Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005)
Aim: The question as to whether the incidence of leukemias and malignant lymphomas among the Chernobyl clean-up workers increased in 20 years after the catastrophe is still a point of much controversy. Precise diagnosis of the main forms of hematopoietic malignancies according to FAB classification...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
2006
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nasplib_isofts_kiev_ua-123456789-1345302025-02-09T13:56:58Z Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) Структура опухолевых заболеваний системы крови у ликвидаторов аварии на чаэс (1996–2005) Gluzman, D. Imamura, N. Sklyarenko, L. Nadgornaya, V. Zavelevich, M. Machilo, V. Original contributions Aim: The question as to whether the incidence of leukemias and malignant lymphomas among the Chernobyl clean-up workers increased in 20 years after the catastrophe is still a point of much controversy. Precise diagnosis of the main forms of hematopoietic malignancies according to FAB classification and new WHO classification and comparison of these data with that in the general population will be helpful in estimating the relative contribution of the radiation factor to the overall incidence of such pathologies. Patients and methods: The data on 218 consecutive cases of malignant diseases of hematopoietic and lymphoid tissues in Chernobyl clean-up workers diagnosed in 1996–2005 are given in comparison with the data of 2697 consecutive patients of general population of the same age group. The morphology and cytochemistry of bone marrow and peripheral blood cells were studied. Immunocytochemical techniques (APAAP, LSAB-AP) and the broad panel of monoclonal antibodies to lineage specific and differentiation antigens of leukocytes were employed for immunophenotyping leukemic cells. Results: Various types of oncohematological diseases developing 10–20 years after Chernobyl accident were registered in a group of clean-up workers under study including myelodysplastic syndromes (MDS), acute leukemias (ALL and AML), chronic myelogenous leukemia (CML) and other chronic myeloproliferative diseases, chronic lymphocytic leukemia (B-CLL) and other chronic lymphoproliferative diseases of B and T cell origin. MDS percentage among patients of clean-up workers group tended to exceed MDS percentage in the group of patients representing the general population examined at the same period (4.58 vs. 3.70%). Among 34 AML cases, leukemia was preceded by MDS in seven patients. The relative contribution of CML to the total number of clean-up workers with leukemia was higher than the corresponding percentage value in general population examined at the same period (9.17 vs. 6.59%). B-CLL was a predominant form of hematopoietic malignancies in clean-up workers under study (25.68%). Nevertheless, B-CLL percentage in patients of clean-up workers group did not differ significantly from that in the patients of general population. The multiple myeloma percentage (7.79%) in the group of patients belonging to clean-up workers in our study turned out to be twice as much as in the patients of general population (4.0%). Conclusion: The verified diagnosis of tumors of hematopoietic and lymphoid tissue according to modern classification (EGIL, WHO) could be the prerequisite for further molecular genetic and analytical epidemiology study of leukemias that may be related to Chernobyl NPP accident consequences. Цель: вопрос о количественных показателях заболеваемости лейкозами и злокачественных лимфомах у ликвидаторов аварии на ЧАЭС, спустя 20 лет после Чернобыльской катастрофы, остается невыясненным. Диагностика этих заболеваний в соответствии с ФАБ- классификацией и новой классификацией ВОЗ, сравнение полученных данных с данными лиц, не подвергавшимся воздействию ионизирующего излучения, является необходимой предпосылкой для разрешения этого вопроса и выяснения роли радиационного фактора в развитии злокачественных заболеваний кроветворной и лимфоидной тканей. Методы: проанализированы 218 последовательных случаев лейкозов, диагностированных в 1996–2005 гг. у ликвидаторов аварии на ЧАЭС, по сравнению с группой лиц того же возраста, которые не подвергались воздействию излучения (2697 больных). Диагностику лейкозов осуществляли на основе морфологического и цитохимического изучения мазков крови и костного мозга, иммунофенотипирования лейкемических клеток с использованием широкой панели моноклональных антител к линейноспецифическим и дифференцировочным антигенам лейкоцитов. Результаты: спустя 10–20 лет после Чернобыльской катастрофы у ликвидаторов аварии на ЧАЭС выявлены различные формы онкогематологических заболеваний, включая миелодиспластические синдромы (МДС), острые лейкозы (ОЛЛ и ОМЛ), хронический миелолейкоз (ХМЛ) и другие миелопролиферативные заболевания, В-клеточный хронический лимфолейкоз (В-ХЛЛ) и другие лимфопролиферативные процессы В- и Т-клеточной природы. Установлена более высокая частота МДС в группе ликвидаторов по сравнению с группой лиц, не подвергавшихся воздействию излучения (4,58 и 3,70% соответственно). У 7 из 34 больных с ОМЛ в группе ликвидаторов заболевание развилось на фоне предшествующего МДС. Более высокой в этой группе была и заболеваемость ХМЛ (9,17 в сравнении с 6,59% в контрольной группе). В-ХЛЛ был преобладающей формой гемобластозов у ликвидаторов в целом, однако не было установлено существенных различий в частоте развития этого заболевания в сравниваемых группах. У ликвидаторов аварии на ЧАЭС почти в два раза чаще, чем у населения в целом, диагностировалась множественная миелома (7,79 в сравнении с 4,0%). Выводы: представленные данные могут служить основой для проведения последующих молекулярно-генетических и эпидемиологических исследований при основных формах гемобластозов, индуцируемых при действии ионизирующей радиации. 2006 Article Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) / D. Gluzman, N. Imamura, L. Sklyarenko, V. Nadgornaya, M. Zavelevich, V. Machilo // Experimental Oncology. — 2006. — Т. 28, № 1. — С. 60-63. — Бібліогр.: 18 назв. — англ. 1812-9269 https://nasplib.isofts.kiev.ua/handle/123456789/134530 en Experimental Oncology application/pdf Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Original contributions Original contributions |
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Original contributions Original contributions Gluzman, D. Imamura, N. Sklyarenko, L. Nadgornaya, V. Zavelevich, M. Machilo, V. Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) Experimental Oncology |
| description |
Aim: The question as to whether the incidence of leukemias and malignant lymphomas among the Chernobyl clean-up workers increased in 20 years after the catastrophe is still a point of much controversy. Precise diagnosis of the main forms of hematopoietic malignancies according to FAB classification and new WHO classification and comparison of these data with that in the general population will be helpful in estimating the relative contribution of the radiation factor to the overall incidence of such pathologies. Patients and methods: The data on 218 consecutive cases of malignant diseases of hematopoietic and lymphoid tissues in Chernobyl clean-up workers diagnosed in 1996–2005 are given in comparison with the data of 2697 consecutive patients of general population of the same age group. The morphology and cytochemistry of bone marrow and peripheral blood cells were studied. Immunocytochemical techniques (APAAP, LSAB-AP) and the broad panel of monoclonal antibodies to lineage specific and differentiation antigens of leukocytes were employed for immunophenotyping leukemic cells. Results: Various types of oncohematological diseases developing 10–20 years after Chernobyl accident were registered in a group of clean-up workers under study including myelodysplastic syndromes (MDS), acute leukemias (ALL and AML), chronic myelogenous leukemia (CML) and other chronic myeloproliferative diseases, chronic lymphocytic leukemia (B-CLL) and other chronic lymphoproliferative diseases of B and T cell origin. MDS percentage among patients of clean-up workers group tended to exceed MDS percentage in the group of patients representing the general population examined at the same period (4.58 vs. 3.70%). Among 34 AML cases, leukemia was preceded by MDS in seven patients. The relative contribution of CML to the total number of clean-up workers with leukemia was higher than the corresponding percentage value in general population examined at the same period (9.17 vs. 6.59%). B-CLL was a predominant form of hematopoietic malignancies in clean-up workers under study (25.68%). Nevertheless, B-CLL percentage in patients of clean-up workers group did not differ significantly from that in the patients of general population. The multiple myeloma percentage (7.79%) in the group of patients belonging to clean-up workers in our study turned out to be twice as much as in the patients of general population (4.0%). Conclusion: The verified diagnosis of tumors of hematopoietic and lymphoid tissue according to modern classification (EGIL, WHO) could be the prerequisite for further molecular genetic and analytical epidemiology study of leukemias that may be related to Chernobyl NPP accident consequences. |
