Gynecological aspects of the management of children with malignant blood diseases and similar conditions
Background. Thanks to the current advances in hematologic oncology, the healthcare system faces a task of preserving the reproductive potential in surviving patients. The high efficiency of specific treatment for malignant blood diseases (MBD) and similar conditions is associated with high risks for reproductive disorders. Pediatric and adolescent patients occupy a special place. In 2017, the number of children with any cancer was 88.1 per 100,000 people in the Russian Federation. At the same time, global statistics show that in girls aged 0 to 14 years, acute leukemias account for up to 40% of cancers, which is 2.6 times higher than those in women aged 15–44 years.Kokhreidze N.A., Alieva K.Kh., Ulrikh E.A., Ekushev K.A., Paina O.V., Zubarovskaya L.S., Efimova-Korzeneva O.A.
Case report. The paper deals with the pattern and features of gynecological diseases characteristic for girls with MBD and similar conditions. Information is provided on the degree of gonadotoxicity of different classes of chemotherapy drugs, the procedures of gonadal shielding, and an individual approach to preventing uterine bleeding, as well as indications for and options of hormonal correction of estrogen deficiency. The paper presents a clinical case of a complication of medication-induced menses suppression in a 16-year-old patient, describes a case of extramedullary (ovarian) leukemic relapse in a 12-year-old girl, and gives an example of management of a 17-year-old patient with genital manifestations of grade III graft-versus-host disease. It considers the features of genital inflammatory diseases in girls with MBD: the high incidence of the torpid course of purulent vulvovaginitis; isolation of bacteria resistant to most antibiotics; the susceptibility of these patients to soft tissue infections; a prolonged course of vulvovaginal candida infection. The paper provides an example of vulvar lesion in a 3.5-year-old child with Langerhans cell histiocytosis.
Conclusion. The literature data and the authors’ own observations contained in the article provide an opportunity to get an idea of the peculiarities of a gynecologist’s work with this specific group of patients as children with MBD and similar conditions.
Keywords
hematological oncology
lymphoma
acute leukemia
menstrual disorders
menopausal hormone therapy
graft-versus-host disease
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Received 23.10.2020
Accepted 29.12.2020
About the Authors
Nadezhda A. Kokhreidze, Dr. Med. Sci., Associate Professor, Head of the Department of Gynecology of Children and Adolescents, Children's Medical and Rehabilitation Complex, Almazov National Medical Research Center, Ministry of Health of Russia. Е-mail: Kokhreidze_NA@almazovcentre.ru. ORCID: 0000-0002-0265-9728; SPIN-код: 9382-2225, AuthorID: 648349. 197341, Russia, Saint-Petersburg, Kolomyazhsky ave., 21-2.Kyaniz Kh. Alieva, obstetrician-gynecologist, Department of Gynecology of Children and Adolescents, Children's Medical and Rehabilitation Complex, Almazov National Medical Research Center, Ministry of Health of Russia; R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology. E-mail: Alieva_KKh@almazovcentre.ru. ORCID: 0000-0003-0083-3689; SPIN-код: 8004-5785, Author ID: 903413. 197341, Russia, Saint-Petersburg, Kolomyazhsky ave., 21-2.
Elena A. Ulrikh, Dr. Med. Sci., Professor, oncologist-gynecologist, Almazov National Medical Research Center, Ministry of Health of Russia.
E-mail: ulrikh_ea@almazovcentre.ru. SPIN-код: 1110-1844, AuthorID: 668989. 197341, Russia, Saint-Petersburg, Kolomyazhny str., 21-2.
Kirill A. Ekushev, oncohematologist, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology.
E-mail: ekushov.kirill@mail.ru. 197022, Russia, Saint-Petersburg, Rentgen str., 12.
Olesya V. Paina, PhD, Head of the Department of Bone Marrow Transplantation for Children No. 1, R.M. Gorbacheva Research Institute of Pediatric Oncology,
Hematology and Transplantology. 197022, Russia, Saint-Petersburg, Rentgen str., 12.
Lyudmila S. Zubarovskaya, Dr. Med. Sci., Professor, Head of the Department of Oncology, Hematology and Transplantology for Children, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology. E-mail: zubarovskaya_ls@mail.ru ORCID: 0000-0003-2594-7703.
197022, Russia, Saint-Petersburg, Rentgen str., 12.
Olesya A. Ephimova-Korzeneva, obstetrician-gynecologist, R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology.
E-mail: olesyakorzeneva@yandex.ru. 197022, Russia, Saint-Petersburg, Rentgen str., 12.
For citation: Kokhreidze N.A., Alieva K.Kh., Ulrikh E.A., Ekushev K.A., Paina O.V., Zubarovskaya L.S., Efimova-Korzeneva O.A. Gynecological aspects of the management of children with malignant blood diseases and similar conditions.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 4: 165-173 (in Russian)
https://dx.doi.org/10.18565/aig.2021.4.165-173
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