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June 2001 Volume 4, Issue 5:
Report From A Russian Myeloma Group
By Eleonora I. Podoltseva, MD
06.01.01

I was born and grew up in the Ukraine. I developed an interest in hematology when I was a student at the 1st Leningrad Medical Institute. At first I was engaged in the study of kinetics of blast cells in acute leukemias, then I got involved in research in the area of multiple myeloma.


In the former USSR, the data of selective research showed the variations of incidence of multiple myeloma from 0.3 to 1.1 per 100,000. In St. Petersburg, the incidence for the period from 1980 to 1994 is variable (0.6 to 1.1 per 100,000 for men and 0.5 to 1.1 per 100,000 for women) and the number of cases per year for the same period of time in different years has varied from 40 to 81. The existing form of statistical reporting does not give survival data.


Prof. Podoltseva (center) and staff of the BMT Center at Hospital #31 in St. Petersburg, Russia with IMF guests Prof. Boccadoro, Prof. Durie and Susie Novis.


The standard treatment for multiple myeloma in the 1970s was based on combinations of sarcolisine or cyclophosphamide with corticosteroids or repeated courses VCAP but these combinations were not able to change the course of multiple myeloma and improve overall survival. In 1980s, pulse therapy of prednisolon and, in cases of refractoriness to first-line therapy, VAD regimen came to be used.


Taking into account the extraordinary diversity in the response to treatment and clinical course of multiple myeloma, my research work was focused on determination of prognostic factors at the time of diagnosis. Based on clinical and laboratory signs identified in retrospective multivariate analysis, we divided patients with progressive myeloma into groups with active and aggressive courses of disease. Patients with aggressive myeloma received VAD as the first line of chemotherapy. Those who responded to this regimen received single or double autologous hematopoietic stem cell transplantation with conditioning by melphalan (200mg/m2).


High-dose chemotherapy using autologous marrow or peripheral blood stem cells became possible upon the creation of a BMT Center at Hospital #31 in St. Petersburg. Our Center consists of three departments: Children’s Oncology and Hematology, Adult’s Oncology and Hematology and the BMT Department. Patients with various malignant tumors are treated in accordance with international schemes and protocols. We are one of the few centers in Russia to see a lot of myeloma patients. In addition to patients from St. Petersburg, patients from the North-West Region of Russia are referred to us as well. We also serve as advisors to other hospitals and regions and cooperate with doctors from all parts of Russia. Periodically, we give lectures at the “School of Hematologists” that is organized annually in Russia. 


Thirty percent of patients in our adult departments have myeloma. Yearly, there are about 15 newly diagnosed myeloma cases in our clinic. The Center also has an out-patient department so that we can closely observe patients for possible relapse and complications, and conduct chemotherapy on an out-patient basis. Since it is possible to conduct modern regimens (VAD, high-dose chemotherapy and autologous stem cell transplantation) at our Center, we primarily select patients with aggressive myeloma and younger patients. In Russia, there are several hematology centers with hematopoietic stem cell transplant programs but our Center has the greatest experience in the treatment of myeloma with high-dose chemotherapy and stem cell transplantation. 


Our Center has a highly qualified staff of hematologists and anesthesiologists, a surgeon, and nurses. We also have proper diagnostic laboratories to provide cytogenetical, immunological and molecular biology diagnosis. The Center is a training base of the St. Petersburg State Medical Academy and the Medical Department of the St. Petersburg State University – postgraduate students work here as members of medical team.


Of course, there are problems that have to be solved. Results of prospective analysis show that although the short-term outcome after aggressive chemotherapy is good, recurrence of myeloma remains a major problem. Despite the high caliber of our team, we do not have adequate financial support to perform research and clinical trials. Treat-ment at the Center is provided free of charge to citizens of St. Petersburg thanks to the Federal Foundation of Mandatory Medical Insurance and Municipal budget but there are shortages of expensive drugs (cytostatics, antibiotics, antifungal drugs, etc.). As a result, not all of our patients are able to be treated by high-quality cytostatic agents and accompanying preparations and, because of our financial problems, at times we must refuse hospitalization at the Center. This is a paradox: the Federal Foundation sponsors only 80¢ per day for conventional myeloma regimens, municipal sponsorship of high-dose therapy is better but most patients have to assume considerable expenses and not all patients are able to pay.


But we try to be optimistic and are working hard on solving our problems in order to provide better care for all our patients. The staff and the patients of the Center are grateful for the opportunity to cooperate with the IMF – this organization is truly international and its existence is one of the main developments in the fight against myeloma.


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