We describe a rare case of myeloid/NK cell precursor acute leukemia (MNKL) in a 38-year-old woman. Upon diagnostic examination, a tumor invasion of bone marrow, lymphatic nodes, liver and spleen was found. The proportion of blasts in peripheral blood reached 54%. The blasts were polymorphic, with round or irregularly shaped nuclei. The tumor cells were negative for myeloperoxidase, non-specific esterase, and lipid staining. The blasts not only expressed CD13+ and CD33+ panmyeloid antigens, but also carried the markers of NK-cell differentiation (CD16+, CD56+, Perforin+). The leukemoid infiltration of liver, acute hepatitis and development of liver cell failure were the distinctive features of the described case. The issues pertaining to differential diagnostics and classification of MNKL are also discussed.

Method for recognizing the structure of blood and bone marrow blast nuclei using light microscopy and computer data processing is proposed to improve the accuracy of diagnosis of acute leukemia, including reducing the subjectivity of microscopic analysis of blood and bone marrow preparations. The paper presents a model of automated recognition of blood cells during microscopic analysis based on objective criteria of classification of images of pathological cells, focused on the differential diagnosis of acute leukemia. The application of the proposed method allows to clarify the variant of the disease and reduce the time of the diagnostic process.

The work is devoted to one of the promising directions in the field of artificial intelligence - recognition of blood cells and bone marrow to differentiate leukocytes by type in the diagnosis of lymphoproliferative diseases using computer microscopy. The article presents a study using neural networks to classify cells by type.

Method of Myelogram Analysis in Leukocyte Recognition Systems Nikitaev V.G.1, Nagornov O.V.1, Pronichev A.N.1, Polyakov E.V.1, Zaytsev V. S.1, Dmitrieva V.V.1, Nagdaseva A.V.1, Selchuk V.Y.2, Tupitsin N.N.2, Frenkel M.A.2, Mozhenkova A.V.2, Beznos O.A.2, Matveeva I.I.2, Blindar V.N.2, and Zubrikhina G.N.2 1National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Kashirskoe shosse 31, 115409, Moscow, Russia 2N.N. Blokhin Russian Cancer Research Center, Ministry of Healthcare of Russian Federation, Kashirskoe shosse 23, Moscow, Russian Federation

The paper describes the method of recognition of T - and B - variants of acute lymphoblastic leukemia in microscopic images of blood cells. The method is based on the use of texture characteristics of images. Experimental recognition accuracy evaluation is obtained from the sample of 38 patients (17 with T-ALL and 21 with B-ALL variants of acute lymphoblastic leukemia). The obtained results show the possibility of applying of the proposed approach to the differential diagnosis of T- and B- variants of acute lymphoblastic leukemia.

The article describes the use of a computer optical microscopy with multispectral camera to characterize the texture of blasts bone marrow of patients with different variants of acute lymphoblastic leukemia: B- and T- types. Specific characteristics of the chromatin of the nuclei of blasts for different types of acute lymphoblastic leukemia were obtained.

The article describes the application of computer microscopy with multi-spectral camera for the comparative characteristics of normal lymphocytes and lymphoid cells in follicular lymphoma. Wavelet functions are used to quantify parameters of the cells nuclei images.

The work investigated the effect of the choice of color space component on blood cell detection based on the calculation of texture attributes of blood cells nuclei in bone marrow. The study identified the most informative color space and texture characteristics of blood cells, designed for components of these spaces. Significance ratio was introduced to assess the quality of features. We offered features that have enabled to divide lymphocytes from lymphoblasts. The selection of the features was based on the results of the data analysis.

The application of the textural analysis methods based on computer microscopy in the visible region of electromagnetic radiation to classify blood cells into lymphoblasts and lymphocytes is considered. The model of digital processing of cell images is proposed. To quantitatively describe cells in diagnostics and differential diagnostics of acute lymphoblastic leucoses (ALLs), textural characteristics of nucleus images with estimation of their parameters are used.