| format |
Article |
| author |
Gluzman, D. Imamura, N. Sklyarenko, L. Nadgornaya, V. Zavelevich, M. Machilo, V. |
| author_facet |
Gluzman, D. Imamura, N. Sklyarenko, L. Nadgornaya, V. Zavelevich, M. Machilo, V. |
| author_sort |
Gluzman, D. |
| title |
Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) |
| title_short |
Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) |
| title_full |
Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) |
| title_fullStr |
Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) |
| title_full_unstemmed |
Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) |
| title_sort |
patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) |
| publisher |
Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
| publishDate |
2006 |
| topic_facet |
Original contributions |
| url |
https://nasplib.isofts.kiev.ua/handle/123456789/134530 |
| citation_txt |
Patterns of hematological malignancies in chernobyl clean-up workers (1996–2005) /
D. Gluzman, N. Imamura, L. Sklyarenko, V. Nadgornaya, M. Zavelevich, V. Machilo // Experimental Oncology. — 2006. — Т. 28, № 1. — С. 60-63. — Бібліогр.: 18 назв. — англ. |
| series |
Experimental Oncology |
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60 Experimental Oncology 28, 60–63, 2006 (March)
The development of leukemias and cancer seem to
represent one of the most serious stochastic effects
of the exposure to ionizing radiation. Meanwhile, the
question as to whether the incidence of leukemias
and malignant lymphomas among 101, 427 Ukrainian
clean-up workers of 1986 and 43,366 clean-up work-
ers of 1987 (average doses of 18.3 cGy and 10.8 cGy
respectively) has increased in 20 years after the catas-
trophe is still a point of much controversy [1–7].
Unfortunately, previously the actual incidence of he-
matopoietic malignancies as well as the risks of increasing
incidence of leukemias were assessed according to the
primary data categorized on the basis of the obsolete
ICD-9 (1975) classification where the acute leukemias
have been registered in total without delineation of myeloid
and lymphoid forms as well as the immunophenotypic
variants. Moreover, until recently only cytomorphology
and several cytochemical techniques were routinely used
for the diagnostic purposes in oncohematology in the vast
majority of the hematological clinics in Ukraine. In 1993,
the Reference Laboratory was set up as a public service
in R.E. Kavetsky Institute of Experimental Pathology, On-
cology and Radiobiology, National Academy of Sciences
of Ukraine with the aim of the precise diagnosis of the
haematopoietic malignancies based on cytomorphology,
cytochemistry, immunophenotyping in accordance with
FAB, WHO, EGIL, ICD-10 and ICD-O-2 classifications.
The aim of the study is to present the data on the
various forms and cytological variants of leukemia
and lymphoma verified by Western standards in the
consecutive group of Ukrainian Chernobyl clean-up
workers developed in 10–19 years after Chernobyl
accident, diagnosed in the Reference Laboratory in
1996–2005 and categorized according to the up-to-
date classification schemes.
MATERIALS AND METHODS
Patients. In all, 218 clean-up workers admitted to on-
cohematological departments of Kyiv Regional Hospital
No. 2, Kyiv Regional Hospital No. 1, Kyiv City Hospital No.
9 and clinics of Research Center for Radiation Medicine,
Academy of Medical Sciences of Ukraine from February
1996 to December 2005 were examined in the Reference
Laboratory (Immunocytochemistry Department of R.E.
Kavetsky Institute of Experimental Pathology, Oncology
and Radiobiology, National Academy of Sciences of
PATTERNS OF HEMATOLOGICAL MALIGNANCIES IN CHERNOBYL
CLEAN-UP WORKERS (1996–2005)
D. Gluzman1,3,*, N. Imamura2,3, L. Sklyarenko1,3, V. Nadgornaya1,3, M. Zavelevich1,3, V. Machilo1,3
1RE Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology,
National Academy of Sciences of Ukraine, Kyiv, Ukraine
2Imamura Memorial Clinic, Dept Hematology a. Oncology, Hiroshima, Japan
3Japanese-Ukrainian Leukemia/Lymphoma Study Group (JULSG), Hiroshima, Japan
Aim: The question as to whether the incidence of leukemias and malignant lymphomas among the Chernobyl clean-up workers increased
in 20 years after the catastrophe is still a point of much controversy. Precise diagnosis of the main forms of hematopoietic malignancies
according to FAB classification and new WHO classification and comparison of these data with that in the general population will be
