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The Department of Oncohematology and Chemotherapy (Oncohematology-16, formerly just Department of Oncohematology) has been functionining since 1990. It provides treatment to children with acute lymphocytic leukemias (including relapses), lymphomas of various histological types and localizations, 4th stage neuroblastomas, and various other soft-tissue tumors (mostly those localized in the head and neck) requiring chemotherapy. Over the last 3 years, the annual number of patients admitted to the department has been increasing by 15% each year. During 2004, almost 500 patients received treatment at the department. The department has 40 beds but actually treats up to 60 children at the same time. From one-quarter to one-third of our patients receive in-hospital treatment. These are the children who are in the most serious condition, receiving round-the-clock chemotherapy, or undergoing an examination. The rest of our patients receive their treatment in the day-patient regime. They live out of hospital (at home, at a rented apartment, together with their relatives or acquaintances, at a hotel or in the residential suites of the hospital) but arrive at the department for the therapeutic procedures and usually leave at lunchtime. As was shown throughout the world, this regime significantly reduces the occurrence of grave in-hospital infections. Our patients have seriously impaired immunity, and this problem is more than important for them.Among patients suffering from lymphomas, most have Burkitt's lymphoma or Burkitt-like B-cell lymphomas. They are among the best curable child tumors. The survival expectancy may reach 95% depending on the stage of the disease. The number of relapses is very small; however, it is such patients that require most of our efforts. Children who arrive at our department are usually those in a very grave condition, with 4th stage lymphomas. The treatment is based on intensive blocks of chemotherapy according to a very strict (biweekly) schedule. To enhance the effect of the treatment, patients with lymphomas may also undergo marrow transplantation. But the treatment is complicated by the fact that the patient's immunity is seriously impaired after each cycle of chemotherapy. As a result, patients suffer from severe infections between the cycles, and virtually all of our children with lymphomas need constant antibacterial and antifungal therapy. However, very few medications are actually suitable for it. In fact, each patient's organism is seriously affected both by the main (oncological) disease and by the toxic chemotherapy, as well as by antibacterial and antifungal medications. This is why the drugs required for treating bacterial and fungal infections must be as mild for the organism as possible and at the same time efficient, like Ambisome, Cancidas, or Vifend. Providing the children with them is a matter of crucial importance. If an infection is not properly treated, the chemotherapy regimen will be disrupted, a thing absolutely intolerable in the case of Burkitt's lymphoma. As soon as the treatment is interrupted, the tumor immediately starts growing again. This is why about one-third of our patients with lymphomas need nearly 1000 USD each day only for the anti-infection therapy. Unfortunately, since these medications are extremely expensive and the patients of our department are often in a very grave condition, budgetary financing is still completely insufficient for purchasing such drugs and we regularly have to ask our friends and sponsors for help. In the most difficult cases, where the disease is already in its developed stages or the patient does not respond to standard chemotherapeutic treatment, such a medication as Mabtera is needed. Usually 5 or 6 infusions of Mabtera are required, each worth 2000 USD. This unique drug shows very good therapeutic effect even in the worst cases. Fortunately, the federal programs have recently paid much more attention to providing this medication to us and we seldom have to search for help in purchasing it. The most numerous group of our patients are children with acute lymphocytic leukemias. Primary acute lymphocytic leukemias can usually be treated at local hospitals successfully enough. We mostly admit patients with relapses of this disease. They require highly intensive treatment, which is still unaffordable for the overwhelming majority of other Russian hospitals. Just as in the case of lymphomas, the treatment is based on chemotherapy cycles administered according to a strictly prescribed schedule. And here is it also very important to avoid fungal and bacterial infections. In some cases, our patients need marrow transplantation after the second remission is attained. The number of such patients increases each year, mainly owing to those needing unrelated transplantations. Our department also performs chemotherapy of cerebral and other tumors (mainly soft-tissue sarcomas; among such patients, 70% suffer from rhabdomyosarcoma of the head or neck). Success in the treatment of these tumors is mostly determined by precise determination of the stage of the disease, good surgical control of the tumor, and adequate radiation therapy. The aim of our department is to provide patients with chemotherapy cycles that will prepare them for the surgical or radiation treatment with utmost care. The surgical treatment takes place either at our hospital or at the Blokhin Oncological Center or Burdenko Research Institute of Neurosurgery. We always try to direct the patient to an institution that can perform the necessary operation for him or her best of all. We also try to ensure that the surgery or radiation treatment takes place as soon as possible, without any delay. Then, the patients again return to our hospital for supportive therapy and control. Since the middle of 2004, our department has also been performing stem cell autotransplantations for patients with 4th stage neuroblastomas and some other diseases whose treatment according to contemporary schemes is unthinkable without intensive chemotherapy. Earlier, such patients died of inevitable relapse or progression of the tumor, or waited for their turn to perform marrow tranasplantation at the corresponding department of the RCCH. Now their chances are better, because they can at last receive contemporary treatment that has long been used in all well-known foreign hospitals. Of course, such an approach requires much more strict requirements to the medical staff, to sterility and intensive anti-infection therapy, including the use of the aforementioned expensive antifungal drugs. In addition, special setups for ultrafine air filtration are also used; their maintenance and regular replacement of antibacterial filters are expensive, and this money is not provided by the hospital (for example, it costs about $550 to prepare the setup for one transplantation). Sponsorship is needed again. A very important part of the treatment is regular checkup of the tumors. It is based on routine CT (computerized tomography), MRI (magnetic resonance imaging), or PET (positron emission tomography) examinations. Unfortunately, we often have to send our patients to other clinics in Moscow for these examinations. The situation is complicated by the fact that 90% of our patients are not from Moscow and, according to the local rules, they have to pay from $150 to $800 (PET) for these examinations. Sometimes, to evaluate the response of the tumor to treatment and to modify the therapy in time, such examinations should be monthly or bimonthly. Needless to say that very few parents in Russia can afford paying $800 for several months. Others will not cope without private sponsors. In addition to the aforementioned visualizing examinations, we often have to perform blood, urine, or feces tests for infections: the so-called bacteriological, mycological, or virological examinatios. They are especially necessary for patients with fever and impaired immunity, because such examinations clearly distinguish the infectious agent and determine its sensitivity to drugs; so, the most efficient medications can be selected. The monthly cost of such tests can amount to $1000-1500. Many patients of our department also need radiation therapy. For this therapy, we have to send them to the Institute of Roentgenology and Radiology. This kind of therapy requires payment, which varies from $300 to $1000. |
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