ISSN 1866-8836
Клеточная терапия и трансплантация
Change template to: announce
array(3) { [0]=> array(49) { ["IBLOCK_SECTION_ID"]=> string(2) "32" ["~IBLOCK_SECTION_ID"]=> string(2) "32" ["ID"]=> string(3) "807" ["~ID"]=> string(3) "807" ["IBLOCK_ID"]=> string(1) "2" ["~IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["~NAME"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["ACTIVE_FROM"]=> NULL ["~ACTIVE_FROM"]=> NULL ["TIMESTAMP_X"]=> string(22) "06/16/2017 12:10:11 am" ["~TIMESTAMP_X"]=> string(22) "06/16/2017 12:10:11 am" ["DETAIL_PAGE_URL"]=> string(146) "/en/archive/tom-6-nomer-1/klinicheskie-stati/pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny/" ["~DETAIL_PAGE_URL"]=> string(146) "/en/archive/tom-6-nomer-1/klinicheskie-stati/pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny/" ["LIST_PAGE_URL"]=> string(12) "/en/archive/" ["~LIST_PAGE_URL"]=> string(12) "/en/archive/" ["DETAIL_TEXT"]=> string(25231) "

Introduction

Ph1-positive acute lymphoblastic leukemia (Ph+ALL) ranks a special place among lymphoid tumors. Initially, Ph1 positivity in ALL cells seemed an unexpected finding, since it challenged a specificity of t(9;22) translocation for chronic myeloid leukemia [17]. Afterwards, upon data gaining, it has become clear that Ph+ ALL may occur in all age groups, being more common in aged people, with minimal rates shown for children. Its prevalence is as high as 20% among adult ALL patients [15]. Until more recent times, the Ph+ ALL was considered an extremely unfavorable clinical variant with respect to all known treatment modes including hematopoietic stem cell transplantation (HSCT) [15]. This problem was solved as soon as different tyrosine kinase inhibitor drugs (TKIs) were introduced to clinics, thus enabling stable molecular remissions of the disease [3,6,13,18], and their usage for successful HSCT [2,16,23] including autologous (auto-) HSCTs [4,7,8,25]. ACA in Ph+ ALL are commonly seen, being described for 30-60% of the cases [5, 11, 14, 24]. Evaluation of allo-HSCT outcomes has shown that their prognosis depends on presence or absence of additional chromosome aberrations in cases of Ph1 chromosome positivity [1]. Moreover, it should be kept in mind that the ACA in Ph+ ALL patients could not be definitive. In particular, efficiency of chemotherapy and HSCT may be very good in cases of Ph1 chromosome combined with high hyperdiploidy [22]. We have previously confirmed it in our studies [9]. Such clinical aspect seems to be of high importance, in view of revisiting auto-HSCT for Ph+ ALL treatment [7,8,25].

Our study concerned a retrospective analysis of allo-HSCT performed in a mixed cohort of children and adults with Ph+ ALL who exhibited different clinical, transplant and cytogenetic characteristics.

Patients and Methods

The study was performed in a group of sixty-five patients with Ph+ ALL who underwent allo-HSCT at the First St. Petersburg I. Pavlov State Medical University over 2008 to 2015. We have used short-term 24-hour culturing of bone marrow  cells  without  mitogen  stimulation.  Cytogenetic  studies were carried out with a GTG chromosome staining using a standard technique [9]. Fluorescent in situ hybridization (FISH) with specific DNA probes proceeded according to the manufacturers’ protocols (MetaSystems, Germany; CytoCell, Great Britain). Interpretation of chromosomal aberrations was performed in accordance with an International System for Human Cytogenetic Nomenclature [20]. Evaluation of overall survival (OS) and event-free survival (EFS) was carried out in the patients with different demographic and clinical characteristics including gender and age, donor type, clinical state at the HSCT, conditioning regimen, source of stem cells and number of stem cells transplanted. The overall survival (OS) has been determined as the time period passed since HSCT to the patient’s death (for any reasons), or until the last examination date. Event-free survival (EFS) was evaluated as a time from HSCT to any adverse event (non-achievement of remission post-transplant, relapse, or death for any reasons), or till the last examination date. Statistical evaluation was performed with digital package ‘R’, version 3.1.1. (The R Foundation for Statistical Computing, Vienna Austria 2012). Survival curves have been plotted, according to Kaplan-Meier analysis. The survival plots were compared by means of a log-rank test; confidence levels by p<0,05 were considered significant. Multivariate analysis has been performed by the Cox regression model.

Results

The group of patients included 26 females (40%), and 39 males (60%), at the age between 5 and 48 years (a median of 26 years). Table 1 represents clinical and transplantation characteristics of the cohort under study. Thirty-one patients (48%) received allo-HSCT in the 1st remission, 20 subjects (31%) were transplanted in the 2nd remission, whereas 14 (21%) of the patients underwent allo-HSCT in active stage of the disorder. Bone marrow was a source of stem cells in 31 patients (48%), whereas peripheral blood stem cell transplants were used in 32 subjects (49%). Two patients got stem cells from the both sources. Reduced-intensity conditioning regimens (RIC) were used in 36 cases (55%), myeloablative treatment, in 29 cases (45%). Eighteen patients (28%) had HLA-identical sibling in their families; whereas 42 patients (65%) could be transplanted from HLA-matched unrelated donors found in an international registry. In 5 cases (7%), a related haploidentical HSCT was performed, since HLAmatched donor was absent in the family or blood donor Registries.

Table 1. Clinical and transplantation characteristics of Ph+ ALL patients under study

table-1-clinical-and-transplantation.jpg

Cytogenetic characteristics of Ph-positive ALL

Primary diagnosis of Ph+ ALL was established by a standard cytogenetic examination performed in 53 (80%) of the patients. In 12 subjects (18%), the diagnosis was based on a fusion chimeric BCR-ABL gene found by FISH technique and chimeric bcr/abl transcript (р190 and/or p210) revealed with PCR.

Afterwards, we considered karyotypic changes in 53 patients with described pre-transplant cytogenetics. A t(9;22) (q34;q11) translocation, as sole karyotypic aberration, has been revealed in 33 patients, including 9 children (38%) and 24 (62%) adults. Accessory chromosomal anomalies were found in 20 patients, 5 (33%), in children and 15 (67%) in adults. The cytogenetic data for the 20 patients with additional chromosomal aberrations (ACA) are represented in Table 2. Both quantitative and structural ACA have been detected. Numerical abnormalities beared, mainly, on the chromosomes 1, 7, 8, 9, 10, being found in 12 out of 20 cases (60%). Trisomy 1 was nonrandom, being found in 2 patients (No5, 6). Similar repeated findings were made for trisomy10 (No4, 20), trisomy 22 (No4, 16), monosomy 7 (No8, 12). Trisomy 2 (in No20), trisomy 17 and 19 (No2), monosomy 9 (No16) were revealed in single patients.

Table 2. Karyotypes of the patients with Ph+ ALL with additional chromosomal abnormalities (ACA)

table-2-karyotypes-of-the-patients.jpg

Note: additional chromosomal abnormalities are marked red.

Additional structural aberrations [except of t(9;22)] were registered in 20 patients. These were unbalanced in 16 of 20 cases (80%). Meanwhile, only 4 patients (20%) exhibited reciprocal translocations. Detailed evaluation of the chromosomal alterations, i.e., complete or partial monosomies and trisomies, is represented in Fig.1. Chromosomes 5, 7, 9, 2, 1, 17, 22 were most commonly involved into additional structural rearrangements. E.g., deletions and translocations in the short arm (p) of the chromosome 9 were observed in 4 patients out of 20 (No1, 5, 9, 15); reciprocal and unbalanced translocations with involvement of 7p were found in 3 cases (No17, 18, 19). Interstitial deletions and unbalanced translocations under involvement of 5q have been registered in 4 patients (No2, 4, 17, 18); deletions/translocations with chromosome 1, in 3 cases (No1, 6, 18); deletions and translocations of the chromosome 2, in 4 subjects (No1, 11, 17, 18). A structurally changed chromosome 17 was noted in 2 cases, as an isochromosome 17q (No2), or as a partner in unbalanced translocation (No4). An accessory derivate of the chromosome 22 was revealed in two patients (No14, 16). Unbalanced rearrangements involving other chromocomes occured occasionally.

A karyotype with three and more chromosomal aberrations was revealed in 13 patients (20%). As an example, the karyograms with a variant t(21;9;22)(q22;q34;q11) translocation and compound chromosomal abnormalities are presented on Fig. 2. The latter include ‘jumping’ segments (1q, 8q, 1q8q) to the partner chromosomes 1, 4, 5, 14, 19, 21 in a patient with chemoresistant Ph+ ALL (No18).

figure-1-figure-illustrates-the-additional-cytogenetic-alterations.jpg

Figure 1. Figure illustrates the additional cytogenetic alterations in the cohort of Ph-positive ALL with the support of CYDAS (http://www.cydas.org/OnlineAnalysis/) [12]. Chromosomal gains are marked in green to the right, losses in red to the left. The thickness of the bars represents the number of cases showing the respective chromosomal gain or loss.

figure-2-karyograms-of-a-bone-marrow-cells.jpg

Figure 2. Karyograms of a bone marrow cells from a patient with chemoresistant Ph+ ALL and complex chromosomal abnormalities including a variant translocation t(21;9;22) and ‘jumping’ segments (1q, 8q, 1q-8q) to the partner chromosomes 1, 4, 5, 14, 21 (A,B – GTG banding; C,D, multi-coloured FISH).

Effects of cytogenetic, clinical and transplantation parameters upon clinical outcomes of allo-HSCT in the Ph+ALL patients

Furthermore, we performed an OS and EFS analysis in the patients different for their clinical and biological characteristics, e.g., gender, age, disease state, donor type, conditioning regimen, source of stem cells, presence of additional chromosomal aberrations and complex karyotypic abnormalities (≥3 per a karyotype). ///
A univariate analysis (Table 3) has shown significant differences in OS and EFS after allo-HSCT for the patients differing in their clinical stage at transplantation (for EFS only), donor type, as well as for groups with ACA, complex chromosomal aberrations (≥3 per karyotype), or ACA-free.

Table 3. Univariate analysis of overall survival (OS) and event-free survival (EFS) for the patients under study

table-3-intestinal-microbiota-diversity-by-weber-et-al.jpg

Our data suggest that clinical efficiency was higher for transplantations performed at the 1st remission (for EFS only), in cases of matched related and unrelated donors, in absence of ACA in karyotype (for OS only), and, in particular, for complex chromosome aberrations (for OS only) (Fig. 3, 4). Meanwhile, no significant differences were obtained in the patients differing for their age, gender, conditioning regimens, stem cell source, time period from initial diagnosis to HSCT, and amount of transplanted CD34+ cells.

figure-3-overall-survival.jpg

Figure 3. Overall survival after allo-HSCT in Ph+ ALL patients dependent on the presence of additional chromosomal abnormalities [except of t(9;22)] (left); and presence of ≥3 additional chromosomal aberrations (right).

figure-4-event-free-survival.jpg

Figure 4. Event-free survival after allo-HSCT in Ph+ ALL patients dependent on clinical stage at time of HSCT.

The results of multivariate analysis (Table 4) have shown that a presence of ≥3 chromosomal abnormalities in karyotype is an independent predictor for OS in ALL patients with t(9;22)/BCR-ABL translocation. Meanwhile, clinical stage at the time of allo-HSCT seems to be an independent predictor of event-free survival (EFS) of these patients.

Table 4. Multivariate analysis of survival predictors post-HSCT in Ph’-positive ALL

table-4-multivariate-analysis.jpg

Discussion

Our study has confirmed recent conclusions on predictive significance of ACA in Ph+ALL patients [1]. According to several studies [5, 24], ACA in Ph+ ALL took place in 30-60% of these patients, and some of them underwent HSCT. As a rule, ACA affect chromosome pairs 7 to 9, 21 and 22 [11, 24]. Since advent of tyrosine kinase inhibitors (TKIs), predictive significance shifted towards ACA of chromosomes 9 and 22, making questionable a predictive role of other chromosomes. [21]. In our cohort, the structural changes in chromosomes 9 and 22 with 9p deletion and accessory Ph’-chromosome encountered in 6 patients. Moreover, ACA included also structural changes of chromosomes 5 (n=4), 7 (n=3), 1 (n=3), 17 (n=2) and some others. When discussing a role of ACA in Ph+ ALL patients, one should mention that some of them, by contrary, might lengthen OS and EFS. In particular, such situation is typical to the patients with a combination of one or two Ph1-cromosomes with high hyperdiploid karyotype [5, 19, 22]. In most of them, it was rather easy to achieve complete remission, due to positive predictive effect of high hyperdiploidy. Such patients were absent from our cohort. In the past, however, we have observed several ALL patients with two Ph’ chromosomes and high hyperdiploid karyotype who developed complete remission, even at standard chemotherapy, without TKI’s, with subsequent consolidation by means of autologous HSCT [9]. Some workers presume that only a combination of glucocorticoids and TKI’s is today sufficient to achieve a molecular remission, which could be fixed with auto-transplant [4, 7, 8]. As seen from our results, this cohort is heterogeneous, with respect to cytogenetic and prognostic parameters. Hence, appropriate therapy should be differentiated and based on cytogenetic data. In case of “favorable” combination of Ph’ chromosome and high hyperdiploid karyotype, the patients should be initially prepared by glucocorticoids and TKI’s (without application of ), then followed by auto-HSCT. What concerns more toxic protocols of therapy followed by auto-HSCT, they should be used, first of all, for treating the patients with other ACA types. Moreover, chemotherapy causes both de novo chromosome damage in Ph+ cells, and triggers a complex, prognostically adverse process of clonal evolution [10]. A resulting delay with HSCT in adult patients with Ph+ALL also remains unacceptable.

Conclusion

Our  data  show  broad  cytogenetic  heterogeneity  among  leukemia patients with Ph+ ALL before HSCT. A significant subgroup exhibits additional chromosomal abnormalities which are associated with inferior clinical outcomes post-transplant. This phenomenon can be due to clonal evolution of malignant karyotype, or chemotherapy performed before HSCT, thus requiring further studies in the field.

Conflict of interest

All the authors have no conflict of interest to declare.

References

  1. Aldoss I, Stiller T, Cao TM, Palmer JM, Thomas SH, Forman SJ, Pullarkat V. Impact of additional cytogenetic abnormalities in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia undergoing allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2015;21(7):1326-1329.

  2. Cai WZ, Cen JN, Chen J, Fu CC, Han Y, Jin ZM, Ma X, Miao M, Qin HY, Tang XW, Xue SL, Sun AN, Chen SN, Wu DP. Major molecular response prior to allogeneic hematopoietic stem cell transplantation predicts better outcome in adult Philadelphia-positive acute lymphoblastic leukemia in first remission. Bone Marrow Transplant 2017;52(3):470-472.

  3. Chiaretti S, Foa R. Management of adult Ph-positive acute lymphoblastic leukemia. Hematology 2015;2015:406-413.

  4. Ding Z, Han MZ, Chen SL, MA QL, Wei JL, Pang AM, Zhang XY, Liang C, Yao JF, Cao YG, Feng SZ, Jiang EL. Outcomes of Adults with Acute Lymphoblastic Leukemia After Autologous Hematopoietic Stem Cell Transplantation and the Significance of Pretransplantation Minimal Residual Disease: Analysis from a Single Center of China. Chin Med J 2015;128(15):2065-2071.

  5. Dombret H, Gabert J, Boiron JM, Rigal-Huguet F, Blaise D, Thomas X, Delannoy A, Buzyn A, Bilhou-Nabera C, Cayuela JM, Fenaux P, Bourhis JH, Fegueux N, Charrin C, Boucheux C, Lheritier V, Esperou H, Macintyre E, Vernant JP, Fiere D. Outcome of treatment in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia – results of the prospective multicenter LALA-94 trial. Blood 2002;100(7):2357-2366.

  6. Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993:  addition  of  imatinib  to  a  standard  treatment  regimen  enhances  long-term  outcomes  in  Philadelphia positive acute lymphoblastic leukemia. Blood 2014;123(6):843-850.

  7. Giebel S, Labopin M, Gorin NC, Caillot D, Leguay Th, Schaap N, Michallet M, Dombret H, Mohty M. Improving results of autologous stem cell transplantation for Philadelphia-positive acute lymphoblastic leukaemia in the era of tyrosine kinase inhibitors: A report from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Eur J Cancer 2014;50(2):411-417.

  8. Giebel S, Labopin M,  Potter M,  Poiré X,  Sengeloev H,  Socié G,  Huynh A,  Afanasyev BV, Schanz U,  Ringden O,  Kalhs P,  Beelen DW,  Campos AM.,  Masszi T,  Mohty M, Nagler A. Comparable Results of Autologous and Allogeneic Hematopoietic Stem Cell Transplantation for Adult Patients with Philadelphia-Positive Acute Lymphoblastic Leukemia in First Complete Molecular Remission: An Analysis By the Acute Leukemia Working Party of the EBMT. Blood 2016;128(26):512.

  9. Gindina TL, Mamaev NN, Barkhatov IM, Solomonova EV, Semyenova EV, Zubarovskaya LS, Morozova EV, Rudnitskaya YuV, Poppova MO, Alexeev SM, Uspenskaya OS, Bondarenko SN, Afanasyev BV. Complex chromosome changes in patients with recurrent acute leukemias after allogeneic hematopoietic stem cell transplantation. Ther Arkh 2012;84(8):61-66 [In Russia].

  10. Gindina TL, Mamaev NN, Bondarenko SN, Semenova EV, Nikolaeva ES, Vlasova ME, Stancheva NV, Slesarchuk OA, Vavilov SN, Morozova EV, Alyanskiy AL, Afanasyev BV. Complex chromosomal aberrations in patients with post-transplantation replases of acute leukemias: clinical and theoretical aspects. Klin. Onkogematol. 2015;8(1):69-77.

  11. Heerema NA, Harbott J, Galimberti S, Camitta BM, Gaynon PS, Janka-Schaub G, Kamps W, Basso G, Pui CH, Schrappe M, Auclerc MF, Carroll AJ, Conter V, Harrison CJ, Pullen J, Raimondi SC, Richards S, Riehm H, Sather HN, Shuster JJ, Silverman LB, Valsecchi MG, Arico M. Secondary cytogenetic aberrations in childhood Philadelphia chromosome positive acute lymphoblastic leukemia are nonrandom and may be associated with outcome. Leukemia 2004;18(4):693-702.

  12. Hiller B, Bradtke J, Balz H, Rieder H. CyDAS: a cytogenetic data analysis system. Bioinformatics. 2005;21(7):1282-1283.

  13. Kebriaei P, Saliba r, Rondon G, Chiattone A, Luthra R, Anderlini P, Andersson B, Shpall E, Popat U, Jones R, Worth L, Ravandi F, Thomas D, O’Brien S, Kantarjian H, de Lima M, Giralt S, Champlin R. Long-term follow-up of allogeneic hematopoietic stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: impact of tyrosine kinase inhibitors on treatment outcomes. Biol Blood Marrow Transplant 2012;18(4):584-592.

  14. Ko BS, Tang JL, Lee FY, Liu MC, Tsai W, Chen YC, Wang CH, Sheng MC, Lin DT, Lin KH, Tien HF. Additional chromosomal abnormalities and variability of BCR breakpoints in Philadelphia chromosome/BCR-ABL-positive acute lymphoblastic leukemia in Taiwan. Am J Hematol 2002;71(4):291-299.

  15. Moorman AV. The clinical relevance of chromosomal and genomic abnormalities in B-cell precursor acute lymphoblastic leukaemia. Blood Reviews 2012;26(3):123-135.

  16. Parma  M,  Vigano  C,  Fumagalli  M,  Collnaghi  F,  Colombo A, Mottadelli F, Rossi V, Elli E, Terruzzi E, Belotti A, Cazzaniga G, Pogliani EM, Pioltelli P. Good outcome for very high risk adult B-cell acute lymphoblastic leukemia carrying genetic abnormalities t(4;11)(q21;q23) or t(9;22)(q34;q11), if promptly submitted to allogeneic transplantation, after obtaining a good molecular remission. Mediterr J Hematol Infect Dis 2015;7(1):e2015041.

  17. Propp S, Lizzi FA. Philadelphia chromosome in acute lymphocytic leukemia. Blood 1970;36(3):353-360.

  18. Ribera JM, Garcia O, Montesinos P, Brunet S, Abella E, Barrios M, Gonzales-Campos J, Bravo P, Hernandez-Rivas JM. Treatment of young patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia using increased dose of imatinib and deintensified chemotherapy before allogeneic stem cell transplantation. Br J Haematol 2012;159(1):78-81.

  19. Rieder H, Lufwig WD, Gassmann W, Maurer J, Janssen JW, Gokbudet N, Schwartz S, Thiel E, Loffler H, Bartram CR, Hoelzer D, Fonatsch C. Prognostic significance of additional chromosome abnormalities in adult patients with Philadelphia chromosome positive acute lymphoblastic leukaemia. Br J Haematol 1996;95(4):678-691.

  20. Schaffer L., McGovan-Jordan J., Schmid M. ISCN. An international System for Human Cytogenetic Nomenclature. S. Karger, Basel. Switzerland, 2013, p.140

  21. Short NY, Kantarjian HM, Sasaki K, Ravandi F, Ko H, Yin CC, Garcia-Manero G, Cortes JE, Garris R, O’Brien SM, Patel K, Khouri M, Thomas D, Jain N, Kadia TM, Daver N, Benton CB, Issa GC, Konopleva M, Jabbour E. Poor outcomes associated with +der(22)t(9;22) and -9/9p in patients with Philadelphia chromosome positive acute lymphobladstic leukemia receiving chemotherapy plus a tyrosine kinase inhibitor. Amer J Haematol. 2017;92(3):238-243.

  22. Tauro S, McMullan D, Griffits M, Craddock C, Mahendra P. High-hyperploidy in Philadelphia positive adult acute lymphoblastic leukemia: case-series and review of literature. Bone Marrow Transplant 2003;31(9):763-766.

  23. Wang L, Liu D-H. Tyrosine kinase inhibitor for treatment of adult allogeneic hematopoietic stem cell transplantation candidate with Philadelphia positive acute lymphoblastic leukemia. Chinese Medical Journal 2017;130(2):127-129.

  24. Wetzler M, Dodge RK, Mrozek K, Stewart CC, Caroll AJ, Tantravahi R, Vardiman JW, Larson RA, Bloomfield CD. Additional cytogenetic abnormalities in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia: a study of the Cancer and Leukemia Group B. Leukemia 2004;124(3):275-288.

  25. Wetzler M, Watson D, Stock W, Koval G, Mulkey FA, Hoke EE, McCarty JM, Blum WG, Powell BL, Marcucci G, Bloomfield CD, Linker CA, Larson RA. Autologous transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia achieves outcomes similar to allogeneic transplantation: results of GALGB Sudy 10001 (Alliance). Haematologica 2014;99(1):111-115.

" ["~DETAIL_TEXT"]=> string(25231) "

Introduction

Ph1-positive acute lymphoblastic leukemia (Ph+ALL) ranks a special place among lymphoid tumors. Initially, Ph1 positivity in ALL cells seemed an unexpected finding, since it challenged a specificity of t(9;22) translocation for chronic myeloid leukemia [17]. Afterwards, upon data gaining, it has become clear that Ph+ ALL may occur in all age groups, being more common in aged people, with minimal rates shown for children. Its prevalence is as high as 20% among adult ALL patients [15]. Until more recent times, the Ph+ ALL was considered an extremely unfavorable clinical variant with respect to all known treatment modes including hematopoietic stem cell transplantation (HSCT) [15]. This problem was solved as soon as different tyrosine kinase inhibitor drugs (TKIs) were introduced to clinics, thus enabling stable molecular remissions of the disease [3,6,13,18], and their usage for successful HSCT [2,16,23] including autologous (auto-) HSCTs [4,7,8,25]. ACA in Ph+ ALL are commonly seen, being described for 30-60% of the cases [5, 11, 14, 24]. Evaluation of allo-HSCT outcomes has shown that their prognosis depends on presence or absence of additional chromosome aberrations in cases of Ph1 chromosome positivity [1]. Moreover, it should be kept in mind that the ACA in Ph+ ALL patients could not be definitive. In particular, efficiency of chemotherapy and HSCT may be very good in cases of Ph1 chromosome combined with high hyperdiploidy [22]. We have previously confirmed it in our studies [9]. Such clinical aspect seems to be of high importance, in view of revisiting auto-HSCT for Ph+ ALL treatment [7,8,25].

Our study concerned a retrospective analysis of allo-HSCT performed in a mixed cohort of children and adults with Ph+ ALL who exhibited different clinical, transplant and cytogenetic characteristics.

Patients and Methods

The study was performed in a group of sixty-five patients with Ph+ ALL who underwent allo-HSCT at the First St. Petersburg I. Pavlov State Medical University over 2008 to 2015. We have used short-term 24-hour culturing of bone marrow  cells  without  mitogen  stimulation.  Cytogenetic  studies were carried out with a GTG chromosome staining using a standard technique [9]. Fluorescent in situ hybridization (FISH) with specific DNA probes proceeded according to the manufacturers’ protocols (MetaSystems, Germany; CytoCell, Great Britain). Interpretation of chromosomal aberrations was performed in accordance with an International System for Human Cytogenetic Nomenclature [20]. Evaluation of overall survival (OS) and event-free survival (EFS) was carried out in the patients with different demographic and clinical characteristics including gender and age, donor type, clinical state at the HSCT, conditioning regimen, source of stem cells and number of stem cells transplanted. The overall survival (OS) has been determined as the time period passed since HSCT to the patient’s death (for any reasons), or until the last examination date. Event-free survival (EFS) was evaluated as a time from HSCT to any adverse event (non-achievement of remission post-transplant, relapse, or death for any reasons), or till the last examination date. Statistical evaluation was performed with digital package ‘R’, version 3.1.1. (The R Foundation for Statistical Computing, Vienna Austria 2012). Survival curves have been plotted, according to Kaplan-Meier analysis. The survival plots were compared by means of a log-rank test; confidence levels by p<0,05 were considered significant. Multivariate analysis has been performed by the Cox regression model.

Results

The group of patients included 26 females (40%), and 39 males (60%), at the age between 5 and 48 years (a median of 26 years). Table 1 represents clinical and transplantation characteristics of the cohort under study. Thirty-one patients (48%) received allo-HSCT in the 1st remission, 20 subjects (31%) were transplanted in the 2nd remission, whereas 14 (21%) of the patients underwent allo-HSCT in active stage of the disorder. Bone marrow was a source of stem cells in 31 patients (48%), whereas peripheral blood stem cell transplants were used in 32 subjects (49%). Two patients got stem cells from the both sources. Reduced-intensity conditioning regimens (RIC) were used in 36 cases (55%), myeloablative treatment, in 29 cases (45%). Eighteen patients (28%) had HLA-identical sibling in their families; whereas 42 patients (65%) could be transplanted from HLA-matched unrelated donors found in an international registry. In 5 cases (7%), a related haploidentical HSCT was performed, since HLAmatched donor was absent in the family or blood donor Registries.

