неблагоприятные цитогенетические варианты

Достижения и проблемы трансплантации аллогенных гемопоэтических стволовых клеток у больных с цитогенетически неблагоприятными вариантами острых лейкозов (обзор литературы)

ОБЗОРЫ , , , , ,

Н.Н. Мамаев, Т.Л. Гиндина, Б.В. Афанасьев

НИИ детской онкологии, гематологии и трансплантологии им. Р.М. Горбачевой, ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова», ул. Льва Толстого, д. 6/8, Санкт-Петербург, Российская Федерация, 197022

Для переписки: Николай Николаевич Мамаев, д-р мед. наук, ул. Льва Толстого, д. 6/8, Санкт-Петербург, Российская Федерация, 197022; e-mail: nikmamaev524@gmail.com

Для цитирования: Мамаев Н.Н., Гиндина Т.Л., Афанасьев Б.В. Достижения и проблемы трансплантации аллогенных гемопоэтических стволовых клеток у больных с цитогенетически неблагоприятными вариантами острых лейкозов (обзор литературы). Клиническая онкогематология. 2019;12(2):111–9.

DOI: 10.21320/2500-2139-2019-12-2-111-119

РЕФЕРАТ

Обзор литературы посвящен анализу результатов лечения с помощью трансплантации аллогенных гемопоэтических стволовых клеток (аллоТГСК) больных с цитогенетически неблагоприятными вариантами острых миелоидных и лимфобластных лейкозов, которые включали моносомные, сложные и гипердиплоидные кариотипы, транслокации t(3;3)/inv(3), t(v;11)(v;q23), t(4;11)(q21;q23), t(9;22)(q34;q11), аномалии abn(17p) и некоторые другие нарушения. По-видимому, основной негативный момент аллоТГСК связан с мощным повреждающим действием на хромосомы входящих в режимы кондиционирования цитостатических препаратов, что, в свою очередь, ассоциируется с появлением в опухолевых элементах дополнительных хромосомных аномалий, ростом нестабильности генома и опухолевым прогрессированием. Наоборот, одним из положительных моментов аллоТГСК может быть присущая ей реакция «трансплантат против лейкоза» (РТПЛ), степень развития которой пока изучена недостаточно. Для уменьшения риска лечения этой категории больных с помощью аллоТГСК представляется необходимым использовать новые лечебные подходы, основанные на принципах деэскалации повреждающей нагрузки на хромосомы и геном в целом, а также внедрять в клиническую практику недавно появившиеся способы активной стимуляции и качественной оценки РТПЛ.

Ключевые слова: острые лейкозы, неблагоприятные цитогенетические варианты, аллоТГСК, исходы, дополнительные хромосомные аномалии, реакция «трансплантат против лейкоза».

Получено: 22 октября 2018 г.

Принято в печать: 2 февраля 2019 г.

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