Diffuse large B-cell lymphoma is the most common immunomorphological variant of lymphoma in adults. Extranodal lesions are observed in a third of patients at the disease onset. The organs most often involved are the gastrointestinal tract, testicles, bones, thyroid gland, and skin. Primary involvement of the nasal cavity and paranasal sinuses occur extremely rarely and cause diagnostic and therapeutic difficulties.The article demonstrates a rare clinical case of newly diagnosed diffuse large B-cell lymphoma with sinonasal tract involvement. It took 6 months to verify the final diagnosis. At the moment, the induction stage of treatment for diffuse large B-cell lymphoma continues, the achieved complete metabolic response is maintained.

Background. The term diffuse large B-cell lymphoma (DLBCL) defines a heterogeneous group of lymphatic tumors. DLBCL is the most frequent immunomorphological variant among aggressive non-Hodgkin lymphomas (NHLs) in adults. It accounts for 30–40 % of all NHLs. Long-term results of treating newly diagnosed DLBCL have not been reliably evidenced in healthcare practice and, therefore, require further study. Aim. To assess the efficacy of chemotherapy for newly diagnosed DLBCL in terms of the 5-year progression-free survival (PFS) based on the analysis of data from the in-house hematology service registry at the Moscow City Clinical Hospital No. 52. Materials & Methods. The study enrolled 156 patients with newly diagnosed DLBCL in the period from 2015 to 2022. The patients were 35–85 years of age (median 65 years). Results. First-line R-CHOP/R-miniCHOP chemotherapy was administered to 70 % of patients, 28 % of patients received R-DA-EPOCH, and 2 % were treated either with R-B or R-CVP. Complete response was achieved in 100 (65 %) patients: 75 out of them (75 %) received R-CHOP/R-miniCHOP, whereas 25 (25 %) received R-DA-EPOCH. Induction mortality was below 2.5 %. The 5-year PFS was 32 % with the survival median of 20 months. As confirmed by the multivariate analysis, the age over 60 years (p = 0.003), high IPI risk group (p = 0.015), advanced stage of the disease (p = 0.002), and non-GCB subtype of tumor (p = 0.045) can be regarded as independent predictors of early DLBCL progression. Conclusion. DLBCL is an aggressive B-cell lymphoma and one of the most frequent immunomorphological NHL variants in the clinical practice of the Moscow City Clinical Hospital No. 52. Despite the use of generally accepted standard immunochemotherapy regimens, the results attained by the present study illustrate unresolved challenges in chemotherapy for newly diagnosed DLBCL patients. By now, more effective first-line DLBCL therapy methods already exist, which are confirmed by the results of clinical trials. As it is sometimes impossible to further escalate immunochemotherapy for obvious reasons (age restrictions, health status, co-morbidities, etc.), a new promising strategy appears to be the personalized chemotherapy based on the study of genetic DLBCL profile of each particular patient.

Classical Hodgkin’s lymphoma (cHL) is a lymphoproliferative disease characterized by the presence of Hodgkin anderezovsky–Reed–Sternberg cells and a tumor microenvironment. Currently, much attention is paid to the microenvironment in cLH. A detailed understanding of the interaction between the tumor and its microenvironment opens up prospects for the cHL diagnosis and treatment. Innovative immunotherapeutic agents such as nivolumab make it possible to control and activate the immune response. Despite the high efficiency of standard protocols in young patients, therapy intensification is associated with organ toxicity and the development of secondary malignant neoplasms. At the same time, in elderly patients, the results of generally accepted antitumor treatment protocols should be considered suboptimal. In the last decade, the treatment of refractory cHL has improved significantly due to the use of immune checkpoint inhibitors.Taking into account the above, the priority issue in modern clinical hematology is to improve cHL treatment strategies not only in elderly but also in young patients by maintaining a balance between high efficacy and low toxicity. Moreover, the inclusion of nivolumab in first-line therapy is not only pathogenetically justified and effective, but also safe. The article presents data from clinical observations of the successful nivolumab use in combination with chemotherapy in patients with newly diagnosed cHL.