Table 1. Clinical and transplantation characteristics of Ph+ ALL patients under study

table-1-clinical-and-transplantation.jpg

Cytogenetic characteristics of Ph-positive ALL

Primary diagnosis of Ph+ ALL was established by a standard cytogenetic examination performed in 53 (80%) of the patients. In 12 subjects (18%), the diagnosis was based on a fusion chimeric BCR-ABL gene found by FISH technique and chimeric bcr/abl transcript (р190 and/or p210) revealed with PCR.

Afterwards, we considered karyotypic changes in 53 patients with described pre-transplant cytogenetics. A t(9;22) (q34;q11) translocation, as sole karyotypic aberration, has been revealed in 33 patients, including 9 children (38%) and 24 (62%) adults. Accessory chromosomal anomalies were found in 20 patients, 5 (33%), in children and 15 (67%) in adults. The cytogenetic data for the 20 patients with additional chromosomal aberrations (ACA) are represented in Table 2. Both quantitative and structural ACA have been detected. Numerical abnormalities beared, mainly, on the chromosomes 1, 7, 8, 9, 10, being found in 12 out of 20 cases (60%). Trisomy 1 was nonrandom, being found in 2 patients (No5, 6). Similar repeated findings were made for trisomy10 (No4, 20), trisomy 22 (No4, 16), monosomy 7 (No8, 12). Trisomy 2 (in No20), trisomy 17 and 19 (No2), monosomy 9 (No16) were revealed in single patients.

Table 2. Karyotypes of the patients with Ph+ ALL with additional chromosomal abnormalities (ACA)

table-2-karyotypes-of-the-patients.jpg

Note: additional chromosomal abnormalities are marked red.

Additional structural aberrations [except of t(9;22)] were registered in 20 patients. These were unbalanced in 16 of 20 cases (80%). Meanwhile, only 4 patients (20%) exhibited reciprocal translocations. Detailed evaluation of the chromosomal alterations, i.e., complete or partial monosomies and trisomies, is represented in Fig.1. Chromosomes 5, 7, 9, 2, 1, 17, 22 were most commonly involved into additional structural rearrangements. E.g., deletions and translocations in the short arm (p) of the chromosome 9 were observed in 4 patients out of 20 (No1, 5, 9, 15); reciprocal and unbalanced translocations with involvement of 7p were found in 3 cases (No17, 18, 19). Interstitial deletions and unbalanced translocations under involvement of 5q have been registered in 4 patients (No2, 4, 17, 18); deletions/translocations with chromosome 1, in 3 cases (No1, 6, 18); deletions and translocations of the chromosome 2, in 4 subjects (No1, 11, 17, 18). A structurally changed chromosome 17 was noted in 2 cases, as an isochromosome 17q (No2), or as a partner in unbalanced translocation (No4). An accessory derivate of the chromosome 22 was revealed in two patients (No14, 16). Unbalanced rearrangements involving other chromocomes occured occasionally.

A karyotype with three and more chromosomal aberrations was revealed in 13 patients (20%). As an example, the karyograms with a variant t(21;9;22)(q22;q34;q11) translocation and compound chromosomal abnormalities are presented on Fig. 2. The latter include ‘jumping’ segments (1q, 8q, 1q8q) to the partner chromosomes 1, 4, 5, 14, 19, 21 in a patient with chemoresistant Ph+ ALL (No18).

figure-1-figure-illustrates-the-additional-cytogenetic-alterations.jpg

Figure 1. Figure illustrates the additional cytogenetic alterations in the cohort of Ph-positive ALL with the support of CYDAS (http://www.cydas.org/OnlineAnalysis/) [12]. Chromosomal gains are marked in green to the right, losses in red to the left. The thickness of the bars represents the number of cases showing the respective chromosomal gain or loss.

figure-2-karyograms-of-a-bone-marrow-cells.jpg

Figure 2. Karyograms of a bone marrow cells from a patient with chemoresistant Ph+ ALL and complex chromosomal abnormalities including a variant translocation t(21;9;22) and ‘jumping’ segments (1q, 8q, 1q-8q) to the partner chromosomes 1, 4, 5, 14, 21 (A,B – GTG banding; C,D, multi-coloured FISH).

Effects of cytogenetic, clinical and transplantation parameters upon clinical outcomes of allo-HSCT in the Ph+ALL patients

Furthermore, we performed an OS and EFS analysis in the patients different for their clinical and biological characteristics, e.g., gender, age, disease state, donor type, conditioning regimen, source of stem cells, presence of additional chromosomal aberrations and complex karyotypic abnormalities (≥3 per a karyotype). ///
A univariate analysis (Table 3) has shown significant differences in OS and EFS after allo-HSCT for the patients differing in their clinical stage at transplantation (for EFS only), donor type, as well as for groups with ACA, complex chromosomal aberrations (≥3 per karyotype), or ACA-free.

Table 3. Univariate analysis of overall survival (OS) and event-free survival (EFS) for the patients under study

table-3-intestinal-microbiota-diversity-by-weber-et-al.jpg

Our data suggest that clinical efficiency was higher for transplantations performed at the 1st remission (for EFS only), in cases of matched related and unrelated donors, in absence of ACA in karyotype (for OS only), and, in particular, for complex chromosome aberrations (for OS only) (Fig. 3, 4). Meanwhile, no significant differences were obtained in the patients differing for their age, gender, conditioning regimens, stem cell source, time period from initial diagnosis to HSCT, and amount of transplanted CD34+ cells.

figure-3-overall-survival.jpg

Figure 3. Overall survival after allo-HSCT in Ph+ ALL patients dependent on the presence of additional chromosomal abnormalities [except of t(9;22)] (left); and presence of ≥3 additional chromosomal aberrations (right).

figure-4-event-free-survival.jpg

Figure 4. Event-free survival after allo-HSCT in Ph+ ALL patients dependent on clinical stage at time of HSCT.

The results of multivariate analysis (Table 4) have shown that a presence of ≥3 chromosomal abnormalities in karyotype is an independent predictor for OS in ALL patients with t(9;22)/BCR-ABL translocation. Meanwhile, clinical stage at the time of allo-HSCT seems to be an independent predictor of event-free survival (EFS) of these patients.

Table 4. Multivariate analysis of survival predictors post-HSCT in Ph’-positive ALL

table-4-multivariate-analysis.jpg

Discussion

Our study has confirmed recent conclusions on predictive significance of ACA in Ph+ALL patients [1]. According to several studies [5, 24], ACA in Ph+ ALL took place in 30-60% of these patients, and some of them underwent HSCT. As a rule, ACA affect chromosome pairs 7 to 9, 21 and 22 [11, 24]. Since advent of tyrosine kinase inhibitors (TKIs), predictive significance shifted towards ACA of chromosomes 9 and 22, making questionable a predictive role of other chromosomes. [21]. In our cohort, the structural changes in chromosomes 9 and 22 with 9p deletion and accessory Ph’-chromosome encountered in 6 patients. Moreover, ACA included also structural changes of chromosomes 5 (n=4), 7 (n=3), 1 (n=3), 17 (n=2) and some others. When discussing a role of ACA in Ph+ ALL patients, one should mention that some of them, by contrary, might lengthen OS and EFS. In particular, such situation is typical to the patients with a combination of one or two Ph1-cromosomes with high hyperdiploid karyotype [5, 19, 22]. In most of them, it was rather easy to achieve complete remission, due to positive predictive effect of high hyperdiploidy. Such patients were absent from our cohort. In the past, however, we have observed several ALL patients with two Ph’ chromosomes and high hyperdiploid karyotype who developed complete remission, even at standard chemotherapy, without TKI’s, with subsequent consolidation by means of autologous HSCT [9]. Some workers presume that only a combination of glucocorticoids and TKI’s is today sufficient to achieve a molecular remission, which could be fixed with auto-transplant [4, 7, 8]. As seen from our results, this cohort is heterogeneous, with respect to cytogenetic and prognostic parameters. Hence, appropriate therapy should be differentiated and based on cytogenetic data. In case of “favorable” combination of Ph’ chromosome and high hyperdiploid karyotype, the patients should be initially prepared by glucocorticoids and TKI’s (without application of ), then followed by auto-HSCT. What concerns more toxic protocols of therapy followed by auto-HSCT, they should be used, first of all, for treating the patients with other ACA types. Moreover, chemotherapy causes both de novo chromosome damage in Ph+ cells, and triggers a complex, prognostically adverse process of clonal evolution [10]. A resulting delay with HSCT in adult patients with Ph+ALL also remains unacceptable.

Conclusion

Our  data  show  broad  cytogenetic  heterogeneity  among  leukemia patients with Ph+ ALL before HSCT. A significant subgroup exhibits additional chromosomal abnormalities which are associated with inferior clinical outcomes post-transplant. This phenomenon can be due to clonal evolution of malignant karyotype, or chemotherapy performed before HSCT, thus requiring further studies in the field.

Conflict of interest

All the authors have no conflict of interest to declare.

References

  1. Aldoss I, Stiller T, Cao TM, Palmer JM, Thomas SH, Forman SJ, Pullarkat V. Impact of additional cytogenetic abnormalities in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia undergoing allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2015;21(7):1326-1329.

  2. Cai WZ, Cen JN, Chen J, Fu CC, Han Y, Jin ZM, Ma X, Miao M, Qin HY, Tang XW, Xue SL, Sun AN, Chen SN, Wu DP. Major molecular response prior to allogeneic hematopoietic stem cell transplantation predicts better outcome in adult Philadelphia-positive acute lymphoblastic leukemia in first remission. Bone Marrow Transplant 2017;52(3):470-472.

  3. Chiaretti S, Foa R. Management of adult Ph-positive acute lymphoblastic leukemia. Hematology 2015;2015:406-413.

  4. Ding Z, Han MZ, Chen SL, MA QL, Wei JL, Pang AM, Zhang XY, Liang C, Yao JF, Cao YG, Feng SZ, Jiang EL. Outcomes of Adults with Acute Lymphoblastic Leukemia After Autologous Hematopoietic Stem Cell Transplantation and the Significance of Pretransplantation Minimal Residual Disease: Analysis from a Single Center of China. Chin Med J 2015;128(15):2065-2071.

  5. Dombret H, Gabert J, Boiron JM, Rigal-Huguet F, Blaise D, Thomas X, Delannoy A, Buzyn A, Bilhou-Nabera C, Cayuela JM, Fenaux P, Bourhis JH, Fegueux N, Charrin C, Boucheux C, Lheritier V, Esperou H, Macintyre E, Vernant JP, Fiere D. Outcome of treatment in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia – results of the prospective multicenter LALA-94 trial. Blood 2002;100(7):2357-2366.

  6. Fielding AK, Rowe JM, Buck G, Foroni L, Gerrard G, Litzow MR, Lazarus H, Luger SM, Marks DI, McMillan AK, Moorman AV, Patel B, Paietta E, Tallman MS, Goldstone AH. UKALLXII/ECOG2993:  addition  of  imatinib  to  a  standard  treatment  regimen  enhances  long-term  outcomes  in  Philadelphia positive acute lymphoblastic leukemia. Blood 2014;123(6):843-850.

  7. Giebel S, Labopin M, Gorin NC, Caillot D, Leguay Th, Schaap N, Michallet M, Dombret H, Mohty M. Improving results of autologous stem cell transplantation for Philadelphia-positive acute lymphoblastic leukaemia in the era of tyrosine kinase inhibitors: A report from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Eur J Cancer 2014;50(2):411-417.

  8. Giebel S, Labopin M,  Potter M,  Poiré X,  Sengeloev H,  Socié G,  Huynh A,  Afanasyev BV, Schanz U,  Ringden O,  Kalhs P,  Beelen DW,  Campos AM.,  Masszi T,  Mohty M, Nagler A. Comparable Results of Autologous and Allogeneic Hematopoietic Stem Cell Transplantation for Adult Patients with Philadelphia-Positive Acute Lymphoblastic Leukemia in First Complete Molecular Remission: An Analysis By the Acute Leukemia Working Party of the EBMT. Blood 2016;128(26):512.

  9. Gindina TL, Mamaev NN, Barkhatov IM, Solomonova EV, Semyenova EV, Zubarovskaya LS, Morozova EV, Rudnitskaya YuV, Poppova MO, Alexeev SM, Uspenskaya OS, Bondarenko SN, Afanasyev BV. Complex chromosome changes in patients with recurrent acute leukemias after allogeneic hematopoietic stem cell transplantation. Ther Arkh 2012;84(8):61-66 [In Russia].

  10. Gindina TL, Mamaev NN, Bondarenko SN, Semenova EV, Nikolaeva ES, Vlasova ME, Stancheva NV, Slesarchuk OA, Vavilov SN, Morozova EV, Alyanskiy AL, Afanasyev BV. Complex chromosomal aberrations in patients with post-transplantation replases of acute leukemias: clinical and theoretical aspects. Klin. Onkogematol. 2015;8(1):69-77.

  11. Heerema NA, Harbott J, Galimberti S, Camitta BM, Gaynon PS, Janka-Schaub G, Kamps W, Basso G, Pui CH, Schrappe M, Auclerc MF, Carroll AJ, Conter V, Harrison CJ, Pullen J, Raimondi SC, Richards S, Riehm H, Sather HN, Shuster JJ, Silverman LB, Valsecchi MG, Arico M. Secondary cytogenetic aberrations in childhood Philadelphia chromosome positive acute lymphoblastic leukemia are nonrandom and may be associated with outcome. Leukemia 2004;18(4):693-702.

  12. Hiller B, Bradtke J, Balz H, Rieder H. CyDAS: a cytogenetic data analysis system. Bioinformatics. 2005;21(7):1282-1283.

  13. Kebriaei P, Saliba r, Rondon G, Chiattone A, Luthra R, Anderlini P, Andersson B, Shpall E, Popat U, Jones R, Worth L, Ravandi F, Thomas D, O’Brien S, Kantarjian H, de Lima M, Giralt S, Champlin R. Long-term follow-up of allogeneic hematopoietic stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: impact of tyrosine kinase inhibitors on treatment outcomes. Biol Blood Marrow Transplant 2012;18(4):584-592.

  14. Ko BS, Tang JL, Lee FY, Liu MC, Tsai W, Chen YC, Wang CH, Sheng MC, Lin DT, Lin KH, Tien HF. Additional chromosomal abnormalities and variability of BCR breakpoints in Philadelphia chromosome/BCR-ABL-positive acute lymphoblastic leukemia in Taiwan. Am J Hematol 2002;71(4):291-299.

  15. Moorman AV. The clinical relevance of chromosomal and genomic abnormalities in B-cell precursor acute lymphoblastic leukaemia. Blood Reviews 2012;26(3):123-135.

  16. Parma  M,  Vigano  C,  Fumagalli  M,  Collnaghi  F,  Colombo A, Mottadelli F, Rossi V, Elli E, Terruzzi E, Belotti A, Cazzaniga G, Pogliani EM, Pioltelli P. Good outcome for very high risk adult B-cell acute lymphoblastic leukemia carrying genetic abnormalities t(4;11)(q21;q23) or t(9;22)(q34;q11), if promptly submitted to allogeneic transplantation, after obtaining a good molecular remission. Mediterr J Hematol Infect Dis 2015;7(1):e2015041.

  17. Propp S, Lizzi FA. Philadelphia chromosome in acute lymphocytic leukemia. Blood 1970;36(3):353-360.

  18. Ribera JM, Garcia O, Montesinos P, Brunet S, Abella E, Barrios M, Gonzales-Campos J, Bravo P, Hernandez-Rivas JM. Treatment of young patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia using increased dose of imatinib and deintensified chemotherapy before allogeneic stem cell transplantation. Br J Haematol 2012;159(1):78-81.

  19. Rieder H, Lufwig WD, Gassmann W, Maurer J, Janssen JW, Gokbudet N, Schwartz S, Thiel E, Loffler H, Bartram CR, Hoelzer D, Fonatsch C. Prognostic significance of additional chromosome abnormalities in adult patients with Philadelphia chromosome positive acute lymphoblastic leukaemia. Br J Haematol 1996;95(4):678-691.

  20. Schaffer L., McGovan-Jordan J., Schmid M. ISCN. An international System for Human Cytogenetic Nomenclature. S. Karger, Basel. Switzerland, 2013, p.140

  21. Short NY, Kantarjian HM, Sasaki K, Ravandi F, Ko H, Yin CC, Garcia-Manero G, Cortes JE, Garris R, O’Brien SM, Patel K, Khouri M, Thomas D, Jain N, Kadia TM, Daver N, Benton CB, Issa GC, Konopleva M, Jabbour E. Poor outcomes associated with +der(22)t(9;22) and -9/9p in patients with Philadelphia chromosome positive acute lymphobladstic leukemia receiving chemotherapy plus a tyrosine kinase inhibitor. Amer J Haematol. 2017;92(3):238-243.

  22. Tauro S, McMullan D, Griffits M, Craddock C, Mahendra P. High-hyperploidy in Philadelphia positive adult acute lymphoblastic leukemia: case-series and review of literature. Bone Marrow Transplant 2003;31(9):763-766.

  23. Wang L, Liu D-H. Tyrosine kinase inhibitor for treatment of adult allogeneic hematopoietic stem cell transplantation candidate with Philadelphia positive acute lymphoblastic leukemia. Chinese Medical Journal 2017;130(2):127-129.

  24. Wetzler M, Dodge RK, Mrozek K, Stewart CC, Caroll AJ, Tantravahi R, Vardiman JW, Larson RA, Bloomfield CD. Additional cytogenetic abnormalities in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia: a study of the Cancer and Leukemia Group B. Leukemia 2004;124(3):275-288.

  25. Wetzler M, Watson D, Stock W, Koval G, Mulkey FA, Hoke EE, McCarty JM, Blum WG, Powell BL, Marcucci G, Bloomfield CD, Linker CA, Larson RA. Autologous transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia achieves outcomes similar to allogeneic transplantation: results of GALGB Sudy 10001 (Alliance). Haematologica 2014;99(1):111-115.

" ["DETAIL_TEXT_TYPE"]=> string(4) "html" ["~DETAIL_TEXT_TYPE"]=> string(4) "html" ["PREVIEW_TEXT"]=> string(0) "" ["~PREVIEW_TEXT"]=> string(0) "" ["PREVIEW_TEXT_TYPE"]=> string(4) "text" ["~PREVIEW_TEXT_TYPE"]=> string(4) "text" ["PREVIEW_PICTURE"]=> NULL ["~PREVIEW_PICTURE"]=> NULL ["LANG_DIR"]=> string(4) "/ru/" ["~LANG_DIR"]=> string(4) "/ru/" ["SORT"]=> string(3) "500" ["~SORT"]=> string(3) "500" ["CODE"]=> string(100) "pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny" ["~CODE"]=> string(100) "pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny" ["EXTERNAL_ID"]=> string(3) "807" ["~EXTERNAL_ID"]=> string(3) "807" ["IBLOCK_TYPE_ID"]=> string(7) "journal" ["~IBLOCK_TYPE_ID"]=> string(7) "journal" ["IBLOCK_CODE"]=> string(7) "volumes" ["~IBLOCK_CODE"]=> string(7) "volumes" ["IBLOCK_EXTERNAL_ID"]=> string(1) "2" ["~IBLOCK_EXTERNAL_ID"]=> string(1) "2" ["LID"]=> string(2) "s2" ["~LID"]=> string(2) "s2" ["EDIT_LINK"]=> NULL ["DELETE_LINK"]=> NULL ["DISPLAY_ACTIVE_FROM"]=> string(0) "" ["IPROPERTY_VALUES"]=> array(18) { ["ELEMENT_META_TITLE"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["ELEMENT_META_KEYWORDS"]=> string(0) "" ["ELEMENT_META_DESCRIPTION"]=> string(413) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia" ["ELEMENT_PREVIEW_PICTURE_FILE_ALT"]=> string(4093) "<h3>Резюме</h3> Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.<br> <h3>Пациенты и методы</h3> Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных. <br> <h3>Результаты</h3> Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (&lt;3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).<br> <h3>Заключение</h3> Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК. <br> <h3>Ключевые слова</h3> Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии." ["ELEMENT_PREVIEW_PICTURE_FILE_TITLE"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["ELEMENT_DETAIL_PICTURE_FILE_ALT"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["ELEMENT_DETAIL_PICTURE_FILE_TITLE"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_META_TITLE"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_META_KEYWORDS"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_META_DESCRIPTION"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_PICTURE_FILE_ALT"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_PICTURE_FILE_TITLE"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_PICTURE_FILE_NAME"]=> string(100) "pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny" ["SECTION_DETAIL_PICTURE_FILE_ALT"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_DETAIL_PICTURE_FILE_TITLE"]=> string(275) "Pезультаты аллогенной трансплантации гемопоэ - тических стволовых клеток в смешанной когорте больных с Ph-позитивным острым лимфобластным лейкозом " ["SECTION_DETAIL_PICTURE_FILE_NAME"]=> string(100) "pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny" ["ELEMENT_PREVIEW_PICTURE_FILE_NAME"]=> string(100) "pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny" ["ELEMENT_DETAIL_PICTURE_FILE_NAME"]=> string(100) "pezultaty-allogennoy-transplantatsii-gemopoe-ticheskikh-stvolovykh-kletok-v-smeshannoy-kogorte-bolny" } ["FIELDS"]=> array(1) { ["IBLOCK_SECTION_ID"]=> string(2) "32" } ["PROPERTIES"]=> array(18) { ["KEYWORDS"]=> array(36) { ["ID"]=> string(2) "19" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:46:01" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(27) "Ключевые слова" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "KEYWORDS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "19" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "4" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "Y" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "Y" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> bool(false) ["VALUE"]=> bool(false) ["DESCRIPTION"]=> bool(false) ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> bool(false) ["~DESCRIPTION"]=> bool(false) ["~NAME"]=> string(27) "Ключевые слова" ["~DEFAULT_VALUE"]=> string(0) "" } ["SUBMITTED"]=> array(36) { ["ID"]=> string(2) "20" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Дата подачи" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "SUBMITTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "20" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11001" ["VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Дата подачи" ["~DEFAULT_VALUE"]=> NULL } ["ACCEPTED"]=> array(36) { ["ID"]=> string(2) "21" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(25) "Дата принятия" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "ACCEPTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "21" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11002" ["VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL } ["PUBLISHED"]=> array(36) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11003" ["VALUE"]=> string(22) "03/10/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "03/10/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Дата публикации" ["~DEFAULT_VALUE"]=> NULL } ["CONTACT"]=> array(36) { ["ID"]=> string(2) "23" ["TIMESTAMP_X"]=> string(19) "2015-09-03 14:43:05" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(14) "Контакт" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "CONTACT" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "23" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(14) "Контакт" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHORS"]=> array(36) { ["ID"]=> string(2) "24" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:45:07" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "AUTHORS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "24" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> bool(false) ["VALUE"]=> bool(false) ["DESCRIPTION"]=> bool(false) ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> bool(false) ["~DESCRIPTION"]=> bool(false) ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_RU"]=> array(36) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11006" ["VALUE"]=> array(2) { ["TEXT"]=> string(416) "Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(416) "Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_RU"]=> array(36) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11007" ["VALUE"]=> array(2) { ["TEXT"]=> string(420) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии, трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский университет им. акад. И. П. Павлова" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(420) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии, трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский университет им. акад. И. П. Павлова" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_RU"]=> array(36) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11008" ["VALUE"]=> array(2) { ["TEXT"]=> string(4093) "<h3>Резюме</h3> Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.<br> <h3>Пациенты и методы</h3> Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных. <br> <h3>Результаты</h3> Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (&lt;3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).<br> <h3>Заключение</h3> Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК. <br> <h3>Ключевые слова</h3> Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии." ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(4005) "

Резюме

Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.

Пациенты и методы

Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных.

Результаты

Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (<3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).

Заключение

Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК.

Ключевые слова

Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии." ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Описание/Резюме" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["DOI"]=> array(36) { ["ID"]=> string(2) "28" ["TIMESTAMP_X"]=> string(19) "2016-04-06 14:11:12" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(3) "DOI" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(3) "DOI" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "28" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11004" ["VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-10-19" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-10-19" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(3) "DOI" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_EN"]=> array(36) { ["ID"]=> string(2) "37" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(6) "Author" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "37" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11032" ["VALUE"]=> array(2) { ["TEXT"]=> string(242) "Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(242) "Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(6) "Author" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_EN"]=> array(36) { ["ID"]=> string(2) "38" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Organization" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "38" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11033" ["VALUE"]=> array(2) { ["TEXT"]=> string(241) "R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(241) "R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Organization" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_EN"]=> array(36) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11034" ["VALUE"]=> array(2) { ["TEXT"]=> string(2343) "Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL. <h3>Patients and methods</h3> We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients. <h3>Results</h3> Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes. <h3>Conclusion</h3> The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation. <h3>Keywords</h3> Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. " ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(2292) "Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL.

Patients and methods

We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients.

Results

Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes.

Conclusion

The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation.

Keywords

Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. " ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Description / Summary" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["NAME_EN"]=> array(36) { ["ID"]=> string(2) "40" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:49:47" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(4) "Name" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "NAME_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "40" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11005" ["VALUE"]=> string(138) "Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(138) "Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(4) "Name" ["~DEFAULT_VALUE"]=> string(0) "" } ["FULL_TEXT_RU"]=> &array(36) { ["ID"]=> string(2) "42" ["TIMESTAMP_X"]=> string(19) "2015-09-07 20:29:18" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(23) "Полный текст" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(12) "FULL_TEXT_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "42" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(23) "Полный текст" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["PDF_RU"]=> array(36) { ["ID"]=> string(2) "43" ["TIMESTAMP_X"]=> string(19) "2015-09-09 16:05:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(7) "PDF RUS" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(6) "PDF_RU" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "F" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "43" ["FILE_TYPE"]=> string(18) "doc, txt, rtf, pdf" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11021" ["VALUE"]=> string(3) "462" ["DESCRIPTION"]=> NULL ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(3) "462" ["~DESCRIPTION"]=> NULL ["~NAME"]=> string(7) "PDF RUS" ["~DEFAULT_VALUE"]=> string(0) "" } ["PDF_EN"]=> array(36) { ["ID"]=> string(2) "44" ["TIMESTAMP_X"]=> string(19) "2015-09-09 16:05:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(7) "PDF ENG" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(6) "PDF_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "F" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "44" ["FILE_TYPE"]=> string(18) "doc, txt, rtf, pdf" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11035" ["VALUE"]=> string(3) "463" ["DESCRIPTION"]=> NULL ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(3) "463" ["~DESCRIPTION"]=> NULL ["~NAME"]=> string(7) "PDF ENG" ["~DEFAULT_VALUE"]=> string(0) "" } ["NAME_LONG"]=> array(36) { ["ID"]=> string(2) "45" ["TIMESTAMP_X"]=> string(19) "2023-04-13 00:55:00" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(72) "Название (для очень длинных заголовков)" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "NAME_LONG" ["DEFAULT_VALUE"]=> array(2) { ["TYPE"]=> string(4) "HTML" ["TEXT"]=> string(0) "" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "45" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(80) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(72) "Название (для очень длинных заголовков)" ["~DEFAULT_VALUE"]=> array(2) { ["TYPE"]=> string(4) "HTML" ["TEXT"]=> string(0) "" } } } ["DISPLAY_PROPERTIES"]=> array(11) { ["AUTHOR_EN"]=> array(37) { ["ID"]=> string(2) "37" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(6) "Author" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "37" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11032" ["VALUE"]=> array(2) { ["TEXT"]=> string(242) "Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(242) "Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(6) "Author" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(242) "Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev" } ["SUMMARY_EN"]=> array(37) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11034" ["VALUE"]=> array(2) { ["TEXT"]=> string(2343) "Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL. <h3>Patients and methods</h3> We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients. <h3>Results</h3> Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes. <h3>Conclusion</h3> The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation. <h3>Keywords</h3> Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. " ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(2292) "Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL.

