – 15.63 %, Hodgkin’s lymphoma – 16.50 %, histiocytosis – 12.5 %, aplastic anemia – 7.94 %, other leukemia – 7.14 %. Symptomatic episodes were more common in patients with lymphomas, especially non-Hodgkin’s, and ALL, while asymptomatic DVT were more common among children with ALL. Conclusion. The DVT prevalence in children with blood disorders exceeds 20 %, most of them are asymptomatic thrombosis, while symptomatic DVT are much less common. Patients receiving treatment for lymphomas and ALL have the highest number of venous thrombotic complications. Further research is needed to address the need for primary thrombotic prophylaxis in children with blood disorders.

Abstract Complex heart rhythm disturbances due to cardiotoxicity may not be identified in time, and this may have an unfavorable outcome for patients. Holter monitoring can be a solution to prevent sudden cardiac death of oncohematology patients.

Complex heart rhythm disturbances due to cardiotoxicity may not be identified in time, and this may have an unfavorable outcome for patients. Holter monitoring can be a solution to prevent sudden cardiac death of oncohematology patients. [ABSTRACT FROM AUTHOR]

Background: In recent years, the incidence of neoplastic diseases in children has increased significantly. Immunodepression triggers undesirable effects in the oral cavity such as mucositis, opportunistic infections, oral bleeding, xerostomia, dysgeusia, decay, dental malformations and pain. Objective: We aim to assess, through salivary tests, the quality of saliva in pediatric patients affected by oncohematological diseases and treated with chemo/radiotherapy compared to non-treated subjects. Methods: A total of 20 subjects aged between 5 and 18 years, with oncological pathologies undergoing radio and/or chemotherapy, were evaluated. The control group consisted of 20 healthy children of the same age. The two groups of subjects were asked to undergo salivary tests. Descriptive statistics were computed for each item. Fisher’s exact test was conducted to compare case and control groups. Results: Subjects treated with chemo/radiotherapy had a lower pH and therefore a higher salivary acidity that predisposes to caries and the oral hygiene of children with oncohematological diseases was more deficient than that of the control group. Conclusions: The early detection of these indicators, and the prevention carried out to limit their severity, is an important aspect of the comprehensive care of oncohematological subjects. Pediatric dentists can play a crucial a role enabling good quality of life during cancer therapy.

The goal of the current study is to perform a pilot study of the cost of some oncohematology diseases in Bulgaria. This is a pilot broader burden of disease research. The official report of the National health insurance fund provided information about the total expenditures paid for medicines, ambulatory services, and hospitalizations in 2015 and 2016. To evaluate the costs from a patient perspective, an internet inquiry was organized with the support of the patient organization. The inquiry contained questions regarding the patients' demography, type of oncohematology disease, year of diagnosis, quality of life (EuroQol v5D), and additional out of pocket expenditures. Quality of Life data were statistically analyzed and Kruskal-Wallis analysis of variance was performed. From 2015 to 2016 the number of patients with oncohematological diseases decreased by approximately 3000 people. Less than 30% were hospitalized and the hospitalization cost decreased, but the cost for medicines increased by nearly 1.5 million Euros. Cost for medicines almost tripled the hospitalization cost. The reported mean quality of life was 0.749 (SD 0.203). There was positive correlation between QoL and current disease state (p = 0.008) and age (p = 0.025). 42% reported to have additional expenditures related to their oncohematology disease, 22% reported other expenditures (diet, change of everyday habits etc.) and 42% reported to have productivity loses due to loss of employment or change of work, 44% of the respondents reported additional payment for medicines for concomitant diseases. Thus, the total cost (public funds and patients) accounted for 37,708,764 Euro. Despite the high public expenditures, the indirect costs due to productivity loses are higher. Costs for medicines are higher than costs of inpatient treatment, but this tendency is observed in all European countries. The increases in the costs of medicines are compensated by reduced costs of hospitalization. Despite their higher costs, newer medicines are an effective and reasonable investment from a societal perspective. Currently the higher levels of copayment increase the burden on the patients.

