Истинная полицитемия: обзор литературы и собственные данные

И.Н. Суборцева, Т.И. Колошейнова, Е.И. Пустовая, Е.К. Егорова, А.М. Ковригина, Ю.В. Плискунова, Т.В. Макарик, А.О. Абдуллаев, А.Л. Меликян

ФГБУ «Гематологический научный центр» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167

Для переписки: Ирина Николаевна Суборцева, канд. мед. наук, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167; тел.: +7(495)612-44-72; e-mail: soubortseva@yandex.ru

Для цитирования: Суборцева И.Н., Колошейнова Т.И., Пустовая Е.И. и др. Истинная полицитемия: обзор литературы и собственные данные. Клиническая онкогематология. 2015;8(4):397–412.

DOI: 10.21320/2500-2139-2015-8-4-397-412


РЕФЕРАТ

Актуальность и цели. Истинная полицитемия (ИП) относится к группе классических Ph-негативных миелопролиферативных заболеваний и характеризуется панмиелозом, панцитозом, высоким риском тромбогеморрагических осложнений, низким качеством жизни из-за присутствия симптомов опухолевой пролиферации. Малые дозы ацетилсалициловой кислоты и проведение кровопусканий/эритроцитафереза рекомендованы для пациентов с низким риском тромбогеморрагических осложнений. Циторедуктивная терапия (гидроксимочевина или интерферон-a) показана пациентам с высоким риском тромбогеморрагических осложнений. В настоящее время проблемам диагностики и лечения больных ИП уделяется все большее внимание.

Методы. В статье представлены краткое описание данного заболевания, обзор современных методов лечения, результаты наблюдения за 100 больными ИП, которые получали терапию в поликлиническом отделении Гематологического научного центра. Длительность наблюдения за пациентами составила 6–262 мес. (медиана 14 мес.).

Результаты. Больные были в возрасте 23–80 лет (медиана 56 лет), доля женщин составила 67 %, мужчин — 33 %. У всех пациентов диагноз ИП установлен в соответствии с классификацией ВОЗ 2008 г. Мутация V617F гена JAKвыявлена в 100 % наблюдений. Спленомегалия констатирована у 70 % пациентов. Плеторический синдром (гиперемия лица, ладоней, инъецированность склер) наблюдался у 65 % больных. Все пациенты предъявляли жалобы на головную боль, головокружение, а 25 % из них — на кожный зуд. Все пациенты получали симптоматическую терапию, антиагреганты, препараты, улучшающие микроциркуляцию, или антигипоксанты. Лечение проводилось в соответствии с клиническими рекомендациями: 49 % пациентов получали гидроксимочевину, 14 % — интерферон (ИФН a-2b), 14 % — комбинированную терапию (гидроксимочевину и кровопускания или ИФН a-2b и кровопускания), 23 % — только кровопускания. Ответ на лечение оценивался согласно критериям Европейской организации по изучению и лечению лейкозов 2009 г. Во всей группе больных без учета проводимой терапии частота полных ремиссий составила 48 %, частичных — 41 %, эффекта не получено у 11 % пациентов. Смена терапии осуществлялась при неэффективности, непереносимости лечения или развитии осложнений. При переключении лечения с одного метода на другой полная ремиссия не была достигнута ни у одного больного.

Заключение. Лечение ИП в основном симптоматическое. Эффективность терапии первой линии (полная ремиссия) равна 14,5–71 %. Необходимо проведение клинических исследований, направленных на оценку эффективности и безопасности новых таргетных препаратов.


Ключевые слова: миелопролиферативные заболевания, истинная полицитемия, JAK2V617F, таргетная терапия.

Получено: 30 июня 2015 г.

Принято в печать: 5 ноября 2015 г.

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