Patients and methods

We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients.

Results

Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes.

Conclusion

The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation.

Keywords

Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. " ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Description / Summary" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(2292) "Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL.

Patients and methods

We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients.

Results

Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes.

Conclusion

The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation.

Keywords

Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. " } ["DOI"]=> array(37) { ["ID"]=> string(2) "28" ["TIMESTAMP_X"]=> string(19) "2016-04-06 14:11:12" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(3) "DOI" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(3) "DOI" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "28" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11004" ["VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-10-19" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-10-19" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(3) "DOI" ["~DEFAULT_VALUE"]=> string(0) "" ["DISPLAY_VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-10-19" } ["NAME_EN"]=> array(37) { ["ID"]=> string(2) "40" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:49:47" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(4) "Name" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "NAME_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "40" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11005" ["VALUE"]=> string(138) "Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(138) "Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(4) "Name" ["~DEFAULT_VALUE"]=> string(0) "" ["DISPLAY_VALUE"]=> string(138) "Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia" } ["ORGANIZATION_EN"]=> array(37) { ["ID"]=> string(2) "38" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Organization" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "38" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11033" ["VALUE"]=> array(2) { ["TEXT"]=> string(241) "R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(241) "R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Organization" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(241) "R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia" } ["AUTHOR_RU"]=> array(37) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11006" ["VALUE"]=> array(2) { ["TEXT"]=> string(416) "Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(416) "Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(416) "Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев" } ["SUBMITTED"]=> array(37) { ["ID"]=> string(2) "20" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Дата подачи" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "SUBMITTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "20" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11001" ["VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Дата подачи" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/17/2017 12:00:00 am" } ["ACCEPTED"]=> array(37) { ["ID"]=> string(2) "21" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(25) "Дата принятия" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "ACCEPTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "21" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11002" ["VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/17/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/17/2017 12:00:00 am" } ["PUBLISHED"]=> array(37) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11003" ["VALUE"]=> string(22) "03/10/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "03/10/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Дата публикации" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "03/10/2017 12:00:00 am" } ["SUMMARY_RU"]=> array(37) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11008" ["VALUE"]=> array(2) { ["TEXT"]=> string(4093) "<h3>Резюме</h3> Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.<br> <h3>Пациенты и методы</h3> Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных. <br> <h3>Результаты</h3> Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (&lt;3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).<br> <h3>Заключение</h3> Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК. <br> <h3>Ключевые слова</h3> Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии." ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(4005) "

Резюме

Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.

Пациенты и методы

Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных.

Результаты

Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (<3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).

Заключение

Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК.

Ключевые слова

Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии." ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Описание/Резюме" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(4005) "

Резюме

Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.

Пациенты и методы

Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных.

Результаты

Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (<3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).

Заключение

Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК.

Ключевые слова

Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии." } ["ORGANIZATION_RU"]=> array(37) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11007" ["VALUE"]=> array(2) { ["TEXT"]=> string(420) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии, трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский университет им. акад. И. П. Павлова" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(420) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии, трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский университет им. акад. И. П. Павлова" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(420) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии, трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский университет им. акад. И. П. Павлова" } } } [1]=> array(49) { ["IBLOCK_SECTION_ID"]=> string(2) "32" ["~IBLOCK_SECTION_ID"]=> string(2) "32" ["ID"]=> string(3) "816" ["~ID"]=> string(3) "816" ["IBLOCK_ID"]=> string(1) "2" ["~IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["~NAME"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["ACTIVE_FROM"]=> NULL ["~ACTIVE_FROM"]=> NULL ["TIMESTAMP_X"]=> string(22) "06/16/2017 03:35:59 pm" ["~TIMESTAMP_X"]=> string(22) "06/16/2017 03:35:59 pm" ["DETAIL_PAGE_URL"]=> string(146) "/en/archive/tom-6-nomer-1/klinicheskie-stati/transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti/" ["~DETAIL_PAGE_URL"]=> string(146) "/en/archive/tom-6-nomer-1/klinicheskie-stati/transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti/" ["LIST_PAGE_URL"]=> string(12) "/en/archive/" ["~LIST_PAGE_URL"]=> string(12) "/en/archive/" ["DETAIL_TEXT"]=> string(38283) "

Gastrointestinal damage after HSCT

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is an effective method of treatment of some solid tumors, hematological, autoimmune and hereditary diseases in children and adults, which is based on providing preceding conditioning (cytostatic and/or radiation therapy) with further intravenous administration of hematopoietic stem cells, to restore bone marrow function in cases of its damage or malfunction [24].

Primary disease status at the time of therapy initiation, and degree of HLA—compatibility between the stem cell recipient fections, in particular — pseudo—membranous colitis associated with Clostridium difi'icile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GVHD, pseudo—membranous colitis and antibiotic—associated diarrhea post—HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial Variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

The efficacy of HSCT is limited by several main factors. First of all, primary or secondary resistance to chemotherapy confers high risk of progression or relapse of underlying disease in the posttransplant period. Second, is the frequent mortality from septic complications of nosocomial multi—drug resistant strains of bacteria, including prevalent Clostridium difi'icile, Klebsiella pneumonia, Pseudomonas aeruginosa and Vancomycin—resistant (VRE). Third, it is immune complications, such as acute and chronic “graft versus host” disease (GVHD), occurring due to affection of recipient tissues and organs by lymphocytes of donor origin [1].

GvHD pathogenesis is based on damage of recipient tissues  that  are  recognized  as  antigens  by  immune  competent  cells   of  the  donor  [6].  GvHD  plays  a  key  role  in  post-transplan- tation  mortality  and  patient’s  quality  of  life.  Most  suscepti- ble tissues to damage usually have high proliferative activity,  such as skin cells, enterocytes and endothelium of small bile  ducts of the liver. In this case, intestinal stem cells and their  niche (Paneth cells) are primary targets of intestinal GvHD,  along with dysbiosis of intestinal microbiota leading to dys- function  of  enterocytes,  bacterial  colonization  and,  conse- quently,  potentiation  of  systemic  inflammatory  response   [18,26]. Intestinal GvHD is manifested by symptoms of diarrhea in its secretory form. This complication is associated by  morphologically seen infiltration of cytotoxic intraepithelial  lymphocytes (CD8+), with damage to mucous epithelial cells  of stomach and/or intestine. Appropriate histological chang- es can vary from lymphoid infiltration of intestinal mucosa  to total destruction of crypts and formation of extensive ne- crotic-ulcerous defects (Fig.1) [13].

figure-1-histology-changes-in-acute-“graft-versus-host-disease”-of-intestine.jpg

Figure 1. Histology changes in acute “graft versus host disease” of intestine [13].
A. Mild degree: focal intraepithelial lymphocytic infiltration (1-2-3 cells, arrows) in part glands with intact integrity and struc- ture of the glands of the mucous membrane.
B. Medium degree: common uneven, often quite abundant lymphocytic infiltration with formation of nuclear foci rexis of epi- thelial cells (arrow) and small foci of subtotal or total destruction of some glands.
C. Severe degree: larger areas of destruction of the mucous membrane, the bottom of defects is loose immature granulation tissue (top right, arrow). Remaining glands are with symptoms of subtotal or total destruction (dotted arrows) or with nuclear rexis of epithelial cells (arrows).

In most cases, gastrointestinal tract (GIT) is a primary organ damaged, thus resulting to enhanced inflammation of immune origin, serious diarrhea, due to GVHD manifestation, and intestinal infections, in particular, pseudo—membranous colitis associated with Clostridium difi'icile associated with massive antibiotic therapy. Consequent elimination of normal intestinal microbiota is among main risk factors for GVHD of GIT, pseudo—membranous colitis and antibiotic—associated diarrhea after HSCT. Frequency of deaths after HSCT is known to be significantly higher in patients with skewed biodiversity of normal microbiota [11].

Intestinal damage after HSCT is clinically manifesting by a maldigestion syndrome which includes anorexia, nausea, vomiting, abdominal pain and diarrhea. These symptoms quickly lead to malfunction of intestinal barrier function, reduced adaptation reserves of the organism, development of protein—energy malnutrition and cachexia.

There are several reasons for high mortality in patients undergoing allo—HSCT. First, long period of pancytopenia which is associated with severe infection complications and requires administration of broad—spectrum antibiotics, which, in turn, leads to partial elimination or lack of normal intestinal microbiota, selection for multi—drug resistant bacterial strains, their subsequent expansion and dominance over normal microbiota (Tab. 1) [20]. Second, intensive chemotherapy and allo—HSCT in most cases leads to altered structure and decreased protective functions of intestinal wall, which is clinically expressed as mucositis which results from direct toxic effects of chemotherapy upon epithelial and Vascular structures of intestine, causing invasion of pathogenic microorganisms into the intestinal wall, in the presence of neutropenia and developing GVHD.

Table 1. Intestinal microbiota: alterations during antibiotic treatment, adapted from Peterson C. et al [20].

table-1-intestinal-microbiota-alterations-during-antibiotic-treatment.jpg

Thus, currently available drugs and technologies for treat- ment Of infectious complications and GVHD do not solve the problem Of early mortality among hematological patients after allo-HSCT. Those patients with severe damage Of di- gestive system are at high risk Of fatal outcome, due to infec- tious complications, metabolic disorders, massive intestinal bleeding and increasing cacheXia, even if achieving com- plete remission Of underlying malignant disease following a successful HSCT.

Positive effects of directed microbiota correction

There are conflicting reports on clinical effects Of intestinal microbiota correction. Some Of these approaches have, how- ever, shown their ability tO prevent complications occurring after organ and cell transplantation (Tab. 2).

Table 2. Results of gut microbial interventions upon results of cell/organ transplantation based on review by Wang et al. [29]

table-2-results-of-gut-microbial-interventions-upon-results-of-cell organ-transplantation.jpg

Human microbiota

Human intestinal microbiota represents a broad set of obligatory and facultative microorganisms that can cause disease in case of suppressed immunity or immunological incompatibility in the host.

There are two kinds of microorganisms classified by their location in the gut: luminal microbiota, which is located in the intestine indigestible dietary fiber and mucosal, adjacent to epithelial cells of the intestine, being integrated into parietal mucin layer. Both luminal and mucosal microbiota may impact the condition of human body, due to their regulatory interactions, and perform many metabolic effects such as detoxification, suppression of pathogenic microorganisms, regulation of immune system, regeneration of epithelium, synthesis of certain Vitamins and essential amino acids, fat metabolism, etc. Dominating intestinal bacteria include 5 types: Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria and Verrucomicrobia. Among them, two types of microbes (Bifidobacterium and Lactobacillus) play a crucial role in development of microbiota till the moment of birth (Tab.3).

Table 3. Intestinal microbiota diversity, by Weber et. al. [30]

table-3-intestinal-microbiota-diversity-by-weber-et-al.jpg

Stable composition of intestinal microbiota and regulation of local immune system reactivity are considered the key aspect for its functional activities. One should take into account of short chain fatty acids (acetate, propionate, butyrate) and antimicrobial peptides produced in situ, regulation of formation of T—regulatory cells (Treg) and IgA in bacteria from intestinal lumen. At the level of lamina propria, metabolic maintenance of transforming growth factor (TGFB), integrin CtE (CD103*), dendritic cells, Treg and T—helper (Th17) producing IL—10, IL—22 are important regenerative factors of epithelial cells. At the level of mesenteric lymph node, one should discuss interaction with innate lymphoid cells via a RORyt nuclear receptor, which reduces local inflammation [29]. Preservation of these interactions allows the growth suppression of pathogenic microbiota, eliminate endogenous and exogenous pathogens, maintain structural integrity of intestinal epithelium.

Variability evaluation of intestinal microbiota

Until now, qualitative identification of composed intestinal microbiota, especially anaerobic microorganisms, represents the main problem in diagnostics of many human bacteria that are undetectable by classical bacteriological methods. Implementation of fecal microbiota transplantation (FMT) procedure into clinical practice and its scientific rationale were largely possible due to development of the microbe identification methods by genome next—generation sequencing (NGS) of bacterial DNAs, and, to a lesser extent, by multiplex real—time polymerase chain (e.g. Colonoflor—16) [8]. Development of the s.c. shotgun next—generation sequencing based on differential analysis of bacterial 16S ribosomal RNA and identification of distinct molecular isolates allowed precise DNA profiling of microbiota composition from donor and recipient, therefore, characterizing the most appropriate fecal donors, and evaluating microbiological results of the treatment [16]. This sequencing procedure consists of 4 successive stages: selection of microbial DNAs from feces, amplification by PCR V4—5 plots of the 16S rRNA gene, sequencing, comparing individual results with a database of previously studied samples, for example, from the NCBI Sequence Read Archive database.

Quantitative 16S RNA analysis in patients with sepsis has revealed sufficient shifts of the main microbial types in the stool samples from the intensive care patients [34]. The workers observed scewed diversity of main microbial communities (1 to 4 bacterial taxa) in 30% of the patients. Bacteria associated with the genera Enterococcus and Staphylococcus and the family Enterobacteriaceae comprised the majority of these communities.

As seen from the Figure 2, normal stool specimens (H1, H2, H3, H4, and H5) were characterized by prevalence of Firmicutes and, in most cases, Bacteroidetes, without Proteobacterial abundance (Fig 2. 1A). In a half of ICU patients (ICU1, ICU4, ICU6, ICU9, ICU11, and ICU15), either Proteobacteria or Firmicutes organisms were totally dominant from at least one time point of stool collection (Fig. 1B and C).

In ICU1, ICU11, and ICU15, the authors observed drastic changes in microbial ratios, with Firmicutes being completely replaced by Proteobacteria. The latter phylum predominated also in most stool samples of the patients ICU6 (Fig 2. 1B) and ICU4 (Fig 2. 1C).

figure-2-composition--of-the-gut-microbiome-.jpg

Figure 2. Composition of the gut microbiome at the phylum level determined by molecular analysis of stool samples collected from healthy controls (A), de- ceased ICU patients with severe sepsis (black circles on the time line) (B), and recovered ICU patients (green circles) (C). Dates of stool collection are displayed in numbered quadrants [34].

Hence, the gross shifts in microbial composition in critically ill patients with clinical signs of sepsis are, mainly, unidirectional, leading to exhaustion of large microbial philae. However, these changes seem to be quite heterogenous and need further clarification for bacterial types associated with worse clinical prognosis.

Under common clinical conditions, however, diagnostics of bacterial dysbiosis is performed for planning different therapeutic measures, including clinical FMT effects. Evaluation of gastrointestinal microflora and mucosa is, generally, performed by means of the following microbiological methods:

— conventional bacteriological tests (microscopy, seeding, assessment of antibiotic resistance).

— biopsy of stomach and/or intestine mucosa with subsequent histology and immunophenotyping of local lymphocytes; verification of infectious lesions at the intestinal mucosa;

— definition of Clostridium difi'icile toxin A and B in stool;

— fecal calprotectin in stool etc.

Fecal microbiota transplantation

In the recent years, FMT was actively developing as a meth- od  to  restore  functional  and  anatomical  integrity  of  intes- tinal  microbiota  in  appropriate  clinical  situations  (Fig.3)   [12,14,21,].

Typical  changes  of  intestinal  microbiota  in  inflammatory   bowel  diseases  include  reduced  diversity  of  obligate  micro- organisms, especially, deficiency of Firmicutes and Bacteroidetes [3]. Ultimately, this leads to lack of butyrate synthesis  by Faecalibacterium  prausnitzii.  This  metabolite  is  a  local  anti-inflammatory agent, acting via IL-8 inhibition [25]. The main known mechanisms of FMT action include com- petition for nutrients, direct inhibition of excessive pathogen  growth,  modulation  of  host  immune  system  by  interaction   with  normal  microbiota.  FMT  seems  to  be  more  effective,   than use of probiotic preparations, in restoring altered intes- tinal microbiota, since the latter is unable to colonize intesti- nal space for an extended period.

FMT also allows correction of both microbiota in digestive  ways,  and  microbial  spectrum  of  other  body  areas  (mouth,   lungs, urinary routes, etc.) to less pathogenic species which  are  more  sensitive  to  antibiotics.  This  effect  can  be  used  to   eradicate   antibiotic-resistant   pathogenic   bacteria   strains    based  on  natural  competition  and  antagonism  between  the   microorganisms [8].

In 2014, a meta-analysis of clinical studies showed that FMT  was effective in 87% of diarrhea cases (a total of 536 patients)  caused  by  Clostridium  difficile,  with  primary  resistance  to   prior  therapy  with  metronidazole  and  vancomycin  [2].  The   transplant administration route was an important factor af- fecting  treatment  outcomes,  i.e.,  the  microflora  delivery  to   the  stomach  yielded  81%  of  clinical  success;  to  duodenum,   86%; via  ascending  part  of  the  colon  (with  fibrocolonosco- py),  93%  response;  to  descending  colon  by  means  of  deep   enema, 84% of successful treatment.

A subsequent review article discussed 45 clinical studies (112  patients), showing ambiguous FMT efficiency in inflamma- tory bowel disease, i.e., only 0 to 68% of the patients achieved  clinical remission [22]. The authors noted that possible fail- ure of FMT could be connected, on the one hand, with poor  state of donor’s microbiota, especially, reduced microbial di- versity.  On  the  other  hand,  severe  malfunction  of  patient’s   GIT with high values of the Mayo scores could also influence  the outcomes.

The attempts of clinical FMT implementation are carried out  not only in clinical conditions related to intestinal infections,  but also presumed irregularities between altered microbiota  and immune system imbalance, such as irritable bowel syn- drome, rheumatoid arthritis, diabetes type 2, autism, chronic  fatigue syndrome, multiple sclerosis and Parkinson’s disease  [5]. There are single reports on FMT performed in order to  treat sepsis with multiple organ dysfunction syndrome, and  to eliminate vancomycin-resistant bacteria [32].

figure-3-fecal-microbiota-transplantation-scheme.jpg

Figure 3. Fecal microbiota transplantation scheme [15].

Increasing number of clinical research reporting successful outcomes of FMT in various diseases is accompanied by arrangement of the first specialized biobank in 2012. This USA—based facility was established for storage of fecal samples for FMT. Currently, the biobank is linked to more than 750 clinics at all the 50 USA states providing an opportunity for a constant access to the samples of donor fecal microbiota. The method was adopted and regulated by the US Food and Drug Administration (FDA). In 2013, this body has approved FMT as a therapeutic method for treatment of refractory infections associated with Clostridi'um difi'icile, for controlled clinical studies (“policy with respect to the investigational new drug requirements for use of fecal microbiota transplantation to treat Clostridi'um difi'ici'le infection not responding to standard treatment”) [27].

On the basis of clinical research, FMT was included to the Guidelines issued by European Society of Clinical Microbiology and Infectious Diseases (ECMID) concerning treatment of Vancomycin—resistant (VRE) infections caused by Clostridium difi'icile, at the AI level of evidence [4]. However, infections associated with Clostridi'um difi'icile, are just among potential indications for the FMT usage. Similarly, the FMT use was approved by the European Crohn’s and Colitis Organization as an approach to treatment of chronic nonspecific inflammatory bowel diseases [21].

Similarly, FMT can significantly modulate immune function and have positive effects on other GIT inflammatory processes of immune origin, in particular, resistant graft—versushost—disease GVHD of intestine. In fact, several researchers confirm that preventive use of FMT leads to a decreased risk of infectious complications during treatment of hematological diseases [16].

Despite some encouraging results of FMT—assisted treatment, it is still rarely used in severely immunocompromised patients, e.g., after alloHSCT. This may be due to low performance status of HSCT recipients, severely damaged gastrointestinal mucosa associated with infectious complications and risk of microbial dissemination with a transplanted donor microbiota. However, it is important to mention, that the transplanted microorganisms potentially substitute multi—drug resistant flora due to natural antagonism and improve the control over infectious complications with standard antibiotics.

Donor selection and transplant delivery of fecal microbiota

Optimal donor selection for FMT is still an uncertain aspect in FMT implementation. Some medical, ethical and economic issues should be resolved, e.g., which kind of graft will be indicated in certain cases, either being related, unrelated or autologous. From economic and ethical viewpoints, an optimal solution is to use autologous source of transplant. However, qualitative composition of a patient’s microbiota is often changed dramatically after previous courses of chemoand antibiotic therapy. Allogeneic donors may be found among healthy relatives: mother, father, siblings. However, “healthy” donor is not yet proven to be the best option for HSCT patient. Development of relevant biobanks will help to resolve the problem of a donor search/selection.

To perform a successful FMT, it is necessary to follow several factors. First of all, an accurate donor selection, must match, on the one hand, classical infectious requirements for allogeneic donor, and should not have any GIT comorbidities or oncologic diseases. On the other hand, the transplant should possess a normally present, diverse intestinal microbiota free of certain virulent pathogens. The standard technology of graft preparation should be used. Is it well developed and tested depending on the form of its delivery, and necessity of long—term storage [28].

Another important factor determining efficiency depends on the transplant delivery route. Currently, there are several options: introduction of donor microbiota to the upper GIT by means of oral capsules; bringing it to the stomach via a gastroscope channel; microbiota delivery to duodenal space with a nasointestinal tube or PEG gastrostomy; delivery to colon, using deep enema, or by means of colonoscopy [33]. Each method has its indications and advantages but, from the point of “engraftment” probability, a multiple delivery to the coecal region by means of colonoscopy is now considered to be the most effective approach (93%). The delivery technologies evolve continuously, aiming at both improving efficiency and increasing patient comfort. E.g., transendoscopic delivery to the cecum with pin—assisted tube fixation, and use of oral capsules are the most promising procedures now [19]. Another important question is the necessity of anesthesia upon delivery of donor’s transplant. In our opinion, the use of medical sedation is required not only for children, but in adults as well, for ethical reasons and better compliance.

Of the new trends, different methods of preparing matrices for transplanted microorganisms should be mentioned, for example, usage of pectin carriers, to increase fermentation activity of the dietary fibers, with synthesis of short chain fatty acids, thus allowing faster multiplication of the donor microorganisms [31].

Features of fecal microbiota transplantation in hematopoietic stem cell transplantation

Allo—HSCT negatively influences patient’s normal microbiota, due to a number of specific factors, e.g., low—microbial diets, often leading to the development of malnutrition; intestinal decontamination associated with eradication of obligate microorganisms, application of cytotoxic drugs and/ or radiation that damage GIT epithelial cells. Along with antibiotic therapy, the above factors lead to severe alterations of bacterial microbiota, development of pathogenic multidrug—resistant microbiota, presumably increasing the risk of acute GVHD [10,23].

Worldwide clinical experience shows, that GVHD of intestine treatment with basic immunosuppressive drugs of different generations is often insufficient to prevent excessive inflammatory response and relief of a diarrhea syndrome. Systemic antibiotic therapy, oral decontamination with non—absorbable antibiotics is ineffective for a significant number of patients with detectable colonization with Clostridium diffici'le. Up to 40% of patients with infection associated with Clostridium difi'icile, are resistant to metronidazole or vancomycin therapy [7]. Massive use of antibiotics post—HSCT leads to significant disturbances of intestinal microbiota homeostasis, whereas use of probiotic bacterial formulae may be ineffective due to their inability to colonize the intestinal spaces for an extended time period.

According to our data, diarrhea after allo—HSCT is observed in 79% of cases and can persist for several months, thus eventually leading to development of cachexia and lethal infectious complications. At the R. Gorbacheva Memorial Institute for Children Oncology, Hematology and Transplantation, we have a successful experience of FMT in four patients after allo—HSCT — adults (n:2) and children (n:2) with prolonged severe diarrheal syndrome, due to immune and infectious complications [8].

Hence, the general idea of using FMT in HSCT looks promising in many aspects: prevention and treatment of infectious complications, prophylaxis of a malabsorption syndrome, and prevention of cachexia, as well as the treatment of steroid—resistant intestinal forms of acute GVHD [12].

Conclusion

A significantly decreased survival is observed in cases of post—HSCT infectious complications resistant to standard antimicrobial therapy, due to increasing mortality caused by septic conditions, usually associated with pathogenic microorganisms: Klebsiella pneumoniae, Pseudomonas aeruginosa, Clostridium difi'icile, Acinetobacter baumannii. Prolonged antibiotic therapy seems to be a key factor leading to multi—drug resistance of some gut bacteria which in turn, may be a trigger to a severe GVHD. Development of intestinal GVHD in most cases leads to the inability of adequate nutrition, along with a maldigestion and malabsorption syndrome, which ultimately leads to protein—energy malnutrition, cachexia and reduced quality of life. Both in sepsis and GVHD, severe changes are observed in qualitative composition and ratios of microbiota living in human gut and other areas of the body.

Initial clinical experience with effective and safe FMT treatment in heavily pretreated category of patients allows to consider this method complementary additional or, in some cases, an alternative technology of therapy for infectious and immune complications after allo—HSCT. FMT results into changes of intestinal microbiota composition, which may help to eradicate multi—drug resistant gut infections, e.g., Clostridium difi'icile, Klebsiella pneumoniae, to reduce antibiotic—associated diarrhea, to replace resistant bacterial species in other areas of the body, and to change microbial profile to a less—virulent landscape.

Further implementation of FMT in clinical practice requires a detailed study, including optimization of criteria for the therapy initiation, selection of the most matched donors by means of multiplex DNA diagnostics, or next—generation DNA sequencing of microbiota, evaluation of long—term efficacy and safety of the transplants.

Conflict of interests

The authors have no conflict of interest to declare.

References

  1. Afanasyev BV, Zubarovskaya LS, Moiseev IS. Allogeneic hematopoietic stem cell transplantation in children: state of art, issues and prospects. Russian Journal of Children Hematology and Oncology 2015;2(2); 28—42 (In Russian).

  2. Cammarota G, Ianitro G, Gasbarrini A. Fecal microbiota transplantation for the treatment of Clostridium difficile infection. A systematic review. I Clin Gastroenterol 2014; 48(Suppl 1):80—84.

  3. Damman CI, Miller SI Surawicz C.M, Zisman TL. The microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation? Am I Gastroenterol 2012;107:1452—1459.

  4. Debast SB, Bauer MP, Kuijper IL. European society of clinical microbiology and infectious diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014; 20(2):1—26.

  5. Evrensel A. Fecal microbiota transplantation and its usage in neuropsychiatric disorders. Clin Psychopharmacol Neurosci 2016;14(3): 231—237.

  6. Ferrara IL, Levine IE, Reddy P, Holler E. Graft—versushost—disease. Lancet 2009; 373(9674): 1550—1561.

  7. Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M. Modulation of microbiota as treatment for intestinal inflammatory disorders: an up—to—date. World I Gastroenterol 2016; 22(32): 7186—7202.