Multiple studies of hepatitis B virus (HBV) genetic variability and its relationship with the disease pathogenesis are currently ongoing, stemming from growing evidence of the clinical significance of HBV mutations. It is becoming increasingly evident that patients with hematologic malignancies may be particularly prone to a higher frequency of such mutations. The present report is the first extensive study of the prevalence of escape mutations in S-HBsAg, performed using isolates from 59 patients from hospital hematology departments with diagnoses of leukemia (n = 32), lymphoma (n = 20), multiple myeloma (n = 3), and non-tumor blood diseases (n = 4). The isolates were serologically examined for the presence of HBV markers and sequenced using either next-generation sequencing (NGS) or Sanger sequencing. Occult hepatitis B was found in 5.1% of cases. Genetic analysis of the region corresponding to S-HBsAg demonstrated an exceptionally high mutation frequency in patients with leukemias (93.4%) and lymphomas (85.0%), along with the prominent mutation heterogeneity. Additionally, more than 15 mutations in one sample were found in patients with leukemias (6.3% of cases) and lymphomas (5.0% of cases). Most of the mutations were clinically significant. The study analyzes the mutation profile of HBV in different oncohematological diseases and the frequency of individual mutations. The data strongly suggest that the NGS method, capable of detecting minor populations of HBV mutations, provides a diagnostic advantage, lays the foundation for the development of screening methods, and allows for the study of the virological and pathogenetic aspects of hepatitis B.

Summary: The objective of the study was the analysis of incidence and outcome of invasive fungal disease (IFD) in children treated for malignancy (PHO, paediatric hematology‐oncology) or undergoing hematopoietic cell transplantation (HCT) over a period of six consecutive years in nationwide study. A total number of 5628 patients with newly diagnosed malignancies and 971 patients after HCT (741 allo‐HCT and 230 auto‐HCT) were screened for infectious complications in biennial reports. IFD incidence was lower among PHO patients: 8.8% vs 21.2% (P < .0001) and survival from IFD was better: 94.2% vs 84.1% (P < .0001). Auto‐HCT patients had lower incidence (10.9% vs 24.4%) and lower mortality than allo‐HCT patients. Introduction of national antifungal prophylaxis programme in HCT and acute leukaemia patients decreased incidence of IFD in HCT (from 23.1% to 13.4%) and AML on conventional chemotherapy (from 36% to 23%) but not in ALL patients during chemotherapy. In multivariate analysis, the incidence of IFD was higher in patients after HCT, diagnosed for ALL, AML or NHL, and in patients > 10 years old. Factors contributing to death with infection were as follows: undergoing HCT, diagnosis of acute leukaemia (ALL or AML) and duration of treatment of infection > 21 days. In conclusion, the incidence of IFD in allo‐HCT and in AML patients on chemotherapy has decreased after introduction of national programme of antifungal prophylaxis, while the incidence of IFD in ALL patients on chemotherapy did not change significantly. The outcome of IFD both in PHO and HCT patients has largely improved in comparison with historical international data. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pediatric cancer patients face an increased risk of nosocomial infections (NI) due to their underlying illnesses and intensive anticancer therapy. To date, no prospective mono/ multicentric Bulgarian studies have been published on this topic. The objectives of this study were to determine: (1) the incidence of NIs, (2) sites of NIs, (3) causal organisms, and (4) characteristics and outcomes of NI among pediatric patients with neoplastic diseases as a first step of improving infection control policity. A prospective surveillance study from Jаnuary through December 2020 was performed in the Pediatric оncohematology unit at the University Hospital “ Tzaritza Yoanna “ in Sofia. Conclusion. A total of 32 pediatric patients with neoplastic diseases and episodes of NIs were reported; 16 of them aged 1-4 yo. Patients with acute leukemia had the highest number of NIs (47.7%); the most common causal organisms in bloodstream were gram positive bacteria (57.44%). Poor outcome we reported in two patients. [ABSTRACT FROM AUTHOR]

COVID-19 convalescent plasma for the treatment of immunocompromised patients: a systematic review. medRxiv. 2021. https://doi.org/10.1101/2021.12.24.21268317 10 Focosi D, Tuccori M. Prescription of anti-spike monoclonal antibodies in COVID-19 patients with resistant SARS-CoV-2 variants in Italy. Keywords: convalescent plasma; COVID-19; oncohematology; SARS-CoV-2 EN convalescent plasma COVID-19 oncohematology SARS-CoV-2 208 209 2 02/03/23 20230201 NES 230201 DATA AVAILABILITY STATEMENT Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. [Extracted from the article]

Copyright of Procesamiento del Lenguaje Natural is the property of Sociedad Espanola para el Procesamiento del Lenguaje Natural and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Leukemia is the most common malignancy of childhood representing about 30 % of oncohematological diseases diagnosed in children less than 15 years of age. We report the case of a 4 year old girl with acute promyelocytic leukemia whose blasts showed the morphology characteristic of acute promyelocytic leukemia variant. The case is reported because in the paediatric population the acute promyelocytic leukemia is a rare occurrence moreover, it represent a true oncohematology emergency, in this case the laboratory has a significant role since the timing of diagnosis must be very short. It helps in therapeutic protocols compared to conventional therapeutic protocols in Acute Myeloid Leukemia (AML), the introduction of retinoid All-Trans-Retinoic Acid (ATRA), both in children and adults with Acute Promyelocytic Leukemia (APL), has significantly reduced the early mortality.

