ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 16 of 60
УЖМБС 2019, 4(6): 110–118
Clinical Medicine

The Influence of the Environmental Environment on the State of Hemopoesis and the Development and Course of Acute Leukemia in Children after the Chernobil Catastrophe

Bebeshko V. G., Bruslova K. M., Tsvetkova N. M., Pushkaryeva T. I., Dmytrenko I. V.

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.

Keywords: leukemia, bone structure, prognosis, environment, risk groups

Full text: PDF (Ukr) 249K

  1. Serdyuk AM, Polka NS, Savina RV, Chernychenko IO. Kontseptsiya rozvytku naukovykh doslidzhen v haluzi okhorony hromadskoho zdorov’ya DU «Instytut hromadskoho zdorov’ya im. OM Marzyeyeva NAMN Ukrainy» na 2018–2022 [The concept of research development in the field of public health of the State Institution «Institute of Public Health. OM Marzeyev of the National Academy of Medical Sciences of Ukraine for 2018–2022]. Dovkillya ta zdorov’ya. 2019; 1(90): 74–7. [Ukrainian]
  2. Antypkyn YuG. Pedyatryya v Ukrayne – strategycheskye napravlenyya segodnya y zavtra. Naukova diyalnist 04.07.2019. Available from:–v–ukrayne–strategycheskye–napravlenyya–segodnya–y–zavtra/ [Russian]
  3. Dinleyici M, Dağlı FŞ. Evaluation of quality of life of healthy siblings of children with chronic disease. Turk Pediatri Ars. 2018 Dec; 53(4): 205–13.
  4. Wakeford R. Chernobyl and Fukushima – where are we now? J Radiol Prot. 2016 Jun; 36(2): E1–5.–4746/36/2/E1
  5. Bebeshko VG, Bruslova KM, Tsvyetkova NM, Lyashenko LO, Pushkarova TI, Gonchar LO, ta insh. Vplyv deyakykh nespryyatlyvykh chynnykiv dovkillya na vyzhyvanist ditey z gostrymy leykemiyamy u viddalenyy period pislya avariyi na ChAES [Impact of some adverse environmental factors for the survival of children with acute leukemia in the remote period after the Chernobyl disaster]. Probl Radiac Med Radiobiol. 2018; 23: 253–61. [Ukrainian]
  6. Radiobiofizychni ta medyko–gigiyenichni naslidky Chornobylskoyi katastrofy: shlyakhy piznannya ta podolannya: Praktychnyy posibnyk simeynogo likarya [Radiobiophysical and Medico–Hygienic Consequences of the Chornobyl Catastrophe: Ways to Know and Overcome: A Family Doctor's Practical Guide]. Ed by VG Bebeshko, BS Prister, MI Omelyanets. Uzhgorod: Patent; 2017. 504 p. Bibliogr: 289– 99. [Ukrainian]
  7. Bebeshko VG, Bruslova KM, Pushkarova TI, Tsvyetkova NM, Lyashenko LO, Yatsemyrskyy SM, ta insh. Riven kortyzolu yak faktor ryzyku rozvytku zloyakisnoyi gematologichnoyi patologiyi u ditey, yaki zaznaly vplyvu ionizuyuchogo vyprominyuvannya vnaslidok avariyi na ChAES [Cortisol levels as a risk factor for malignant hematologic pathology in children exposed to ionizing radiation due to the Chernobyl accident]. Probl Radiac Med Radiobiol. 2017; 22: 306–15. [Ukrainian]
  8. Doron B, Handu M, Kurre P. Concise Review: Adaptation of the Bone Marrow Stroma in Hematopoietic Malignancies: Current Concepts and Models. Stem Cells. 2018 Mar; 36(3): 304–12.
  9. Zhao M, Tao F, Venkatraman A, Li Z, Smith SE, Unruh J, et al. N–Cadherin–Expressing Bone and Marrow Stromal Progenitor Cells Maintain Reserve Hematopoietic Stem Cells. Cell Rep. 2019 Jan 15; 26(3): 652–69.
  10. Asada N. Regulation of Malignant Hematopoiesis by Bone Marrow Microenvironment. Front Oncol. 2018; 8: 119.
  11. Garcia M, Chen CC. The bone marrow microenvironment—driver of leukemia evolution? Stem Cell Investig. 2017; 4: 11.
  12. Lee G, Jeong S, Lee H, Oh Il–H. Age–related differences in the bone marrow stem cell niche generate specialized microenvironments for the distinct regulation of normal hematopoietic and leukemia stem cells. Sci Rep. 2019; 9: 1007.
  13. Valkenburg K, Groot A, Pienta K. Targeting the tumour stroma to improve cancer therapy. Nat Rev Clin Oncol. 2018 Jun; 15(6): 366–81.–018–0007–1
  14. Menon H, Ramapriyan R, Cushman T, Verma V, Kim H, Schoenhals J, et al. Role of Radiation Therapy in Modulation of the Tumor Stroma and Microenvironment. Front Immunol. 2019; 10: 193.
  15. Liu F. Tam K, Pishesha N, Poon Z, Van Vliet K. Improving hematopoietic recovery through modeling and modulation of the mesenchymal stromal cell secretome. Stem Cell Res Ther. 2018 Oct 24; 9(1): 268.–018–0982–2