  8. Goloschapov OV, Kucher MA, Suvorova MA, Klementeva RV, Shcherbakov AA, Shvetcov AN, Moiseev IS, Chukhlovin AB, Afanasyev BV. First experience of treatment for multidrug resistant infectious complications associated with Clostridium difficile and Klebsiella pneumoniae with fecal microbiota transplantation in patients after allogeneic hematopoietic stem cell. Infekzionnye Bolezni 2017; 15(2) In press (In Russian).

  9. Gratwohl A, Baldomero H, Schwendener A, Gratwohl M, Apperley I, Frauendorfer K, Niederwieser D. The EBMT activity survey 2008: impact of team size, team density and new trends. Bone Marrow Transplant 2011;46: 174—191.

  10. Ienq RR, Ubeda C, Taur Y, Menezes CC, Khanin R, Dudakov IA, Liu C, West ML, Singer NV, Equinda MI, Gobourne A, Lipuma L, Young LF, Smith OM, Ghosh A, Hanash AM, Goldberg ID, Aoyama K, Blazar BR, Pamer EG, van den Brink MR. Regulation of intestinal inflammation by microbiota following allogeneic bone marrow transplantation. I Exp Med 2012; 209; 903—91 1.

  11. Ienq RR, Taur Y, Devlin SM, Ponce DM, Goldberg ID, Ahr KF, Littmann ER, Ling L, Gobourne AC, Miller LC, Docampo MD, Peled IU, Arpaia N, Cross IR, Peets TK, Lumish MA, Shono Y, Dudakov IA, Poeck H, Hanash AM, Barker IN, Perales MA, Giralt SA, Pamer EG, van den Brink MR. Intestinal Blautia is associated with reduced death from graftversus—host disease. Biol Blood Marrow Transplant 2015; 21(8):1373—1383.

  12. Kakihana K. Fecal microbiota transplantation for patients with steroid—resistant acute graft—versus—host disease ofthe gut. Blood 2016; 128(16):2083—2088.

  13. Kucher MA, Pirogova OV, Goloschapov OV, Karev VE, Shvetcov AN, Afanasyev BV. Specificities of complex nutritive support of patients with cytostatic therapy and haemopoietic stem cell transplantation. Voprosy Dietologii 2016;6(1):5—12. (In Russian).

  14. Leszczyszyn ll, Radomski M, Leszczyszyn AM. Intestinal microbiota transplant — current state of knowledge. Reumatologia. 2016;54(1):24—28.

  15. Medscape 2015 (Gastroenterology, AGA Institute) http:// img.medscape.com/article/ 849/ 384/ 849384—fig1 .jpg

  16. Montassier E, Al—Ghalith GA, Ward T, Corvec S, Gastinne T, Potel G, Moreau P, Cochetiere M, Batard E, Knights D. Pretreatment gut microbiome predicts chemotherapy—related bloodstream infection. Genome Med 2016; 8(1):49.

  17. Moore—Connors IM, Dunn KA, Bielawski IP, Van Limbergen I. Novel strategies for applied metagenomics. Inflamm Bowel Dis 2015; 22:709—718.

  18. Nalle SC, Turner IR. Intestinal barrier loss as a critical link between inflammatory bowel disease and graft—versushost disease. Mucosal Immunol 2015; 8(4):720—730.

  19. Peng Z, Xiang I, He Z, Zhang T, Xu L, Cui B, Li P, Huang G, Ii G, Nie Y, Wu K, Fan D, Zhang F. Colonic transendoscopic enteral tubing: A novel way of transplanting fecal microbiota. Endoscopy International Open. 2016; 4(6): E610E613.

  20. Peterson C, Round IL. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol 2014;16(7):1024—1033.

  21. Rahier IF, Magro F, Abreu C, Armuzzi A, Ben—Horin S, Chowers Y, Cottone M, de Ridder L, Doherty G, Ehehalt R, Esteve M, Katsanos K, Lees CW, Macmahon E, Moreels T, Reinisch \N, Tilg H, Tremblay L, Veereman—Wauters G, Viget N, Yazdanpanah Y, Eliakim R, Colombel IF. Second European evidence—based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel diseases. I Crohns Colitis 2014; 8:443—468.

  22. Rossen NG, McDonald IK, deVries EM, D’Haens GR, de Vos WM, Zoetendal EG, Ponsioen CY. Faecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World I Gastroenterol 2015; 21:5359—5371.

  23. Shono Y. Intestinal microbiota related effects on graft versus host disease. Int I Hematol 2015; 101; 428—437.

  24. Slavin, S. New strategies for bone marrow transplantation. Curr Opin Immunol 2000; 12: 542—551.

  25. Sokol H. Faecalibacterium prausnitzii is an anti—inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Nat Acad Sci USA 2008; 105(43): 16731—16736.

  26. Teshima T, Reddy P, Zeiser R. Acute graft—versus—host disease: novel biological insights. Biol Blood Marrow Transplant 2016; 22(1):11—16.

  27. US. Food and Drug Administration. Guidance for Industry. Enforcement policy regarding investigational new drug requirements for use of fecal microbiota for transplantation to treat Clostridium difficile infection not responsive to standard therapies. Dept Health and Human Services, Iuly 2013. http://www.fda.goV/BiologicsBloodVaccines/ GuidanceComplianceRegulatoryInformation/Guidances/ Vaccines/ucm361379.htm

  28. van Nood E, Speelman P, Kuijper EI, Keller II. Struggling with recurrent Clostridium difficile infections: is donor faeces the solution? Eurosurveillance 2009; 14(34):1—6.

  29. Wang M], Xu S, Ren Z, Iiang I, Zheng S. Gut microbiota and allogeneic transplantation. I Transl Med 2015; 13(275): 2— 1 1.

  30. Weber D., Ienq R., Hiergeist A., Oefner P, Dettmer K., Weber M., Koestler I., Gessner A., Taur Y., van den Brink M., Pamer E., Wolff D., Hahn I., Herr W, Holler E. Early systemic broad spectrum antibiotic treatment increases risk of graft versus host disease and treatment—related mortality after allogeneic stem cell transplantation — possible role of indirect effects by microbiome disruption. Bone Marrow Transplant 2016; 51(1); 3—4.

  31. Wei Y. Pectin enhances the effect of fecal microbiota transplantation in ulcerative colitis by delaying the loss of diversity of gut flora. BMC Microbiol 2016; 16: 1—9.

  32. Wei Y. Successful treatment with fecal microbiota transplantation in patients with multiple organ dysfunction syndrome and diarrhea following severe sepsis. Critical Care 2016; 20: 332.

  33. Youngster 1. Oral, frozen fecal microbiota transplant (FMT) capsules for recurrent Clostridium difficile infection. BMC Medicine 2016; 14:134.

  34. Zaborin A, Smith D, Garfield K, Quensen J, Shakhsheer B,  Kade  M,  Tirrell  M,  Tiedje  J,  Gilbert  JA,  Zaborina  O,  Alverdy  JC.  Membership  and  behavior  of  ultra-low-diversity pathogen communities present in the gut of humans during prolonged critical illness. MBio 2014; 5(5): e01361-14.

" ["~DETAIL_TEXT"]=> string(38283) "

Gastrointestinal damage after HSCT

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is an effective method of treatment of some solid tumors, hematological, autoimmune and hereditary diseases in children and adults, which is based on providing preceding conditioning (cytostatic and/or radiation therapy) with further intravenous administration of hematopoietic stem cells, to restore bone marrow function in cases of its damage or malfunction [24].

Primary disease status at the time of therapy initiation, and degree of HLA—compatibility between the stem cell recipient fections, in particular — pseudo—membranous colitis associated with Clostridium difi'icile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GVHD, pseudo—membranous colitis and antibiotic—associated diarrhea post—HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial Variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

The efficacy of HSCT is limited by several main factors. First of all, primary or secondary resistance to chemotherapy confers high risk of progression or relapse of underlying disease in the posttransplant period. Second, is the frequent mortality from septic complications of nosocomial multi—drug resistant strains of bacteria, including prevalent Clostridium difi'icile, Klebsiella pneumonia, Pseudomonas aeruginosa and Vancomycin—resistant (VRE). Third, it is immune complications, such as acute and chronic “graft versus host” disease (GVHD), occurring due to affection of recipient tissues and organs by lymphocytes of donor origin [1].

GvHD pathogenesis is based on damage of recipient tissues  that  are  recognized  as  antigens  by  immune  competent  cells   of  the  donor  [6].  GvHD  plays  a  key  role  in  post-transplan- tation  mortality  and  patient’s  quality  of  life.  Most  suscepti- ble tissues to damage usually have high proliferative activity,  such as skin cells, enterocytes and endothelium of small bile  ducts of the liver. In this case, intestinal stem cells and their  niche (Paneth cells) are primary targets of intestinal GvHD,  along with dysbiosis of intestinal microbiota leading to dys- function  of  enterocytes,  bacterial  colonization  and,  conse- quently,  potentiation  of  systemic  inflammatory  response   [18,26]. Intestinal GvHD is manifested by symptoms of diarrhea in its secretory form. This complication is associated by  morphologically seen infiltration of cytotoxic intraepithelial  lymphocytes (CD8+), with damage to mucous epithelial cells  of stomach and/or intestine. Appropriate histological chang- es can vary from lymphoid infiltration of intestinal mucosa  to total destruction of crypts and formation of extensive ne- crotic-ulcerous defects (Fig.1) [13].

figure-1-histology-changes-in-acute-“graft-versus-host-disease”-of-intestine.jpg

Figure 1. Histology changes in acute “graft versus host disease” of intestine [13].
A. Mild degree: focal intraepithelial lymphocytic infiltration (1-2-3 cells, arrows) in part glands with intact integrity and struc- ture of the glands of the mucous membrane.
B. Medium degree: common uneven, often quite abundant lymphocytic infiltration with formation of nuclear foci rexis of epi- thelial cells (arrow) and small foci of subtotal or total destruction of some glands.
C. Severe degree: larger areas of destruction of the mucous membrane, the bottom of defects is loose immature granulation tissue (top right, arrow). Remaining glands are with symptoms of subtotal or total destruction (dotted arrows) or with nuclear rexis of epithelial cells (arrows).

In most cases, gastrointestinal tract (GIT) is a primary organ damaged, thus resulting to enhanced inflammation of immune origin, serious diarrhea, due to GVHD manifestation, and intestinal infections, in particular, pseudo—membranous colitis associated with Clostridium difi'icile associated with massive antibiotic therapy. Consequent elimination of normal intestinal microbiota is among main risk factors for GVHD of GIT, pseudo—membranous colitis and antibiotic—associated diarrhea after HSCT. Frequency of deaths after HSCT is known to be significantly higher in patients with skewed biodiversity of normal microbiota [11].

Intestinal damage after HSCT is clinically manifesting by a maldigestion syndrome which includes anorexia, nausea, vomiting, abdominal pain and diarrhea. These symptoms quickly lead to malfunction of intestinal barrier function, reduced adaptation reserves of the organism, development of protein—energy malnutrition and cachexia.

There are several reasons for high mortality in patients undergoing allo—HSCT. First, long period of pancytopenia which is associated with severe infection complications and requires administration of broad—spectrum antibiotics, which, in turn, leads to partial elimination or lack of normal intestinal microbiota, selection for multi—drug resistant bacterial strains, their subsequent expansion and dominance over normal microbiota (Tab. 1) [20]. Second, intensive chemotherapy and allo—HSCT in most cases leads to altered structure and decreased protective functions of intestinal wall, which is clinically expressed as mucositis which results from direct toxic effects of chemotherapy upon epithelial and Vascular structures of intestine, causing invasion of pathogenic microorganisms into the intestinal wall, in the presence of neutropenia and developing GVHD.

Table 1. Intestinal microbiota: alterations during antibiotic treatment, adapted from Peterson C. et al [20].

table-1-intestinal-microbiota-alterations-during-antibiotic-treatment.jpg

Thus, currently available drugs and technologies for treat- ment Of infectious complications and GVHD do not solve the problem Of early mortality among hematological patients after allo-HSCT. Those patients with severe damage Of di- gestive system are at high risk Of fatal outcome, due to infec- tious complications, metabolic disorders, massive intestinal bleeding and increasing cacheXia, even if achieving com- plete remission Of underlying malignant disease following a successful HSCT.

Positive effects of directed microbiota correction

There are conflicting reports on clinical effects Of intestinal microbiota correction. Some Of these approaches have, how- ever, shown their ability tO prevent complications occurring after organ and cell transplantation (Tab. 2).

Table 2. Results of gut microbial interventions upon results of cell/organ transplantation based on review by Wang et al. [29]

table-2-results-of-gut-microbial-interventions-upon-results-of-cell organ-transplantation.jpg

Human microbiota

Human intestinal microbiota represents a broad set of obligatory and facultative microorganisms that can cause disease in case of suppressed immunity or immunological incompatibility in the host.

There are two kinds of microorganisms classified by their location in the gut: luminal microbiota, which is located in the intestine indigestible dietary fiber and mucosal, adjacent to epithelial cells of the intestine, being integrated into parietal mucin layer. Both luminal and mucosal microbiota may impact the condition of human body, due to their regulatory interactions, and perform many metabolic effects such as detoxification, suppression of pathogenic microorganisms, regulation of immune system, regeneration of epithelium, synthesis of certain Vitamins and essential amino acids, fat metabolism, etc. Dominating intestinal bacteria include 5 types: Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria and Verrucomicrobia. Among them, two types of microbes (Bifidobacterium and Lactobacillus) play a crucial role in development of microbiota till the moment of birth (Tab.3).

Table 3. Intestinal microbiota diversity, by Weber et. al. [30]

table-3-intestinal-microbiota-diversity-by-weber-et-al.jpg

Stable composition of intestinal microbiota and regulation of local immune system reactivity are considered the key aspect for its functional activities. One should take into account of short chain fatty acids (acetate, propionate, butyrate) and antimicrobial peptides produced in situ, regulation of formation of T—regulatory cells (Treg) and IgA in bacteria from intestinal lumen. At the level of lamina propria, metabolic maintenance of transforming growth factor (TGFB), integrin CtE (CD103*), dendritic cells, Treg and T—helper (Th17) producing IL—10, IL—22 are important regenerative factors of epithelial cells. At the level of mesenteric lymph node, one should discuss interaction with innate lymphoid cells via a RORyt nuclear receptor, which reduces local inflammation [29]. Preservation of these interactions allows the growth suppression of pathogenic microbiota, eliminate endogenous and exogenous pathogens, maintain structural integrity of intestinal epithelium.

Variability evaluation of intestinal microbiota

Until now, qualitative identification of composed intestinal microbiota, especially anaerobic microorganisms, represents the main problem in diagnostics of many human bacteria that are undetectable by classical bacteriological methods. Implementation of fecal microbiota transplantation (FMT) procedure into clinical practice and its scientific rationale were largely possible due to development of the microbe identification methods by genome next—generation sequencing (NGS) of bacterial DNAs, and, to a lesser extent, by multiplex real—time polymerase chain (e.g. Colonoflor—16) [8]. Development of the s.c. shotgun next—generation sequencing based on differential analysis of bacterial 16S ribosomal RNA and identification of distinct molecular isolates allowed precise DNA profiling of microbiota composition from donor and recipient, therefore, characterizing the most appropriate fecal donors, and evaluating microbiological results of the treatment [16]. This sequencing procedure consists of 4 successive stages: selection of microbial DNAs from feces, amplification by PCR V4—5 plots of the 16S rRNA gene, sequencing, comparing individual results with a database of previously studied samples, for example, from the NCBI Sequence Read Archive database.

Quantitative 16S RNA analysis in patients with sepsis has revealed sufficient shifts of the main microbial types in the stool samples from the intensive care patients [34]. The workers observed scewed diversity of main microbial communities (1 to 4 bacterial taxa) in 30% of the patients. Bacteria associated with the genera Enterococcus and Staphylococcus and the family Enterobacteriaceae comprised the majority of these communities.

As seen from the Figure 2, normal stool specimens (H1, H2, H3, H4, and H5) were characterized by prevalence of Firmicutes and, in most cases, Bacteroidetes, without Proteobacterial abundance (Fig 2. 1A). In a half of ICU patients (ICU1, ICU4, ICU6, ICU9, ICU11, and ICU15), either Proteobacteria or Firmicutes organisms were totally dominant from at least one time point of stool collection (Fig. 1B and C).

In ICU1, ICU11, and ICU15, the authors observed drastic changes in microbial ratios, with Firmicutes being completely replaced by Proteobacteria. The latter phylum predominated also in most stool samples of the patients ICU6 (Fig 2. 1B) and ICU4 (Fig 2. 1C).

figure-2-composition--of-the-gut-microbiome-.jpg

Figure 2. Composition of the gut microbiome at the phylum level determined by molecular analysis of stool samples collected from healthy controls (A), de- ceased ICU patients with severe sepsis (black circles on the time line) (B), and recovered ICU patients (green circles) (C). Dates of stool collection are displayed in numbered quadrants [34].

Hence, the gross shifts in microbial composition in critically ill patients with clinical signs of sepsis are, mainly, unidirectional, leading to exhaustion of large microbial philae. However, these changes seem to be quite heterogenous and need further clarification for bacterial types associated with worse clinical prognosis.

Under common clinical conditions, however, diagnostics of bacterial dysbiosis is performed for planning different therapeutic measures, including clinical FMT effects. Evaluation of gastrointestinal microflora and mucosa is, generally, performed by means of the following microbiological methods:

— conventional bacteriological tests (microscopy, seeding, assessment of antibiotic resistance).

— biopsy of stomach and/or intestine mucosa with subsequent histology and immunophenotyping of local lymphocytes; verification of infectious lesions at the intestinal mucosa;

— definition of Clostridium difi'icile toxin A and B in stool;

— fecal calprotectin in stool etc.

Fecal microbiota transplantation

In the recent years, FMT was actively developing as a meth- od  to  restore  functional  and  anatomical  integrity  of  intes- tinal  microbiota  in  appropriate  clinical  situations  (Fig.3)   [12,14,21,].

Typical  changes  of  intestinal  microbiota  in  inflammatory   bowel  diseases  include  reduced  diversity  of  obligate  micro- organisms, especially, deficiency of Firmicutes and Bacteroidetes [3]. Ultimately, this leads to lack of butyrate synthesis  by Faecalibacterium  prausnitzii.  This  metabolite  is  a  local  anti-inflammatory agent, acting via IL-8 inhibition [25]. The main known mechanisms of FMT action include com- petition for nutrients, direct inhibition of excessive pathogen  growth,  modulation  of  host  immune  system  by  interaction   with  normal  microbiota.  FMT  seems  to  be  more  effective,   than use of probiotic preparations, in restoring altered intes- tinal microbiota, since the latter is unable to colonize intesti- nal space for an extended period.

FMT also allows correction of both microbiota in digestive  ways,  and  microbial  spectrum  of  other  body  areas  (mouth,   lungs, urinary routes, etc.) to less pathogenic species which  are  more  sensitive  to  antibiotics.  This  effect  can  be  used  to   eradicate   antibiotic-resistant   pathogenic   bacteria   strains    based  on  natural  competition  and  antagonism  between  the   microorganisms [8].

In 2014, a meta-analysis of clinical studies showed that FMT  was effective in 87% of diarrhea cases (a total of 536 patients)  caused  by  Clostridium  difficile,  with  primary  resistance  to   prior  therapy  with  metronidazole  and  vancomycin  [2].  The   transplant administration route was an important factor af- fecting  treatment  outcomes,  i.e.,  the  microflora  delivery  to   the  stomach  yielded  81%  of  clinical  success;  to  duodenum,   86%; via  ascending  part  of  the  colon  (with  fibrocolonosco- py),  93%  response;  to  descending  colon  by  means  of  deep   enema, 84% of successful treatment.

A subsequent review article discussed 45 clinical studies (112  patients), showing ambiguous FMT efficiency in inflamma- tory bowel disease, i.e., only 0 to 68% of the patients achieved  clinical remission [22]. The authors noted that possible fail- ure of FMT could be connected, on the one hand, with poor  state of donor’s microbiota, especially, reduced microbial di- versity.  On  the  other  hand,  severe  malfunction  of  patient’s   GIT with high values of the Mayo scores could also influence  the outcomes.

The attempts of clinical FMT implementation are carried out  not only in clinical conditions related to intestinal infections,  but also presumed irregularities between altered microbiota  and immune system imbalance, such as irritable bowel syn- drome, rheumatoid arthritis, diabetes type 2, autism, chronic  fatigue syndrome, multiple sclerosis and Parkinson’s disease  [5]. There are single reports on FMT performed in order to  treat sepsis with multiple organ dysfunction syndrome, and  to eliminate vancomycin-resistant bacteria [32].

figure-3-fecal-microbiota-transplantation-scheme.jpg

Figure 3. Fecal microbiota transplantation scheme [15].

Increasing number of clinical research reporting successful outcomes of FMT in various diseases is accompanied by arrangement of the first specialized biobank in 2012. This USA—based facility was established for storage of fecal samples for FMT. Currently, the biobank is linked to more than 750 clinics at all the 50 USA states providing an opportunity for a constant access to the samples of donor fecal microbiota. The method was adopted and regulated by the US Food and Drug Administration (FDA). In 2013, this body has approved FMT as a therapeutic method for treatment of refractory infections associated with Clostridi'um difi'icile, for controlled clinical studies (“policy with respect to the investigational new drug requirements for use of fecal microbiota transplantation to treat Clostridi'um difi'ici'le infection not responding to standard treatment”) [27].

On the basis of clinical research, FMT was included to the Guidelines issued by European Society of Clinical Microbiology and Infectious Diseases (ECMID) concerning treatment of Vancomycin—resistant (VRE) infections caused by Clostridium difi'icile, at the AI level of evidence [4]. However, infections associated with Clostridi'um difi'icile, are just among potential indications for the FMT usage. Similarly, the FMT use was approved by the European Crohn’s and Colitis Organization as an approach to treatment of chronic nonspecific inflammatory bowel diseases [21].

Similarly, FMT can significantly modulate immune function and have positive effects on other GIT inflammatory processes of immune origin, in particular, resistant graft—versushost—disease GVHD of intestine. In fact, several researchers confirm that preventive use of FMT leads to a decreased risk of infectious complications during treatment of hematological diseases [16].

Despite some encouraging results of FMT—assisted treatment, it is still rarely used in severely immunocompromised patients, e.g., after alloHSCT. This may be due to low performance status of HSCT recipients, severely damaged gastrointestinal mucosa associated with infectious complications and risk of microbial dissemination with a transplanted donor microbiota. However, it is important to mention, that the transplanted microorganisms potentially substitute multi—drug resistant flora due to natural antagonism and improve the control over infectious complications with standard antibiotics.

Donor selection and transplant delivery of fecal microbiota

Optimal donor selection for FMT is still an uncertain aspect in FMT implementation. Some medical, ethical and economic issues should be resolved, e.g., which kind of graft will be indicated in certain cases, either being related, unrelated or autologous. From economic and ethical viewpoints, an optimal solution is to use autologous source of transplant. However, qualitative composition of a patient’s microbiota is often changed dramatically after previous courses of chemoand antibiotic therapy. Allogeneic donors may be found among healthy relatives: mother, father, siblings. However, “healthy” donor is not yet proven to be the best option for HSCT patient. Development of relevant biobanks will help to resolve the problem of a donor search/selection.

To perform a successful FMT, it is necessary to follow several factors. First of all, an accurate donor selection, must match, on the one hand, classical infectious requirements for allogeneic donor, and should not have any GIT comorbidities or oncologic diseases. On the other hand, the transplant should possess a normally present, diverse intestinal microbiota free of certain virulent pathogens. The standard technology of graft preparation should be used. Is it well developed and tested depending on the form of its delivery, and necessity of long—term storage [28].

Another important factor determining efficiency depends on the transplant delivery route. Currently, there are several options: introduction of donor microbiota to the upper GIT by means of oral capsules; bringing it to the stomach via a gastroscope channel; microbiota delivery to duodenal space with a nasointestinal tube or PEG gastrostomy; delivery to colon, using deep enema, or by means of colonoscopy [33]. Each method has its indications and advantages but, from the point of “engraftment” probability, a multiple delivery to the coecal region by means of colonoscopy is now considered to be the most effective approach (93%). The delivery technologies evolve continuously, aiming at both improving efficiency and increasing patient comfort. E.g., transendoscopic delivery to the cecum with pin—assisted tube fixation, and use of oral capsules are the most promising procedures now [19]. Another important question is the necessity of anesthesia upon delivery of donor’s transplant. In our opinion, the use of medical sedation is required not only for children, but in adults as well, for ethical reasons and better compliance.

Of the new trends, different methods of preparing matrices for transplanted microorganisms should be mentioned, for example, usage of pectin carriers, to increase fermentation activity of the dietary fibers, with synthesis of short chain fatty acids, thus allowing faster multiplication of the donor microorganisms [31].

Features of fecal microbiota transplantation in hematopoietic stem cell transplantation

Allo—HSCT negatively influences patient’s normal microbiota, due to a number of specific factors, e.g., low—microbial diets, often leading to the development of malnutrition; intestinal decontamination associated with eradication of obligate microorganisms, application of cytotoxic drugs and/ or radiation that damage GIT epithelial cells. Along with antibiotic therapy, the above factors lead to severe alterations of bacterial microbiota, development of pathogenic multidrug—resistant microbiota, presumably increasing the risk of acute GVHD [10,23].

Worldwide clinical experience shows, that GVHD of intestine treatment with basic immunosuppressive drugs of different generations is often insufficient to prevent excessive inflammatory response and relief of a diarrhea syndrome. Systemic antibiotic therapy, oral decontamination with non—absorbable antibiotics is ineffective for a significant number of patients with detectable colonization with Clostridium diffici'le. Up to 40% of patients with infection associated with Clostridium difi'icile, are resistant to metronidazole or vancomycin therapy [7]. Massive use of antibiotics post—HSCT leads to significant disturbances of intestinal microbiota homeostasis, whereas use of probiotic bacterial formulae may be ineffective due to their inability to colonize the intestinal spaces for an extended time period.

According to our data, diarrhea after allo—HSCT is observed in 79% of cases and can persist for several months, thus eventually leading to development of cachexia and lethal infectious complications. At the R. Gorbacheva Memorial Institute for Children Oncology, Hematology and Transplantation, we have a successful experience of FMT in four patients after allo—HSCT — adults (n:2) and children (n:2) with prolonged severe diarrheal syndrome, due to immune and infectious complications [8].

Hence, the general idea of using FMT in HSCT looks promising in many aspects: prevention and treatment of infectious complications, prophylaxis of a malabsorption syndrome, and prevention of cachexia, as well as the treatment of steroid—resistant intestinal forms of acute GVHD [12].

Conclusion

A significantly decreased survival is observed in cases of post—HSCT infectious complications resistant to standard antimicrobial therapy, due to increasing mortality caused by septic conditions, usually associated with pathogenic microorganisms: Klebsiella pneumoniae, Pseudomonas aeruginosa, Clostridium difi'icile, Acinetobacter baumannii. Prolonged antibiotic therapy seems to be a key factor leading to multi—drug resistance of some gut bacteria which in turn, may be a trigger to a severe GVHD. Development of intestinal GVHD in most cases leads to the inability of adequate nutrition, along with a maldigestion and malabsorption syndrome, which ultimately leads to protein—energy malnutrition, cachexia and reduced quality of life. Both in sepsis and GVHD, severe changes are observed in qualitative composition and ratios of microbiota living in human gut and other areas of the body.