helpful in estimating the relative contribution of the radiation factor to the overall incidence of such pathologies. Patients and methods:
The data on 218 consecutive cases of malignant diseases of hematopoietic and lymphoid tissues in Chernobyl clean-up workers diagnosed
in 1996–2005 are given in comparison with the data of 2697 consecutive patients of general population of the same age group. The
morphology and cytochemistry of bone marrow and peripheral blood cells were studied. Immunocytochemical techniques (APAAP,
LSAB-AP) and the broad panel of monoclonal antibodies to lineage specific and differentiation antigens of leukocytes were employed
for immunophenotyping leukemic cells. Results: Various types of oncohematological diseases developing 10–20 years after Chernobyl
accident were registered in a group of clean-up workers under study including myelodysplastic syndromes (MDS), acute leukemias
(ALL and AML), chronic myelogenous leukemia (CML) and other chronic myeloproliferative diseases, chronic lymphocytic leukemia
(B-CLL) and other chronic lymphoproliferative diseases of B and T cell origin. MDS percentage among patients of clean-up workers
group tended to exceed MDS percentage in the group of patients representing the general population examined at the same period
(4.58 vs. 3.70%). Among 34 AML cases, leukemia was preceded by MDS in seven patients. The relative contribution of CML to the
total number of clean-up workers with leukemia was higher than the corresponding percentage value in general population examined
at the same period (9.17 vs. 6.59%). B-CLL was a predominant form of hematopoietic malignancies in clean-up workers under study
(25.68%). Nevertheless, B-CLL percentage in patients of clean-up workers group did not differ significantly from that in the patients
of general population. The multiple myeloma percentage (7.79%) in the group of patients belonging to clean-up workers in our study
turned out to be twice as much as in the patients of general population (4.0%). Conclusion: The verified diagnosis of tumors of hema-
topoietic and lymphoid tissue according to modern classification (EGIL, WHO) could be the prerequisite for further molecular genetic
and analytical epidemiology study of leukemias that may be related to Chernobyl NPP accident consequences.
Key Words: Chernobyl clean-up workers, leukemias, cytochemistry, immunophenotyping.
Received: February 11, 2006.
*Correspondence: Fax: + 380 44 258 1656
E-mail: vals@onconet.kiev.ua
Abbreviations used: ALL – acute lymphoblastic leukemia; AML — acute
myeloid leukemia; CLL — chronic lymphocytic leukemia; CML — chronic
myelogenous leukemia; LGL-L — large granular lymphocytic leukemia;
MDS — myelodysplastic syndromes; NHL — non-Hodgkin’s lymphomas.
Exp Oncol 2006
28, 1, 60–63
Experimental Oncology 28, 60–63, 2006 (March) 61
Ukraine). All the clean-up workers referred to the Refer-
ence Laboratory in the period stated above were exam-
ined consecutively without any previous selection of the
cases. The radiation dose load of the clean-up workers
under study varied from 7.5 to 25 cGy.
2697 consecutive patients of general population
aged over 30, mainly the residents of Kyiv city and
district (hereinafter referred as ‘general population’),
diagnosed in the Reference Laboratory at the same
period comprised the group of comparison, again
presented without any selection.
Methods. Bone marrow and peripheral blood smears
stained by May-Grunwald-Giemsa were studied morpho-
logically. Activities of myeloperoxidase, acid phosphatase
(tartrate-sensitive and tartrate-resistant), non-specific
esterase (sodium fluoride-sensitive), naphtol-AS-D-chlor-
acetate esterase, alkaline phosphatase were analyzed
cytochemically. Glycogen was assayed cytochemically by
PAS-reaction. Immunocytochemical techniques (APAAP,
LSAB-AP) and a broad panel of monoclonal antibodies
(MoAbs) against lineage specific, differentiation and
activation antigens of leukocytes were employed for im-
munophenotyping pathological cells [8].
The following antigens have been assayed immu-
nocytochemically: the markers of hematopoietic stem
cells and the markers of commitation (CD34, CD38,
CD45RA, HLA-DR), the antigens of myeloid cells
(CD33, CD13, CD15, CD64, CD16, MPO), the antigens
of erythroid and megakaryocytic cells (CD71, CD61,
CD62, CD41, CD42, glycophorin A), the antigens
of T-cells (CD7, CD5, CD3, CD2, CD1a, CD4, CD8,
CD45RO, γσTCR) and B-cells (CD19, CD20, CD22,
CD23, CD10, κ, λ and μ chains of immunoglobulins).