To reveal the specific features of hematopoiesis in patients with head and neck squamous cell carcinoma (HNSCC), the authors analyzed the indicators of 41 bone marrow aspirates in relation to the clinical and morphological characteristics of the tumor and micrometastases detected in bone marrow. Puncture samples were morphologically and molecularly examined at the Laboratory of Hematopoiesis Immunology, N.N. Blokhin Russian Cancer Research Center. The found changes in the bone marrow cell composition in HNSCC patients showed themselves as an increase in the relative count of segmented neutrophils and a decrease in the level of immature granulocytes with no alternations in the neutrophil maturation index and in the percentage of granulocyte lineage cells. Bone marrow hypocellularity is a characteristic feature of high-grade HNSCC. The significantly enhanced leuko-erythroblastic ratio was due to a reduction in red blood cells: the erythroid cell maturation index rose, by increasing the percentage of bone marrow oxyphilic normoblasts in patients with locally advanced HNSCC. A highly sensitive method for detecting mRNA of the specific squamous cell carcinoma protein E48 was perfected using reverse-transcription polymerase chain reaction and Southern blotting, followed by an enzyme immunoassay that could recognize bone marrow micrometastases in 35 % of the patients with HNSCC. The patients with found bone marrow micrometastases showed a significant decrease in the proportion of polychromatophilic normoblasts and a significant increase in granulocytes in the presence of normal values of lymphocytes and other cellular elements of myelograms. It was established that in the presence of regional lymph node involvement, bone marrow micrometastases were significantly more frequently in the patients with HNSCC and tumor progression over a period of up to 9 months.

Objective. To determine clinical and laboratory features and prognosis of mixed-phenotype acute leukemia (MPAL). Methods. Of 208 AL patients treated in the N.N. Blokhin Russian Cancer Research Center over past 14 years, MPAL was diagnosed in 5 cases (2.4 %). In total 13 patients were enrolled in this study; these patients were hospitalized in the N.N. Blokhin Russian Cancer Research Center (n = 5) and in four other hematological hospitals of Moscow (n = 8). The disease was diagnosed in accordance with the 2008 WHO classification. The median age was 48 years (ranged from 20 to 75 years). Results. B/M-phenotype was diagnosed in most patients (n = 11) and T/M only in 2 patients. Translocation t(9;22) (q34;q11) was the most common chromosome aberration diagnosed in 5 (55.5 %) patients. BCR-ABL chimeric gene was in 8 of 9 patients. Treatment strategy was determined by molecular biological and cytogenetic MPAL profiles. Patients with t(9;22)(q34;q11) and/or BCR-ABL chimeric gene treated with imatinib combined with ALL-regimes (n = 8). Patients with Ph-negative MPAL (n = 1) or unknown molecular biological and cytogenetic MPAL profiles (n = 4) received AML-directed therapy or combined regimes for the treatment of ALL and AML. Complete remission (CR) was obtained in most patients (83.3 %) with low rate of early mortality (8.3 %). 3-year OS was 18.2 % (median 14 months), 3-year RFS was 12.8 % (median 16 months). CRs were induced in all Ph+ MPAL patients. Conclusion. There are no specific clinical and laboratory predictors of MPAL. Tyrosine kinase inhibitors (TKI) play the key role in the treatment of Ph+ MPAL. TKI combined with low intensity ALL regimes seem more promising. The problem of treatment of Ph-negative MPAL patients remains unsolved.

Objective. To assess treatment outcomes of 132 patients with acute myeloid leukemia (AML) treated in hematology department of the N.N. Blokhin Russian Cancer Research Center over the period from January, 2003, till November, 2014. Methods. 106 patients with primary AML and 26 patients with secondary AML and AML arising from MDS were enrolled in this study. Median age was 43.5 years (varied from 15 to 82). The study design provided 1 cycle of remission induction according to the 3+7+7 scheme (idarubicin 12 mg/m 2 on days 1-3, cytarabine 100 mg/m 2 every 12 h on days 1-7, etoposide 75 mg/m 2 on days 1-7), 2 cycles of consolidation according to the HAI scheme (cytarabine 3 g/m 2 on days 1, 3, 5; idarubicin 10 mg/m 2 on days 2, 4), and 6 cycles of maintenance treatment according the 1+5+5 scheme for patients younger than 60 years (cytarabine 100 mg/m 2 every 12 h on days 1-5, idarubicin 15 mg/m 2 on day 1, etoposide 75 mg/m 2 on days 1-5). The treatment protocol for patients aged 60-65 did not include etoposide, and the cytarabine dose was reduced to 1 g/m 2 at the remission consolidation stage. Results. The analysis of treatment efficacy in 71 patients younger than 60 years with primary AML demonstrated that the percentage of complete remissions (CR) was 77.5 %. In 41 (74.5 %) patients the CR was achieved after the 1st induction cycle. The 5-year overall survival (OS) and relapse-free survival (RFS) rates were 43 % and 52 %, respectively. In the favorable cytogenetic risk group, the CR rate was 90 %, 5-year ОS and RFS were 65 % and 100 %, respectively; in the intermediate cytogenetic risk group these parameters were 90.5 %, 45 %, and 48 %, respectively. In the high risk group, CR was achieved in 36.4 % patients achieved; the resistant disease was observed in 63.6 % of cases, 2-years ОБ and DFS rates were 16 % and 0 %, respectively. Among patients aged 60-65 years receiving intensified consolidation therapy, the CR rate was 61.5 %, the resistant disease was observed in 23.1 % of cases. The early mortality rate was 15.4 %, and the 3-year ОБ and DFS rates were 14 % and 50 %, respectively. Conclusion. The treatment program with intensified consolidation demonstrated high long-term survival rates in patients with primary AML younger than 60 years. The best results were obtained in the favorable cytogenetic risk group. Management of patients over 60 years of age and patients with AML in high-risk cytogenetic group is still a challenge.