Initial clinical experience with effective and safe FMT treatment in heavily pretreated category of patients allows to consider this method complementary additional or, in some cases, an alternative technology of therapy for infectious and immune complications after allo—HSCT. FMT results into changes of intestinal microbiota composition, which may help to eradicate multi—drug resistant gut infections, e.g., Clostridium difi'icile, Klebsiella pneumoniae, to reduce antibiotic—associated diarrhea, to replace resistant bacterial species in other areas of the body, and to change microbial profile to a less—virulent landscape.

Further implementation of FMT in clinical practice requires a detailed study, including optimization of criteria for the therapy initiation, selection of the most matched donors by means of multiplex DNA diagnostics, or next—generation DNA sequencing of microbiota, evaluation of long—term efficacy and safety of the transplants.

Conflict of interests

The authors have no conflict of interest to declare.

References

  1. Afanasyev BV, Zubarovskaya LS, Moiseev IS. Allogeneic hematopoietic stem cell transplantation in children: state of art, issues and prospects. Russian Journal of Children Hematology and Oncology 2015;2(2); 28—42 (In Russian).

  2. Cammarota G, Ianitro G, Gasbarrini A. Fecal microbiota transplantation for the treatment of Clostridium difficile infection. A systematic review. I Clin Gastroenterol 2014; 48(Suppl 1):80—84.

  3. Damman CI, Miller SI Surawicz C.M, Zisman TL. The microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation? Am I Gastroenterol 2012;107:1452—1459.

  4. Debast SB, Bauer MP, Kuijper IL. European society of clinical microbiology and infectious diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014; 20(2):1—26.

  5. Evrensel A. Fecal microbiota transplantation and its usage in neuropsychiatric disorders. Clin Psychopharmacol Neurosci 2016;14(3): 231—237.

  6. Ferrara IL, Levine IE, Reddy P, Holler E. Graft—versushost—disease. Lancet 2009; 373(9674): 1550—1561.

  7. Gallo A, Passaro G, Gasbarrini A, Landolfi R, Montalto M. Modulation of microbiota as treatment for intestinal inflammatory disorders: an up—to—date. World I Gastroenterol 2016; 22(32): 7186—7202.

  8. Goloschapov OV, Kucher MA, Suvorova MA, Klementeva RV, Shcherbakov AA, Shvetcov AN, Moiseev IS, Chukhlovin AB, Afanasyev BV. First experience of treatment for multidrug resistant infectious complications associated with Clostridium difficile and Klebsiella pneumoniae with fecal microbiota transplantation in patients after allogeneic hematopoietic stem cell. Infekzionnye Bolezni 2017; 15(2) In press (In Russian).

  9. Gratwohl A, Baldomero H, Schwendener A, Gratwohl M, Apperley I, Frauendorfer K, Niederwieser D. The EBMT activity survey 2008: impact of team size, team density and new trends. Bone Marrow Transplant 2011;46: 174—191.

  10. Ienq RR, Ubeda C, Taur Y, Menezes CC, Khanin R, Dudakov IA, Liu C, West ML, Singer NV, Equinda MI, Gobourne A, Lipuma L, Young LF, Smith OM, Ghosh A, Hanash AM, Goldberg ID, Aoyama K, Blazar BR, Pamer EG, van den Brink MR. Regulation of intestinal inflammation by microbiota following allogeneic bone marrow transplantation. I Exp Med 2012; 209; 903—91 1.

  11. Ienq RR, Taur Y, Devlin SM, Ponce DM, Goldberg ID, Ahr KF, Littmann ER, Ling L, Gobourne AC, Miller LC, Docampo MD, Peled IU, Arpaia N, Cross IR, Peets TK, Lumish MA, Shono Y, Dudakov IA, Poeck H, Hanash AM, Barker IN, Perales MA, Giralt SA, Pamer EG, van den Brink MR. Intestinal Blautia is associated with reduced death from graftversus—host disease. Biol Blood Marrow Transplant 2015; 21(8):1373—1383.

  12. Kakihana K. Fecal microbiota transplantation for patients with steroid—resistant acute graft—versus—host disease ofthe gut. Blood 2016; 128(16):2083—2088.

  13. Kucher MA, Pirogova OV, Goloschapov OV, Karev VE, Shvetcov AN, Afanasyev BV. Specificities of complex nutritive support of patients with cytostatic therapy and haemopoietic stem cell transplantation. Voprosy Dietologii 2016;6(1):5—12. (In Russian).

  14. Leszczyszyn ll, Radomski M, Leszczyszyn AM. Intestinal microbiota transplant — current state of knowledge. Reumatologia. 2016;54(1):24—28.

  15. Medscape 2015 (Gastroenterology, AGA Institute) http:// img.medscape.com/article/ 849/ 384/ 849384—fig1 .jpg

  16. Montassier E, Al—Ghalith GA, Ward T, Corvec S, Gastinne T, Potel G, Moreau P, Cochetiere M, Batard E, Knights D. Pretreatment gut microbiome predicts chemotherapy—related bloodstream infection. Genome Med 2016; 8(1):49.

  17. Moore—Connors IM, Dunn KA, Bielawski IP, Van Limbergen I. Novel strategies for applied metagenomics. Inflamm Bowel Dis 2015; 22:709—718.

  18. Nalle SC, Turner IR. Intestinal barrier loss as a critical link between inflammatory bowel disease and graft—versushost disease. Mucosal Immunol 2015; 8(4):720—730.

  19. Peng Z, Xiang I, He Z, Zhang T, Xu L, Cui B, Li P, Huang G, Ii G, Nie Y, Wu K, Fan D, Zhang F. Colonic transendoscopic enteral tubing: A novel way of transplanting fecal microbiota. Endoscopy International Open. 2016; 4(6): E610E613.

  20. Peterson C, Round IL. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol 2014;16(7):1024—1033.

  21. Rahier IF, Magro F, Abreu C, Armuzzi A, Ben—Horin S, Chowers Y, Cottone M, de Ridder L, Doherty G, Ehehalt R, Esteve M, Katsanos K, Lees CW, Macmahon E, Moreels T, Reinisch \N, Tilg H, Tremblay L, Veereman—Wauters G, Viget N, Yazdanpanah Y, Eliakim R, Colombel IF. Second European evidence—based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel diseases. I Crohns Colitis 2014; 8:443—468.

  22. Rossen NG, McDonald IK, deVries EM, D’Haens GR, de Vos WM, Zoetendal EG, Ponsioen CY. Faecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World I Gastroenterol 2015; 21:5359—5371.

  23. Shono Y. Intestinal microbiota related effects on graft versus host disease. Int I Hematol 2015; 101; 428—437.

  24. Slavin, S. New strategies for bone marrow transplantation. Curr Opin Immunol 2000; 12: 542—551.

  25. Sokol H. Faecalibacterium prausnitzii is an anti—inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Nat Acad Sci USA 2008; 105(43): 16731—16736.

  26. Teshima T, Reddy P, Zeiser R. Acute graft—versus—host disease: novel biological insights. Biol Blood Marrow Transplant 2016; 22(1):11—16.

  27. US. Food and Drug Administration. Guidance for Industry. Enforcement policy regarding investigational new drug requirements for use of fecal microbiota for transplantation to treat Clostridium difficile infection not responsive to standard therapies. Dept Health and Human Services, Iuly 2013. http://www.fda.goV/BiologicsBloodVaccines/ GuidanceComplianceRegulatoryInformation/Guidances/ Vaccines/ucm361379.htm

  28. van Nood E, Speelman P, Kuijper EI, Keller II. Struggling with recurrent Clostridium difficile infections: is donor faeces the solution? Eurosurveillance 2009; 14(34):1—6.

  29. Wang M], Xu S, Ren Z, Iiang I, Zheng S. Gut microbiota and allogeneic transplantation. I Transl Med 2015; 13(275): 2— 1 1.

  30. Weber D., Ienq R., Hiergeist A., Oefner P, Dettmer K., Weber M., Koestler I., Gessner A., Taur Y., van den Brink M., Pamer E., Wolff D., Hahn I., Herr W, Holler E. Early systemic broad spectrum antibiotic treatment increases risk of graft versus host disease and treatment—related mortality after allogeneic stem cell transplantation — possible role of indirect effects by microbiome disruption. Bone Marrow Transplant 2016; 51(1); 3—4.

  31. Wei Y. Pectin enhances the effect of fecal microbiota transplantation in ulcerative colitis by delaying the loss of diversity of gut flora. BMC Microbiol 2016; 16: 1—9.

  32. Wei Y. Successful treatment with fecal microbiota transplantation in patients with multiple organ dysfunction syndrome and diarrhea following severe sepsis. Critical Care 2016; 20: 332.

  33. Youngster 1. Oral, frozen fecal microbiota transplant (FMT) capsules for recurrent Clostridium difficile infection. BMC Medicine 2016; 14:134.

  34. Zaborin A, Smith D, Garfield K, Quensen J, Shakhsheer B,  Kade  M,  Tirrell  M,  Tiedje  J,  Gilbert  JA,  Zaborina  O,  Alverdy  JC.  Membership  and  behavior  of  ultra-low-diversity pathogen communities present in the gut of humans during prolonged critical illness. MBio 2014; 5(5): e01361-14.

" ["DETAIL_TEXT_TYPE"]=> string(4) "html" ["~DETAIL_TEXT_TYPE"]=> string(4) "html" ["PREVIEW_TEXT"]=> string(0) "" ["~PREVIEW_TEXT"]=> string(0) "" ["PREVIEW_TEXT_TYPE"]=> string(4) "text" ["~PREVIEW_TEXT_TYPE"]=> string(4) "text" ["PREVIEW_PICTURE"]=> NULL ["~PREVIEW_PICTURE"]=> NULL ["LANG_DIR"]=> string(4) "/ru/" ["~LANG_DIR"]=> string(4) "/ru/" ["SORT"]=> string(3) "500" ["~SORT"]=> string(3) "500" ["CODE"]=> string(100) "transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti" ["~CODE"]=> string(100) "transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti" ["EXTERNAL_ID"]=> string(3) "816" ["~EXTERNAL_ID"]=> string(3) "816" ["IBLOCK_TYPE_ID"]=> string(7) "journal" ["~IBLOCK_TYPE_ID"]=> string(7) "journal" ["IBLOCK_CODE"]=> string(7) "volumes" ["~IBLOCK_CODE"]=> string(7) "volumes" ["IBLOCK_EXTERNAL_ID"]=> string(1) "2" ["~IBLOCK_EXTERNAL_ID"]=> string(1) "2" ["LID"]=> string(2) "s2" ["~LID"]=> string(2) "s2" ["EDIT_LINK"]=> NULL ["DELETE_LINK"]=> NULL ["DISPLAY_ACTIVE_FROM"]=> string(0) "" ["IPROPERTY_VALUES"]=> array(18) { ["ELEMENT_META_TITLE"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["ELEMENT_META_KEYWORDS"]=> string(0) "" ["ELEMENT_META_DESCRIPTION"]=> string(342) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation" ["ELEMENT_PREVIEW_PICTURE_FILE_ALT"]=> string(2901) "Резюме Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения. <h3>Ключевые слова</h3> Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность." ["ELEMENT_PREVIEW_PICTURE_FILE_TITLE"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["ELEMENT_DETAIL_PICTURE_FILE_ALT"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["ELEMENT_DETAIL_PICTURE_FILE_TITLE"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_META_TITLE"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_META_KEYWORDS"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_META_DESCRIPTION"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_PICTURE_FILE_ALT"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_PICTURE_FILE_TITLE"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_PICTURE_FILE_NAME"]=> string(100) "transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti" ["SECTION_DETAIL_PICTURE_FILE_ALT"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_DETAIL_PICTURE_FILE_TITLE"]=> string(228) "Трансплантация фекальной микробиоты, как метод лечения осложнений после трансплантации гемопоэтических стволовых клеток " ["SECTION_DETAIL_PICTURE_FILE_NAME"]=> string(100) "transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti" ["ELEMENT_PREVIEW_PICTURE_FILE_NAME"]=> string(100) "transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti" ["ELEMENT_DETAIL_PICTURE_FILE_NAME"]=> string(100) "transplantatsiya-fekalnoy-mikrobioty-kak-metod-lecheniya-oslozhneniy-posle-transplantatsii-gemopoeti" } ["FIELDS"]=> array(1) { ["IBLOCK_SECTION_ID"]=> string(2) "32" } ["PROPERTIES"]=> array(18) { ["KEYWORDS"]=> array(36) { ["ID"]=> string(2) "19" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:46:01" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(27) "Ключевые слова" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "KEYWORDS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "19" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "4" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "Y" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "Y" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> bool(false) ["VALUE"]=> bool(false) ["DESCRIPTION"]=> bool(false) ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> bool(false) ["~DESCRIPTION"]=> bool(false) ["~NAME"]=> string(27) "Ключевые слова" ["~DEFAULT_VALUE"]=> string(0) "" } ["SUBMITTED"]=> array(36) { ["ID"]=> string(2) "20" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Дата подачи" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "SUBMITTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "20" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11063" ["VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Дата подачи" ["~DEFAULT_VALUE"]=> NULL } ["ACCEPTED"]=> array(36) { ["ID"]=> string(2) "21" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(25) "Дата принятия" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "ACCEPTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "21" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11064" ["VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL } ["PUBLISHED"]=> array(36) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11065" ["VALUE"]=> string(22) "03/17/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "03/17/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Дата публикации" ["~DEFAULT_VALUE"]=> NULL } ["CONTACT"]=> array(36) { ["ID"]=> string(2) "23" ["TIMESTAMP_X"]=> string(19) "2015-09-03 14:43:05" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(14) "Контакт" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "CONTACT" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "23" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(14) "Контакт" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHORS"]=> array(36) { ["ID"]=> string(2) "24" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:45:07" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "AUTHORS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "24" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> bool(false) ["VALUE"]=> bool(false) ["DESCRIPTION"]=> bool(false) ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> bool(false) ["~DESCRIPTION"]=> bool(false) ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_RU"]=> array(36) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11122" ["VALUE"]=> array(2) { ["TEXT"]=> string(124) "Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(124) "Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_RU"]=> array(36) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11123" ["VALUE"]=> array(2) { ["TEXT"]=> string(445) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(445) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_RU"]=> array(36) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11124" ["VALUE"]=> array(2) { ["TEXT"]=> string(2901) "Резюме Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения. <h3>Ключевые слова</h3> Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность." ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(2889) "Резюме Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения.

Ключевые слова

Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность." ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Описание/Резюме" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["DOI"]=> array(36) { ["ID"]=> string(2) "28" ["TIMESTAMP_X"]=> string(19) "2016-04-06 14:11:12" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(3) "DOI" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(3) "DOI" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "28" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11066" ["VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-20-29" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-20-29" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(3) "DOI" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_EN"]=> array(36) { ["ID"]=> string(2) "37" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(6) "Author" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "37" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11118" ["VALUE"]=> array(2) { ["TEXT"]=> string(73) "Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(73) "Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(6) "Author" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_EN"]=> array(36) { ["ID"]=> string(2) "38" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Organization" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "38" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11119" ["VALUE"]=> array(2) { ["TEXT"]=> string(555) "R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;<br> Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022<br> Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(543) "R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;
Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022
Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Organization" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_EN"]=> array(36) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11120" ["VALUE"]=> array(2) { ["TEXT"]=> string(1529) "Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications. <h3>Keywords</h3> Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. " ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(1517) "Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

Keywords

Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. " ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Description / Summary" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["NAME_EN"]=> array(36) { ["ID"]=> string(2) "40" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:49:47" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(4) "Name" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "NAME_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "40" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11067" ["VALUE"]=> string(114) " Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(114) " Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(4) "Name" ["~DEFAULT_VALUE"]=> string(0) "" } ["FULL_TEXT_RU"]=> array(36) { ["ID"]=> string(2) "42" ["TIMESTAMP_X"]=> string(19) "2015-09-07 20:29:18" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(23) "Полный текст" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(12) "FULL_TEXT_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "42" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(23) "Полный текст" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["PDF_RU"]=> array(36) { ["ID"]=> string(2) "43" ["TIMESTAMP_X"]=> string(19) "2015-09-09 16:05:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(7) "PDF RUS" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(6) "PDF_RU" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "F" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "43" ["FILE_TYPE"]=> string(18) "doc, txt, rtf, pdf" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11125" ["VALUE"]=> string(3) "467" ["DESCRIPTION"]=> NULL ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(3) "467" ["~DESCRIPTION"]=> NULL ["~NAME"]=> string(7) "PDF RUS" ["~DEFAULT_VALUE"]=> string(0) "" } ["PDF_EN"]=> array(36) { ["ID"]=> string(2) "44" ["TIMESTAMP_X"]=> string(19) "2015-09-09 16:05:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(7) "PDF ENG" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(6) "PDF_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "F" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "44" ["FILE_TYPE"]=> string(18) "doc, txt, rtf, pdf" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11121" ["VALUE"]=> string(3) "466" ["DESCRIPTION"]=> NULL ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(3) "466" ["~DESCRIPTION"]=> NULL ["~NAME"]=> string(7) "PDF ENG" ["~DEFAULT_VALUE"]=> string(0) "" } ["NAME_LONG"]=> array(36) { ["ID"]=> string(2) "45" ["TIMESTAMP_X"]=> string(19) "2023-04-13 00:55:00" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(72) "Название (для очень длинных заголовков)" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "NAME_LONG" ["DEFAULT_VALUE"]=> array(2) { ["TYPE"]=> string(4) "HTML" ["TEXT"]=> string(0) "" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "45" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(80) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(72) "Название (для очень длинных заголовков)" ["~DEFAULT_VALUE"]=> array(2) { ["TYPE"]=> string(4) "HTML" ["TEXT"]=> string(0) "" } } } ["DISPLAY_PROPERTIES"]=> array(11) { ["AUTHOR_EN"]=> array(37) { ["ID"]=> string(2) "37" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(6) "Author" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "37" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11118" ["VALUE"]=> array(2) { ["TEXT"]=> string(73) "Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(73) "Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(6) "Author" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(73) "Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev" } ["SUMMARY_EN"]=> array(37) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11120" ["VALUE"]=> array(2) { ["TEXT"]=> string(1529) "Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications. <h3>Keywords</h3> Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. " ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(1517) "Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

Keywords

Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. " ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Description / Summary" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(1517) "Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

Keywords

Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. " } ["DOI"]=> array(37) { ["ID"]=> string(2) "28" ["TIMESTAMP_X"]=> string(19) "2016-04-06 14:11:12" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(3) "DOI" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(3) "DOI" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "28" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11066" ["VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-20-29" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-20-29" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(3) "DOI" ["~DEFAULT_VALUE"]=> string(0) "" ["DISPLAY_VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-20-29" } ["NAME_EN"]=> array(37) { ["ID"]=> string(2) "40" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:49:47" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(4) "Name" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "NAME_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "40" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11067" ["VALUE"]=> string(114) " Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(114) " Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(4) "Name" ["~DEFAULT_VALUE"]=> string(0) "" ["DISPLAY_VALUE"]=> string(114) " Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation" } ["ORGANIZATION_EN"]=> array(37) { ["ID"]=> string(2) "38" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Organization" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "38" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11119" ["VALUE"]=> array(2) { ["TEXT"]=> string(555) "R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;<br> Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022<br> Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(543) "R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;
Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022
Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Organization" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(543) "R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;
Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022
Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru" } ["AUTHOR_RU"]=> array(37) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11122" ["VALUE"]=> array(2) { ["TEXT"]=> string(124) "Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(124) "Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(124) "Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев" } ["SUBMITTED"]=> array(37) { ["ID"]=> string(2) "20" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Дата подачи" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "SUBMITTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "20" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11063" ["VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Дата подачи" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/27/2017 12:00:00 am" } ["ACCEPTED"]=> array(37) { ["ID"]=> string(2) "21" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(25) "Дата принятия" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "ACCEPTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "21" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11064" ["VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/27/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/27/2017 12:00:00 am" } ["PUBLISHED"]=> array(37) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11065" ["VALUE"]=> string(22) "03/17/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "03/17/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Дата публикации" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "03/17/2017 12:00:00 am" } ["SUMMARY_RU"]=> array(37) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11124" ["VALUE"]=> array(2) { ["TEXT"]=> string(2901) "Резюме Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения. <h3>Ключевые слова</h3> Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность." ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(2889) "Резюме Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения.

Ключевые слова

Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность." ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Описание/Резюме" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(2889) "Резюме Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения.

Ключевые слова

Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность." } ["ORGANIZATION_RU"]=> array(37) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11123" ["VALUE"]=> array(2) { ["TEXT"]=> string(445) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(445) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(445) "НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия" } } } [2]=> array(49) { ["IBLOCK_SECTION_ID"]=> string(2) "32" ["~IBLOCK_SECTION_ID"]=> string(2) "32" ["ID"]=> string(3) "826" ["~ID"]=> string(3) "826" ["IBLOCK_ID"]=> string(1) "2" ["~IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["~NAME"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["ACTIVE_FROM"]=> NULL ["~ACTIVE_FROM"]=> NULL ["TIMESTAMP_X"]=> string(22) "06/15/2017 10:34:06 pm" ["~TIMESTAMP_X"]=> string(22) "06/15/2017 10:34:06 pm" ["DETAIL_PAGE_URL"]=> string(147) "/en/archive/tom-6-nomer-1/klinicheskie-stati/opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts/" ["~DETAIL_PAGE_URL"]=> string(147) "/en/archive/tom-6-nomer-1/klinicheskie-stati/opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts/" ["LIST_PAGE_URL"]=> string(12) "/en/archive/" ["~LIST_PAGE_URL"]=> string(12) "/en/archive/" ["DETAIL_TEXT"]=> string(26726) "

Introduction

The Unit of Oncohematology and Bone Marrow Transplantation  (BMT)  was  arranged  on  basis  of  the  Republican  Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010, using previous clinical experience  of  the  regional  hematologists.  At  the  beginning,  our  unit consisted of ten hospital beds for chemotherapy of leukemia  and  lymphomas.  First  bone  marrow  transplantation  in  Kazakhstan  was  performed  just  on  the  basis  of  our  specialized unit. Time sequence of our main advances is shown in Table 1.

Table 1. Main steps in development of Oncohematology Unit

table-1-main-steps-in-development-of-oncohematology-unit.jpg

Invaluable  support  and  contribution  to  the  development  of  the  BMT  Unit  should  be  mentioned.  Our  activities  were  supported  by  Professor  Boris  Afanasyev,  Director,  R.  Gorbacheva  Memorial  Research  Institute  of  Children  Oncology, Hematology and Transplantation at the St. Petersburg I. Pavlov  State  Medical  University.  Several  leading  specialists  from the Gorbacheva Institute, e.g., Professor Alexander D. Kulagin, Dr. Sergey N. Bondarenko, Dr. Vladimir N. Vavilov worked hardly at Astana, in order to consult severe patients, arrange  optimal  transplantation  regimens,  analyze  difficult  clinical cases, perform master classes and conferences. This collaboration  has  been  sufficiently  promoted  by  Dr.  Irina  Pivovarova whose contribution to these advances should be highly evaluated.

Since  01.03.2013,  the  Department  was  rearranged  to  the  Unit  of  Hemoblastoses,  Hematopoietic  Aplasias  and  BMT,  followed by extension to 25 beds, with appropriately trained staff.  The  unit  is  a  part  of  Hematology  and  Transfusiology  Department.

Deep renovation of the hospital building (April to September 2013) resulted into opening of aseptic wards with laminar air flow, including BMT unit with six beds and an intensive care unit of four hospital beds.

In September 2013, the Institute of Children Oncology, Hematology  and  Transplantation  (St.  Petersburg,  Russia),  together with our Department, performed the VII Memorial R. Gorbacheva International Symposium with a main topic: Hematopoietic Stem Cell Transplantation in Children and Adults. This event has promoted further development of BMT in Republic of Kazakhstan, and broadening of international cooperation  in  the  field.  Due  to  these  advances,  Kazakhstan  first  appeared at the EBMT map, with a total of 46 transplants in 2013 (Fig. 1). The Memorial Symposium attracted prominent specialists from Europe and USA (Fig. 2, 3).

Figure 1. Allogeneic stem cell transplants per 10,000,000 inhabitants: an EBMT map for 2013 (EBMT Report, 2013).

Figure 1. Allogeneic stem cell transplants per 10,000,000 inhabitants: an EBMT map for 2013 (EBMT Report, 2013).

figure-2-participants-at-the-vii-r-gorbacheva-memori-.jpg

Figure 2. Participants at the VII R. Gorbacheva Memorial International Symposium in Hematology and transplantation in Astana (September 2013).

figure-3-international-team-of-hematologists-visiting-the-new-bmt-department-in-astana.jpg

Figure 3. International team of hematologists visiting the new BMT Department in Astana (September 2013).

Since July 4, 2014, a Clinical Department with 69 beds was arranged,  and  the  Centre  was  renamed  to  the  National  Research Centre for Oncology and Transplantation SC. An oncohematological and BMT Department consisted of a Transfusion Unit and Oncohematology Unit with an intensive care ward  (4  beds).  20.09.2016,  the  Department  was  rearranged  once again, with a Unit of Oncohematological Resuscitation and Intensive Care for 6 beds established.

Clinical activities

Composition  of  hematological  disorders  treated  at  the  Department changed over years, however, with acute leukemias (AL)  taking  a  leading  place  (54.8%).  Meanwhile,  this  ratio  is increased by 10% in 2015, as compared to 2013, with increased admittance of the patients with acute lymphoblastic leukemias  (increase  by  16.6%  against  2013),  mainly,  due  to  introduction  of  continuous  treatment  protocols,  including  high-dose consolidation phase.

Since 2016, we noted higher admission for the patients with acute promyelocytic leukemia, due to improved diagnostics of  this  leukemia  type,  e.g.,  molecular  genetic  studies  performed  by  FISH  assays  at  the  laboratory  in  St.  Petersburg  (Russia).  The  most  significant  admittance  growth  was  for  bone marrow harvesting, i.e., from 9 cases in 2013 to 55 in 2016,  due  to  establishment  and  development  of  bone  marrow transplantation in the country.

Along with leukemias, we observed a significant increase in hospitalized  patients  with  lymphoproliferative  disorders  is,  i.e.,  with  non-Hodgkin’s  lymphomas  (from  18  to  85  cases),  Hodgkin’s  disease  (from  8  to  60  cases),  and  with  multiple  myeloma (from 23 to 100 subjects).

Bone marrow transplantation

The first bone marrow transplantation at our clinic was performed in 2010. In further time, a weak growth in HSCT was noted,  i.e.,  only  six  in  2011  (including  1  allogeneic  related,  and  1  haploidentical;  nine,  in  2012  (5  allogeneic  and  4,  autologous).  Since  2013,  after  opening  a  clean  block  (6  beds),  we have sufficiently increased the BMT number, i.e., 18 BMT (5 auto, 9 allogeneic compatible, and 4 haploidentical transplants); in 2014, 46 (5 auto-, 9 allogeneic and 4 haploidentical). During next years, a stabilization in HSCT amounts is observed: 2015, 54 BMT, 2016, 52 BMT (Fig.4).