The main biological forms and cytological vari-
ants of hematopoietic malignancies were diagnosed
according to FAB-classification, immunological clas-
sification of acute leukemias proposed by EGIL group,
and REAL classification schemes. In 2000–2005 the
diagnostic findings were revised in accordance with
recently published new WHO classification [9].
RESULTS
The various types of oncohematological diseases
developing in 10–20 years after Chernobyl accident were
registered in a group of Chernobyl clean-up workers under
study including myelodysplastic syndromes (MDS), acute
leukemias (ALL and AML), chronic myelogenous leukemia
(CML) and other forms of chronic myeloproliferative dis-
eases, B-CLL and other forms of chronic lymphoprolifera-
tive diseases of B- and T-cell origin (Table).
Various forms of MDS have been observed in
Chernobyl clean-up workers, namely refractory anemia
(RA) and RA with the excess of blasts (RAEB-1 and
RAEB-2). MDS percentage among patients of clean-up
workers group tended to exceed MDS percentage in the
group of patients representing the general population
examined at the same period (4.68 vs. 3.70%).
The peculiar feature of AML in Chernobyl clean-up
workers under study consisted in the development of
leukemia in the setting of preceding MDS in 22.5% of
all AML cases studied. In some of these patients a p53
gene mutation has been found [10, 11].
Table. Summary of leukaemia cases diagnosed in patients belonging
to Chernobyl clean-up workers and general population in 1996–2005
Type of leukemia
Absolute number of patients
(percentage is given in the brackets)
Chernobyl
clean-up workers
General
population
Myelodysplastic syndromes 10 (4.58%) 107 (3.70%)
Acute myeloid leukemia 34 (15.59%) 732 (27.14%)
Acute lymphoblastic leukemia 10 (4.58%) 214 (7.93%)
Chronic myelogenous leukemia 20 (9.17%) 178 (6.59%)
Polycythemia vera 5 (2.29%) 3 (0.11%)
Essential thrombocythemia 7 (3.21%) –
Chronic eosinophylic leukemia/
Hypereosinophylic syndrome
2 (0.91%) –
Chronic idiopatic myelofibrosis 2 (0.91%) 2 (0.07%)
Chronic myelomonocytic leukemia 6 (2.75%) 84 (3.11%)
Chronic lymphocytic leukemia 56 (25.68%) 791 (29.32%)
B-cell prolymphocytic leukemia 3 (1.37%) 23 (0.85%)
Hairy cell leukemia 8 (3.67%) 118 (4.37%)
Multiple myeloma 17 (7.79%) 108 (4.00%)
Non-Hodgkin’s lymphoma (leukemic
change)
28 (12.84%) 296 (10.97%)
Sezary syndrome 3 (1.37%) 8 (0.29%)
T-cell prolymphocytic leukemia 2 (0.91%) 3 (0.11%)
Large granular lymphocytic leukemia 5 (2.29%) 3 (0.11%)
ALL to AML ratio in the group of Chernobyl clean-up
workers was typical of that in adult patients from general
populations not exposed to ionizing radiation. Five sub-
variants of ALL of B-cell origin (ALL with phenotype of
stem hematopoietic cell; pre-pre-B-ALL; common ALL;
pre-B-ALL; B-ALL) and four subvariants of ALL of T-cell
origin (blast cells with phenotype of subcortical, cortical
and medullar thymocytes, and leukemic cells with γσT-cell
receptor) were delineated upon immunophenotyping.
The relative frequencies of selected types of leuke-
mias in clean-up workers and in the general population
are given in Fig. 1. Several patterns concerning the
relative contribution of particular leukemias forms into
the total number of the leukemias having been studied
are worthwhile to be noticed.
Fig. 1. Percentage of selected forms of hematopoietic
malignancies in clean-up workers and in general population
First, the relative contribution of CML to the total
number of clean-up workers with leukemia was higher
than the corresponding percentage value in general
population examined at the same period (9.17 vs.
6.59%). The multiple myeloma percentage (7.79%) in
the group of patients belonging to clean-up workers in
our study turned out to be about twice as much as in
the patients of general population (4.00%).
In contrast, while B-CLL was a predominant form
of hematopoietic malignancies in clean-up workers
under study (25.68%), its percentage in the patients
62 Experimental Oncology 28, 60–63, 2006 (March)
of clean-up workers group did not differ significantly
from that in the patients of general population.
