Background. Renal failure (RF) is the most common complication of multiple myeloma (MM), and severe RF requiring hemodialysis is diagnosed in 2–4 % of cases. RF associated with MM is potentially reversible. Severe RF requiring hemodialysis is associated with low overall survival rates, increased risk of complications and early death, low quality of life for patients. Aim. To analyze treatment results of newly diagnosed MM patients with severe RF requiring hemodialysis. Materials and methods. We analyzed data of 39 patients with newly diagnosed MM and severe RF requiring hemodialysis (CKD-EPI < 15 mL/min/1.73 m2) who underwent combination therapy at the N.N. Blokhin National Medical Research Center of Oncology between January 2000 and December 2020. Results. As induction therapy, 25 (64.1 %) patients received bortezomib-based regimens: 13 (33.3 %), VCD (bortezomib + cyclophosphamide + dexamethasone); 12 (30.8 %), VCP (bortezomib + cyclophosphamide + prednisolone); 14 (35.9 %) patients received chemotherapy: VAD (vincristine + doxorubicin + prednisolone), VMCP (vincristine + melphalan + cyclophosphamide + prednisolone), CD (cyclophosphamide + prednisolone). Seven (17.9 %) patients underwent high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation, 5 (71.4 %) patients from this group received bortezomib-based regimens (VCD, VCP), and 2 (28.6 %) – chemotherapy (VAD). After induction therapy, 19 (48.7 %) patients achieved objective hematologic response, and 23 (59 %) patients achieved objective renal response. The use of bortezomib-based induction therapy significantly increased the likelihood of achieving both hematologic and renal responses (p = 0.021 and p = 0.049, respectively) compared with the use of regimens without bortezomib. With a median follow-up of 19 months (95 % confidence interval 1–64 months), median progression-free survival was 15 months (95 % confidence interval: 8–26 months), median overall survival was 29 months (95 % confidence interval: 9–47 months). Multivariate analysis showed statistical significance of the effect of receiving autologous hematopoietic stem cell transplantation on progression-free survival and overall survival (p = 0.015 and p = 0.018, respectively). Conclusion. Using bortezomib-based regimens in newly diagnosed MM patients with severe RF requiring hemodialysis is associated with greater likelihood of achieving both hematologic and renal responses. Performing autologous hematopoietic stem cell transplantation improves progression-free survival and overall survival.

Background. Renal failure (RF) is unfavorable prognostic factor for the multiple myeloma (MM) patients, negatively affecting overall survival. High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is associated with an increased risk of HSCT-related complications and mortality, which may limit its implementation in MM patients with RF, especially in patients with severe RF requiring hemodialysis.Aim. To analyze the effectiveness and adverse events of high-dose chemotherapy followed by auto-HSCT in newly diagnosed MM patients with severe RF requiring hemodialysis.Materials and methods. We analyzed the data of 7 newly diagnosed MM patients with severe RF requiring hemodialysis, who received auto-HSCT.Results. Complete remission achieved 2 (28.6 %) patients, very good partial remission – 4 (57.1 %) patients, partial remission – 1 (14.3 %) patient on the 100th day after auto-HSCT. Complete renal response achieved 6 (85.7 %) patients, 1 (14.3 %) patient remained a minimal renal response. Auto-HSCT led to an improvement in both hematological and renal responses in 1 (14.3 %) patient, hematological response – in 2 (28.6 %) patients. With a median follow-up of 19 months, median progression-free survival and overall survival were 43 and 81 months, respectively. In the early post-transplant period, febrile neutropenia (71.4 %) and grade III–IV mucositis (71.4 %) were most often diagnosed. In the study group of patients, there was no auto-HSCT-related mortality.Conclusion. Auto-HSCT is an effective and safe method of treating newly diagnosed MM patients with severe RF requiring hemodialysis.

The hemostasis system was studied in 35 cancer patients with comorbid terminal chronic renal failure (tCFR) before and after program hemodialysis (HD) at different stages of treatment. All patients underwent bicarbonate HD using equipment 4008 S ("Fresenius", Germany). Appropriate anticoagulation was performed according to the following scheme: at the beginning of the procedure, 1000-3000 units of sodium heparin were injected into the extracorporeal system; further in the process of extracorporeal hemocorrection operation the dose of sodium heparin was from 5 to 15 U/kg of body weight per hour. Hypercoagulability with signs of activation of intravascular blood coagulation, combined with impaired synthesis of individual coagulation factors, occurred in cancer patients with tCFR before the start of renal replacement therapy (RRT). All patients underwent HD procedure 3 times a week. After completion of the programmed HD procedure, multidirectional changes in the hemostasis system were observed. On the one hand, significant hypercoagulability with signs of intravascular coagulation activation remained, which increases the risk of thrombotic complications, on the other hand — prolongation of activated partial thromboplastin time (APTT), decreased activity of prothrombin complex factors and platelet aggregation ability increased the risk of hemorrhagic complications, which dictates the need for a cautious, balanced approach to the prescription of anticoagulants. According to Doppler ultrasonography (DU) in duplex mode of paired vessels (arteries or veins), no signs of thrombosis were detected. The mean hemoglobin level and platelet count before and after the programmed HD procedure did not differ. The use of programmed HD in cancer patients with tCFR, taking into account blood parameters, allows for adequate antitumor treatment, improves the quality and prognosis of life of cancer patients.

