Pulmonary comorbidity in chronic lymphoproliferative diseases: realities of the problem in the Dnipro region

The prevalence of the chronic lymphoproliferative diseases is increasing worldwide with increase of the population age. It is known that the presence of comorbidities in such patients plays an important role in predicting treatment outcomes. The aim of the work was to study the prevalence and determine the structure of respiratory symptoms and comorbid pulmonary pathology in patients with chronic lymphoproliferative diseases (CLPD) in the Dnipro region of Ukraine. After analyzing 986 cards of inpatients of the hematology department, whose average age was 65 (56; 69) years, it was determined that 9.0% of patients had at least one chronic respiratory disease, the most common among which were chronic bronchitis, chronic obstructive pulmonary disease, as well as community-acquired pneumonia. Dyspnea and tachypnea are also common among patients with CLPD without established respiratory comorbidity, cardiovascular disease, or anemia. Based on the data obtained, we can recommend a study of the respiratory function and pulse oximetry, as well as a thorough collection of anamnesis of smoking and analysis of the results of chest computed tomography in all patients with CLPD in order to identify the possible cause of shortness of breath and establish the presence of respiratory comorbidity.

Management of autoimmune complications in patients with lymphoid cancer

Autoimmune conditions can occur at any temporary relationship with malignant lymphomas. In many instances, treatment at diagnosis is not required, but symptomatic autoimmune conditions represent an indication for treatment particularly in chronic lymphoproliferative diseases. Treatment is selected depending on the predominant condition - autoimmune disease (immunosuppression) or lymphoma (anti-lymphoma therapy). Steroids as well as anti-CD20 antibodies are effective against both and may suppress the autoimmune complication for a prolonged period. Efficacy of B-cell receptor inhibitors has provided us with novel insights into the pathophysiology of antibody-producing B-cells. Screening for underlying autoimmune conditions is part of the lymphoma work-up since other drugs like immunomodulators or checkpoint inhibitors should be avoided or used with caution. Here we discuss diagnostic challenges and treatment approaches for different situations involving lymphomas and autoimmune cytopenias.

Prognostic Role of C-Reactive Protein, C-Reactive Protein Kinetics and C-Reactive Protein/ Albumin Ratio in Newly Diagnosed B-Cell Chronic Lymphoproliferative Diseases

Introduction: C-reactive protein (CRP), the most commonly used clinical indicator of inflammation, plays an important role in disease diagnosis and efficacy evaluation. Recent studies identified elevated CRP level and CRP kinetics, dynamic change of CRP level throughout treatment, were associated with decreased clinical outcome in some malignancies. Because of increased catabolism and the reduce of hepatic synthesis, albumin is oppositely associated with inflammatory. CRP/ albumin ratio (CAR) is a novel and superior prognostic factor involving inflammatory and nutritional factors in various cancers. However, the prognostic role of CRP, CRP kinetics and CRA in B-cell chronic lymphoproliferative diseases (B-CLPD) were not well characterized yet. Our study focused on the prognostic role of CRP, CRP kinetics and CRA in newly diagnosed B-CLPD. Methods: In total, 243 newly diagnosed B-CLPD patients from January 2012 to December 2019 at the Shandong provincial hospital in China were analyzed for overall survival (OS) and disease-free survival (DFS), depending on CRP, CRP kinetics and CRA. OS and DFS were determined by Kaplan-Meier curves and log-rank test. Cox proportional analysis was performed to examine the prognostic significance of clinicopathological variables in multivariate analyses. Results: The five-year OS of patients with elevated pretreatment CRP level (94.3% vs. 56.7%, p<0.001) (Figure 1a), elevated post-treatment CRP level (81.7% vs. 39.4%, p<0.001) (Figure 1c), continuously elevated CRP level during the whole treatment process (80.0% vs. 47.1%, p<0.001) (Figure 1e) and elevated pretreatment CRA level (93.1% vs. 61.9%, p<0.001) (Figure 1g) were shorter than normal patients, respectively. Compared to normal patients, the five-year DFS of patients with elevated pretreatment CRP level (88.0% vs. 33.9%, p<0.001) (Figure 1b), elevated post-treatment CRP level (56.4% vs.35.7%, p=0.020) (Figure 1d), ever-elevated CRP level (62.9% vs. 35.3%, p<0.001) (Figure 1f), continuously elevated CRP level during the whole treatment process (80.2% vs. 35.3%, p<0.001) (Figure 1f) and elevated pretreatment CRA level (87.3% vs. 42.8%, p<0.001) (Figure 1h) were shorter, respectively. Multivariate analyses identified that elevated pretreatment CRP level (HR: 5.110, p=0.001) (Table 1), elevated post-treatment CRP level (HR: 5.826, p=0.006) (Table 2), continuously elevated CRP level (HR: 6.461, p<0.001) (Table 3) and elevated pretreatment CAR (HR: 3.768, p=0.008) (Table 4) had association with worse OS. Likewise, elevated pretreatment CRP level (HR: 3.767, p=0.001) (Table 1), post-treatment CRP level (HR: 2.384, p=0.043) (Table 2), ever-elevated CRP level (HR: 2.425, p=0.027) (Table 3), continuously elevated CRP level (HR: 4.748, p<0.001) (Table 3) and elevated pretreatment CAR level (HR: 2.824, p=0.007) (Table 4) were in independent significance with worse DFS. Conclusions : We demonstrate that CRP level, CRP kinetics and CAR could be potential prognostic indicators with independent significance in patients with B-CLPD. CRP and CAR make an implementation for prognostic evaluation more easily and effectively in B-CLPD patients. Disclosures No relevant conflicts of interest to declare.

OCCURRENCE OF THE RISKS FOR DEVELOPMENT OF RESPIRATORY DISEASES IN CHILDREN EXPOSED TO THE CHEMICAL FACTORS OF THE EXPOSURE OF ALUMINA REFINERY- ASSOCIATED BUSINESS ACTIVITY

Alumina refineries are among the leading sources of atmospheric air pollution with a wide range of pollutants hazardous to human respiratory organs. It is relevant to study and evaluate the occurrence of the risks for development of respiratory diseases in children living in the area affected by the emission components of an alumina refinery. We assessed air quality of the area under observation and comparison according to monitoring observations, risk of non-carcinogenic effects from the respiratory organs. The content of chemicals in the blood and urine adequate to risk factors was quantified. The structure of individual groups of respiratory diseases was analyzed. The causal relationships of violations of laboratory parameters with an increased content of chemicals in biological media were evaluated. It was found that an aerogenic exposure of chemical pollutants is formed on the territory with the production of metallurgical alumina. It determines the risk for development of respiratory diseases, exceeding an acceptable level up to 49.9 times. In the exposed children, the content of manganese, chromium, nickel, copper, xylenes, formaldehyde and aluminum, fluoride ion in the urine was increased to 4.2 times in relation to the indices in the comparison group. A high level of additional respiratory morbidity(1.8 times) was revealed. Chronic lymphoproliferative diseases of the nasopharynx and inflammatory diseases of the upper respiratory tract (up to 6.6 times more often), inflammatory diseases with a predominance of the mechanism of allergic inflammation ( up to 2.1 times more often)are more often detected in the framework of the respiratory diseases. Negative effects on the part of the respiratory system in the form of activation of antioxidant processes, the development of an inflammatory reaction, local, general and specific sensitization of the respiratory tract were established. It confirms the occurrence of the risks for the development of respiratory diseases in children in the exposure area of the chemical factors of alumina refinery-associated economic activity.