The different forms of B-cell non-Hodgkin’s lym-
phomas (NHL) in leukemization phase were diagnosed
(follicular lymphoma, lymphoplasmacytic lymphoma,
mantle cell lymphoma, splenic marginal zone B-cell
lymphoma, diffuse large B cell lymphoma, extranodal
marginal zone B-cell lymphoma of MALT type). The
overall average percentage of NHL of B-cell origin
among the patients of clean-up workers group tended
to exceed that in the patients of general population.
In five patients working in Chernobyl in 1986–1987
the unusual chronic lymphoproliferative disorder,
large granular lymphocytic leukemia (LGL-L) was
diagnosed. Three of LGL-L cases belonged to T-cell
subvariant (CD3+, CD5+, CD2+, CD7low, CD4–, CD8+,
CD56low, CD57+/–, CD16+, HLA-DR–) and two – to
NK-cell subvariant (CD3–, CD5–, CD2+, CD7+, CD4–,
CD8+/–, CD56low, CD57+, CD16+, HLA-DRlow). Recently
Imamura [12, 13] described three cases of chronic NK-
cell leukemia upon studying 52 patients with chronic
neutropenia in Hiroshima A-bomb survivors.
Cytochemical study of the smears of bone marrow
in clean-up workers suffering from malignant diseases
of hematopoietic and lymphoid tissue as well as clean-
up workers without overt malignant diseases revealed
the villous cells which are strongly alkaline phospha-
tase-positive (Fig. 2). Such features were not evident
in samples of bone marrow of the patients observed
in pre-Chernobyl period.
Fig. 2. Reactive response in bone marrow microenvironment
in clean-up workers (a, b). Strongly alkaline phosphatase positive
dendritic-like cells (endothelium or blood vessels? precursors of
osteoblasts?), x 900
DISCUSSION
The long-term study performed by the Reference
Laboratory in R.E. Kavetsky Institute of Experimental Pa-
thology, Oncology and Radiobiology in collaboration with
the clinical facilities is one of the attempts to character-
ize in details the major forms and cytological variants of
the oncohematological diseases in Chernobyl clean-up
workers that became evident in 10–19 years after their
exposure to radiation. The data on the relative frequency
of the various forms of hematopoietic malignancies in the
Chernobyl clean-up workers (218 consecutive cases)
have been compared with the groups of the patients of
the same age who have not been exposed to the ionizing
radiation (2697 patients). The leukemias have been di-
agnosed according to FAB-classification as well as new
WHO classification taking into account morphology and
cytochemistry of bone marrow and peripheral blood cells
and immunophenotype of leukemic cells assessed with
the aid of the broad panel of MAbs to lineage-specific
and differentiation antigens of leukocytes.
As it is seen from the data presented above, practically
all the major forms of malignant diseases of hematopoi-
etic and lymphoid tissues were diagnosed in the group of
Chernobyl clean-up workers under study. The comparison
of the relative distribution of the specified forms of hema-
topoietic and lymphoid malignancies in the patients diag-
nosed among Chernobyl clean-up workers demonstrates
the increasing multiple myeloma rate, and the tendency
to the increasing NHL (in leukemization phase) and CML
rates as compared to the group of general population. The
significant excess of LGL-L, which is extremely rare in the
general population, is also worthwhile to mention.
B-CLL was shown to be a predominant form of he-
matopoietic malignancies in clean-up workers under
study (25.68%). While in our study B-CLL percentage in
patients of clean-up workers group did not differ signifi-
cantly from that in the patients of general population, the
question of B-CLL association with exposure to ionizing
radiation seems to be worth of further study. Several
authors in fact believe that there is not a persuasive
basis for the accepted view that B-CLL is nonradiogenic
form of cancer [14]. The delineation of specific B-CLL
subtypes with different somatic mutations contributing
to the genesis of the disease followed by the analysis of
their incidence will undoubtedly clarify this subject.
The reactive responses in bone marrow stroma in
clean-up workers suffering from malignant diseases of
hematopoietic and lymphoid tissue exhibiting the strongly
alkaline phosphatase-positive villous cells (endothelium of
sinuses or blood vessels? cells precursors of osteoblasts?)
does not seem to be incidental. The appearance of these
cells in bone marrow of clean-up workers (both leukemia
patients and patients with non-malignant diseases of
hematopoietic and lymphoid tissue) could be regarded
as a response to incorporation of the osteotropic heavy
metals including radionuclides in endostal areas. It is highly
probable that such cells that were not evident in the bone
marrow of the patients observed in pre-Chernobyl period
could serve as the markers of radiogenic leukemias. This
problem deserves further studying.