В настоящее время частота заболеваний печени и желчевыводящей системы неуклонно растет, что делает проблему все более актуальной. Причины исходной патологии печени, предрасполагающие к развитию печеночной недостаточности, многообразны — острые и хронические вирусные гепатиты, медикаментозное поражение гепатотоксическими препаратами, употребление алкоголя и наркотиков, другие инфекционные и паразитарные заболевания, системные и онкологические заболевания и др. В клинических рекомендациях представлены особенности предоперационного осмотра и подготовки пациентов с сопутствующими заболеваниями печени. Обсуждается влияние анестетиков на функцию печени и влияние печеночной дисфункции на фармакокинетику препаратов. Рассмотрены осложнения, возникающие в послеоперационном периоде у пациентов с сопутствующими заболеваниями печени (печеночная энцефалопатия, асцит и спонтанный бактериальный перитонит, гепаторенальный синдром, кровотечение из варикозно расширенных вен пищевода, дилюционная гипонатриемия, печеночная коагулопатия). В основу статьи положены современные рекомендации Европейской ассоциации по изучению печени (European Association for the Study of the Liver, EASL), Американской ассоциации по изучению болезней печени (American Association for the Study of Liver Diseases, AASLD), Европейского общества анестезиологов (ESA), Российского общества хирургов, Российского общества по изучению печени, а также соответствующие литературные первоисточники.

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Почечная недостаточность — широко распространенное и опасное состояние. Она может быть хронической, на фоне хронических болезней почек (ХБП), и острой, вследствие острого повреждения почек (ОПП). ОПП, несмотря на совершенствование медицинских технологий, зачастую несвоевременно диагностируется и является причиной неблагоприятных исходов, в том числе летальных. Пациенты с патологией почек часто подвергаются оперативным вмешательствам, при этом анестезиологический риск значительно увеличивается. Наличие сложных гемодинамических, биохимических и водно-электролитных нарушений требует особых подходов к выбору анестетиков, технике анестезии, к периоперационному мониторингу. В данной статье представлены факторы риска развития ОПП, критерии диагностики ОПП, особенности коррекции доз различных препаратов при этой патологии, особенности инфузионной терапии и нутритивной поддержки и многие другие аспекты периоперационного ведения пациентов с почечной недостаточностью.

Dysfunction of the natural detoxification organs remains a significant problem in patients with hematological malignancies. The reasons for the development of renal failure are associated with the individual characteristics of the malignant process, the patient’s comorbid background, the toxic effects of anticancer treatment and its complications. The efficacy of many anticancer drugs correlates with their dose, an increase in which is associated with increased toxic effects on healthy organs, including the kidneys. The main reasons for the renal failure development in hematological cancer patients and syndromes that prevent adequate antitumor therapy are considered. Diagnostic algorithm optimization and supportive intensive care of acute renal failure is the key to the successful application of highly effective modern protocols of drug anticancer treatment.A special group is represented by patients suffering from monoclonal gammopathies with acute renal injury and hyperproduction of immunoglobulins free light chains. Renal failure can be the onset and dominant clinical manifestation of multiple myeloma in 18–56 % of cases, of which 10 % require programmed hemodialysis. Antitumor therapy in presence of renal failure is limited, and in some cases impossible, while the renal function recovery is associated with an increase in survival.Organ damage in oncohematological patients can be a manifestation of paraneoplastic syndromes. Tumor lysis syndrome is an urgent problem of oncohematological practice associated with the development of acute renal injury and high mortality.The development of organ failure in oncohematological patients causes significant difficulties in antitumor therapy; a combination of organ dysfunction and the resulting change in anticancer therapy regimens worsen the prognosis. Modern methods of organ failure prevention and treatment can successfully solve complex clinical problems.

The basis of modern high-effective therapeutic programs for pediatric lymphomas is an intensive, risk-adopted therapy, which complicated with myelosuppression. In myelotoxic agranulocytosis condition infectious complications are often and its treatment results depend on duration and level of agranulocytosis, and sensitivity of microorganism to antimicrobial agents. Multi-drug resistant strains of Pseudomonas aeruginosa, Acinetobacter baumannii and etc. are a serious problem in supportive care of postchemotherapy complications, when even multidisciplinary approach with pediatric oncologists/hematologists, microbiologists, clinical pharmacists, surgeons, specialists in extracorporeal blood purification modalities and intensive care are ineffective.