Background. Diffuse large B-cell lymphoma (DLBCL) is a potentially curable biologically heterogeneous lymphatic tumor. Standard R-CHOP therapy shows disappointing results, both immediate and longterm. To improve efficacy without additional toxicity, it is worth considering the possibility of using biologically oriented therapy.Aim. To evaluate the clinical efficacy and toxicity of the genotypedirected R-CHOP-X in patients with newly diagnosed DLBCL in real clinical practice.Materials and methods. A single-center prospective interventional clinical study included 30 patients with newly diagnosed DLBCL between September 2023 and September 2024. The median age was 60 (38–78) years. According to the international prognostic index, 23 (77 %) patients were classified as having a high risk of progression. Genotype incidence in the study cohort: MCD – 7 %, N1 – 20 %, BN2 – 7 %, EZB– 16 %, ST2 – 7 %, NOS – 43 %.Results. 30 patients received personalized genotype-directed therapy. Of these, 21 (70 %) patients completed treatment: the overall response rate was 100 % (complete metabolic response – 100 %). 9 (30 %) patients continue therapy: the overall response rate is 100 %. At 12 months, overall survival and progression-free survival were 100 % (95 % confidence interval 100 %). Hematological toxicity was assessed depending on the number of cycles (n = 144): grade III–I neutropenia was detected in 7 % of cycles, grade III–I anemia and grade III–I thrombocytopenia in 1.4 and 3.5 % of cycles, respectively. Non-hematological toxicity was generally grade ≤I–II.Conclusion. The results of this clinical trial are promising and provide preliminary evidence for the benefit of personalized genotype-directed antitumor therapy in newly diagnosed DLBCL. This therapeutic strategy demonstrates high clinical efficacy, particularly in the main target group – DLBCL with a high risk of progression with low toxicity. Further randomized studies are needed to confirm the effectiveness and implement the new approach in routine clinical practice.

Treatment of immunocompromised patients with novel coronavirus infection (COVID-19) presents significant challenges. Currently, there are no unified approaches to the treatment of persistent COVID-19 in hematological malignancies. There is a need to develop recommendations for the management of such patients, chemotherapy protocols, as well as therapy for COVID-19 in case of SARS-CoV-2 virus persistence. Doctors are faced with cases of virus persistence, clinical manifestations during a long course of the infectious process and are not provided with methodological recommendations for patient supervision. As scientific data on the persistent COVID-19 course in patients with lymphoproliferative diseases accumulates, it is planned to create recommendations for the treatment of COVID-19 for patients in this group. This article describes a clinical case of persistent COVID-19 course in a comorbid patient with primary central nervous system large B-cell lymphoma during chemotherapy.

The effects of baricitinib, a selective reversible inhibitor of Janus kinase 1 and 2, in the treatment of COVID-19 are associated with different aspects of pathogenesis — inhibition of viral endocytosis, reduction of excessive inflammatory response, and mitigation of vascular and pulmonary damage, which is a strong rationale for using baricitinib to treat patients with COVID-19. In the period from April to May 2020, City Clinical Hospital No. 52 obtained clinical experience of baricitinib clinical use in the therapy of 113 patients with COVID-19: 58 (51%) women and 55 (49%) men, whose average age was 57±12.6 years old. Analysis of the results of using baricitinib showed that therapy with baricitinib against the background of standard pathogenetic therapy was found to be effective in 95 (84%) patients and ineffective in 18 (16%). Significant positive changes were shown in comparison with the baseline level of the following indicators: body temperature (from 37.2±0.8˚C to 36, ±0.68˚C, P=0.000), blood oxygen saturation (from 95.5±3.0% to 96.5±2.2%, P=0.011), C-reactive protein (from 46.1±48.0 mg/L to 33.5±43.7 mg/L, P=0.010 ), National Early Warning Score (NEWS) (from 1.7±1.3 to 1.1±1.2, p=0.001). From the safety point of view, patients showed a slight decrease in the average value of the number of neutrophils — from (3.1±1.4)×109 to (3.0±2.0)×109 and lymphocytes — from (1.8±0,9)×109 to (1.7±0.9)×109, as well as minimal multidirectional changes in the mean values of transaminase activity — alanine aminotransferase changed from 33.9±23.6 U/L to 34.9±47.5 U/L, aspartate aminotransferase — from 40.6±49.0 U/L to 38.5±25.5 U/L. In general, the results obtained within the experience of the clinical use of baricitinib in 113 Russian patients with COVID-19 are consistent with the available data from foreign clinical studies and confirm the efficacy and safety of baricitinib.

