Background: Myeloid sarcoma (MS) is a very rare condition, develops both in patients with other hematological neoplasms, and as isolated tumor. MS of the gynecologic tract is extremely rare. An available literature data about diagnosis and management of MS is summarized in the article. The role of chemotherapy, radiation therapy, surgery and bone marrow transplantation in the treatment is discussed. Polychemotherapy and allogeneic bone marrow transplantation were suggested to be the optimal treatment strategy of MS of the gynecological tract. The use of new targeted agents results in promising clinical data. Case presentation: We are presenting a rare clinical case of a MS of the uterine cervix with concomitant bone marrow involvement and describe all the peculiarities of the clinical course, diagnosis, and treatment. The patient received chemotherapy followed by allogeneic bone marrow transplantation. The pre-transplant therapy allowed us to perform allogeneic bone marrow transplantation with the deepest response possible: complete PET-negative and MRD-negative remission of the disease. Conclusions: MS remains a subject of discussion regarding its diagnostic and therapeutic aspects. The use of novel targeting agents can be perspective option for patient with extramedullary disease.

В представленном обзоре литературы описываются антиэстрогенный, противовоспалительный, антиоксидантный, антиангиогенный, проапоптотический, антипролиферативный и анальгезирующий эффекты мелатонина, что позволяет рассматривать его в качестве патогенетически обоснованного препарата для лечения наружного генитального эндометриоза.

Objectives: To the best of our knowledge, data from Gemtuzumab ozogamicin in Acute Myeloid Leukemia (AML) patients with failure of organ functions and poor performance status are extremely lacking. Moreover, the fast recovery from organ failure, after Gemtuzumab ozogamicin administration, has never been reported. This study aimed to demonstrate the efficacy and rapid response of Gemtuzumab ozogamicin in refractory acute myeloid leukemia (AML) patients with pulmonary and kidney failure and poor performance status. Three refractory AML patients, with organ dysfunction, are described. One patient was pre-treated with intensive chemotherapy, and two other patients progressed during Azacitidine treatment. Two patients had respiratory failure grade 2 and one patient suffered from acute kidney insufficiency. Two patients were highly febrile with an elevated С-Reactive Protein (CRP) level. The WHO performance status of three was measured in all patients. Gemtuzumab ozogamicin administration was performed in three patients, followed by a further switch to Gemtuzumab ozogamicin + Azacitidine or “7+3” treatment. Results: Gemtuzumab ozogamicin administration resulted in abrupt fever cessation in two febrile patients simultaneously with a rapid decrease in CRP level and fast resolution of respiratory failure. Recovery of kidney function was noticed rapidly in patients with renal insufficiency. The WHO performance status was elevated in all three patients. No adverse grade II–III effects were noticed. Further treatment made two patients eligible for intensive chemotherapy, one patient underwent allogeneic stem cell transplantation, and the patient with kidney failure obtained complete remission. Conclusions: Gemtuzumab ozogamicin therapy appeared to be safe and highly efficacious in relapsed/refractory AML patients with organ dysfunction, like pulmonary or renal failure and poor performance status, and may contribute to rapid recovery from organ failures.

The treatment of refractory acute myeloid leukemia (AML) patients presents considerable challenges. They are often critically ill. The critical conditions of these patients are mainly associated with severe infectious complications resulting in sepsis as well as with the extramedullary lesions with organ dysfunctions. So far, the obtained data demonstrated the successful use of gemtuzumab ozogamicin, the mechanism of which is likely to be based not only on depletion of CD33-positive tumor cells but also on its immunomodulatory effect. The present article focuses on the fast-effect mechanisms of gemtuzumab ozogamicin and deals with clinical experience of successful use of this drug combined with hypomethylating agents in patients with refractory AML whose condition is critical by the time therapy begins. The use of this drug combination results in fast stabilization of health status, recovery of internal organs, and apyrexia with the decreasing systemic inflammatory response within the first days of therapy. All this together with significantly lower blast count in blood and in bone marrow can bring critically ill patients to recovery.

AIM. To assess the efficacy and safety of combined obinutuzumab-based regimens in the first-line therapy for follicular lymphoma (FL) in real-world clinical practice. MATERIALS & METHODS. This retrospective multicenter study enrolled 279 newly diagnosed FL patients treated with obinutuzumab in combination with chemotherapy at 41 medical institutions in Russia from 2018 to 2026. The median age of patients was 49.2 years (range 30–83 years), 60.6 % of them were women. Obinutuzumab-based regimens were predominantly administered to patients with stage III/IV (86.4 %), advanced tumor spread (60.2 %), and often with intraabdominal location (76.3 %). More than 1/3 of patients had extranodal lesions (41.9 %) and bulky tumors (34.8 %). According to FLIPI score, there were 74.9 % of patients with intermediate and poor prognosis. More than half of the patients (54.4 %) received anthracycline-based G-CHOP regimen as initial therapy, GB was administered to 30.1 % of patients. Maintenance therapy with obinutuzumab was used in 72.8 % of cases. RESULTS. Overall response to therapy was achieved in 95.6 % of patients, the rate of complete metabolic response was 91.1 %. Adverse events of any grade were observed in 51.8 % of patients, grade ≥ 3 was identified in 29 % (primarily neutropenia and infectious complications). With the median follow-up of 16.3 months, disease progression or relapse were diagnosed in 21 (7.5 %) patients, histological transformation into diffuse large B-cell lymphoma was reported after 6 out of 14 biopsies performed at the stage of FL relapse. The 2-year progression-free survival was 89.6 %, and the 2-year overall survival was 98 %. CONCLUSION. The results of this study confirm high efficacy of obinutuzumab in the first-line therapy for FL patients with prognostically unfavorable characteristics of tumor. Overall and complete metabolic response rates are consistent with the international data. The administration of obinutuzumab-based regimens provide significant therapeutic control of the disease and confirm the reproducibility of the data from clinical studies in real-world healthcare practice.