Birkitt lymphoma (BL) is one of the most studied and curable type of lymphoma in children. But inspite of lymphomagenesis deep understanding on immunologic, molecular and genetic levels, diagnosis of some rare clinical presentations of disease become challenging task for well-qualified clinicians. In the current issue we present rare case of skin involvement in pediatric 4 year old patient with disseminated BL. It is presented clinical and morphologic characteristic of specific skin presentation. Used multiagent chemotherapy with rituximab deliver the result of complete response. Skin site regression was found on 2d day of treatment. Parents give their agreement to use personal data, including fotos, in research and publications.

Birkitt lymphoma (BL) is one of the most studied and curable type of lymphoma in children. But inspite of lymphomagenesis deep understanding on immunologic, molecular and genetic levels, diagnosis of some rare clinical presentations of disease become challenging task for well-qualified clinicians. In the current issue we present rare case of skin involvement in pediatric 4 year old patient with disseminated BL. It is presented clinical and morphologic characteristic of specific skin presentation. Used multiagent chemotherapy with rituximab deliver the result of complete response. Skin site regression was found on 2d day of treatment. Parents give their agreement to use personal data, including fotos, in research and publications.

The objective of study is to estimate the efficiency of extracorporeal free light chains of immunoglobulin elimination in patients with monoclonal gammopathies (n = 12) during hemodialysis using selective filters.Materials and methods. A blood and dialysate free light chains concentrations change was criterion of efficiency.Results and conclusion. The selective free light chains filtration give the possibility of an adequate anti-tumor therapy, could prevent the development of irreversible renal failure and hypoalbuminemia.

20 patients with gram-negative sepsis were enrolled in the study. The criteria for including patients into the study were as follows: clinical signs of septic shock, procalcitonin blood concentration more than 2 ng/ml. The patients received from 1 to 6 hemoperfusion procedures applying LPS-adsorber Duration of each procedure was 2 hours. The following values were determined in the patients before and after each hemoperfusion procedure: the values of IL-4, IL-6, IL-8, IL-10, IL-18 in serum and washout from LPS-adsorber; concentrations of LPS in serum LPS-adsorber were measured by LAL-test and modified micro gel clot test. The decrease in the level of LPS was accompanied by the normalization of clinical and laboratory indicators. In particular, in the group of surviving patients there was a significant increase in mean arterial pressure, a decrease in body temperature and a decrease in the catecholamine load and the PCT level. LPS-adsorber (Alteco) is able to eliminate from the bloodstream not only LPS, but excess cytokines. The obtained data testify to the prospects of further randomized studies of the efficacy of LPS-adsorbers in patients with sepsis and septic shock to clarify the indications for their use.

Objective: to assess the early and late functional results of partial nephrectomy in patients with solitary functioning kidney tumors.Materials and methods. Medical data of 131 consecutive patients with solitary kidney parenchymal tumor, who had undergone partial nephrectomy at the N. N. Blokhin Russian Cancer Research Center, were analyzed. The median age was 57 (26–75) years. All the patients were diagnosed with solitary kidney tumor (median RENAL score was 7.0 ± 2.4 and median PADUA score was 9.0 ± 2.2). The median baseline glomerular filtration rate (GFR) was 74 (33–159) ml/min/1.73 m2 (30 (22.9 %) – stage III chronic kidney disease (CKD) and 0 (0 %) – stages IV–V CKD). All the patients underwent partial nephrectomy (with ischemia in 98 (74.8 %) patients, including cold ischemia in 59 (45.1 %)). The median time of ischemia was 24 (7–80) min. The median blood loss was 800 (20–4500) ml.Results. Acute renal injury was recorded in 69 (52.7 %) cases; 6 patients (4.6 %) had indications for acute dialysis. The independent risk factors of acute renal injury were sinus invasion (hazard ratio (HR) 0.08; 95 % confidence interval (CI) 0.03–0.22; p = 0.051), baseline GFR <80 ml/min/1.73 m2 (HR 0.45; 95 % CI 0.22–0.92; p = 0.021), parenchymal ischemia (HR 0.13; 95 % CI 0.05–0.33; p = 0.032), and >500-ml blood loss (HR 0.24; 95 % CI 0.12–0.51; p = 0.005). Progression of previously diagnosed CKD was recorded in 58 (44.6 %) patients; chronical dialysis was required in 2 (1.5 %) patients. The independent risk factors of CKD progression were sinus invasion (HR 0.38; 95 % CI 0.18–0.81; p = 0.002), medial location of the tumor (HR 0.19; 95 % CI 0.09–0.41; p = 0.001), baseline GFR, <60 ml/min/1.73 m2 (HR 0.24; 95 % CI 0.10–0.56; p <0.0001), warm ischemia (HR 0.41; 95 % CI 0.17–1.00; p = 0.052).Conclusion. Solitary kidney resection is associated with a low risk for renal function loss. To achieve optimal functional results, it is desirable to follow the balance between the indications for renal vessel ligation and the need to avoid >500-ml blood loss and cold ischemia.