Bone  marrow  was  used  as  a  source  of  stem  cells  in  71  cases  (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). Poor stem cell mobilizing ability was revealed in multiple  myeloma  (1  case  after  Cyclophosphamide  injections)  and  2  lymphoma  patients  (DHAP-treatment).  Better  HSC  mobilization  was  performed  with  Etoposide  (in  myeloma  case), and in 1 patient, G-CSF was applied as hemostimulant. In 40 cases, both primed BM and PBSCs were infused to the patients.  Peripheral  stem  cell  harvesting  was  performed  at  the Center of Blood Transfusion in Astana by means of obsolete collection devices (Haemonetics MCS+). At initial steps of  our  transplantation  activities,  we  obtained  inferior  stem  cell harvests, therefore infusing additional amounts of native bone marrow cells. However, the situation has changed since 2016,  after  installation  of  new  equipment  (Terumo  Spectra  Optia), we are able to yield sufficient amounts of peripheral stem cells for transplantation.

figure-4-total-bmt-figures-by-years-at-the-center-of-oncohematology-and-bone-marrow-transplantation.jpg

Figure  4.  Total  BMT  figures  by  years  at  the  Center  of  Oncohematology  and  Bone  Marrow  Transplantation  (Astana,  Kazakhstan).  A  total  of  186  transplants  were  performed. Abscissa, number of transplants; ordinate, year of observation.

The  total  amounts  of  HSCT  do  not  meet  appropriate  Kazakhstan requirements. As seen from EBMT Reports, most European countries perform over 100 transplants per 10 Mio persons. To reach this level, we should make about 200 transplants annually (Table 2).

Table 2. Estimated BMT requirements for Republic of Kazakhstan

table-2-estimated-bmt-requirements-for-republic-of-kazakhstan.jpg

Donor availability

The  ratio  of  haploidentical  transplants  performed  in  our  clinic is increased from 4 BMTs (2013) to 23 transplants in 2015. (Fig. 5). A significant growth in haplo-HSCT is noted in 2015 (23 BMTs, 43%) as compared to 2014 (9 BMTs, 19% of total). However, a lack for HLA-identical donors was evident. According to ASBMT, about 70% of the patients with malignant blood disorder do not have available HLA-identical related donor [1]. A median tine for searching an unrelated donor is ca. 4 months in 50-60% of cases. This term is too long, due to risk of the disease relapse.

There  is  an  imbalance  for  different  BMT  types  (Fig.  6).  The  number of auto-BMT, according to EBMT data, twice exceeds allo-BMT  numbers.  Relative  number  of  auto-BMT  (24%  in  2015)  is  minimal  at  the  Oncohematology  and  Bone  Marrow  Transplantation Department, compared to other types. Haplo-BMT  (43%)  and  allogeneic  BMT  (33)  are  prevailing  here.  Such an imbalance occurs due to deficiency of transplantation beds, low activities of regions by the patient stratification and their selection for bone marrow transplantation.

Therefore,  we  considered  arrangement  of  a  local  hematopoietic stem cell donor registry as a possible solution of this problem. This Registry was established in 2013. Consolidated registry of Russian Federation and Kazakh Republic have been created year later, and, currently, 5500 potential donors from Kazakhstan are introduced to this database. In 2014, a first HLA-identical donor from Kazakhstan was activated in this Registry, and the first unrelated allogeneic transplantation  from  this  donor  was  performed  02.09.2016  at  out  Department.  Arrangement  and  advances  of  the  Bone  Marrow  Donor  Registry  in  our  Republic  are  closely  associated  with  collaboration  and  advices  from  Dr.  Alexander  L.  Alyansky,  Chief of a big Donor Registry at the R. Gorbacheva Research Institute of Children Oncology, Hematology and Transplantation (St. Petersburg).

figure-5-ratios-of-different-transplant-types.jpg

Figure 5. Ratios of different transplant types.

figure-6-time-dynamics-of-bmts-by-several-years-with-respect-to-the-bmt-types.jpg

Figure 6. Time dynamics of BMTs by several years, with respect to the BMT types.

Clinical results of BMT procedures

In 2015, we have performed analysis of total survival among the BMT patients (Fig. 7). This analysis shows a significantly higher  total  survival  in  a  group  of  patients  after  allo-BMT  performed  in  the  1st  remission,  as  compared  to  survival  in  the  group  after  allogeneic  BMT  carried  out  in  the  absence  of remission, i.e., 59% vs 20%. Overall survival after haploidentical BMT is also higher in the patients transplanted in 1st remission, as compared to the patients, undergoing BMT out of remission (41% vs 23%).

Clinical results of BMT proceduresIn 2015, we have performed analysis of total survival among the BMT patients (Fig. 7). This analysis shows a significantly higher  total  survival  in  a  group  of  patients  after  allo-BMT  performed  in  the  1st  remission,  as  compared  to  survival  in  the  group  after  allogeneic  BMT  carried  out  in  the  absence  of remission, i.e., 59% vs 20%. Overall survival after haploidentical BMT is also higher in the patients transplanted in 1st remission, as compared to the patients, undergoing BMT out of remission (41% vs 23%).

figure-7-total-survival-after-allogeneic-bmt-and-haplo-bm.jpg

Figure 7. Total survival after allogeneic BMT and haplo-BMT in the patients with acute leukemias dependent on the state of disease by the time of transplant.

Overall survival (OS) was also determined in a group of patients with acute myeloblastic leukemia. We compared 3 patient groups, Group1, patients receiving chemotherapy only; Group 2 obtained BMT in remission, and Group3, patients receiving  an  off-remission  BMT  (Fig.7).  Overall  survival  among  patients  from  the  2nd  group  was  sufficiently  higher  than  for  groups  1  and  3,  i.e.,  10%  vs  60%.  However,  OS  among  the  patients  after  BMT  beyond  remission  was  twofold higher than among subjects getting chemotherapy only (20% vs 10%).

Preliminary  analysis  of  overall  survival  among  acute  leukemia patients (observed for 30 months in haplo-HSCT, or 40 months in allo-HSCT) has shown an important role of the disease status by the time of BMT, thus being in full accordance with available international data. Our results should be further  analysed  for  5-year  survival  in  a  group  of  ≥30  patients [2, 3, 4].

figure-8-overall-survival-among-patients-with-acute-leukemias-aml-and-all.jpg

Figure 8. Overall survival among patients with acute leukemias (AML and ALL), when performing standard chemotherapy (left) and allo-HSCT at our BMT Department (right).

Despite the arrangement of ‘clean unit’, and BMT numbers increased to 54 in 2015, high requirements for transplantation remain in the country. E.g., according to statistical data (Table 2), 152 patients in Kazakhstan need BMT yearly, either allogeneic  or  autologous  procedure.  Acute  leukemias  (77  BMTs  per year) are most common at our Department, including 29 ALL cases and 48 AML patients. Multiple myeloma takes next position (31 BMT annually), followed by aplastic anemia (14 BMTs),  myelodysplastic  syndromes  (n=12)  and  non-Hodgkin’s  lymphomas  (n=12),  as  well  as  Hodgkin’s  lymphoma  (6  BMTs yearly). To cover these requirements, we are planning increase in patient places (beds), with subsequent expansion of the ‘clean’ space from 6 to 15 beds.

Cooperation with clinics abroad

A  big  contribution  to  development  of  the  Oncohematology  Department  and  BMT  activity  was  made  by  the  staff  of  the R. Gorbacheva Research Institute of Children Oncology, Hematology and Transplantation at the First I. Pavlov State Medical  University  (St.  Petersburg,  Russia),  having  been  provided over last years. Over 2014-2015, we have trained in St.  Petersburg  four  clinicians  in  Hematology  at  a  postgraduate  course  Current  Hematology  and  Bone  Marrow  Transplantation;  two  clinical  laboratory  doctors  for  diagnostics  of  malignant  blood  disorders,  trained  a  laboratory  doctor  in  clinical  cytogenetics.  Our  collaborators  from  Gorbacheva Institute have teached a specialist in hematopoietic stem cells harvesting, treatment and cryoconservation; performed educational courses for 5 clinical hematolologists at the VIII and  IX  R.  Gorbacheva  Memorial  Symposia  (2014,  2015,  St. Petersburg).

Moreover,  some  specialists  from  St.  Petersburg  R.  Gorbacheva  Memorial  Institute  performed  in  Kazakhstan  several seminars and master classes over 2014, e.g., in flow cytometry for detection of minimal residual disease (Babenko Elena  V.,  2014);  arrangement  of  hematological  services  in  Kazakhstan  (Morozova  Elena  V.,  Bondarenko  Sergey  N.,  Darskaya  Elena  I.);  a  4-week  tutorial  concerning  Basics  of  Modern Diagnostics and Treatment in Oncohematology which took place in Almaty (Kazakhstan).

A  special  longitudinal  cooperation  is  performed  in  the  field  of  arrangement  of  a  Bone  Marrow  Donor  Registry  in  Kazakhstan  Republic.  A  common  Russian-Kazakh  donor  search platform is arranged in order to recruit bone marrow donors from Russian Registry for Kazakh patients.

Some   other   tutorials   were   performed   in   2015,   including   a   school   for   paroxysmal   nocturnal   hemoglobinuria   (Babenko E. V., Kulagin A. D., held in St. Petersburg), a master class by E. V. Babenko concerning immune phenotyping of PNH markers (April 2015, Astana, Kazakhstan); an expert council on invasive fungal invasions in hematology (13 May, 2015, Research Institute of Pediatrics and Children Surgery, Prof.  K.  O.  Omarova,  N.  N.  Klimko,  PhD  M.  O.  Popova). A  tutorial  “Hematopoietic  stem  cell  transplantation  in  the  children  with  oncohematological  diseases  and  orphan  diseases” was performed on May 25-30, 2015, in Astana, led by Dr. S. N. Bondarenko), followed by a master class: Arrangement  of  a  Bone  Marrow  Donor  Registry  (May  26-28,  2015,  Astanа, led by Dr. A. L. Alyansky).Further prospectivesFuture cooperation between the 1st St. Petersburg State Medical  I.  Pavlov  University  and  hematological  institutions  in  St. Petersburg and Kazakhstan in the field of hematopoietic transplantation should be developed in the abovementioned directions:

  1. Hematopoietic  transplantation  in  pediatric  practice  and  adult patients.

    1. Further development of diagnostic base in oncohematology  (morphology,  immunohistochemistry,  immune  phenotyping, cytogenetics, molecular diagnostics).

    2. Unified and improved diagnostic and therapeutic protocols, in order to assess and treat tumor and non-tumor blood diseases.

    3. Orphan dieases (diagnostics, registries, bone marrow transplantation, target therapy).

  2. Functioning of a common Bone Marrow Donor Registry.

Our plans for the nearest future are connected with meeting the requirements of Kazakh patients in transplantation assistance, e.g., an increase of clinical facilities by 5 hospital beds, and  opening  a  special  block  for  therapy  of  lymphoproliferative disorders with 15 beds, as well as expansion of critical care unit to 9 beds. Increasing number of patients needs arrangement of outpatient service and polyclinics.

Conflicts of interest

The authors have no conflict of interest to declare.

References

  1. Bayraktar  UD,  Champlin  RE,  Ciurea  SO.  Progress  in  haploidentical stem cell transplantation. Biol Blood Marrow Transplant 2012; 18:372-380.

  2. Olifirovich A, Pivovarova I, Kemaykin V, Klodzinskiy A, Nemerovchenko  A,  Tussipova  A,  Vildanova  R,  Sataeva  M,  Kolesnev A, Iskakova A. Remission at secondary acute myeloid leukemia after haploidentical stem cells microtransplantation (a clinical case); Abstract XXXV World Congress International Society of Hematology, Sept. 4-7, Beijing, China, 2014: 133, ЕР-05-001.

  3. Pivovarova  IA,  Klodzinsky  AA,  Kemaikin  VM,  Olifirovich  AA,  Kolesnev  AV,  Iskakova  AM,  Sataeva  MS.  Lethality  trends  after  haploidentical  hematopoietic  stem  cell  transplantation.  Kazakhstanskaya  Transplantologiya,  2014;  No1:46-53.

  4. Vildanova   R,   Pivovarova   I,   Klodzinskiy   A,   Kemaikin  V,  Kolesnev  A,  Sataeva  M,  Iskakova  A,  Olifirovich  A,  Tussipova  A,  Nemerovchenko  A.  BeEAM  as  conditioning  regimen for haploidentical bone marrow transplantation in patients  with  Ph-positive  ALL  (two  case  reports);  Abstract  XXXV  World  Congress  International  Society  of  Hematology, Sept. 4-7, Beijing, China, 2014: 124, ЕР-04-001.

" ["~DETAIL_TEXT"]=> string(26726) "

Introduction

The Unit of Oncohematology and Bone Marrow Transplantation  (BMT)  was  arranged  on  basis  of  the  Republican  Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010, using previous clinical experience  of  the  regional  hematologists.  At  the  beginning,  our  unit consisted of ten hospital beds for chemotherapy of leukemia  and  lymphomas.  First  bone  marrow  transplantation  in  Kazakhstan  was  performed  just  on  the  basis  of  our  specialized unit. Time sequence of our main advances is shown in Table 1.

Table 1. Main steps in development of Oncohematology Unit

table-1-main-steps-in-development-of-oncohematology-unit.jpg

Invaluable  support  and  contribution  to  the  development  of  the  BMT  Unit  should  be  mentioned.  Our  activities  were  supported  by  Professor  Boris  Afanasyev,  Director,  R.  Gorbacheva  Memorial  Research  Institute  of  Children  Oncology, Hematology and Transplantation at the St. Petersburg I. Pavlov  State  Medical  University.  Several  leading  specialists  from the Gorbacheva Institute, e.g., Professor Alexander D. Kulagin, Dr. Sergey N. Bondarenko, Dr. Vladimir N. Vavilov worked hardly at Astana, in order to consult severe patients, arrange  optimal  transplantation  regimens,  analyze  difficult  clinical cases, perform master classes and conferences. This collaboration  has  been  sufficiently  promoted  by  Dr.  Irina  Pivovarova whose contribution to these advances should be highly evaluated.

Since  01.03.2013,  the  Department  was  rearranged  to  the  Unit  of  Hemoblastoses,  Hematopoietic  Aplasias  and  BMT,  followed by extension to 25 beds, with appropriately trained staff.  The  unit  is  a  part  of  Hematology  and  Transfusiology  Department.

Deep renovation of the hospital building (April to September 2013) resulted into opening of aseptic wards with laminar air flow, including BMT unit with six beds and an intensive care unit of four hospital beds.

In September 2013, the Institute of Children Oncology, Hematology  and  Transplantation  (St.  Petersburg,  Russia),  together with our Department, performed the VII Memorial R. Gorbacheva International Symposium with a main topic: Hematopoietic Stem Cell Transplantation in Children and Adults. This event has promoted further development of BMT in Republic of Kazakhstan, and broadening of international cooperation  in  the  field.  Due  to  these  advances,  Kazakhstan  first  appeared at the EBMT map, with a total of 46 transplants in 2013 (Fig. 1). The Memorial Symposium attracted prominent specialists from Europe and USA (Fig. 2, 3).

Figure 1. Allogeneic stem cell transplants per 10,000,000 inhabitants: an EBMT map for 2013 (EBMT Report, 2013).

Figure 1. Allogeneic stem cell transplants per 10,000,000 inhabitants: an EBMT map for 2013 (EBMT Report, 2013).

figure-2-participants-at-the-vii-r-gorbacheva-memori-.jpg

Figure 2. Participants at the VII R. Gorbacheva Memorial International Symposium in Hematology and transplantation in Astana (September 2013).

figure-3-international-team-of-hematologists-visiting-the-new-bmt-department-in-astana.jpg

Figure 3. International team of hematologists visiting the new BMT Department in Astana (September 2013).

Since July 4, 2014, a Clinical Department with 69 beds was arranged,  and  the  Centre  was  renamed  to  the  National  Research Centre for Oncology and Transplantation SC. An oncohematological and BMT Department consisted of a Transfusion Unit and Oncohematology Unit with an intensive care ward  (4  beds).  20.09.2016,  the  Department  was  rearranged  once again, with a Unit of Oncohematological Resuscitation and Intensive Care for 6 beds established.

Clinical activities

Composition  of  hematological  disorders  treated  at  the  Department changed over years, however, with acute leukemias (AL)  taking  a  leading  place  (54.8%).  Meanwhile,  this  ratio  is increased by 10% in 2015, as compared to 2013, with increased admittance of the patients with acute lymphoblastic leukemias  (increase  by  16.6%  against  2013),  mainly,  due  to  introduction  of  continuous  treatment  protocols,  including  high-dose consolidation phase.

Since 2016, we noted higher admission for the patients with acute promyelocytic leukemia, due to improved diagnostics of  this  leukemia  type,  e.g.,  molecular  genetic  studies  performed  by  FISH  assays  at  the  laboratory  in  St.  Petersburg  (Russia).  The  most  significant  admittance  growth  was  for  bone marrow harvesting, i.e., from 9 cases in 2013 to 55 in 2016,  due  to  establishment  and  development  of  bone  marrow transplantation in the country.

Along with leukemias, we observed a significant increase in hospitalized  patients  with  lymphoproliferative  disorders  is,  i.e.,  with  non-Hodgkin’s  lymphomas  (from  18  to  85  cases),  Hodgkin’s  disease  (from  8  to  60  cases),  and  with  multiple  myeloma (from 23 to 100 subjects).

Bone marrow transplantation

The first bone marrow transplantation at our clinic was performed in 2010. In further time, a weak growth in HSCT was noted,  i.e.,  only  six  in  2011  (including  1  allogeneic  related,  and  1  haploidentical;  nine,  in  2012  (5  allogeneic  and  4,  autologous).  Since  2013,  after  opening  a  clean  block  (6  beds),  we have sufficiently increased the BMT number, i.e., 18 BMT (5 auto, 9 allogeneic compatible, and 4 haploidentical transplants); in 2014, 46 (5 auto-, 9 allogeneic and 4 haploidentical). During next years, a stabilization in HSCT amounts is observed: 2015, 54 BMT, 2016, 52 BMT (Fig.4).

Bone  marrow  was  used  as  a  source  of  stem  cells  in  71  cases  (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). Poor stem cell mobilizing ability was revealed in multiple  myeloma  (1  case  after  Cyclophosphamide  injections)  and  2  lymphoma  patients  (DHAP-treatment).  Better  HSC  mobilization  was  performed  with  Etoposide  (in  myeloma  case), and in 1 patient, G-CSF was applied as hemostimulant. In 40 cases, both primed BM and PBSCs were infused to the patients.  Peripheral  stem  cell  harvesting  was  performed  at  the Center of Blood Transfusion in Astana by means of obsolete collection devices (Haemonetics MCS+). At initial steps of  our  transplantation  activities,  we  obtained  inferior  stem  cell harvests, therefore infusing additional amounts of native bone marrow cells. However, the situation has changed since 2016,  after  installation  of  new  equipment  (Terumo  Spectra  Optia), we are able to yield sufficient amounts of peripheral stem cells for transplantation.

figure-4-total-bmt-figures-by-years-at-the-center-of-oncohematology-and-bone-marrow-transplantation.jpg

Figure  4.  Total  BMT  figures  by  years  at  the  Center  of  Oncohematology  and  Bone  Marrow  Transplantation  (Astana,  Kazakhstan).  A  total  of  186  transplants  were  performed. Abscissa, number of transplants; ordinate, year of observation.

The  total  amounts  of  HSCT  do  not  meet  appropriate  Kazakhstan requirements. As seen from EBMT Reports, most European countries perform over 100 transplants per 10 Mio persons. To reach this level, we should make about 200 transplants annually (Table 2).

Table 2. Estimated BMT requirements for Republic of Kazakhstan

table-2-estimated-bmt-requirements-for-republic-of-kazakhstan.jpg

Donor availability

The  ratio  of  haploidentical  transplants  performed  in  our  clinic is increased from 4 BMTs (2013) to 23 transplants in 2015. (Fig. 5). A significant growth in haplo-HSCT is noted in 2015 (23 BMTs, 43%) as compared to 2014 (9 BMTs, 19% of total). However, a lack for HLA-identical donors was evident. According to ASBMT, about 70% of the patients with malignant blood disorder do not have available HLA-identical related donor [1]. A median tine for searching an unrelated donor is ca. 4 months in 50-60% of cases. This term is too long, due to risk of the disease relapse.

There  is  an  imbalance  for  different  BMT  types  (Fig.  6).  The  number of auto-BMT, according to EBMT data, twice exceeds allo-BMT  numbers.  Relative  number  of  auto-BMT  (24%  in  2015)  is  minimal  at  the  Oncohematology  and  Bone  Marrow  Transplantation Department, compared to other types. Haplo-BMT  (43%)  and  allogeneic  BMT  (33)  are  prevailing  here.  Such an imbalance occurs due to deficiency of transplantation beds, low activities of regions by the patient stratification and their selection for bone marrow transplantation.

Therefore,  we  considered  arrangement  of  a  local  hematopoietic stem cell donor registry as a possible solution of this problem. This Registry was established in 2013. Consolidated registry of Russian Federation and Kazakh Republic have been created year later, and, currently, 5500 potential donors from Kazakhstan are introduced to this database. In 2014, a first HLA-identical donor from Kazakhstan was activated in this Registry, and the first unrelated allogeneic transplantation  from  this  donor  was  performed  02.09.2016  at  out  Department.  Arrangement  and  advances  of  the  Bone  Marrow  Donor  Registry  in  our  Republic  are  closely  associated  with  collaboration  and  advices  from  Dr.  Alexander  L.  Alyansky,  Chief of a big Donor Registry at the R. Gorbacheva Research Institute of Children Oncology, Hematology and Transplantation (St. Petersburg).

figure-5-ratios-of-different-transplant-types.jpg

Figure 5. Ratios of different transplant types.

figure-6-time-dynamics-of-bmts-by-several-years-with-respect-to-the-bmt-types.jpg

Figure 6. Time dynamics of BMTs by several years, with respect to the BMT types.

Clinical results of BMT procedures

In 2015, we have performed analysis of total survival among the BMT patients (Fig. 7). This analysis shows a significantly higher  total  survival  in  a  group  of  patients  after  allo-BMT  performed  in  the  1st  remission,  as  compared  to  survival  in  the  group  after  allogeneic  BMT  carried  out  in  the  absence  of remission, i.e., 59% vs 20%. Overall survival after haploidentical BMT is also higher in the patients transplanted in 1st remission, as compared to the patients, undergoing BMT out of remission (41% vs 23%).

Clinical results of BMT proceduresIn 2015, we have performed analysis of total survival among the BMT patients (Fig. 7). This analysis shows a significantly higher  total  survival  in  a  group  of  patients  after  allo-BMT  performed  in  the  1st  remission,  as  compared  to  survival  in  the  group  after  allogeneic  BMT  carried  out  in  the  absence  of remission, i.e., 59% vs 20%. Overall survival after haploidentical BMT is also higher in the patients transplanted in 1st remission, as compared to the patients, undergoing BMT out of remission (41% vs 23%).

figure-7-total-survival-after-allogeneic-bmt-and-haplo-bm.jpg

Figure 7. Total survival after allogeneic BMT and haplo-BMT in the patients with acute leukemias dependent on the state of disease by the time of transplant.

Overall survival (OS) was also determined in a group of patients with acute myeloblastic leukemia. We compared 3 patient groups, Group1, patients receiving chemotherapy only; Group 2 obtained BMT in remission, and Group3, patients receiving  an  off-remission  BMT  (Fig.7).  Overall  survival  among  patients  from  the  2nd  group  was  sufficiently  higher  than  for  groups  1  and  3,  i.e.,  10%  vs  60%.  However,  OS  among  the  patients  after  BMT  beyond  remission  was  twofold higher than among subjects getting chemotherapy only (20% vs 10%).

Preliminary  analysis  of  overall  survival  among  acute  leukemia patients (observed for 30 months in haplo-HSCT, or 40 months in allo-HSCT) has shown an important role of the disease status by the time of BMT, thus being in full accordance with available international data. Our results should be further  analysed  for  5-year  survival  in  a  group  of  ≥30  patients [2, 3, 4].

figure-8-overall-survival-among-patients-with-acute-leukemias-aml-and-all.jpg

Figure 8. Overall survival among patients with acute leukemias (AML and ALL), when performing standard chemotherapy (left) and allo-HSCT at our BMT Department (right).

Despite the arrangement of ‘clean unit’, and BMT numbers increased to 54 in 2015, high requirements for transplantation remain in the country. E.g., according to statistical data (Table 2), 152 patients in Kazakhstan need BMT yearly, either allogeneic  or  autologous  procedure.  Acute  leukemias  (77  BMTs  per year) are most common at our Department, including 29 ALL cases and 48 AML patients. Multiple myeloma takes next position (31 BMT annually), followed by aplastic anemia (14 BMTs),  myelodysplastic  syndromes  (n=12)  and  non-Hodgkin’s  lymphomas  (n=12),  as  well  as  Hodgkin’s  lymphoma  (6  BMTs yearly). To cover these requirements, we are planning increase in patient places (beds), with subsequent expansion of the ‘clean’ space from 6 to 15 beds.

Cooperation with clinics abroad

A  big  contribution  to  development  of  the  Oncohematology  Department  and  BMT  activity  was  made  by  the  staff  of  the R. Gorbacheva Research Institute of Children Oncology, Hematology and Transplantation at the First I. Pavlov State Medical  University  (St.  Petersburg,  Russia),  having  been  provided over last years. Over 2014-2015, we have trained in St.  Petersburg  four  clinicians  in  Hematology  at  a  postgraduate  course  Current  Hematology  and  Bone  Marrow  Transplantation;  two  clinical  laboratory  doctors  for  diagnostics  of  malignant  blood  disorders,  trained  a  laboratory  doctor  in  clinical  cytogenetics.  Our  collaborators  from  Gorbacheva Institute have teached a specialist in hematopoietic stem cells harvesting, treatment and cryoconservation; performed educational courses for 5 clinical hematolologists at the VIII and  IX  R.  Gorbacheva  Memorial  Symposia  (2014,  2015,  St. Petersburg).

Moreover,  some  specialists  from  St.  Petersburg  R.  Gorbacheva  Memorial  Institute  performed  in  Kazakhstan  several seminars and master classes over 2014, e.g., in flow cytometry for detection of minimal residual disease (Babenko Elena  V.,  2014);  arrangement  of  hematological  services  in  Kazakhstan  (Morozova  Elena  V.,  Bondarenko  Sergey  N.,  Darskaya  Elena  I.);  a  4-week  tutorial  concerning  Basics  of  Modern Diagnostics and Treatment in Oncohematology which took place in Almaty (Kazakhstan).

A  special  longitudinal  cooperation  is  performed  in  the  field  of  arrangement  of  a  Bone  Marrow  Donor  Registry  in  Kazakhstan  Republic.  A  common  Russian-Kazakh  donor  search platform is arranged in order to recruit bone marrow donors from Russian Registry for Kazakh patients.

