The purpose of the study was to develop criteria for the formation of risk group for oncohematological pathology in a pediatric population exposed to adverse environmental factors, based on genealogy, clinical–hematological characteristics, structural changes in bone tissue and features of acute leukemia. Material and methods. 145 patients with acute leukemia (104 with acute lymphoblastic leukemia, 41 with acute myeloblastic leukemia) and 83 individuals in comparison group were examined. The genealogy, clinical–hematological characteristics, variants and prognosis of leukemia were evaluated. We studied the levels of cortisol, thyroid–stimulating pituitary hormone, osteocalcin and ferritin in serum, the number of colony–forming units of bone marrow stromal fibroblasts in vitro, the excretion of amino acids and calcium phosphate in the urine, alkaline phosphatase, and bone density. The impact of negative environmental factors was assessed by the degree of integral pollution of the territories (moderate, contaminated, very and extremely soiled). Results and discussion. We established age periods, intense growth, and characteristicы of the disease in children with acute leukemia. 73.1% of patients had a "common" type of acute lymphoblastic leukemia, more often in children under 6 years. T–acute lymphoblastic leukemia and acute myeloblastic leukemia were more commonly diagnosed in children older than 6 years. Oncological diseases in relatives of patients with acute leukemia were recorded in 19.3% (in the comparison group 9.7%). In the acute period of acute leukemia, 55.2% were diagnosed with normochromic–normocytic anemia. The leukocyte count above 100.0 G/l was 6.9%. The colony–forming units of bone marrow stromal fibroblasts proliferative activity above 70.0 and below 11.0 for 105 nucleated cells coincided with the shorter survival of patients. The content of amino acids that were part of collagen, prevailed catabolic processes over anabolic. The level of alkaline phosphatase below 200 U/l in serum coincided with the low colony–forming units of bone marrow stromal fibroblasts (rs = 0.48). Short patient survival was correlated with densitometry below 65 conv.un. The correlation between densitometry and alkaline phosphatase was established (rs = –0.44). Osteocalcin in children with acute leukemia was reduced at all times. In 25.0% of patients with acute lymphoblastic leukemia, the level of cortisol in the initial period was 25–30% lower, than the normative, that coincided with the shorter survival and the likelihood of relapse. We also determined the dependence of the course of acute leukemia and the age of patients at the time of diagnosis, depending on the type of pathology in the pedigree. Residents of very and extremely polluted territories had unfavorable course of acute leukemia compared to inhabitants of moderately and contaminated territories. Conclusions. The obtained results helped us to formulate criteria for a risk group for oncohematologic pathology and provided a hierarchical structure of indicators influencing changes in bone tissue and bone marrow microenvironment, and playing a role in the mechanisms of leukogenesis: stromal fibroblasts → collagen structure for amino acid content → mineral bone component → bone density → endocrine regulation, which is the basis for further scientific research.
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