According to accumulated clinical data, one of the causes of severe damage to lung epithelial cells associated with SARS-CoV-2 (2019-nCoV) is an acute, timely underestimated "cytokine storm" (cytokine cascade, hypercytokinaemia) with characteristic signs of an expressed hyper-inflammatory syndrome with subsequent polyorganic failure. The study presents the results of the analysis of the effectiveness of tocilizumab therapy (TCZ) in patients (n = 181) of different age groups with developed pneumonia caused by SARS-CoV-2. The aim of the study was to evaluate the effectiveness of TCZ therapy in patients of different age groups with developed pneumonia in the frame of COVID-19. Methods. Patients (n = 181) with community-acquired pneumonia caused by coronavirus SARS-CoV-2 are included in a one-center, non-randomized, prospective study to evaluate the effectiveness of TCZ therapy conducted at the State Public Health Institution "City Clinical Hospital No.52" of the Moscow City Health Department. Patients were divided into 3 age subgroups – up to 50 years, 50–70 years and over 70 years. Patients with community-acquired SARS-CoV-2-induced pneumonia receiving non-invasive oxygen support and patients who had artificial lung ventilation (ALV) were given a single dose of 400 mg of TCZ in addition to basic therapy. Results. There are no significant differences between age groups in the severity of pneumonia according to the data of the computed tomography (CT), however, a more severe condition and a higher mortality rate (p < 0.001) were reliably observed in patients over 70 age compared to the other age groups. After TCZ treatment in patients of each age group, the severity of the condition assessed on the National Early Warning Score (NEWS2) has been significantly reduced compared to the baseline. Conclusion. According to the data of the pilot study the efficacy and safety of TCZ in patients of all presented age groups with COVID-associated pulmonary tissue lesion and signs of "cytokine storm" was demonstrated. At the same time, patients up to 50 years after the therapy of TCZ managed to achieve greater clinical efficiency compared to patients in other groups. According to the severity of the state and laboratory criteria, the lowest clinical efficacy of TCZ therapy was observed in patients over 70 years of age; as a consequence, the highest mortality rate was observed in the same group. At the same time, the TCZ therapy has not had a positive impact on the change of laboratory values and the severity of the disease in case of unfavorable outcome.

Для лечения и профилактики осложнений, связанных с COVID-19, используют хлорохина фосфат и гидроксихлорохина сульфат. Применение этих препаратов потенциально может вызывать удлинение интервала QT. Сочетание антималярийных препаратов с фторхинолонами и макролидами увеличивает риск возникновения нарушения ритма. ЦЕЛЬ ИССЛЕДОВАНИЯ На основе анализа собственных клинических данных определить значение величины QTc-интервала для коррекции мониторинга пациентов с COVID-19-ассоциированной внебольничной пневмонией во время курса антипротозойного препарата в сочетании с антибактериальными средствами, обладающими сердечно-сосудистой токсичностью (макролид или фторхинолон). МАТЕРИАЛ И МЕТОДЫ Одноцентровое нерандомизированное проспективное исследование по оценке безопасности терапии гидроксихлорохина сульфатом в сочетании с фторхинолонами или макролидами включало 98 пациентов с внебольничной пневмонией COVID-19, разделенных на две группы: 39 пациентов с наличием сердечно-сосудистых заболеваний, 59 — без сердечно-сосудистых заболеваний. РЕЗУЛЬТАТЫ В группе пациентов без сердечно-сосудистых заболеваний достоверно увеличивалось время интервала QTc на 5-е и 10-е сутки в сравнении с 1-ми сутками терапии: 360 [350; 380] мс против 390 [360; 400] мс; p=0,003 и 360 [350; 380] мс против 400 [390; 430] мс соответственно (p=0,005). У пациентов с сердечно-сосудистыми заболеваниями лишь на 10-е сутки терапии достоверно увеличился интервал QTc в сравнении с 1-ми сутками терапии: 360 [340; 410] мс против 400 [370; 450] мс (p=0,03). ВЫВОДЫ При совместном назначении гидроксихлорохина сульфата с фторхинолонами или макролидами у пациентов с COVID-19 не наблюдалось значимого увеличения интервала QTc, а также серьезных нарушений ритма.

