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D. A. Bazyka1, V. A. Zhovnir1, K. M. Bruslova1, L. O. Lyashenko1, T. I. Pushkareva1,
N. M. Tsvietkova1, I. V. Trychl³b1, S. M. Bakalinska3, T. P. Gavrylenko3, Z. M. Rodina3,
S. G. Galkina1, V. G. Kondrashova1, Zh. S. Yaroshenko1, L. O. Gonchar1, S. M. Iatsemyrskyi1,
V. D. Pismenniy2, V. G. Boyarskyi1, O. Y. Pleskach1, T. O. Chernysh1
1State Institution «National Research Center for Radiation Medicine, Hematology and Oncology of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka Str., Kyiv, 04050, Ukraine
2O. O. Bogomolets Memorial National Medical University, 13 Taras Shevchenko Blvd, Kyiv, 01024,
Ukraine
3Consultative and Diagnostic Center #1 of Kyiv City Darnytsky district, 8D Trostianetska St., Kyiv,
02091, Ukraine
THE PROLIFERATIVE-DIFFERENTIAL PROCESSES IN BONE MARROW UNDER CHEMOTHERAPY DELIVERY DEPENDING ON THE IRON METABOLISM IN CHILDREN WITH ACUTE LYMPHOID LEUKEMIA LIVING IN RADIOLOGICALLY CONTAMINATED TERRITORIES
Objective: assessment of the role of iron metabolism in proliferation, differentiation and hematopoietic recovery
types under the chemotherapy (CT) delivery in children with acute lymphoid leukemia (ALL), living in radiologically contaminated territories (RCT) of Ukraine.
Materials and methods. The ALL patients (n = 61) aged 3 to 15 years, residing in RCT, were examined. The observation period was 20 years. There were pre-B (n = 7), «general» type (n = 50), and pro-B (n = 4) ALL variants among
the study subjects. Patients had received CT according to the adapted protocols by the Berlin-Frankfurt-Munster
group (BFM). Study schedule featured the Period «0» before the CT initiation with respective studied parameters,
Period 1 and Period 2 corresponding to the remission induction therapy, and periods 3, 4 and 5 corresponding to the
remission consolidation therapy. The hemogram and myelogram parameters were studied during all periods. Serum
iron (SI), serum ferritin (SF) and transferrin levels were assayed. The results of treatment were taken into account.
Radiation doses to the bone marrow (BM) were calculated.
Results. There was the highest BM cellularity by the number of myelokaryocytes (MKC) ((202.0 ± 21.2) G/l) before
CT initiation due to the tumor clone followed by a decrease during periods of remission induction therapy and
increase during periods of consolidation ((126.7 ± 11.5) G/l), not exceeding however the limits of normative values.
More often the BM recovery during CT had occurred by the granulocytic type. The erythroid type was observed in a
third of patients only at the beginning of CT. The monocytic type was specific to the patients in the first periods of
consolidation. After the end of CT the content of iron in 62.3 % of children was within normal range with in 37.7 %
of them being increased ((38.0 ± 2.1) µmol/l). Level of iron in 24.6 % of patients was high ((345.3 ± 16.4) ng/ml),
indicating an excess of iron in the body. Level of iron after the CT completion was higher in pro-B-ALL type cases
((485.0 ± 22.7) ng/ml) compared to pre-B-HLL ((278.3 ± 19.6) ng/ml) and «general» type ones ((311.1 ± 21.3) ng/ml)
(ð < 0.05). An inverse correlation was established between the ALL prognosis and SI (r = -1.0; ð < 0.001) and SF levels (r = -0.44; ð < 0.05). The average radiation dose to the BM was (3.87 ± 1.12) mSv with no effect on the type of
BM recovery during CT and iron metabolism.
Conclusions. Proliferation and differentiation of hematopoietic elements during the BM recovery in ALL patients
under CT depend on the iron metabolism. Excess iron in the body negatively affects the disease prognosis in children.
Key words: children; acute lymphoid leukemia; chemotherapy; type of bone marrow recovery; iron metabolism;
radiation factor.
Problems of Radiation Medicine and Radiobiology.
2025;30:322-333. doi: 10.33145/2304-8336-2025-30-322-333
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