We report a case of a 35-year-old, non-HIV-infected male diagnosed simultaneously with a disseminated form of Kaposi’s sarcoma (KS; skin, stomach and colon are involved) and Hodgkin’s lymphoma. There is no sign of changes in the immune status, but three herpes viruses were detected in the patient’s blood (EBV, HHV6 and HHV8). He received ABVD chemotherapy and achieved complete metabolic remission for Hodgkin’s lymphoma. Moreover, the signs of the disseminated KS were resolved. Our observations indicate that a combination of distinct types of viruses may play an important role in triggering the development of angio- and lymphoproliferative disorders in the same person. In addition, treatment with chemotherapy cycles, which included doxorubicin and vinblastine, led to the stable remission of both diseases.

Extramedullary and paraskeletal plasmacytomas are not common and are usually one of the possible complications of multiple myeloma. This variant of the disease is more aggressive, less responsive to therapy, and recurs more often than conventional multiple myeloma. In our work, we described two cases of aggressively ongoing multiple myeloma with a mixed plasmacytic variant diagnosed at the time of setting the diagnosis. In both cases, a rapid progressive course was observed despite the wide range of both the newest drugs and the classical chemotherapy drugs used during treatment. Thus, this variant of the disease remains most often resistant to the therapy, with an unfavorable prognosis, and requires further study and improvement of the treatment approach to improve outcomes.

Aim. To compare the secretion of interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) in cancer patients with anemia of chronic disease (ACD), iron deficiency anemia (IDA) and a combination of these two anemia types. To assess the effect of the studied cytokines on erythropoiesis in patients with malignant neoplasms separately for each type of anemia studied.Materials and methods. 106 patients with stage II–IV of solid malignant neoplasms were examined: 84 with anemia (55 men, 29 women, 67.1 ± 9.9 years), 22 without anemia (17 men, 5 women, mean age 60.2 ± 14.9 years). In accordance with Van Santen and Worwood criteria, by determining the transferrin saturation coefficient, ferritin concentrations, C-reactive protein, patients were divided into 4 groups: group 1 – patients with ACD, 31 (20 / 11 patients), 2 group – ACD / IDA, 28 (18 / 10 patients), group 3 – IDA, 25 (17 / 8 patients), group 4 (control) – 22 patients without anemia. In all patients, the number of erythrocytes, the concentration of hemoglobin, ferritin, C-reactive protein, transferrin saturation coefficient, IL-6, TNF-α, IL-10 were determined. For quantitative indicators, the arithmetic mean and interquartile range (IQR) were calculated. Significance of differences between several unrelated groups was determined using the Kruskal–Wallis test. To assess the relationship between variables, the Spearman correlation coefficient (r) was calculated.Results. In the ACD group, the maximum IL-6 concentration was 73.3 (IQR 6.2–51), TNF-α – 24.4 (IQR 15.3–60.7) and IL-10 – 8.7 (IQR 4.7–12.1) compared with the ACH3 / IDA group (IL-6 – 9.3 [IQR 4.4–13.2], TNF-α – 7.2 [IQR 4.5–9.6] and IL-10 – 6.7 [IQR 4.1–11.4]), and the IDA group (IL-6 – 3.4 [IQR 1.4–5.9], TNF-α – 4.6 [IQR 3.7–6] and IL-10 – 2.5 [IQR 0–5]) (p <0.05). In the ACD group, the highest correlation coefficients were found between IL-6 and erythrocytes (r = –0.74) and hemoglobin (r = –0.88), between TNF-α and erythrocytes (r = –0.66) and hemoglobin (r = –0.77), between IL-10 and erythrocytes (r = –0.36) and hemoglobin (r = –0.63). In the IDA group, the correlation coefficients between cytokines, erythrocytes, and hemoglobin are low or absent.Conclusion. In cancer patients, ACD, IDA, as well as their combination can occur. Increased cytokine secretion in ACD group patients is important due to the proven strong negative effect of cytokines on erythropoiesis. Further study of ACD pathogenesis is needed in order to improve treatment.