According to accumulated clinical data, one of the causes of severe damage to lung epithelial cells associated with SARS-CoV-2 (2019-nCoV) is an acute, timely underestimated cytokine storm (cytokine cascade, hypercytokinaemia) with characteristic signs of an expressed hyper-inflammatory syndrome with subsequent polyorganic failure. The study presents the results of the analysis of the effectiveness of tocilizumab therapy (TCZ) in patients (n = 181) of different age groups with developed pneumonia caused by SARS-CoV-2. The aim of the study was to evaluate the effectiveness of TCZ therapy in patients of different age groups with developed pneumonia in the frame of COVID-19. Methods. Patients (n = 181) with community-acquired pneumonia caused by coronavirus SARS-CoV-2 are included in a one-center, non-randomized, prospective study to evaluate the effectiveness of TCZ therapy conducted at the State Public Health Institution Clinical Hospital No.52 of the Moscow City Health Department. Patients were divided into 3 age subgroups - up to 50 years, 50-70 years and over 70 years. Patients with community-acquired SARS-CoV-2-induced pneumonia receiving non-invasive oxygen support and patients who had artificial lung ventilation (ALV) were given a single dose of 400 mg of TCZ in addition to basic therapy. Results. There are no significant differences between age groups in the severity of pneumonia according to the data of the computed tomography (CT), however, a more severe condition and a higher mortality rate (p < 0.001) were reliably observed in patients over 70 age compared to the other age groups. After TCZ treatment in patients of each age group, the severity of the condition assessed on the National Early Warning Score (NEWS2) has been significantly reduced compared to the baseline. Conclusion. According to the data of the pilot study the efficacy and safety of TCZ in patients of all presented age groups with COVID-associated pulmonary tissue lesion and signs of cytokine storm was demonstrated. At the same time, patients up to 50 years after the therapy of TCZ managed to achieve greater clinical efficiency compared to patients in other groups. According to the severity of the state and laboratory criteria, the lowest clinical efficacy of TCZ therapy was observed in patients over 70 years of age; as a consequence, the highest mortality rate was observed in the same group. At the same time, the TCZ therapy has not had a positive impact on the change of laboratory values and the severity of the disease in case of unfavorable outcome.

The article reviews studies that confirm the relationship of a negative prognosis with the presence of risk factors for cardiovascular complications during respiratory infections, including novel coronavirus infection COVID-19. The article presents the relevant research results that provide evidence on the myocardial damage in coronavirus infection. We present a clinical case of a patient with confirmed diagnosis of COVID-19 and severe viral myocarditis, verified by histological and immunohistochemical studies.

The article reviews studies that confirm the relationship of a negative prognosis with the presence of risk factors for cardiovascular complications during respiratory infections, including novel coronavirus infection COVID-19. The article presents the relevant research results that provide evidence on the myocardial damage in coronavirus infection. We present a clinical case of a patient with confirmed diagnosis of COVID-19 and severe viral myocarditis, verified by histological and immunohistochemical studies.

