Andrey I. Vorobyov (1928-2020), Academician of the Russian Academy of Medical Sciences and the Russian Academy of Sciences, Doctor of Medical Sciences, Professor.
Andrey Vorobyov was born on November 1, 1928 in Moscow. In 1953 he graduated from the 1st Moscow Medical Institute. From 1953 to 1956 he worked as a doctor in the Volokolamsk District Hospital, where he was engaged in therapy, pathological anatomy and pediatrics. In 1956 he entered clinical residency at the Central Institute for Advanced Medical Studies at the Department of Therapy under the leadership of the most famous Soviet therapist - Academician Iosif Abramovich Kassirsky.
After residency, he remained at the department as an assistant, and in 1956 he became an associate professor. In 1963 he defended his thesis for the degree of Candidate of Medical Sciences, devoted to the study of the structure of erythrocytes in hemolytic anemia.
By 1965 Vorobyov had formulated and published his understanding of tumor progression, based on the then original clonal understanding of the nature of leukemias, the mutational basis of their variability, morphology and behavior, their division into
In 1966 Vorobyov was appointed Head of the Clinical Department of the Institute of Biophysics of the USSR Ministry of Health. Some of the employees of Kassirsky’s department left with him. The team’s main topic of focus was radiation sickness. For the first time in the world, a system of biological dosimetry was developed based on clinical signs and the time of their appearance, changes in the blood and chromosomal analysis (Evgeny Kirillovich Pyatkin), which allowed for the determination of future severity, the timing of agranulocytosis, etc., even before the development of vivid symptoms of the disease.
The first bone marrow transplants began at the clinic and aseptic boards were created (A.E.Baranov). All this was later transferred to the Hematological Research Center of the Russian Academy of Medical Sciences.
In 1968 Vorobyov defended his doctoral dissertation on the problems of tumor progression in leukemia, and in 1969 he was awarded the academic title of Professor.
In 1971, after the death of I.A.Kassirsky, Andrei Vorobyov became the head of the Department of Hematology and Intensive Therapy of the Central Institute for Advanced Medical Training.
In the early 1970’s (earlier than Western colleagues), together with M.D. Brilliant, Vorobyov introduced intralumbar cytostatic prevention of neuroleukemia instead of irradiation of the head.
Working at the Institute of Biophysics and at the department, the team of Andrey Vorobyov worked closely with the scientists of the Institute of Blood Transfusion (I.L. Chertkov, L.S. Lyubimova, V.V. Kochemasov.) Even then, the features of emergency acute radiation sickness were clear, which showed the futility of hope for bone marrow transplantation. The result of this work was the abandonment of bone marrow banks already built in the USSR in the event of a nuclear war. Thanks to this work, the USSR was significantly ahead of its hypothetical adversary - the United States.
At the same time, an important concept was formulated about cytostatic disease, its pathogenesis, and principles and conditions of therapy. The team gave a classical description of the pathogenesis of radiation sickness, created the world's only comprehensive system of biological dosimetry, including analysis of the kinetics of cell populations and analysis of chromosomal rearrangements and morphological changes in tissues. This led to the development of the theoretical foundations of pathogenetic intensive therapy in radiation pathology, hematology and other conditions characterized by massive tissue decay.
Together with the outstanding organizer of "radiation medicine" V. I. Shakhmatov, the field of emergency acute radiation sickness was clinically stimulated. And although it was impossible to foresee the epidemiological consequences, Russia’s medicine was ready for the Chernobyl accident in 1986, when the indispensability of pathogenetic intensive therapy in conditions of massive radiation injuries was confirmed.
In 1984 Vorobyov was elected a corresponding member and in 1987, a full member of the Academy of Medical Sciences of the USSR.
The works of the collective under the direction of Andrey Vorobyov have received well-deserved recognition in Russia and abroad. It is he and his staff who are credited with introducing programmed therapy for acute leukemia into domestic medical practice, which made it possible to no longer consider acute leukemia as an incurable disease. In 1987, Andrey Vorobyov and co-authors were awarded the title of laureate of the USSR State Prize for the series of works "New Methods of Diagnostics and Intensive Therapy of Diseases of the Blood System."
In 1988 Vorobyov was elected from the Russian Academy of Medical Sciences as a People's Deputy of the Congress of People's Deputies of the USSR, and later to the Supreme Soviet of the RSFSR.
From 1987 to 2011 he was the director of the Hematological Research Center of the Russian Academy of Medical Sciences.
Andrey Vorobyov had great organizational talent. His work on the organization of the elimination of the medical consequences of the Chernobyl accident, for which he was awarded the Order of Lenin (1988), is well known. His contribution to the development of methods of crush syndrome therapy in earthquakes and in the creation of new principles of transfusiological care in the centers of natural and man-made mass disasters, corresponding to the modern development of delivery and evacuation means, is significant.
Andrey Vorobyov was successful in transferring the Hematological Research Center from the subordination of the Ministry of Health to the Russian Academy of Medical Sciences.
For the first time in the country’s history, the Hematological Research Center mastered the industrial production of VIII and IX clotting factors, providing itself with factor IX completely. A patent for genetically engineered factor VIII was also obtained.
Following the example of the pre-war years, branches of the Hematological Research Center were opened in Krasnoyarsk and Arkhangelsk.
To combat very high maternal mortality from massive blood loss, an aid team was created at the Hematological Research Center under the leadership of V.M. Gorodetsky, who wrote the instructions for assistance. These instructions traveled throughout the maternity wards of the country and introduced into obstetric practice the use of fresh frozen plasma, not whole blood, to stop massive bleeding. As a result, the mortality rate of women during childbirth in the country was reduced by half, and in large cities by four or more times.
High-dose and, as it turned out, highly effective programs began to be introduced (A.V. Kremenetskaya).
Success was achieved in the treatment of previously incurable lymphosarcomas of various localization, Burkitt's lymphoma, which did not respond well to stage IV lymphogranulomatosis. This resulted in persistent remissions in the first cycle of modified high-dose therapy programs. Such remissions, after several years, should be considered recovery. These results exceeded the data of foreign publications.
Through the efforts of the scientists of the Hematological Research Center, for the first time in the world, several tumors of the blood system became curable with an efficiency close to 100%: B-cell lymphosarcomas of the lymph nodes, tonsils, spleen, stomach, Burkitt.
1991-1992 - Minister of Health in the government of Boris Yeltsin. During the difficult years of the collapse of the economy and the financial system, putting the needs of the patient above all, with the help of like- minded people in the Government, Andrey Vorobyov prepared a Presidential Decree on financing particularly expensive types of medical care in a separate budget line: cardiovascular surgery, neurosurgery, hematology, etc. This Decree (dated September 26, 1992) saved high-tech medical care, which was not covered by the usual insurance and budget, and to a decisive extent contributed to the preservation of the national health care system, scientific personnel and priority scientific areas and centers.
As a result, the Hematological Research Center along with highly qualified personnel remained.
The scientific school of A.I. Vorobyov is among the leading scientific schools in Russia and has received the support of the Russian Foundation for Basic Research. On several occasions Vorobyov represented Russian medicine at international forums and congresses.
The scientific team led by Andrey Vorobyov made a fundamental contribution to the development of modern hematology clinically, morphologically and experimentally. He developed a scheme of hematopoiesis, which is the basis of all modern works on leukogenesis. An original theory of tumor progression of leukemias was developed based on the phenomenon of increased mutability of tumor cells and the appearance of subclones in a previously monoclonal tumor. Instead of the previously existing descriptive approach to tumor growth, the identification of universal patterns of the development of malignant tumors was carried out. Thanks to this, the previously unrelated morphological, functional, cytogenetic and clinical signs of tumor growth were made clear.
By studying the differentiation of erythropoiesis by age profile using the analysis of the kinetics of lysis, the existence of potentially isolated (reserve clone) erythrocytes that are produced by the bone marrow under conditions of intense erythropoiesis was shown. Using the same methodological approach, the fundamental difference of erythrocytes of different age groups (with their morphological similarity) was shown, which was another confirmation of the theory of "cell layers".
Based on a comprehensive analysis of the widest spectrum of human pathology, primarily leucogenesis, the theory of "cell layers" was proposed, which states that in the postnatal development of the organism there is a change in functionally related ancestral cellular elements, which, in particular, explains the fundamental difference between tumors of the same age period from morphologically similar tumors of another age period.
Andrey Vorobyov's work was inextricably linked with teaching not only hematology, but also cardiology, transfusiology, morphology, differential diagnosis and intensive care of critical conditions at the Department of Hematology and Intensive Care of the Central Institute for Advanced Medical Studies (now the Russian Medical Academy of Postgraduate Education). His brilliant lectures on the problems of internal medicine at morning conferences, where starting from specific clinical situations, the most pressing issues of diagnosis and treatment were discussed. These morning lectures are widely known not only in Moscow, but also far beyond its borders. The annual ten days in memory of I. A. Kassirsky "New in hematology and transfusiology", held under his leadership since 1972, have become practically informal congresses of hematologists throughout the country and the CIS countries.
Andrey I. Vorobyov is the author of about 400 scientific works, including monographs, textbooks and teaching aids. The most important of them: "Cardialgia" (1998), "Acute Massive Blood Loss" (2001), "Guide to Hematology” in 2 volumes (2002, 2003). 57 dissertations were defended under his supervision, including 15 doctoral dissertations.
Since 2000, Andrey Vorobyov has been an Academician of the Russian Academy of Sciences.
For more than 30 years, Vorobyov was the chairman of the Moscow City Scientific Society of Physicians, the chief physician of the Medical Center of the Administrative Department of the Presidential Administration of the Russian Federation. He was the editor-in-chief of the journal “Hematology and Transfusiology.”