Biosensors are devices that are capable of detecting specific biological analytes and converting their presence or concentration into some electrical, thermal, optical or other signal that can be easily analysed. The first biosensor was designed by Clark and Lyons in 1962 as a means of measuring glucose. Since then, much progress has been made and the applications of biosensors are today potentially boundless. This review is limited to their clinical applications, particularly in the field of oncohematology. Biosensors have recently been developed in order to improve the diagnosis and treatment of patients affected by hematological malignancies, such as the biosensor for assessing the in vitro pre-treatment efficacy of cytarabine in acute myeloid leukemia, and the fluorescence resonance energy transfer-based biosensor for assessing the efficacy of imatinib in chronic myeloid leukemia. The review also considers the challenges and future perspectives of biosensors in clinical practice.

Background: The relevance of the study lies in the fact that although the role of polymorphism of some genes that are responsible for cell apoptosis and deoxyribonucleic acid repair in the development of acute leukemia has already been established, its relationship with the gender of patients has not been studied enough. This study was aimed at studying the relationship between the Arg399Gln polymorphism in the XRCC1 deoxyribonucleic acid repair gene and the Arg72Pro polymorphism in the TP53 tumor suppressor gene encoding the p53 protein with the gender of children with acute leukemia., Material and Methods: The study included 100 newly diagnosed pediatric patients of Kyrgyz nationality (69 boys and 31 girls), among which there were 77 patients with acute lymphoblastic leukemia, 22 patients with acute myeloblastic leukemia and 1 patient with a biphenotypic variant. Determination of polymorphisms was carried out by PCR-RFLP analysis or polymerase chain reaction followed by an analysis of restriction fragment length polymorphism. The interrelation of the results obtained with the patients' gender was assessed using statistical methods., Results: The study showed that there were no gender differences for all three genotypes of the Arg72Pro polymorphic marker of the tumor suppressor p53 (ТР53). Three Arg399Gln genotypes of the XRCC1 gene also did not depend on gender. However, with a separate analysis of each polymorphism, there was a tendency for a greater proportion of the Arg/Gln genotype in the group of boys compared to girls. The Gln/Gln polymorphism relationship requires further study due to insufficient data for analysis., Conclusion: The study has expanded the understanding of genetic changes and their relationship with gender, which have diagnostic, prognostic and therapeutic implications in acute leukemia. The conducted research of the relationship between individual phenotypes of acute lymphoblastic leukemia with risky polymorphisms in some genes contributes to the study of AL.

Leukemia is the most common malignancy of childhood representing about 30 % of oncohematological diseases diagnosed in children less than 15 years of age. We report the case of a 4 year old girl with acute promyelocytic leukemia whose blasts showed the morphology characteristic of acute promyelocytic leukemia variant. The case is reported because in the paediatric population the acute promyelocytic leukemia is a rare occurrence moreover, it represent a true oncohematology emergency, in this case the laboratory has a significant role since the timing of diagnosis must be very short. It helps in therapeutic protocols compared to conventional therapeutic protocols in Acute Myeloid Leukemia (AML), the introduction of retinoid All-Trans-Retinoic Acid (ATRA), both in children and adults with Acute Promyelocytic Leukemia (APL), has significantly reduced the early mortality. [ABSTRACT FROM AUTHOR]

Pediatric cancer patients face an increased risk of nosocomial infections (NI) due to their underlying illnesses and intensive anticancer therapy. To date, no prospective mono/ multicentric Bulgarian studies have been published on this topic. The objectives of this study were to determine: (1) the incidence of NIs, (2) sites of NIs, (3) causal organisms, and (4) characteristics and outcomes of NI among pediatric patients with neoplastic diseases as a first step of improving infection control policity. A prospective surveillance study from Jаnuary through December 2020 was performed in the Pediatric оncohematology unit at the University Hospital “ Tzaritza Yoanna “ in Sofia. Conclusion. A total of 32 pediatric patients with neoplastic diseases and episodes of NIs were reported; 16 of them aged 1-4 yo. Patients with acute leukemia had the highest number of NIs (47.7%); the most common causal organisms in bloodstream were gram positive bacteria (57.44%). Poor outcome we reported in two patients. [ABSTRACT FROM AUTHOR]