Кidney injury is a frequent and significant complication of cancer and cancer therapy. The kidneys are susceptible to injury from malignant infiltration, damage by metabolites of malignant cells, glomerular  injury, nephrotoxic drugs including chemotherapeutic agents. Also  bone marrow transplantation complications, infections with immune  suppression (including septicemia), tumor lysis syndrome should be  taken into account. Chemotherapeutic agents are a common cause  of acute kidney injury but can potentially lead to chronic kidney  disease development in cancer patients. This article summarizes risk  factors of acute kidney injury in cancer patients. Risk factors are  divided into two groups. The systemic are decrease of total  circulating blood volume, infiltration of kidney tissue by tumor cells,  dysproteinemia, electrolyte disturbances. The local (renal) risk  factors are microcirculation disturbances, drugs biotransformation  with formation of reactive oxygen intermediates, high concentration of nephrotoxic agents in proximal tubules and its  sensitivity to ischemia. Drug-related risk factors include: drugs  combination with cytotoxic effect high doses long term use necessity, direct cytotoxic effect of not only chemotherapeutic agents but also its metabolites, mean solubility forming intratubular  precipitates. Early diagnosis, timely prevention and treatment of  these complications provide significantly improve nononcologic results of treatment.

Presented are three clinical observations of patients with a rare, but one of the oldest, genetic disease, which according to modern concepts belongs to the group of autoinflammatory diseases — familial Mediterranean fever. In the cases described, the diagnosis was first made in adulthood. The main purpose of the description of these cases is to draw the attention of practitioners to the possibility of early diagnosis and adequate pathogenetic therapy of this cohort of patients with an ethnic predisposition, but manifested regardless of the place of modern residence.

e19515 Background: In order to identify the features of the course of the disease in patients with chronic lymphocytic leukemia (CLL) when prescribing standard polychemotherapy (PCT) according to the RFC scheme (rituximab, fludarabine, cyclophosphamide) we investigated chromosomal aberrations in leukemia cells. Methods: We observed 190 patients (aged 57.4±23.7 years, 87 men, 103 women). Cytogenetic studies were conducted. Clinical and hematological remission was evaluated. Results: 52% of patients had single chromosomal aberrations, 25% - double, 23% - complex. A deletion of 17p13 (del (17p13)) with a level on leukemia cells from 2 to 98% in the period from the moment of CLL diagnosis of 11.8±7.2 months was found in 85 people (44.7%), with a level of more than 15% - in 24 (12.6%), of which with a level of 21% - 98% - in 12 (6.3%). During standard PCT according to the RFC scheme, among 44 patients with a level of cells with del (17р13) less than 15%, when controlled after 12 months, 12 (37.5%) showed an increase in the number of these cells to an average of 22.5%, which correlated (p < 0.1) with early relapses of the disease and the formation of secondary resistance to cytostatic treatment; in 20, there was no correlation between an increase in the number of cells and progression (partial remission (PR) was achieved); in 12 patients, cells with del (17p13) were not detected, and patients were characterized by the achievement of complete clinical and hematological remission (CR), which indicates the effectiveness of the FCR scheme in most patients. In 12 patients with the level of cells with del (17p13) 21% - 98%, no statistically significant increase in them was detected after 12±3 months (p > 0.15), however, remission was not achieved. They were treated with ibrutinib. Among the 8 patients with a recurrent course while taking ibrutinib at a dose of 420 mg per day for 2 to 4 years, severe infections were observed in the first months of therapy; in 4 patients the number of infectious episodes reduced later. 4 achieved PR (50%), 3 - PR (37.5%), 1 - stabilization. Conclusions: Thus, the level of blood cells with del (17p13) less than 15% in patients with CLL does not determine the severity of the disease and sensitivity to cytostatic treatment. These patients in the first line of chemotherapy are indicated for R, which, as a rule, does not cause irreversible elimination of cells with del (17p13), but slows down the growth of the tumor clone. This may determine the achievement of longer CR and PR and lead to a significant improvement in the long-term prognosis of the disease, and therefore the widely used RFC chemotherapy for B-CLL remains effective in most primary and pretreated patients. The detection of forms with a 17p13 deletion in an amount of more than 15% among tumor leukemia cells makes it possible to select a group of patients for prescribing ibrutinib, the overall response rate in which was 87.5%.

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