ПОСЛЕОПЕРАЦИОННАЯ КОГНИТИВНАЯ ДИСФУНКЦИЯ – ЧТО МЫ ЗНАЕМ И КУДА ДВИГАТЬСЯ ДАЛЕЕ

In this single-center analysis, we evaluated the trends in 5185 hematopoietic cell transplantations performed between 1990 and 2022. The study group comprised 3237 allogeneic (alloHCT) and 1948 autologous (autoHCT) hematopoietic cell transplantations. In the multivariate analysis, there was an improvement in event-free-survival (EFS) after autoHCT (HR 0.6, 95% CI 0.4–0.7, p < 0.0001) due to reduced cumulative incidence of relapse in the last five years (56% in 2010–2014 vs. 38% in 2015–2022). An improvement in EFS after alloHCT over time was observed (HR 0.33, 95% CI 0.23–0.48, p < 0.0001), which was due to reduced non-relapse mortality. No difference in cumulative relapse incidence was observed over the last decade for allografted patients. Survival after autoHCT improved in Hodgkin’s disease (HR 0.1, 95% CI 0.1–0.3), multiple myeloma (HR 0.4, 95% CI 0.2–0.7) and solid tumors (HR 0.2, 95% CI 0.2–0.4), while after alloHCT, improvement was observed in acute myeloid leukemia (HR 0.3, 95% CI 0.1–0.5), acute lymphoblastic leukemia (HR 0.2, 95% CI 0.1–0.5), Hodgkin’s disease (HR 0.1, 95% CI 0.0–0.4), non-Hodgkin’s lymphomas and chronic lymphocytic leukemia (HR 0.2, 95% CI 0.0–0.6), inborn diseases (HR 0.2, 95% CI 0.2–0.4) and acquired aplastic anemia with matched related donors and matched unrelated donors (HR 0.3, 95% CI 0.2–0.8).

Acute symptomatic epileptic seizures are one of the complications of hematopoietic stem cell transplantation. The etiological factors leading to the development of this complication differ from those in the general population, while the significance of each of them is different depending on the time after transplantation. We analyze the literature data on the role of drugs, metabolic disorders and infectious complications, as well as the structural pathology of the brain substance in the development of acute symptomatic seizures in patients with oncohematological pathology. We also consider the clinical features of symptomatic epileptic seizures and the possible prognostic significance of their development in patients who underwent hematopoietic stem cell transplantation.

Высокодозная иммуносупрессивная терапия с аутологичной трансплантацией гемопоэтических стволовых клеток при рассеянном склерозе: современный взгляд на метод (обзор литературы)

Introduction. High-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation (HDIT/AHSCT) is a promising and effective method for treating immune disorders, including multiple sclerosis (MS). The frequency and severity of adverse effects from therapy have decreased significantly over the last 20 years due to a reduction in conditioning regimen intensity, changes in patient selection, and the accumulated experience of the transplantation centres. Study aim: to analyse the published data on HDIT/AHSCT complications in MS and ways to reduce their risk. Materials and methods. We analysed and summarized the research findings regarding conditioning regimen protocols for HDIT/AHSCT, early and late complications, and risk factors associated with treatment recipients. Results. HDIT/AHSCT may have a wide range of serious complications. However, the shift to less intense conditioning regimens and stricter patient selection criteria have minimized adverse events. The latest moderate-intensity protocols may be less effective than high-intensity protocols, but their timely use may provide the maximum benefit to people with MS refractory to standard treatment. HDIT/AHSCT cannot be the method of choice for all categories of patients with MS, because expectations may not be met due to the significant risk of complications, in particular, in cases of long-term disease, significant neurological deficit, and no disease activity. The maximum effect should be expected in early or emergency HDIT/AHSCT. Conclusion. This information can be used to justify further expansion of the medical assistance provided to patients with MS in the Russian Federation.

Показания к трансплантации гемопоэтических стволовых клетокIndications for hematopoietic stem cell transplantation