Polyshchuk O. Clinical/hematological peculiarities and treatment of B-cell chronic lymphocytic leukemia in Chornobyl NPP accident clean-up workers of 1986-1987 period.

Dissertation is devoted to the study of B-cell chronic lymphocytic leukemia in Chornobyl NPP accident clean-up workers. Reversed correlation was found between disease duration and radiation dose exceeding 20 cSv. Some clinical hematological peculiarities were proven in clean-up workers with chronic lymphocytic leukemia i.e. frequent occurrence in young age, accelerated progression, aggressive course, and resistance to the treatment. Frequency rates of secondary malignancies were found significantly higher in exposed group. Disease progression and resistance to treatment diagnostic parameters based on the peripheral blood lymphocytes cytochemistry and bone marrow trepanation biopsy histological study were elaborated. Marked intracellular lymphocyte metabolic disorders were revealed including deposition of PAS-positive granules, a-GPDG, LDH and NADP enhanced activity along with CPK, NE, SDH, G-6-PDH and NAD decreased activity. Diffuse alteration of bone marrow by pathological lymphocytes defining an unfavorable disease prognosis was found at the time of diagnosis in substantial number of clean-up workers with B-CLL. Decrease of IL-2 and alfa-IFN spontaneous production along with IL-1, -4, -10, and TNF synthesis amplification were revealed in B-CLL. Management with fludarabine plus cyclophosphamide showed its efficiency as a first-line treatment of B-CLL in clean-up workers and in cases resistant to standard chemotherapy regimens and resulted in prolonged remissions.