Objective: Hematological malignancies (HM) are the relatively frequent nosological entities within the structure of morbidity by malignant tumors, exhibiting a severe evolution, restrained prognosis and negative socio-economic impact in the advanced stages and phases. The objective of the study was to analyze the incidence and diagnosis patterns of HM in Moldova.
Methodology: The following research methods were used: epidemiological, descriptive statistics, clinico-analytic. The type of HM was identified according to the Revised 2017 WHO Classification of Tumours of Hematopoietic and Lymphoid Tissues. The diagnosis was proved by histopathological, cytological, cytogenetic, molecular and immunophenotyping examinations. The quantitative real-time PCR was used in order to assess the expression of BCR-ABL p210 and p190 transcripts for CML diagnosis. The quantitative detection of JAK2 V617F mutation served as a major criterion for diagnosis of polycythemia vera (PV) and primary myelofibrosis (PMF).
Results: The number of newly diagnosed and followed-up patients with HM at the Institute of Oncology in 2016, 2017, 2018 and 2019 amounted respectively to 725, 802, 613 and 628, the incidence (new cases per 100,000 population) being 17.6, 19.5, 14.9 and 17.7. In 2019 Hodgkin lymphoma was diagnosed in 9.4% of cases, non-Hodgkin lymphomas – in 36.4%, multiple myeloma and plasma cells neoplasms – in 8.6%, lymphoid leukemias – in 13.7%, myeloid leukemias – in 8.3%, monocytic leukemias – in 1.7%, and other leukemias – in 19.8%. The male's rate was 51.5%, the female's rate – 48.5%. The age of 50–79 years prevailed in both genders (males – 65%, females – 72.5%). The children constituted 4.0% of newly diagnosed cases and 4.8% of those under the follow-up at the end of the year. Regarding the chronic myeloproliferative neoplasms (CMN), prefibrotic stage of PMF was confirmed in 42.1% of cases, fibrotic stage – in 57.9%. The diagnosis of CML was asserted in chronic phase in 89.3% of patients and in accelerated phase in 10.7%. PV was diagnosed in erythremic stage in all cases: II A – in 87.1% of cases, IIB – in 12.9%. The age group of 60–69 years proved to be more numerous in PV (80.6%), as compared with CML (53.4%) and PMF (52.6%) cases. The disease span range from the onset to diagnosis was 1.4–7 months (median – 3.5±0.63 months) in PMF, 1.5–12 months (median – 2.1±0.37 months) in CML, and 1–8 months (median – 3.8±0.54 months) in PV. The clinical onset and addressability of patients with CML and PMF did not significantly differ, the absolute majority (over 90%) being consulted by the family doctors because of the appearance of fatigue, left upper hemiabdomen heaviness and pain. The majority of PV patients (67.7%) addressed for the medical care by reason of a stable arterial hypertension and astheno-vegetative syndrome.
Conclusion: The incidence of malignant lymphomas and leukemias in Moldova emerged rather lower than in the majority of European countries mainly due to the migration of a workable population. Mostly the 50–79 years old males proved to be affected. PV yielded to be less frequently registered CMN, diagnosed more tardily due to the resemblance with cardio-vascular disorders.