Background About 20-30% patients with newly diagnosed multiple myeloma (ND MM) experience damage to kidneys and in 2-4% of cases, hemodialysis is required. NT‐proBNP synthesize in atria and ventricles cardiomyocytes and excreted by the kidney. The purpose of this work was to analyze the predictive utility of NT-proBNP in patients with ND MM, complicated by severe dialysis-dependent renal failure (RF). Methods Between 10.2016 and 07.2017, 20 patients with ND MM and terminal RF enrolled in this prospective study. Exclusion criteria were diagnosed at AL-amyloidosis and a significant cardiac pathology. Samples for NT‐proBNP analysis were collected before antimyeloma chemotherapy and not earlier than 36 hours after hemodialysis. The ROC analysis determined the area under the error curve as 0.75 (0.52-0.97), and the cut-off point for the OS was an NT-proBNP concentration of 7036 pg/ml (sensitivity 79%; specificity 44%). According to these data, the patients were divided into two groups, depending on the NT-proBNP value less than (n = 9) or more than (n = 11) 7000 pg/ml for the subsequent analysis. Results The median age of the patients was 67 years (range, 63-76). Median of estimated glomerular filtration CKD-EPI rate was 4.0 (IQR 4.0-5.0) ml/min/1.73 m2. The only difference between the groups was the volume of residual diuresis 1250 (550-2500) vs. 50.0 (37.5-1038) ml/day (P = 0.036). As induction therapies, 11 (55%) patients underwent a VCD regimen, 7 (35%) - VD), and 2 (10%) - VMP. The ASCT accomplished in 1 patient. The renal response was documented in 4 (25.0%) cases including one complete response. With a median follow-up of 17.3 months, the overall OS was 48.5±11.5%. The 18-month OS for comparison groups were 76.6±14.8% and 27.3±13.4% (P = 0.020), respectively. There were no causes of death due to cardiovascular complications. Conclusions According to our data, NT-proBNP > 7400 pg/ml are associated with the severity of kidney damage and the risk of non-cardiac mortality in ND MM patients. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Prognostic value of N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) was analyzed in patients with multiple myeloma complicated by dialysisdependent renal failure. The prospective study included 20 patients with newly diagnosed multiple myeloma. The concentrations of NT-proBNP were measured before antimyeloma chemotherapy. The median age of the patients was 67 (63-76) years. The median glomerular filtration rate was 4 (4, 5) ml/min/1.73 m2. For overall survival, the area under ROC curve was 0.75 and the cut-off point was 7000 pg/ml. At median follow-up of 17.3 months, the overall survival was 76.6±14.8 and 27.3±13.4% (p=0.02) for cases with NT-proBNP levels below and above the cut-off point, respectively. There were no cases of death due to cardiovascular causes. We concluded that the increase in serum concentration of NT-proBNP>7400 pg/ml is associated with the severity of kidney damage and the risk of non-cardiac mortality.

Mediastinal masses include a wide range of both benign and malignant diseases. Current evidence shows that they constitute 3–7% of all oncological diseases, with primary tumours (thymoma, lymphoma, germ cell tumours) accounting for 3% of all mediastinal masses. Lymphoma and thymoma, for instance, are the most common, while germ cell tumours are of much less frequent occurrence. Neurogenic tumours, it bears noting, are also widespread making up 12–21% of all mediastinal masses, predominantly so among paediatric population. Morphologically 25–49% of all masses are malignant. The rationale of the subject matter is the fact that statistics for progress of the disease masked as other conditions have been on the rise. It is noted that about 60% of mediastinal masses manifest themselves in classical respiratory symptoms, while the rest of cases are represented by a variable clinical picture, which makes it more difficult to diagnose and decide on the therapeutic approach. The article presents a clinical case of a 32-year-old female patient diagnosed as primary mediastinal large B-cell lymphoma which made its first appearance as a clinical picture of respiratory complaints. This clinical case describes the diagnosis algorithm using up-to-date laboratory and instrumental methods.

The review is focused on the recent data on the causes of type 2 myocardial infarction and specifics of its diagnostics and management in patients with vasospastic angina. Significance of the problem is based upon the fact that strategies of this sort of patients management are lacking and usually do not fit guidelines. There is absence of agreed princips of long term management of such patients. The selection of strategy (medication therapy, revascularization of the spastic region, prevention of complications and another infarction) is disputable. The case provided, illustrating some of the listed issues from a real practice point of view.