Some   other   tutorials   were   performed   in   2015,   including   a   school   for   paroxysmal   nocturnal   hemoglobinuria   (Babenko E. V., Kulagin A. D., held in St. Petersburg), a master class by E. V. Babenko concerning immune phenotyping of PNH markers (April 2015, Astana, Kazakhstan); an expert council on invasive fungal invasions in hematology (13 May, 2015, Research Institute of Pediatrics and Children Surgery, Prof.  K.  O.  Omarova,  N.  N.  Klimko,  PhD  M.  O.  Popova). A  tutorial  “Hematopoietic  stem  cell  transplantation  in  the  children  with  oncohematological  diseases  and  orphan  diseases” was performed on May 25-30, 2015, in Astana, led by Dr. S. N. Bondarenko), followed by a master class: Arrangement  of  a  Bone  Marrow  Donor  Registry  (May  26-28,  2015,  Astanа, led by Dr. A. L. Alyansky).Further prospectivesFuture cooperation between the 1st St. Petersburg State Medical  I.  Pavlov  University  and  hematological  institutions  in  St. Petersburg and Kazakhstan in the field of hematopoietic transplantation should be developed in the abovementioned directions:

  1. Hematopoietic  transplantation  in  pediatric  practice  and  adult patients.

    1. Further development of diagnostic base in oncohematology  (morphology,  immunohistochemistry,  immune  phenotyping, cytogenetics, molecular diagnostics).

    2. Unified and improved diagnostic and therapeutic protocols, in order to assess and treat tumor and non-tumor blood diseases.

    3. Orphan dieases (diagnostics, registries, bone marrow transplantation, target therapy).

  2. Functioning of a common Bone Marrow Donor Registry.

Our plans for the nearest future are connected with meeting the requirements of Kazakh patients in transplantation assistance, e.g., an increase of clinical facilities by 5 hospital beds, and  opening  a  special  block  for  therapy  of  lymphoproliferative disorders with 15 beds, as well as expansion of critical care unit to 9 beds. Increasing number of patients needs arrangement of outpatient service and polyclinics.

Conflicts of interest

The authors have no conflict of interest to declare.

References

  1. Bayraktar  UD,  Champlin  RE,  Ciurea  SO.  Progress  in  haploidentical stem cell transplantation. Biol Blood Marrow Transplant 2012; 18:372-380.

  2. Olifirovich A, Pivovarova I, Kemaykin V, Klodzinskiy A, Nemerovchenko  A,  Tussipova  A,  Vildanova  R,  Sataeva  M,  Kolesnev A, Iskakova A. Remission at secondary acute myeloid leukemia after haploidentical stem cells microtransplantation (a clinical case); Abstract XXXV World Congress International Society of Hematology, Sept. 4-7, Beijing, China, 2014: 133, ЕР-05-001.

  3. Pivovarova  IA,  Klodzinsky  AA,  Kemaikin  VM,  Olifirovich  AA,  Kolesnev  AV,  Iskakova  AM,  Sataeva  MS.  Lethality  trends  after  haploidentical  hematopoietic  stem  cell  transplantation.  Kazakhstanskaya  Transplantologiya,  2014;  No1:46-53.

  4. Vildanova   R,   Pivovarova   I,   Klodzinskiy   A,   Kemaikin  V,  Kolesnev  A,  Sataeva  M,  Iskakova  A,  Olifirovich  A,  Tussipova  A,  Nemerovchenko  A.  BeEAM  as  conditioning  regimen for haploidentical bone marrow transplantation in patients  with  Ph-positive  ALL  (two  case  reports);  Abstract  XXXV  World  Congress  International  Society  of  Hematology, Sept. 4-7, Beijing, China, 2014: 124, ЕР-04-001.

" ["DETAIL_TEXT_TYPE"]=> string(4) "html" ["~DETAIL_TEXT_TYPE"]=> string(4) "html" ["PREVIEW_TEXT"]=> string(0) "" ["~PREVIEW_TEXT"]=> string(0) "" ["PREVIEW_TEXT_TYPE"]=> string(4) "text" ["~PREVIEW_TEXT_TYPE"]=> string(4) "text" ["PREVIEW_PICTURE"]=> NULL ["~PREVIEW_PICTURE"]=> NULL ["LANG_DIR"]=> string(4) "/ru/" ["~LANG_DIR"]=> string(4) "/ru/" ["SORT"]=> string(3) "500" ["~SORT"]=> string(3) "500" ["CODE"]=> string(101) "opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts" ["~CODE"]=> string(101) "opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts" ["EXTERNAL_ID"]=> string(3) "826" ["~EXTERNAL_ID"]=> string(3) "826" ["IBLOCK_TYPE_ID"]=> string(7) "journal" ["~IBLOCK_TYPE_ID"]=> string(7) "journal" ["IBLOCK_CODE"]=> string(7) "volumes" ["~IBLOCK_CODE"]=> string(7) "volumes" ["IBLOCK_EXTERNAL_ID"]=> string(1) "2" ["~IBLOCK_EXTERNAL_ID"]=> string(1) "2" ["LID"]=> string(2) "s2" ["~LID"]=> string(2) "s2" ["EDIT_LINK"]=> NULL ["DELETE_LINK"]=> NULL ["DISPLAY_ACTIVE_FROM"]=> string(0) "" ["IPROPERTY_VALUES"]=> array(18) { ["ELEMENT_META_TITLE"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["ELEMENT_META_KEYWORDS"]=> string(0) "" ["ELEMENT_META_DESCRIPTION"]=> string(389) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантацииAstana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation" ["ELEMENT_PREVIEW_PICTURE_FILE_ALT"]=> string(2833) "<h3>Резюме</h3> Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов. <br> <h3>Ключевые слова</h3> Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.<br>" ["ELEMENT_PREVIEW_PICTURE_FILE_TITLE"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["ELEMENT_DETAIL_PICTURE_FILE_ALT"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["ELEMENT_DETAIL_PICTURE_FILE_TITLE"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_META_TITLE"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_META_KEYWORDS"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_META_DESCRIPTION"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_PICTURE_FILE_ALT"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_PICTURE_FILE_TITLE"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_PICTURE_FILE_NAME"]=> string(101) "opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts" ["SECTION_DETAIL_PICTURE_FILE_ALT"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_DETAIL_PICTURE_FILE_TITLE"]=> string(252) "Опыт Астаны: отдел онкогематологии и трансплан- тации костного мозга, Национальный исследова - тельский Центр онкологии и трансплантации" ["SECTION_DETAIL_PICTURE_FILE_NAME"]=> string(101) "opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts" ["ELEMENT_PREVIEW_PICTURE_FILE_NAME"]=> string(101) "opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts" ["ELEMENT_DETAIL_PICTURE_FILE_NAME"]=> string(101) "opyt-astany-otdel-onkogematologii-i-transplan-tatsii-kostnogo-mozga-natsionalnyy-issledova-telskiy-ts" } ["FIELDS"]=> array(1) { ["IBLOCK_SECTION_ID"]=> string(2) "32" } ["PROPERTIES"]=> array(18) { ["KEYWORDS"]=> array(36) { ["ID"]=> string(2) "19" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:46:01" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(27) "Ключевые слова" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "KEYWORDS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "19" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "4" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "Y" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "Y" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> bool(false) ["VALUE"]=> bool(false) ["DESCRIPTION"]=> bool(false) ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> bool(false) ["~DESCRIPTION"]=> bool(false) ["~NAME"]=> string(27) "Ключевые слова" ["~DEFAULT_VALUE"]=> string(0) "" } ["SUBMITTED"]=> array(36) { ["ID"]=> string(2) "20" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Дата подачи" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "SUBMITTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "20" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11177" ["VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Дата подачи" ["~DEFAULT_VALUE"]=> NULL } ["ACCEPTED"]=> array(36) { ["ID"]=> string(2) "21" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(25) "Дата принятия" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "ACCEPTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "21" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11178" ["VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL } ["PUBLISHED"]=> array(36) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11179" ["VALUE"]=> string(22) "02/24/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/24/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Дата публикации" ["~DEFAULT_VALUE"]=> NULL } ["CONTACT"]=> array(36) { ["ID"]=> string(2) "23" ["TIMESTAMP_X"]=> string(19) "2015-09-03 14:43:05" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(14) "Контакт" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "CONTACT" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "23" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(14) "Контакт" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHORS"]=> array(36) { ["ID"]=> string(2) "24" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:45:07" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "AUTHORS" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "E" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "Y" ["XML_ID"]=> string(2) "24" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "3" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(13) "EAutocomplete" ["USER_TYPE_SETTINGS"]=> array(9) { ["VIEW"]=> string(1) "E" ["SHOW_ADD"]=> string(1) "Y" ["MAX_WIDTH"]=> int(0) ["MIN_HEIGHT"]=> int(24) ["MAX_HEIGHT"]=> int(1000) ["BAN_SYM"]=> string(2) ",;" ["REP_SYM"]=> string(1) " " ["OTHER_REP_SYM"]=> string(0) "" ["IBLOCK_MESS"]=> string(1) "N" } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> bool(false) ["VALUE"]=> bool(false) ["DESCRIPTION"]=> bool(false) ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> bool(false) ["~DESCRIPTION"]=> bool(false) ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_RU"]=> array(36) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11218" ["VALUE"]=> array(2) { ["TEXT"]=> string(494) "Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(494) "Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_RU"]=> array(36) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11219" ["VALUE"]=> array(2) { ["TEXT"]=> string(239) "Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, Республика Казахстан" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(239) "Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, Республика Казахстан" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_RU"]=> array(36) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11220" ["VALUE"]=> array(2) { ["TEXT"]=> string(2833) "<h3>Резюме</h3> Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов. <br> <h3>Ключевые слова</h3> Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.<br>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(2797) "

Резюме

Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов.

Ключевые слова

Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.
" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Описание/Резюме" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["DOI"]=> array(36) { ["ID"]=> string(2) "28" ["TIMESTAMP_X"]=> string(19) "2016-04-06 14:11:12" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(3) "DOI" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(3) "DOI" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "28" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11180" ["VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-30-36" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-30-36" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(3) "DOI" ["~DEFAULT_VALUE"]=> string(0) "" } ["AUTHOR_EN"]=> array(36) { ["ID"]=> string(2) "37" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(6) "Author" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "37" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11256" ["VALUE"]=> array(2) { ["TEXT"]=> string(283) "Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(283) "Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(6) "Author" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["ORGANIZATION_EN"]=> array(36) { ["ID"]=> string(2) "38" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Organization" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "38" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11257" ["VALUE"]=> array(2) { ["TEXT"]=> string(387) "Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan<br> Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan<br> Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(375) "Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan
Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan
Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Organization" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["SUMMARY_EN"]=> array(36) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11258" ["VALUE"]=> array(2) { ["TEXT"]=> string(1532) "The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences. <h3>Keywords</h3> Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. " ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(1520) "The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences.

Keywords

Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. " ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Description / Summary" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["NAME_EN"]=> array(36) { ["ID"]=> string(2) "40" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:49:47" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(4) "Name" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "NAME_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "40" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11181" ["VALUE"]=> string(137) "Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(137) "Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(4) "Name" ["~DEFAULT_VALUE"]=> string(0) "" } ["FULL_TEXT_RU"]=> array(36) { ["ID"]=> string(2) "42" ["TIMESTAMP_X"]=> string(19) "2015-09-07 20:29:18" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(23) "Полный текст" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(12) "FULL_TEXT_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "42" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(23) "Полный текст" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } } ["PDF_RU"]=> array(36) { ["ID"]=> string(2) "43" ["TIMESTAMP_X"]=> string(19) "2015-09-09 16:05:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(7) "PDF RUS" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(6) "PDF_RU" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "F" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "43" ["FILE_TYPE"]=> string(18) "doc, txt, rtf, pdf" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11221" ["VALUE"]=> string(3) "469" ["DESCRIPTION"]=> NULL ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(3) "469" ["~DESCRIPTION"]=> NULL ["~NAME"]=> string(7) "PDF RUS" ["~DEFAULT_VALUE"]=> string(0) "" } ["PDF_EN"]=> array(36) { ["ID"]=> string(2) "44" ["TIMESTAMP_X"]=> string(19) "2015-09-09 16:05:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(7) "PDF ENG" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(6) "PDF_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "F" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "44" ["FILE_TYPE"]=> string(18) "doc, txt, rtf, pdf" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11259" ["VALUE"]=> string(3) "470" ["DESCRIPTION"]=> NULL ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(3) "470" ["~DESCRIPTION"]=> NULL ["~NAME"]=> string(7) "PDF ENG" ["~DEFAULT_VALUE"]=> string(0) "" } ["NAME_LONG"]=> array(36) { ["ID"]=> string(2) "45" ["TIMESTAMP_X"]=> string(19) "2023-04-13 00:55:00" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(72) "Название (для очень длинных заголовков)" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "NAME_LONG" ["DEFAULT_VALUE"]=> array(2) { ["TYPE"]=> string(4) "HTML" ["TEXT"]=> string(0) "" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "45" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(80) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> NULL ["VALUE"]=> string(0) "" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(0) "" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(72) "Название (для очень длинных заголовков)" ["~DEFAULT_VALUE"]=> array(2) { ["TYPE"]=> string(4) "HTML" ["TEXT"]=> string(0) "" } } } ["DISPLAY_PROPERTIES"]=> array(11) { ["AUTHOR_EN"]=> array(37) { ["ID"]=> string(2) "37" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(6) "Author" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "37" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11256" ["VALUE"]=> array(2) { ["TEXT"]=> string(283) "Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(283) "Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(6) "Author" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(283) "Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova" } ["SUMMARY_EN"]=> array(37) { ["ID"]=> string(2) "39" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Description / Summary" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "39" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11258" ["VALUE"]=> array(2) { ["TEXT"]=> string(1532) "The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences. <h3>Keywords</h3> Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. " ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(1520) "The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences.

Keywords

Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. " ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Description / Summary" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(1520) "The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences.

Keywords

Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. " } ["DOI"]=> array(37) { ["ID"]=> string(2) "28" ["TIMESTAMP_X"]=> string(19) "2016-04-06 14:11:12" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(3) "DOI" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(3) "DOI" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "28" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11180" ["VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-30-36" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-30-36" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(3) "DOI" ["~DEFAULT_VALUE"]=> string(0) "" ["DISPLAY_VALUE"]=> string(37) "10.18620/ctt-1866-8836-2017-6-1-30-36" } ["NAME_EN"]=> array(37) { ["ID"]=> string(2) "40" ["TIMESTAMP_X"]=> string(19) "2015-09-03 10:49:47" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(4) "Name" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(7) "NAME_EN" ["DEFAULT_VALUE"]=> string(0) "" ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "80" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "40" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "Y" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> NULL ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11181" ["VALUE"]=> string(137) "Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(137) "Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(4) "Name" ["~DEFAULT_VALUE"]=> string(0) "" ["DISPLAY_VALUE"]=> string(137) "Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation" } ["ORGANIZATION_EN"]=> array(37) { ["ID"]=> string(2) "38" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:02:59" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Organization" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_EN" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "38" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11257" ["VALUE"]=> array(2) { ["TEXT"]=> string(387) "Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan<br> Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan<br> Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(375) "Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan
Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan
Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Organization" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(375) "Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan
Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan
Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com" } ["AUTHOR_RU"]=> array(37) { ["ID"]=> string(2) "25" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(12) "Авторы" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "AUTHOR_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "25" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11218" ["VALUE"]=> array(2) { ["TEXT"]=> string(494) "Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(494) "Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(12) "Авторы" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(494) "Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова" } ["SUBMITTED"]=> array(37) { ["ID"]=> string(2) "20" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(21) "Дата подачи" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "SUBMITTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "20" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11177" ["VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(21) "Дата подачи" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/02/2017 12:00:00 am" } ["ACCEPTED"]=> array(37) { ["ID"]=> string(2) "21" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(25) "Дата принятия" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(8) "ACCEPTED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "21" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11178" ["VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/02/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(25) "Дата принятия" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/02/2017 12:00:00 am" } ["PUBLISHED"]=> array(37) { ["ID"]=> string(2) "22" ["TIMESTAMP_X"]=> string(19) "2015-09-02 17:21:42" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Дата публикации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(9) "PUBLISHED" ["DEFAULT_VALUE"]=> NULL ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "22" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(8) "DateTime" ["USER_TYPE_SETTINGS"]=> NULL ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11179" ["VALUE"]=> string(22) "02/24/2017 12:00:00 am" ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> string(22) "02/24/2017 12:00:00 am" ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Дата публикации" ["~DEFAULT_VALUE"]=> NULL ["DISPLAY_VALUE"]=> string(32) "02/24/2017 12:00:00 am" } ["SUMMARY_RU"]=> array(37) { ["ID"]=> string(2) "27" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(29) "Описание/Резюме" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(10) "SUMMARY_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "27" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11220" ["VALUE"]=> array(2) { ["TEXT"]=> string(2833) "<h3>Резюме</h3> Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов. <br> <h3>Ключевые слова</h3> Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.<br>" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(2797) "

Резюме

Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов.

Ключевые слова

Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.
" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(29) "Описание/Резюме" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(2797) "

Резюме

Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов.

Ключевые слова

Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.
" } ["ORGANIZATION_RU"]=> array(37) { ["ID"]=> string(2) "26" ["TIMESTAMP_X"]=> string(19) "2015-09-02 18:01:20" ["IBLOCK_ID"]=> string(1) "2" ["NAME"]=> string(22) "Организации" ["ACTIVE"]=> string(1) "Y" ["SORT"]=> string(3) "500" ["CODE"]=> string(15) "ORGANIZATION_RU" ["DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["PROPERTY_TYPE"]=> string(1) "S" ["ROW_COUNT"]=> string(1) "1" ["COL_COUNT"]=> string(2) "30" ["LIST_TYPE"]=> string(1) "L" ["MULTIPLE"]=> string(1) "N" ["XML_ID"]=> string(2) "26" ["FILE_TYPE"]=> string(0) "" ["MULTIPLE_CNT"]=> string(1) "5" ["TMP_ID"]=> NULL ["LINK_IBLOCK_ID"]=> string(1) "0" ["WITH_DESCRIPTION"]=> string(1) "N" ["SEARCHABLE"]=> string(1) "N" ["FILTRABLE"]=> string(1) "N" ["IS_REQUIRED"]=> string(1) "N" ["VERSION"]=> string(1) "1" ["USER_TYPE"]=> string(4) "HTML" ["USER_TYPE_SETTINGS"]=> array(1) { ["height"]=> int(200) } ["HINT"]=> string(0) "" ["PROPERTY_VALUE_ID"]=> string(5) "11219" ["VALUE"]=> array(2) { ["TEXT"]=> string(239) "Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, Республика Казахстан" ["TYPE"]=> string(4) "HTML" } ["DESCRIPTION"]=> string(0) "" ["VALUE_ENUM"]=> NULL ["VALUE_XML_ID"]=> NULL ["VALUE_SORT"]=> NULL ["~VALUE"]=> array(2) { ["TEXT"]=> string(239) "Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, Республика Казахстан" ["TYPE"]=> string(4) "HTML" } ["~DESCRIPTION"]=> string(0) "" ["~NAME"]=> string(22) "Организации" ["~DEFAULT_VALUE"]=> array(2) { ["TEXT"]=> string(0) "" ["TYPE"]=> string(4) "HTML" } ["DISPLAY_VALUE"]=> string(239) "Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, Республика Казахстан" } } } }

Case report

Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia
Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev
Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation
Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova

Case report

						Array
(
    [KEYWORDS] => Array
        (
            [ID] => 19
            [TIMESTAMP_X] => 2015-09-03 10:46:01
            [IBLOCK_ID] => 2
            [NAME] => Ключевые слова
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => KEYWORDS
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => Y
            [XML_ID] => 19
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 4
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => Y
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => Y
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Ключевые слова
            [~DEFAULT_VALUE] => 
        )

    [SUBMITTED] => Array
        (
            [ID] => 20
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата подачи
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => SUBMITTED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 20
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11001
            [VALUE] => 02/17/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/17/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата подачи
            [~DEFAULT_VALUE] => 
        )

    [ACCEPTED] => Array
        (
            [ID] => 21
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата принятия
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => ACCEPTED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 21
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11002
            [VALUE] => 02/17/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/17/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата принятия
            [~DEFAULT_VALUE] => 
        )

    [PUBLISHED] => Array
        (
            [ID] => 22
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата публикации
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => PUBLISHED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 22
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11003
            [VALUE] => 03/10/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 03/10/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата публикации
            [~DEFAULT_VALUE] => 
        )

    [CONTACT] => Array
        (
            [ID] => 23
            [TIMESTAMP_X] => 2015-09-03 14:43:05
            [IBLOCK_ID] => 2
            [NAME] => Контакт
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => CONTACT
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 23
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 3
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => Y
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => N
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Контакт
            [~DEFAULT_VALUE] => 
        )

    [AUTHORS] => Array
        (
            [ID] => 24
            [TIMESTAMP_X] => 2015-09-03 10:45:07
            [IBLOCK_ID] => 2
            [NAME] => Авторы
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => AUTHORS
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => Y
            [XML_ID] => 24
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 3
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => Y
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => N
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Авторы
            [~DEFAULT_VALUE] => 
        )

    [AUTHOR_RU] => Array
        (
            [ID] => 25
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Авторы
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => AUTHOR_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 25
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11006
            [VALUE] => Array
                (
                    [TEXT] => Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => Татьяна Л. Гиндина, Николай Н. Мамаев, Елена С. Николаева, Ирина А. Петрова, Елена И. Дарская, Ольга В. Пирогова, Яна В. Гудожникова, Олеся В. Паина, Александр Л. Алянский, Сергей Н. Бондаренко, Людмила С. Зубаровская, Борис В. Афанасьев
                    [TYPE] => HTML
                )

            [~DESCRIPTION] => 
            [~NAME] => Авторы
            [~DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

        )

    [ORGANIZATION_RU] => Array
        (
            [ID] => 26
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Организации
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => ORGANIZATION_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 26
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11007
            [VALUE] => Array
                (
                    [TEXT] => НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии,
трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский 
университет им. акад. И. П. Павлова
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой; кафедра гематологии,
трансфузиологии и трансплантологии ПДО, Первый Санкт-Петербургский Государственный медицинский 
университет им. акад. И. П. Павлова
                    [TYPE] => HTML
                )

            [~DESCRIPTION] => 
            [~NAME] => Организации
            [~DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

        )

    [SUMMARY_RU] => Array
        (
            [ID] => 27
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Описание/Резюме
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => SUMMARY_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 27
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11008
            [VALUE] => Array
                (
                    [TEXT] => <h3>Резюме</h3>
 Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.<br>
<h3>Пациенты и методы</h3>
 Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных. <br>
<h3>Результаты</h3>
 Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (&lt;3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).<br>
<h3>Заключение</h3>
 Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК. <br>
<h3>Ключевые слова</h3>
Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии.
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => 

Резюме

Дополнительные хромосомные аномалии (ДХА) при Ph-позитивном остром лимфобластном лейкозе (Ph+ ОЛЛ) встречаются довольно часто, однако, их прогностическое значение в эру тирозин-киназных ингибиторов и аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) до конца не изучено. Недавнее исследование [1] показало, что ДХА оказывают неблагоприятный эффект на результаты трансплантации у взрослых больных Ph+ ОЛЛ.

Пациенты и методы

Проведен ретроспективный анализ результатов лечения смешанной когорты больных Ph+ ОЛЛ, 19 детей и 46 взрослых, которым алло-ТГСК была выполнена в нашем университете в период с 2008 по 2015 годы. Среди 65 больных Ph+ ОЛЛ, данные стандартного цитогенетического исследования перед алло-ТГСК были доступны у 53 больных.

Результаты

Тридцать три из 53 больных (51%) имели изолированную транслокацию t(9;22). ДХА были выявлены у 20/53 (31%) больных, включая 13/53 (20%) больных с 3 и более хромосомными аномалиями. Наиболее частыми хромосомами, вовлекающимися в дополнительные нарушения были 1, 5, 7, 9, 22. Структурные аномалии из числа ДХА были несбалансированными у 16 (80%) больных, в то время только 4 (20%) больных имели сбалансированные транслокации. При однофакторном анализе прогностическими факторами, связанными с лучшей ОВ и БСВ были тип донора (совместимый родственный/совместимый неродственный vs. гаплоидентичный; p=0,02), клинический статус на момент ТГСК (1 ремиссия vs. другой статус; p=0,01, только для БСВ), дополнительные хромосомные аномалии (ДХА- vs. ДХА+; p=0,04, только для ОВ) и, особенно, комплексные хромосомные аномалии (<3ХА vs ≥3ХА; p=0,01, только для ОВ). Согласно многофакторному анализу независимыми прогностическими факторами клинических исходов являются комплексные хромосомные аномалии на кариотип (HR 2,79, 95% ДИ 1,23-6,34; р=0,01, только для ОВ) и клинический статус на момент ТГСК (HR 2,15, 95% ДИ 1,13-4,09; р=0,01, только для БСВ).

Заключение

Исследование показало, что комплексные хромосомные аномалии и статус заболевания на момент ТГСК являются независимыми прогностическими факторами в смешанной когорте больных Ph+ ОЛЛ, леченных ТГСК.

Ключевые слова

Острый лимфобластный лейкоз, Ph1-позитивный, алло-ТГСК, дополнительные хромосомные аномалии. [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Описание/Резюме [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [DOI] => Array ( [ID] => 28 [TIMESTAMP_X] => 2016-04-06 14:11:12 [IBLOCK_ID] => 2 [NAME] => DOI [ACTIVE] => Y [SORT] => 500 [CODE] => DOI [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 80 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 28 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11004 [VALUE] => 10.18620/ctt-1866-8836-2017-6-1-10-19 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 10.18620/ctt-1866-8836-2017-6-1-10-19 [~DESCRIPTION] => [~NAME] => DOI [~DEFAULT_VALUE] => ) [AUTHOR_EN] => Array ( [ID] => 37 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Author [ACTIVE] => Y [SORT] => 500 [CODE] => AUTHOR_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 37 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11032 [VALUE] => Array ( [TEXT] => Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Author [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [ORGANIZATION_EN] => Array ( [ID] => 38 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Organization [ACTIVE] => Y [SORT] => 500 [CODE] => ORGANIZATION_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 38 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11033 [VALUE] => Array ( [TEXT] => R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Organization [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [SUMMARY_EN] => Array ( [ID] => 39 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Description / Summary [ACTIVE] => Y [SORT] => 500 [CODE] => SUMMARY_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 39 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11034 [VALUE] => Array ( [TEXT] => Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL. <h3>Patients and methods</h3> We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients. <h3>Results</h3> Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes. <h3>Conclusion</h3> The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation. <h3>Keywords</h3> Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL.

Patients and methods

We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients.

Results

Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes.

Conclusion

The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation.