2 Федеральное государственное бюджетное учреждение «Гематологический научный центр» Минсоцразвития России, 3 Федеральное Objective: to consider clinical practice problems in the differential diagnosis of different types of plasma cell dyscrasias (PCD). Subjects and methods. Fourteen patients (8 men and 6 women) aged 52±12 years, in whom rheumatic diseases (RD) were ruled out and who were diagnosed as having primary PCD: different types of myeloma in 7 patients, myeloma + AL-amyloidosis in 2, AL-amyloidosis in 3, and Waldenstrom's macroglobulinemia in 2, were examined. Results and discussion. The most common maldiagnosed RDs in patients with PCD were seronegative rheumatoid arthritis (RA), systemic lupus erythematosus, Sjogren's disease, and different forms of vasculitis. The most frequent masks of RD were kidney (78%) and osteoarticular system (64%) lesions, vascular disorders (36%), peripheral polyneuropathies (36%), and enlarged salivary glands with xerostomia (28.5%). Serum and urine immunochemical study should be performed in all patients who have clinical manifestations of seropositive RA, spondyloarthritis, inten- sive bone pain syndrome, ulceronecrotic vasculitis, enlarged submandibular salivary glands with macroglossia in the absence of markers of autoimmune disease for the timely diagnosis of PCD and the exclusion of RD. The paper esti-

Nowadays, the analysis of hematopoiesis in patients with acute lymphoblastic leucosis includes only quantitative characteristics of residue myeloid process of bone marrow. The evaluation of myelodysplasia is unexplored still. The analysis of myelopoiesis was carried on sampling of 108 patients with primary acute lymphoblastic leucosis (27 - T-acute lymphohlastic leucosis, 81 - B-acute Iymphoblastic leucosis). The characteristics of dysplasia of granulocytes, erythroid cells and megakaryocytes were based on the parameters of WHO classification of acute myeloid leucosis (2001). The monolinear dysplasia was established in 35 patients (32.4%). multilinear dysplasia--in 9 patients (8.3%). Under T- acute lymphoblastic leucosis the bilinear dysplasia was detected reliably more often and absence of dysplasia more rare than under B-acute lymphoblastic leucosis. The signs of dysplasia of various myeloid lines had no inter-correlation and had no dependencies from indicators of expression of early antigens (CCD34 and TdT) and myeloid antigens (CD13, CD33). The comparison of factual data with indicators of dysplasia under acute mteloid leucosis (181 patients) demonstrated that rates of uni- and multilinear dysplasia under T-acute Iymphoblastic leucosis and acute myeloid leucosis have no significant difference. The myelodysplasia is detected reliably (more often under B-acute lymphoblastic leucosis as compared with acute myeloid leucosis.

Objective: to consider clinical practice problems in the differential diagnosis of different types of plasma cell dyscrasias (PCD). Subjects and methods. Fourteen patients (8 men and 6 women) aged 52±12 years, in whom rheumatic diseases (RD) were ruled out and who were diagnosed as having primary PCD: different types of myeloma in 7 patients, myeloma + AL-amyloidosis in 2, AL-amyloidosis in 3, and Waldenstrom’s macroglobulinemia in 2, were examined. Results and discussion. The most common maldiagnosed RDs in patients with PCD were seronegative rheumatoid arthritis (RA), systemic lupus erythematosus, Sjogren’s disease, and different forms of vasculitis. The most frequent masks of RD were kidney (78%) and osteoarticular system (64%) lesions, vascular disorders (36%), peripheral polyneuropathies (36%), and enlarged salivary glands with xerostomia (28.5%). Serum and urine immunochemical study should be performed in all patients who have clinical manifestations of seropositive RA, spondyloarthritis, intensive bone pain syndrome, ulceronecrotic vasculitis, enlarged submandibular salivary glands with macroglossia in the absence of markers of autoimmune disease for the timely diagnosis of PCD and the exclusion of RD. The paper estimates the sensitivity and specificity of main methods used to diagnose different types of PCD.

We report a rare case of multiple myeloma in a 61 years old patient. Malignant plasma cells are characterized by lymphoid appearance and blast-like chromatin. Immunohistochemical and flow cytometry methods lead to diagnose multiple myeloma, plasmablastic variant.