Our data to some extent are comparable with the
findings of the increased leukemia incidence (primarily
acute and chronic myeloid leukemias) in the cohort of
the Cheliabinsk region residents subjected to 5–20
years of the protracted radiation exposure due to
Kyshtym accident [15].
In Japan in the cohort of 86,572 A-bomb survivors
followed up in 1950–1990 upon the reclassification of
hematopoietic malignancies according to FAB system
accounting new dosimetry systems DS86 and DS02 the
differential effects of radiation on major subtypes of human
leukemias were shown. In particular, the incidence of mul-
tiple myeloma, ALL and CML was affected more than the
incidence of other biological subtypes of leukemia [16].
Experimental Oncology 28, 60–63, 2006 (March) 63
At present, it is evident that only verified diagnosis
could be the prerequisite for the advanced studies in
analytical epidemiology of leukemias aimed at elucidat-
ing the role of the radiogenic factor in the pathogenesis
of the malignant diseases of hematopoietic and lymphoid
tissue [17, 18]. In this context, joint research efforts are of
utmost importance to resolve this challenging issue.
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СТРУКТУРА ОПУХОЛЕВЫХ ЗАБОЛЕВАНИЙ СИСТЕМЫ КРОВИ
У ЛИКВИДАТОРОВ АВАРИИ НА ЧАЭС (1996–2005)
Цель: вопрос о количественных показателях заболеваемости лейкозами и злокачественных лимфомах у ликвидаторов
аварии на ЧАЭС, спустя 20 лет после Чернобыльской катастрофы, остается невыясненным. Диагностика этих заболеваний
в соответствии с ФАБ- классификацией и новой классификацией ВОЗ, сравнение полученных данных с данными лиц,
не подвергавшимся воздействию ионизирующего излучения, является необходимой предпосылкой для разрешения этого
вопроса и выяснения роли радиационного фактора в развитии злокачественных заболеваний кроветворной и лимфоидной
тканей. Методы: проанализированы 218 последовательных случаев лейкозов, диагностированных в 1996–2005 гг.
у ликвидаторов аварии на ЧАЭС, по сравнению с группой лиц того же возраста, которые не подвергались воздействию
излучения (2697 больных). Диагностику лейкозов осуществляли на основе морфологического и цитохимического
изучения мазков крови и костного мозга, иммунофенотипирования лейкемических клеток с использованием широкой
панели моноклональных антител к линейноспецифическим и дифференцировочным антигенам лейкоцитов. Результаты:
спустя 10–20 лет после Чернобыльской катастрофы у ликвидаторов аварии на ЧАЭС выявлены различные формы
онкогематологических заболеваний, включая миелодиспластические синдромы (МДС), острые лейкозы (ОЛЛ и ОМЛ),
хронический миелолейкоз (ХМЛ) и другие миелопролиферативные заболевания, В-клеточный хронический лимфолейкоз
(В-ХЛЛ) и другие лимфопролиферативные процессы В- и Т-клеточной природы. Установлена более высокая частота МДС в
группе ликвидаторов по сравнению с группой лиц, не подвергавшихся воздействию излучения (4,58 и 3,70% соответственно).
У 7 из 34 больных с ОМЛ в группе ликвидаторов заболевание развилось на фоне предшествующего МДС. Более высокой
в этой группе была и заболеваемость ХМЛ (9,17 в сравнении с 6,59% в контрольной группе). В-ХЛЛ был преобладающей
формой гемобластозов у ликвидаторов в целом, однако не было установлено существенных различий в частоте развития
этого заболевания в сравниваемых группах. У ликвидаторов аварии на ЧАЭС почти в два раза чаще, чем у населения в
целом, диагностировалась множественная миелома (7,79 в сравнении с 4,0%). Выводы: представленные данные могут
служить основой для проведения последующих молекулярно-генетических и эпидемиологических исследований при
основных формах гемобластозов, индуцируемых при действии ионизирующей радиации.
Ключевые слова: ликвидаторы аварии на ЧАЭС, лейкозы, цитохимия, иммунофенотипирование.
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