Keywords

Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities. [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Description / Summary [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [NAME_EN] => Array ( [ID] => 40 [TIMESTAMP_X] => 2015-09-03 10:49:47 [IBLOCK_ID] => 2 [NAME] => Name [ACTIVE] => Y [SORT] => 500 [CODE] => NAME_EN [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 80 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 40 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11005 [VALUE] => Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia [~DESCRIPTION] => [~NAME] => Name [~DEFAULT_VALUE] => ) [FULL_TEXT_RU] => Array ( [ID] => 42 [TIMESTAMP_X] => 2015-09-07 20:29:18 [IBLOCK_ID] => 2 [NAME] => Полный текст [ACTIVE] => Y [SORT] => 500 [CODE] => FULL_TEXT_RU [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 42 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Полный текст [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [PDF_RU] => Array ( [ID] => 43 [TIMESTAMP_X] => 2015-09-09 16:05:20 [IBLOCK_ID] => 2 [NAME] => PDF RUS [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_RU [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 43 [FILE_TYPE] => doc, txt, rtf, pdf [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11021 [VALUE] => 462 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 462 [~DESCRIPTION] => [~NAME] => PDF RUS [~DEFAULT_VALUE] => ) [PDF_EN] => Array ( [ID] => 44 [TIMESTAMP_X] => 2015-09-09 16:05:20 [IBLOCK_ID] => 2 [NAME] => PDF ENG [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_EN [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 44 [FILE_TYPE] => doc, txt, rtf, pdf [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11035 [VALUE] => 463 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 463 [~DESCRIPTION] => [~NAME] => PDF ENG [~DEFAULT_VALUE] => ) [NAME_LONG] => Array ( [ID] => 45 [TIMESTAMP_X] => 2023-04-13 00:55:00 [IBLOCK_ID] => 2 [NAME] => Название (для очень длинных заголовков) [ACTIVE] => Y [SORT] => 500 [CODE] => NAME_LONG [DEFAULT_VALUE] => Array ( [TYPE] => HTML [TEXT] => ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 45 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 80 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Название (для очень длинных заголовков) [~DEFAULT_VALUE] => Array ( [TYPE] => HTML [TEXT] => ) ) )
Results of allogeneic hematopoietic stem cell transplantation in a mixed cohort of patients with Ph-positive acute lympho-blastic leukemia

Download PDF version

Tatiana L. Gindina, Nikolai N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Elena I. Darskaya, Olga V. Pirogova, Yana V. Gudozhnikova, Olesya V. Paina, Alexander L. Alyanskyi, Sergey N. Bondarenko, Ludmila S. Zubarovskaya, Boris V. Afanasyev

R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Department of Hematology, Transfusiology and Transplantation, The First St. Petersburg I. Pavlov State Medical University, St. Petersburg, Russia
Additional chromosomal abnormalities (ACA) are rather common in Ph+ acute lymphoblastic leukemia (ALL). However, their prognostic significance in the era of protein tyrosine kinase inhibitors and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still poorly known. A recent study [1] has shown that ACA exert unfavorable effect upon HSCT results in adult patients with Ph+ALL.

Patients and methods

We have performed a retrospective analysis of treatment results for a mixed cohort of the patients with Ph+ ALL, including 19 children (aged 5 – 18 y.o.) and 46 adults (aged 19 – 57 y.o.) who received allo-HSCT at our Institute over 2008 to 2015. Among sixty-five subjects with Ph+ ALL, the results of standard cytogenetic studies were available for 53 patients.

Results

Thirty-three patients of 53 (51%) exhibited an isolated t(9;22) translocation. ACA were revealed in 20/53 patients (31%), including 13/53 (20%) subjects with 3 and more chromosome abnormalities. Chromosomes 1, 5, 7, 8, 9, 22 were most commonly affected with additional anomalies. Structural abnormalities attributable to ACA were imbalanced in 16 patients (80%), whereas only 4 patients (20%) showed balanced translocations. In a univariate analysis, significance was shown for the donor type (matched related and unrelated vs haploidentical, p=0.02), clinical stage at HSCT (1st remission vs other stages, p=0.01, for EFS only), additional chromosomal abnormalities (ACA-negative vs ACA-positive, p=0.04, for OS only), and, in particular, complex chromosomal aberrations (<3 anomalies vs ≥3 anomalies, p=0.01, for OS only). According to multivariate analysis, the number of additional chromosomal abnormalities per karyotype (HR 2.79, 95% CI 1.23-6.34; р=0.01, for OS only) and clinical stage at HSCT (HR 2.15, 95% CI 1.13-4.09; р=0.01, for EFS only) are independent prognostic factors for clinical outcomes.

Conclusion

The study has shown that complex chromosomal anomalies and the stage of disease at the moment of HSCT are independent prognostic factors in a mixed cohort of Ph+ ALL patients treated with hematopoietic stem cell transplantation.

Keywords

Acute lymphoblastic leukemia, Ph1-positive, allo-HSCT, additional chromosomal abnormalities.

Case report

						Array
(
    [KEYWORDS] => Array
        (
            [ID] => 19
            [TIMESTAMP_X] => 2015-09-03 10:46:01
            [IBLOCK_ID] => 2
            [NAME] => Ключевые слова
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => KEYWORDS
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => Y
            [XML_ID] => 19
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 4
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => Y
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => Y
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Ключевые слова
            [~DEFAULT_VALUE] => 
        )

    [SUBMITTED] => Array
        (
            [ID] => 20
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата подачи
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => SUBMITTED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 20
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11063
            [VALUE] => 02/27/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/27/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата подачи
            [~DEFAULT_VALUE] => 
        )

    [ACCEPTED] => Array
        (
            [ID] => 21
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата принятия
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => ACCEPTED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 21
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11064
            [VALUE] => 02/27/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/27/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата принятия
            [~DEFAULT_VALUE] => 
        )

    [PUBLISHED] => Array
        (
            [ID] => 22
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата публикации
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => PUBLISHED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 22
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11065
            [VALUE] => 03/17/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 03/17/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата публикации
            [~DEFAULT_VALUE] => 
        )

    [CONTACT] => Array
        (
            [ID] => 23
            [TIMESTAMP_X] => 2015-09-03 14:43:05
            [IBLOCK_ID] => 2
            [NAME] => Контакт
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => CONTACT
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 23
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 3
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => Y
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => N
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Контакт
            [~DEFAULT_VALUE] => 
        )

    [AUTHORS] => Array
        (
            [ID] => 24
            [TIMESTAMP_X] => 2015-09-03 10:45:07
            [IBLOCK_ID] => 2
            [NAME] => Авторы
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => AUTHORS
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => Y
            [XML_ID] => 24
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 3
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => Y
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => N
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Авторы
            [~DEFAULT_VALUE] => 
        )

    [AUTHOR_RU] => Array
        (
            [ID] => 25
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Авторы
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => AUTHOR_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 25
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11122
            [VALUE] => Array
                (
                    [TEXT] => Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => Максим А. Кучер, Олег В. Голощапов, Иван С. Моисеев, Борис В. Афанасьев
                    [TYPE] => HTML
                )

            [~DESCRIPTION] => 
            [~NAME] => Авторы
            [~DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

        )

    [ORGANIZATION_RU] => Array
        (
            [ID] => 26
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Организации
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => ORGANIZATION_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 26
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11123
            [VALUE] => Array
                (
                    [TEXT] => НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой, Кафедра гематологии, трансфузиологии и трансплантологии, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова, Санкт-Петербург, Россия
                    [TYPE] => HTML
                )

            [~DESCRIPTION] => 
            [~NAME] => Организации
            [~DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

        )

    [SUMMARY_RU] => Array
        (
            [ID] => 27
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Описание/Резюме
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => SUMMARY_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 27
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11124
            [VALUE] => Array
                (
                    [TEXT] => Резюме
Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения. 
<h3>Ключевые слова</h3>
Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность.
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => Резюме
Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) – радикальный метод лечения онкогематологических и наследственных заболеваний у взрослых и детей. Несмотря на свою эффективность, ТГСК ассоциирована со значительным числом жизнеугрожающих осложнений. Главные причины неудачи лечения – это летальность от септических осложнений, вызванных нозокомиальными поли- и панрезистентными штаммами бактерий, среди которых превалирует Clostridium difficile и Klebsiella pneumoniae, и иммунных осложнений, таких как острая и хроническая реакция «трансплантат против хозяина» (РТПХ), в основе которой лежит поражение органов пациента лимфоцитами донора. В большинстве случаев первичным органом-мишенью является желудочно-кишечный тракт (ЖКТ) в результате развития неконтролируемого воспаления и тяжелой диареи при РТПХ, а также кишечных инфекций, в частности – псевдомембранозного колита ассоциированного с Clostridium difficile на фоне массивной антибиотикотерапии. Одним из основных факторов риска развития РТПХ с вовлечением ЖКТ, псевдомембранозного колита и антибиотико-ассоциированной диареи после ТГСК считают элиминацию нормальной микробиоты кишечника. Трансплантация фекальной микробиоты (ТФМ) здорового донора позволяет восстановить физиологическое микробное разнообразие и функциональную активность микробиоты кишечника и может приводить к эрадикации патогенных микроорганизмов, тем самым купируя инфекционные осложнения. 

Ключевые слова

Трансплантация фекальной микробиоты, трансплантация гемопоэтических стволовых клеток, антибиотикорезистентность. [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Описание/Резюме [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [DOI] => Array ( [ID] => 28 [TIMESTAMP_X] => 2016-04-06 14:11:12 [IBLOCK_ID] => 2 [NAME] => DOI [ACTIVE] => Y [SORT] => 500 [CODE] => DOI [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 80 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 28 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11066 [VALUE] => 10.18620/ctt-1866-8836-2017-6-1-20-29 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 10.18620/ctt-1866-8836-2017-6-1-20-29 [~DESCRIPTION] => [~NAME] => DOI [~DEFAULT_VALUE] => ) [AUTHOR_EN] => Array ( [ID] => 37 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Author [ACTIVE] => Y [SORT] => 500 [CODE] => AUTHOR_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 37 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11118 [VALUE] => Array ( [TEXT] => Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Author [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [ORGANIZATION_EN] => Array ( [ID] => 38 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Organization [ACTIVE] => Y [SORT] => 500 [CODE] => ORGANIZATION_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 38 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11119 [VALUE] => Array ( [TEXT] => R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;<br> Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022<br> Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;
Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022
Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Organization [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [SUMMARY_EN] => Array ( [ID] => 39 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Description / Summary [ACTIVE] => Y [SORT] => 500 [CODE] => SUMMARY_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 39 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11120 [VALUE] => Array ( [TEXT] => Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications. <h3>Keywords</h3> Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

Keywords

Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance. [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Description / Summary [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [NAME_EN] => Array ( [ID] => 40 [TIMESTAMP_X] => 2015-09-03 10:49:47 [IBLOCK_ID] => 2 [NAME] => Name [ACTIVE] => Y [SORT] => 500 [CODE] => NAME_EN [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 80 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 40 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11067 [VALUE] => Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation [~DESCRIPTION] => [~NAME] => Name [~DEFAULT_VALUE] => ) [FULL_TEXT_RU] => Array ( [ID] => 42 [TIMESTAMP_X] => 2015-09-07 20:29:18 [IBLOCK_ID] => 2 [NAME] => Полный текст [ACTIVE] => Y [SORT] => 500 [CODE] => FULL_TEXT_RU [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 42 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Полный текст [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [PDF_RU] => Array ( [ID] => 43 [TIMESTAMP_X] => 2015-09-09 16:05:20 [IBLOCK_ID] => 2 [NAME] => PDF RUS [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_RU [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 43 [FILE_TYPE] => doc, txt, rtf, pdf [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11125 [VALUE] => 467 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 467 [~DESCRIPTION] => [~NAME] => PDF RUS [~DEFAULT_VALUE] => ) [PDF_EN] => Array ( [ID] => 44 [TIMESTAMP_X] => 2015-09-09 16:05:20 [IBLOCK_ID] => 2 [NAME] => PDF ENG [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_EN [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 44 [FILE_TYPE] => doc, txt, rtf, pdf [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11121 [VALUE] => 466 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 466 [~DESCRIPTION] => [~NAME] => PDF ENG [~DEFAULT_VALUE] => ) [NAME_LONG] => Array ( [ID] => 45 [TIMESTAMP_X] => 2023-04-13 00:55:00 [IBLOCK_ID] => 2 [NAME] => Название (для очень длинных заголовков) [ACTIVE] => Y [SORT] => 500 [CODE] => NAME_LONG [DEFAULT_VALUE] => Array ( [TYPE] => HTML [TEXT] => ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 45 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 80 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Название (для очень длинных заголовков) [~DEFAULT_VALUE] => Array ( [TYPE] => HTML [TEXT] => ) ) )
Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation

Download PDF version

Maxim A. Kucher, Oleg V. Goloschapov, Ivan S. Moiseev, Boris V. Afanasyev

R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; Chair of Hematology, Transfusiology and Transplantation, The First State I. Pavlov Medical University, St. Petersburg, Russia;
Dr. Maxim A. Kucher, Head, Department of Clinical Nutrition, R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation; The First State I. Pavlov Medical University, St. Petersburg, Russia, L. Tolstoy St. 6-8, 197022
Phone: 8 (812) 338 6260, +7 (921) 993 9902 E-mail: doctorkucher@yandex.ru
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method of treatment for hematological, malignant and hereditary diseases in adults and children. Despite its efficiency, HSCT is associated with several potential life-threatening complications. Mortality from bloodstream infections is the main limiting factor for HSCT. Those are caused by bacterial strains refractory to antimicrobial treatment, e.g., Clostridium difficile and Klebsiella pneumoniae, and due to immune complications, such as acute and chronic “graft versus host disease” (GvHD), which represents a conflict between donor lymphocytes and patients’ tissues. In most cases, gastrointestinal tract (GIT) is primarily damaged post-HSCT, as a result of enhanced inflammation, serious diarrhea manifesting in GvHD and intestinal infections, in particular – pseudo-membranous colitis associated with Clostridium difficile which often occur after massive antibiotic therapy. Elimination of normal intestinal microbiota is a sufficient risk factor for GIT GvHD, pseudo-membranous colitis and antibiotic-associated diarrhea post-HSCT. Fecal microbiota transplantation (FMT) from healthy donors allows restoration of a physiological microbial variability and functional activity of intestinal microbiota leading to eradication of pathogenic microorganisms, therefore abrogating infectious complications.

Keywords

Fecal microbiota transplantation, hematopoietic stem cell transplantation, antibiotic resistance.

Case report

						Array
(
    [KEYWORDS] => Array
        (
            [ID] => 19
            [TIMESTAMP_X] => 2015-09-03 10:46:01
            [IBLOCK_ID] => 2
            [NAME] => Ключевые слова
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => KEYWORDS
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => Y
            [XML_ID] => 19
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 4
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => Y
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => Y
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Ключевые слова
            [~DEFAULT_VALUE] => 
        )

    [SUBMITTED] => Array
        (
            [ID] => 20
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата подачи
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => SUBMITTED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 20
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11177
            [VALUE] => 02/02/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/02/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата подачи
            [~DEFAULT_VALUE] => 
        )

    [ACCEPTED] => Array
        (
            [ID] => 21
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата принятия
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => ACCEPTED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 21
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11178
            [VALUE] => 02/02/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/02/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата принятия
            [~DEFAULT_VALUE] => 
        )

    [PUBLISHED] => Array
        (
            [ID] => 22
            [TIMESTAMP_X] => 2015-09-02 17:21:42
            [IBLOCK_ID] => 2
            [NAME] => Дата публикации
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => PUBLISHED
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 22
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => DateTime
            [USER_TYPE_SETTINGS] => 
            [HINT] => 
            [PROPERTY_VALUE_ID] => 11179
            [VALUE] => 02/24/2017 12:00:00 am
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 02/24/2017 12:00:00 am
            [~DESCRIPTION] => 
            [~NAME] => Дата публикации
            [~DEFAULT_VALUE] => 
        )

    [CONTACT] => Array
        (
            [ID] => 23
            [TIMESTAMP_X] => 2015-09-03 14:43:05
            [IBLOCK_ID] => 2
            [NAME] => Контакт
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => CONTACT
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 23
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 3
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => Y
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => N
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Контакт
            [~DEFAULT_VALUE] => 
        )

    [AUTHORS] => Array
        (
            [ID] => 24
            [TIMESTAMP_X] => 2015-09-03 10:45:07
            [IBLOCK_ID] => 2
            [NAME] => Авторы
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => AUTHORS
            [DEFAULT_VALUE] => 
            [PROPERTY_TYPE] => E
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => Y
            [XML_ID] => 24
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 3
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => Y
            [VERSION] => 1
            [USER_TYPE] => EAutocomplete
            [USER_TYPE_SETTINGS] => Array
                (
                    [VIEW] => E
                    [SHOW_ADD] => Y
                    [MAX_WIDTH] => 0
                    [MIN_HEIGHT] => 24
                    [MAX_HEIGHT] => 1000
                    [BAN_SYM] => ,;
                    [REP_SYM] =>  
                    [OTHER_REP_SYM] => 
                    [IBLOCK_MESS] => N
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 
            [VALUE] => 
            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => 
            [~DESCRIPTION] => 
            [~NAME] => Авторы
            [~DEFAULT_VALUE] => 
        )

    [AUTHOR_RU] => Array
        (
            [ID] => 25
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Авторы
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => AUTHOR_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 25
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11218
            [VALUE] => Array
                (
                    [TEXT] => Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => Вадим М. Кемайкин, Анастасия A. Олифирович, Александр В. Колеснев, Анатолий В. Немеровченко, Рузаль Ф. Вильданова, Ольга В. Гайнутдинова, Адия А. Тусипова, Аяужан Е. Есимбекова, Алия K. Баймурзина, Айзат С. Сулейменова, Ольга O. Лесечко, Гульназ Д. Ансатбаева, Мария С. Алимбетова
                    [TYPE] => HTML
                )

            [~DESCRIPTION] => 
            [~NAME] => Авторы
            [~DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

        )

    [ORGANIZATION_RU] => Array
        (
            [ID] => 26
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Организации
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => ORGANIZATION_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 26
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11219
            [VALUE] => Array
                (
                    [TEXT] => Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, 
Республика Казахстан
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => Департамент трансплантации костного мозга, Национальный научный центр онкологии и трансплантации, Астана, 
Республика Казахстан
                    [TYPE] => HTML
                )

            [~DESCRIPTION] => 
            [~NAME] => Организации
            [~DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

        )

    [SUMMARY_RU] => Array
        (
            [ID] => 27
            [TIMESTAMP_X] => 2015-09-02 18:01:20
            [IBLOCK_ID] => 2
            [NAME] => Описание/Резюме
            [ACTIVE] => Y
            [SORT] => 500
            [CODE] => SUMMARY_RU
            [DEFAULT_VALUE] => Array
                (
                    [TEXT] => 
                    [TYPE] => HTML
                )

            [PROPERTY_TYPE] => S
            [ROW_COUNT] => 1
            [COL_COUNT] => 30
            [LIST_TYPE] => L
            [MULTIPLE] => N
            [XML_ID] => 27
            [FILE_TYPE] => 
            [MULTIPLE_CNT] => 5
            [TMP_ID] => 
            [LINK_IBLOCK_ID] => 0
            [WITH_DESCRIPTION] => N
            [SEARCHABLE] => N
            [FILTRABLE] => N
            [IS_REQUIRED] => N
            [VERSION] => 1
            [USER_TYPE] => HTML
            [USER_TYPE_SETTINGS] => Array
                (
                    [height] => 200
                )

            [HINT] => 
            [PROPERTY_VALUE_ID] => 11220
            [VALUE] => Array
                (
                    [TEXT] => <h3>Резюме</h3>
Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов. <br>
<h3>Ключевые слова</h3>
Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.<br>
                    [TYPE] => HTML
                )

            [DESCRIPTION] => 
            [VALUE_ENUM] => 
            [VALUE_XML_ID] => 
            [VALUE_SORT] => 
            [~VALUE] => Array
                (
                    [TEXT] => 

Резюме

Отделение  онкогематологии  и  трансплантации  костного мозга (ТКМ) было организовано на базе Республиканского научного центра неотложной медицинской помощи (Астана, Республика Казахстан) в августе 2010 г. С июля 2014 г. организован клинический департамент на 60 коек, и было учреждено АО «Национальный научный Центр онкологии и трансплантации». С 2010 по 2016 гг. начали внедряться различные типы трансплантации гемопоэтических стволовых клеток (ТГСК) – от аутологичной ТКМ до аллогенной ТГСК от совместимых доноров (33% в 2016 г.) и гаплоидентичной ТГСК (43% от общего числа пересадок в 2016 г.). Всего с 2010 г. в отделении проведены 186 ТГСК. Костный мозг в качестве трансплантата использовали в 71 случае (71 донор для алло-ТГСК 69 реципиентам), тогда как периферические стволовые клетки заготавливали в 73 случаях (15 доноров для алло-ТГСК), и 58 заготовок костного мозга для аутологичных ТКМ). Особый вклад в развитие нашей клиники ТКМ и регистра доноров костного мозга внесли ведущие специалисты НИИ детской онкологии, гематологии и трансплантологии им. Р. М. Горбачевой в Санкт-Петербурге. Эти мероприятия по обучению и образованию позволили организовать эффективную структуру для ТГСК за 3 года. Такая помощь оказывалась по линии консультирования тяжелых клинических случаев, назначения оптимальных режимов трансплантации, анализа сложных клинических случаев, в виде конференций и мастер-классов.

Ключевые слова

Трансплантация гемопоэтических стволовых клеток, организация клиники, Астана, казахстанский опыт.
[TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Описание/Резюме [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [DOI] => Array ( [ID] => 28 [TIMESTAMP_X] => 2016-04-06 14:11:12 [IBLOCK_ID] => 2 [NAME] => DOI [ACTIVE] => Y [SORT] => 500 [CODE] => DOI [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 80 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 28 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11180 [VALUE] => 10.18620/ctt-1866-8836-2017-6-1-30-36 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 10.18620/ctt-1866-8836-2017-6-1-30-36 [~DESCRIPTION] => [~NAME] => DOI [~DEFAULT_VALUE] => ) [AUTHOR_EN] => Array ( [ID] => 37 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Author [ACTIVE] => Y [SORT] => 500 [CODE] => AUTHOR_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 37 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11256 [VALUE] => Array ( [TEXT] => Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Author [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [ORGANIZATION_EN] => Array ( [ID] => 38 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Organization [ACTIVE] => Y [SORT] => 500 [CODE] => ORGANIZATION_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 38 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11257 [VALUE] => Array ( [TEXT] => Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan<br> Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan<br> Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan
Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan
Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Organization [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [SUMMARY_EN] => Array ( [ID] => 39 [TIMESTAMP_X] => 2015-09-02 18:02:59 [IBLOCK_ID] => 2 [NAME] => Description / Summary [ACTIVE] => Y [SORT] => 500 [CODE] => SUMMARY_EN [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 39 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => 11258 [VALUE] => Array ( [TEXT] => The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences. <h3>Keywords</h3> Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. [TYPE] => HTML ) [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Array ( [TEXT] => The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences.

Keywords

Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan. [TYPE] => HTML ) [~DESCRIPTION] => [~NAME] => Description / Summary [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [NAME_EN] => Array ( [ID] => 40 [TIMESTAMP_X] => 2015-09-03 10:49:47 [IBLOCK_ID] => 2 [NAME] => Name [ACTIVE] => Y [SORT] => 500 [CODE] => NAME_EN [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 80 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 40 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => Y [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11181 [VALUE] => Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation [~DESCRIPTION] => [~NAME] => Name [~DEFAULT_VALUE] => ) [FULL_TEXT_RU] => Array ( [ID] => 42 [TIMESTAMP_X] => 2015-09-07 20:29:18 [IBLOCK_ID] => 2 [NAME] => Полный текст [ACTIVE] => Y [SORT] => 500 [CODE] => FULL_TEXT_RU [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 42 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Полный текст [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [PDF_RU] => Array ( [ID] => 43 [TIMESTAMP_X] => 2015-09-09 16:05:20 [IBLOCK_ID] => 2 [NAME] => PDF RUS [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_RU [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 43 [FILE_TYPE] => doc, txt, rtf, pdf [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11221 [VALUE] => 469 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 469 [~DESCRIPTION] => [~NAME] => PDF RUS [~DEFAULT_VALUE] => ) [PDF_EN] => Array ( [ID] => 44 [TIMESTAMP_X] => 2015-09-09 16:05:20 [IBLOCK_ID] => 2 [NAME] => PDF ENG [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_EN [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 44 [FILE_TYPE] => doc, txt, rtf, pdf [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => 11259 [VALUE] => 470 [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => 470 [~DESCRIPTION] => [~NAME] => PDF ENG [~DEFAULT_VALUE] => ) [NAME_LONG] => Array ( [ID] => 45 [TIMESTAMP_X] => 2023-04-13 00:55:00 [IBLOCK_ID] => 2 [NAME] => Название (для очень длинных заголовков) [ACTIVE] => Y [SORT] => 500 [CODE] => NAME_LONG [DEFAULT_VALUE] => Array ( [TYPE] => HTML [TEXT] => ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => 45 [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 80 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Название (для очень длинных заголовков) [~DEFAULT_VALUE] => Array ( [TYPE] => HTML [TEXT] => ) ) )
Astana experience: Department of Oncohematology and Bone Marrow Transplantation, National Research Center of Oncology and Transplantation

Download PDF version

Vadim M. Kemaikin, Anastasiya A. Olifirovich, Alexandr V. Kolesnev, Anatoliy V. Nemerovchenko, Ruzal F. Vildanova, Olga V. Gainutdinova, Adiya A. Tusipova, Ayauzhan E. Esimbekova, Aliya K. Baimursina, Ayzat S. Suleimenova, Olga O. Lesechko, Gulnaz D. Ansatbaeva, Mariya S. Alimbetova

Bone Marrow Transplantation Department, National Research Center for Oncology and Transplantation, Astana, Republic of Kazakhstan
Dr. Vadim M. Kemaikin, Chief, BMT Department, National Research Centre for Oncology and Transplantation, Kerey, Zhanibek Khanov st., 3, Astana, 010000, Republic of Kazakhstan
Phone: +7 7172 70 29 41 E-mail: hematology.astana@gmail.com
The Unit of Oncohematology and Bone Marrow Transplantation (BMT) was arranged on basis of the Republican Research Center of Hospital Emergencies SC (Astana, Republic of Kazakhstan) in August 2010. Since July 2014, a Clinical Department with 69 beds was arranged, and National Research Center for Oncology and Transplantation SC was arranged. From 2010 to 2016, the modalities of hematopoietic stem cell transplantation have been advanced, from autologous BMT to allogeneic hematopoietic stem cell transplants (HSCT) from matched donors (33%), and haploidentical HSCTs (43% in 2016), a total of 186 transpants. Bone marrow was used as a source of stem cells in 71 cases (71 donors for allo-HSCT in 69 recipients), whereas peripheral stem cells were harvested in 73 cases (15 donors for 15 recipients of allo-BMT, and 58 marrow harvests for autologous BMT). In particular, our BMT clinic and Bone Marrow Donor Registry developed with invaluable support and contribution by the leading specialists from R. Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation at the St. Petersburg. This system of education and training allowed to arrange an effective HSCT structure within 3 years. This assistance was performed in order to consult severe patients, arrange optimal transplantation regimens, analyze difficult clinical cases, perform master classes and conferences.

Keywords

Hematopoietic stem cell transplantation, clinical advancements, Astana, Republic of Kazakhstan.