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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Оптимизация диагностики и лечения лимфомы Беркитта у детей, подростков и молодых взрослых

Т.Т. Валиев1, Е.А. Барях2, П.А. Зейналова3, А.М. Ковригина2, С.К. Кравченко2, Т.Н. Обухова2, Н.А. Фалалеева3, А.И. Сендерович3, И.Н. Серебрякова3, И.В. Каминская1, А.C. Левашов1, Г.Л. Менткевич1

1 НИИ детской онкологии и гематологии ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва, Российская Федерация

2 ФГБУ «Гематологический научный центр» МЗ РФ, Москва, Российская Федерация

3 НИИ клинической онкологии ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва, Российская Федерация


РЕФЕРАТ

В работе представлен и обобщен опыт ведущих российских онкогематологических клиник. В статье приводятся иммуноморфологические и цитогенетические критерии диагностики лимфомы Беркитта (ЛБ) у детей, подростков и молодых взрослых. Описаны клинические особенности ЛБ в разных возрастных группах. Освещены вопросы лечения ЛБ по современным программами B-NHL-BFM 90/95 и CODOX-M/IVAC. Приводятся результаты лечения по оригинальному отечественному протоколу ЛБ-М-04. Обсуждается место ритуксимаба в терапии ЛБ.


Ключевые слова: лимфома Беркитта, дети, подростки, молодые взрослые, клиника, диагностика, лечение

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Эволюция взглядов на диагностику и лечение лимфомы Беркитта

Т.Т. Валиев1, Е.А. Барях2

1 НИИ детской онкологии и гематологии ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» РАМН, Москва, Российская Федерация

2 ФГБУ «Гематологический научный центр» МЗ РФ, Москва, Российская Федерация


РЕФЕРАТ

В историческом аспекте освещены вопросы диагностики и лечения наиболее агрессивной лимфоидной опухоли — лимфомы Беркитта (ЛБ). Представлены клинико-лабораторные особенности эндемического и спорадического вариантов ЛБ. Описаны возможные механизмы участия вируса Эпштейна—Барр и Plasmodium falciparum в патогенезе опухоли. Приведены основные морфологические, иммунологические и цитогенетические диагностические критерии. Рассмотрены вопросы дифференциальной диагностики с гетерогенной группой диффузных В-крупноклеточных лимфом и высокоагрессивными зрелоклеточными лимфомами из В-клеток с дополнительными аберрациями протоонкогенов («double hit» и «triple hit» лимфомы). Отдельное внимание в статье уделено вопросам терапии ЛБ и месту в ней ритуксимаба.


Ключевые слова: лимфома Беркитта, клиника, диагностика, лечение.

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