The features of erythropoietin secretion in patients with a rheumatic pathology and anemia of the chronic diseases in comparison with patients having iron deficiency anemia, as well as the relationship between erythropoietin, hepcidin, proinflammatory, and antiinflammatory cytokines, have been investigated. 126 patients suffering from the rheumatic pathology were examined, including 34 men aged 3655 years and 92 women aged 3860 years. At the same time, 104 (82.5%) patients suffered from anemia, 22 (17.5%) patients did not have it. Patients suffering from anemia, depending on the leading pathogenetic factor, were divided into three groups such as: the 1st group patients suffering from anemia of chronic diseases; 2nd grouppatients suffering from a combination of anemia of chronic diseases and iron deficiency anemia; 3rd grouppatients suffering from iron deficiency anemia. In patients suffering from anemia of chronic diseases, the maximum concentration of interleukin-6, hepcidin, and the minimum concentration of erythropoietin were detected in comparison with the patients suffering from iron deficiency anemia and patients suffering from anemia of chronic diseases, and iron deficiency anemia (p 0.05). The maximum concentration of the erythropoietin has been established in patients suffering from iron deficiency anemia. About the concentrations of interleukin-10 and interleukin-1, tumor necrosis factor-, interferon-, no differences were found in the study groups. A direct correlation was found between the erythropoietin and erythrocytes (r = 0.57), hemoglobin (r = 0.41), hepcidin (r = 0.65). There was a strong negative correlation between the erythropoietin and interleukin-6 (r = 0.75), and a weak relationship with interferon gamma, tumor necrosis factor alpha, interleukin-10, and interleukin-1 (r 0.3). Thus, for patients with a rheumatic profile, a specific molecular profile should be identified, leading to the development of anemia of the chronic diseases, which consists in increased concentrations of hepcidin and interleukin-6 in combination with the insufficient secretion of erythropoietin. The found changes fit into the structure of the previously proposed working version of the classification of anemia of chronic diseases (with a predominant iron deficiency, with disturbances in the regulatory mechanisms of the erythropoiesis, with an insufficient production of erythropoietin). Isolation of the leading factor in the development of anemia of chronic diseases in the future will allow for a more optimal approach to its correction, including with the targeted therapy drugs.

Relevance. Anemia of chronic diseases has a significant impact on the quality of life of patients with malignant neoplasms, as well as on the course of the underlying disease and prognosis. Aim. To study the characteristics of the secretion of interleukin-1β (IL-1β), interferon-γ (INF-γ) in patients with malignant neoplasms with and without anemia of chronic diseases. To study the effect of these cytokines on hemoglobin synthesis, erythropoiesis and some indicators of iron metabolism. To propose a working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor in the development of anemia. Material and methods. The study involved 42 (27 patients with anemia - 19 men, 8 women, average age 65.1 ± 8.1 years, 15 without it, 10 men, 5 women, average age 61.1 ± 10.1 years) patients with II- Stage IV malignant neoplasm. A comparative analysis was carried out between groups with and without anemia and a correlation analysis between IL-1β, INF-γ and indicators of hemogram, iron metabolism, C-reactive protein (CRP), hepcidin. Results. In patients with malignant neoplasms and ACD, in comparison with patients in the control group, a more pronounced inflammation was proved, accompanied by an increase in the synthesis of ferritin, CRP and IL-1β, INF-γ (p <0.05). For IL-1β, a moderate correlation was found with the concentration of iron (r = 0.46), CST (r = 0.48), hemoglobin (r = -0.61) and a strong correlation with the concentrations of hepcidin (r = 0.8), ferritin (r = 0.78), CRP (r = 0.87). A weak correlation was found between IL-1β and the number of erythrocytes, TIBC and transferrin. For IFN-γ, a moderate correlation was established with erythrocytes (r = -0.68), hemoglobin (r = -0.57), CST (r = -0.57), ferritin (r = 0.57) and a strong correlation connection with CRP (r = 0.83), hepcidin (r = 0.9), transferrin (r = -0.83). A weak correlation has been established between INF-γ and the concentration of iron, TIBC. Conclusions. In patients with malignant neoplasms and ACD, a more pronounced inflammation was proved, accompanied by an increase in the synthesis of ferritin, CRP and IL-1β, INF-γ. The influence of the investigated cytokines on erythropoiesis, synthesis of hemoglobin and hepcidin, and iron metabolism has been proved. This reflects the pleiotropic effect of these cytokines and the complex pathogenesis of ACD in patients with malignant neoplasms, including erythropoiesis disorders, changes in iron metabolism, and increased synthesis of proinflammatory cytokines. A working version of the classification of ACD (with a predominant iron deficiency, with impaired regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed.