Преодоление резистентности при рецидивах анапластической крупноклеточной лимфомы, ALK-позитивной (обзор литературы и собственное клиническое наблюдение)

Ю.Е. Виноградова1, Н.Г. Чернова2

1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет), ул. Трубецкая, д. 8, стр. 2, Москва, Российская Федерация, 119991

2 ФГБУ «НМИЦ гематологии» Минздрава России, Новый Зыковский пр-д, д. 4а, Москва, Российская Федерация, 125167

Для переписки: Юлия Ейхеновна Виноградова, канд. мед. наук, ул. Трубецкая, д. 8, стр. 2, Москва, Российская Федерация, 119991; тел.: +7(495)609-14-00, +7(916)195-68-57; е-mail: jvinogr@gmail.com

Для цитирования: Виноградова Ю.Е., Чернова Н.Г. Преодоление резистентности при рецидивах анапластической крупноклеточной лимфомы, ALK-позитивной (обзор литературы и собственное клиническое наблюдение). Клиническая онкогематология. 2019;12(2):179–84.

DOI: 10.21320/2500-2139-2019-12-2-179-184


РЕФЕРАТ

Периферические Т-клеточные лимфомы (ПТКЛ) характеризуются плохим прогнозом и худшей выживаемостью по сравнению с В-клеточными. Вероятность достижения ремиссии при терапии первой линии при ПТКЛ не превышает 60 %, отмечается высокая частота развития рецидивов. В большинстве случаев рецидивов/прогрессирующего течения ПТКЛ не удается достичь продолжительной ремиссии. В настоящей статье представлены обзор литературы и описание собственного клинического наблюдения анапластической крупноклеточной лимфомы, ALK-позитивной, протекающей с первичным поражением кожи и мягких тканей у пациентки 65 лет. После проведения интенсивной химиотерапии по программе NHL-BFM-90 больная пребывала в первой полной ремиссии 5,5 года. В дальнейшем развился рецидив заболевания, резистентный к СНОР-терапии. Резистентность опухоли к химиотерапии была успешно преодолена добавлением к цитостатическому противоопухолевому воздействию эпигенетических препаратов. Продолжительность второй полной ремиссии составляет 3 года. При лечении онкогематологических заболеваний с исходной резистентностью к химиотерапии или с резистентностью, приобретенной в процессе противоопухолевого лечения, наиболее рационально использовать различные лечебные комбинации, включающие моноклональные антитела, эпигенетические препараты и цитостатическую терапию.

Ключевые слова: анапластическая крупноклеточная лимфома, ALK-позитивная, вовлечение кожи, резистентность при рецидивах, эпигенетические препараты.

Получено: 26 июля 2018 г.

Принято в печать: 15 января 2019 г.

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Неходжкинские лимфомы у детей: 25 лет терапии

Т.Т. Валиев, А.В. Попа, А.С. Левашов, Е.С. Беляева, Н.С. Куличкина, Б.В. Курдюков, Р.С. Равшанова, Г.Л. Менткевич

НИИ детской онкологии и гематологии ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Москва, Каширское ш., д. 24, Российская Федерация, 115478

Для переписки: Тимур Теймуразович Валиев, д-р мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: +7(499)324-98-69; e-mail: timurvaliev@mail.ru

Для цитирования: Валиев Т.Т., Попа А.В., Левашов А.С. и др. Неходжкинские лимфомы у детей: 25 лет терапии. Клиническая онкогематология. 2016;9(4):420–37.

DOI: 10.21320/2500-2139-2016-9-4-420-437


РЕФЕРАТ

Актуальность и цели. Современные программы полихимиотерапии, в основе которых лежит дифференцированный риск-адаптированный подход, позволили рассматривать неходжкинские лимфомы (НХЛ), ранее считавшимися фатальными, как потенциально излечимые заболевания. Цель настоящей работы — обобщение и анализ результатов лечения НХЛ за 25-летний период.

Методы. В исследование включено 246 больных, проходивших лечение в отделении химиотерапии гемобластозов НИИ ДОГ ФГБУ «РОНЦ им. Н.Н. Блохина» МЗ РФ за 25 лет: с 1.04.1991 по 1.06.2016 г. При В-клеточных НХЛ (n = 130) использовались программы B-NHL-BFM 90/95, а также модифицированная программа B-NHL-BFM 95 (включен ритуксимаб). Больным лимфобластным лейкозом (n = 75) лечение проводилось по протоколам ALL-mBFM 90/95 и ALL IC-BFM 2002. При анапластической крупноклеточной лимфоме (АККЛ) 21 больной получил лечение по протоколу B-NHL-BFM 90/95, 20 — по программе НИИ ДОГ-АККЛ-2007.

Результаты. С учетом клинико-иммунологических особенностей АККЛ авторами был разработан оригинальный протокол НИИ ДОГ-АККЛ-2007. Особое внимание уделялось возможности модификации стандартных программ лечения НХЛ из зрелых В-клеток (В-НХЛ) путем включения ритуксимаба. Показана эволюция в назначении ритуксимаба при В-НХЛ и возможность редукции общего числа блоков полихимиотерапии при поздних стадиях опухоли без снижения результатов лечения.

Заключение. Полученные данные позволяют считать, что внедрение достижений онкоиммунологии, молекулярной биологии и цитогенетики станет основой последующей модификации существующих программ терапии НХЛ.


Ключевые слова: лимфома Беркитта, диффузная В-крупноклеточная лимфома, анапластическая крупноклеточная лимфома, первичная медиастинальная (тимическая) В-крупноклеточная лимфома, Т- и В-лимфобластные лимфомы, лечение, дети.

Получено: 12 июня 2016 г.

Принято в печать: 17 июня 2016 г.

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Современные аспекты диагностики и лечения анапластической крупноклеточной лимфомы у детей (обзор литературы)

А.С. Левашов1, Т.Т. Валиев1, А.М. Ковригина2, А.В. Попа1, Г.Л. Менткевич1

1 ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Москва, Российская Федерация, 115478

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

Для переписки: Андрей Сергеевич Левашов, научный сотрудник, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: +7(916)233-05-75; e-mail: andreyslevashov@mail.ru

Для цитирования: Левашов А.С., Валиев Т.Т., Ковригина А.М. и др. Современные аспекты диагностики и лечения анапластической крупноклеточной лимфомы у детей (обзор литературы). Клиническая онкогематология. 2016;9(2):199–207.

DOI: 10.21320/2500-2139-2016-9-2-199-207


РЕФЕРАТ

Анапластическая крупноклеточная лимфома (АККЛ) включает различные варианты заболевания, гетерогенные по клиническим, морфологическим, иммунологическим, цитогенетическим и молекулярно-биологическим параметрам. В обзоре не только приведены основные клинические и иммуноморфологические особенности АККЛ, но и представлены данные по экспрессии и прогностической роли STAT3, pSTAT3tyr705, survivin (транскрипционный фактор). Показано значение определения минимальной диссеминированной болезни (минимальная диссеминированная болезнь оценивается перед началом лечения методом ПЦР, минимальная остаточная болезнь — в процессе лечения и после его завершения), обозначены клинические и молекулярно-биологические факторы прогноза. Единой программы терапии АККЛ у детей в настоящее время нет. Однако наиболее эффективными признаются NHL-BFM 90/95, CCG5941, SFOP-LM 89/91, UKCCSG, ALCL99-Vinblastine, POG АРО 9315, AIEOP LNH-92/97. Результаты лечения по этим протоколам представлены в настоящей работе. Отдельное внимание уделяется изучению молекулярно-биологических маркеров, которые открывают путь к дальнейшему совершенствованию стратификации больных на группы риска и возможности применения таргетных препаратов (мультикиназных ингибиторов и моноклональных антител), улучшающих результаты терапии.


Ключевые слова: анапластическая крупноклеточная лимфома, диагностика, лечение, дети.

Получено: 3 февраля 2016 г.

Принято в печать: 10 февраля 2016 г.

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Т-клеточные лимфомы: возможности терапии при ограниченном выборе

В.А. Доронин

ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва, Российская Федерация


РЕФЕРАТ

Периферические и кожные Т-клеточные лимфомы (ПТКЛ и КТКЛ) представляют собой особую группу неходжкинских лимфом (НХЛ) с широким спектром молекулярных и генетических особенностей, а также разнообразными симптомами и клиническими проявлениями. Разнородность и редкость этих заболеваний создают трудности при проведении клинических исследований, а прогресс в лечении идет гораздо медленнее, чем при более распространенных В-клеточных НХЛ. Вследствие этого для Т-клеточных лимфом до настоящего времени не существует стандартов терапии. Лечение часто проводится в рамках клинических исследований. В статье рассматриваются оптимальные возможности терапии ПТКЛ и КТКЛ, обсуждаются также новые варианты лечения.


Ключевые слова: Т-клеточные лимфомы, периферическая Т-клеточная лимфома неуточненная, ангиоиммунобластная Т-клеточная лимфома, анапластическая крупноклеточная лимфома, кожные Т-клеточные лимфомы.

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