Журнал «Боль. Суставы. Позвоночник» 2 (18) 2015

Статья опубликована на с. 99-100

Introduction. Modern chemotherapy and immunotherapy of chronic lymphoid leukemia (CLL) has increased the overall survival of patients, so the question of the quality of life is particularly relevant. It’s not actually studied the prevalence of secondary osteoporotic lesions (OL) of bone tissue (BT) at patients with CLL in different age groups and therefore there is no scientific basis of depending on the state of BT on age, sex and stage of lymphoproliferative process and methods of chemotherapy treatment that prevents timely diagnosis of osteoporotic (OP) and osteopenic changes BT at this category of patients and their adequate medical treatment and prevention.

Identify the major factors of modification BT at patients with CLL, depending on age, sex and stage lymphoproliferative process and methods of chemotherapy. Conduct clinical trials of treatment programs for correcting reduced bone mineral density (BMD) in patients with CLL. To improve the quality of life of patients with CLL.

Materials and methods. At the dual energy X–ray bone absorptiometry DPX–A «LunarCorp» company (USA) –examined the lumbar spine (LS) at 180 patients with CLL.

There were clinically tested the treatment programs for the correction of reduced bone mineral density at patients with CLL: 1) treatment program number 1 with usage of the integrated product Calcium–D₃ Nycomed; 2) treatment program number 2 using the drug Ostalon; 3) treatment program number 3 with the drug Bivalos.

Treatment regimens due to the presence of osteopenia and OP changes BT LS surveyed 57 patients (37 women, 20 men) with CLL. The choice of treatment options depend on the depth of osteopenic changes BT identified by two–photon absorptiometry, and indications and contraindications to pharmacological stimulants.

Using the method of evaluation of clinical efficacy of medical facilities two groups of criteria were selected: 1) the state of BT LLS, which was assessed by BMD, total content of minerals and calcium BT LS; 2) changes of the general condition of patients (on a scale Karnofsky and impact on quality of life — in the main questionnaire EORTC QLQ–C30).

The drug Calcium–D₃ Nycomed was appointed to 9 women aged 47 to 83 years old (middle age 64.00 ± 3.94 years), duration of menopause from 0 to 27 years (middle duration of menopause 10.44 ± 3.18), CLL duration from 1 to 108 months (average length of 42.00 ± 12.30) and disease stage B and C for 4 months and 16 men aged 48 to 85 years (mean age 65.38 ± 2.89 years) with duration CLL from 0 to 132 months (average length of 37.44 ± 9.28 months) for 4 months at a dose of 1,000 mg per day.

The drug Ostalon was appointed to 11 women aged 53 to 79 years (middle age 67.82 ± 2.71 years), duration of menopause from 0 to 32 years (average length of 13.73 ± 2.97 years) and duration of CLL 1 to 240 months (average length of 46.27 ± 20.76 months) and 4 men aged 46 to 75 years (middle age 61.75 ± 6.18 years) with disease duration from 2 to 18 months (middle duration of 7.50 ± 3.66 months.) with stage B and C disease.

Bivalos was intended for 3 months to 17 women aged 55 to 79 years (middle age 71.29 ± 1.56 years), duration of menopause from 0 to 39 years (average length of 19.50 ± 2.23 years) with disease duration from 0 to 180 months (average length of 47.82 ± 12.61 months) with stage B and C disease.

Statistical analysis and visualization of the data were performed using the statistical package OpenStat and Statgraphics (version 3.0).

Results. The patients with CLL levels of minerals in the ВT of the LS in a group of women with age categories up to and over 60 years was significantly lower than in groups of men in their respective age categories. Osteopenic and OP changes in bone LS were observed in the group of men and women with CLL, and to over 60 years. Osteopenic syndrome is part of the clinical course of CLL — his lowest percentage (25 %) found in the category of men to 60 years of disease duration of 1 year, and the largest (100 %) — a group of women 60 and older than 60 years in groups with a duration disease over 5 years. In general patients with CLL groups OP level changes than the general population BT parameters and is over 50 %. Osteopenic and OP changes in BT LS were observed in the group of men and women with CLL, and to over 60 years.

Statistical modeling methods were statistical models of BMD changes depending on: a) sex and stage of disease (p < 0.01); b) sex, stage of disease and relative terms due to the BMD in young age (R2 = 0.93; p < 0.05); c) the stage of disease and chemotherapy protocols (R2 = 0.96; p < 0.05), corresponding to a high level of predictive. The calculation of the interest component of effective model proved reliable factors significant contribution of sex and stage of disease, and depending on the method chosen and the last chemotherapy treatment, prediction of BMD at the patients with CLL.

The prescription of Calcium–D₃ Nycomed for 4 months at a dose of 1000 mg per day for women did not give any results in significant changes in BMD. Analyzing the state of BT LS at the men after treatment Calcium–D₃ Nycomed marked increase in BMD was significantly in all areas studied, except vertebra L2. The ratio of the detected BMD due to its the same age, expressed as a percentage, was significantly increased in the vertebrae L1 and L3 and the total areas L1–L2, L1–L3, L1–L4, L2–L3, L3–L4. In absolute terms was significant growth in all areas of study except L3–L4.

The prescription of the drug Ostalon for women with CLL has led to the increase of BMD statistically reliable data in L3, L1–L3, L1–L4 (at 5.4 %), L2–L3. Significant increase in the correlation between BMD diagnosed with due at a young age as a percentage observed in L3 and the total areas of the L1–L2, L1–L3, L1–L4, L2–L3. In absolute terms, it is statistically increased in areas of total L1–L3, L3–L4. The content of minerals has grown significantly in L2 and the total area of L1–L4 (8.5 %).

There was observed a significant increase in BMD LS at the women after therapy Bivalos and statistical reliability in all vertebrae. Significant increase in the correlation between BMD detected due to the young age as a percentage and in absolute terms the whole strength of LS. The same pattern was observed in relation to the value of BMD detected due to the same age. The content of minerals in BT was significantly increased after treatment  Bivalos throughout the study area (total area at L1–L4 18.5 %), with the exception of vertebra L4. As for the geometric characteristics of LS — height, width and area of the vertebrae, changing these parameters were not statistically significant.

The index, which reflects the ratio of the width of the content of minerals vertebrae was significantly increased by vertebrae L1, L2, L3 and summary sections L1–L2, L1–L3, L1–L4 (13.5 %).

In assessing of the impact on EORTC QLQ–C30 there was revealed a significant increase in the basic indicators of women who received treatment programs correction ВT, comparing with groups of men.

Conclusion. Structural and functional state of BT at the patients with CLL is characterized by a decrease in the strength of the main characteristics of BT mineral content and BMD decrease. Reduced BMD in osteopenic and osteoporotic form changes require the development of adequate methods of medical treatment at different stages of the disease. Treatment with the drug program Calcium–D₃ Nycomed, drug Ostalon and drug Bivalos can be implemented in practice treatment of osteopenic syndrome at the patients with CLL.