Хромотрипсис в онкологии: обзор литературы и собственное наблюдение

Н.Н. Мамаев1, Т.Л. Гиндина1, Э.Г. Бойченко2

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

2 Детская городская больница № 1, ул. Авангардная, д. 14, Санкт-Петербург, Российская Федерация, 198205

Для переписки: Татьяна Леонидовна Гиндина, канд. мед. наук, ул. Льва Толстого, д. 6/8, Санкт-Петербург, Российская Федерация, 197022; тел.: + 7(812)233-12-43; e-mail: cytogenetics.bmt.lab@gmail.com

Для цитирования: Мамаев Н.Н., Гиндина Т.Л., Бойченко Э.Г. Хромотрипсис в онкологии: обзор литературы и собственное наблюдение. Клиническая онкогематология. 2017;10(2):191–205.

DOI: 10.21320/2500-2139-2017-10-2-191-205


РЕФЕРАТ

Представлено собственное наблюдение и обзор литературы, посвященный недавно открытому феномену хромотрипсиса в онкологии. Хромотрипсис — тип комплексных геномных изменений, при которых хромосома сначала разрывается на десятки и даже тысячи частей, а потом эти фрагменты соединяются в случайном порядке. Иногда в перестройке участвует несколько хромосом. В результате формируются мутантные зоны генома, провоцирующие развитие онкологических и врожденных заболеваний. Иными словами, использование определенных методических подходов (многоцветной флюоресцентной гибридизации in situ, метода SKY и некоторых других) позволяет увидеть под микроскопом распад на фрагменты двух или более хромосом и воссоединение этих фрагментов в новые необычные двух- или многоцветные структуры — хромосомные маркеры. Хромотрипсис — редкий феномен со своеобразной картиной, наблюдаемой в клонах клеток самых разнообразных опухолей, включая новообразования кроветворной и лимфоидной тканей. В литературе имеются указания о большей частоте этого феномена у больных с миелодиспластическим синдромом и опухолями костей. Важную роль в формировании хромотрипсиса играют мутации гена TP53. Использование секвенирования концевой спаренной ДНК или метода SNP в онкологии представляется перспективным как в теоретическом, так и клиническом плане. В первую когорту исследуемых должны включаться пациенты с мутациями генов TP53 и MLL, со сложными хромосомными нарушениями, гиперэкспрессией гена EVI1 и некоторые другие. В статье представлен феномен хромотрипсиса у девочки 8 мес. с М7-вариантом острого миелоидного лейкоза.

Ключевые слова: хромотрипсис, онкогематология, рак, мутации гена TР53.

Получено: 2 октября 2016 г.

Принято в печать: 6 января 2017 г.

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Рекомендации по седации и общей анестезии при различных исследованиях и процедурах в детской онкогематологии

Н.В. Матинян, Т.Т. Валиев

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

Для переписки: Нуне Вануниевна Матинян, д-р мед. наук, Каширское ш., 24, Москва, Российская Федерация, 115478; тел: +7(499)324-32-12; e-mail: n9031990633@yandex.ru

Для цитирования: Матинян Н.В., Валиев Т.Т. Рекомендации по седации и общей анестезии при различных исследованиях и процедурах в детской онкогематологии. Клиническая онкогематология. 2017;10(1):108–12.

DOI: 10.21320/2500-2139-2017-10-1-108-112


РЕФЕРАТ

Современные программы лекарственной противоопухолевой терапии при онкогематологических заболеваниях у детей предполагают проведение диагностических и лечебных процедур в условиях седации. На основании международного и собственного опыта в настоящей работе приводятся рекомендации по выбору оптимального метода анестезии при различных манипуляциях в онкогематологии.

Ключевые слова: анестезия, онкогематология, дети.

Получено: 1 августа 2016 г.

Принято в печать: 12 декабря 2016 г.

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Основные закономерности ангиогенеза при онкогематологических заболеваниях

А.А. Вартанян

ФГБУ «Российский онкологический центр им Н.Н. Блохина» РАМН, Москва, Российская Федерация


РЕФЕРАТ

Концепция о том, что VEGF-индуцируемый ангиогенез — фактор, лимитирующий рост солидных опухолей, сегодня считается общепринятой. Исследования последних лет показывают, что ангиогенез также необходимое условие прогрессии онкогематологических заболеваний. Процесс ветвления близлежащих сосудов в костном мозге начинается с выброса опухолевыми клетками растворимых активаторов ангиогенеза. Основным медиатором, стимулирующим формирование микрососудов в костном мозге, считается VEGF. С другой стороны, повышенная секреция VEGF приводит к высвобождению клетками микроокружения GM-CSF, G-CSF, IL-6, PlGF, HGF, IGF, цитокинов, способствующих выживанию и пролиферации злокачественных миелоидных и лимфоидных клеток. Увеличение уровня VEGF в плазме онкогематологических больных считается неблагоприятным прогностическим фактором течения болезни.

В настоящем обзоре обсуждаются основные закономерности формирования аутокринного и паракринного пула VЕGF, ангиогенез-зависимая и -независимая функции VEGF, а также результаты клинического изучения антиангиогенных препаратов в онкогематологии.


Ключевые слова: онкогематология, костный мозг, ангиогенез, антиангиогенная терапия.

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Современные аспекты диагностики и лечения осложненных форм неходжкинских лимфом тонкой и толстой кишки

Малихова О.А., Туманян А.О., Шаленков В.А., Малихов А.Г., Кувшинов Ю.П., Унгиадзе Г.В.

ФГБНУ «Российский онкологический научный центр им. Н.Н. Блохина», Каширское ш., д. 24, Москва, Российская Федерация, 115478

Для переписки: Ольга Александровна Малихова, д-р мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: +7(499)324-43-27; e-mail: malikhova@inbox.ru

Для цитирования: Малихова О.А., Туманян А.О., Шаленков В.А. и др. Современные аспекты диагностики и лечения осложненных форм неходжкинских лимфом тонкой и толстой кишки. Клиническая онкогематология. 2015;8(2):129–35.


РЕФЕРАТ

Актуальность и цели. Среди всех опухолей ЖКТ 5–10 % представлены лимфомами, в подавляющем большинстве случаев неходжкинскими (НХЛ). Они составляют 30–45 % всех экстранодальных форм НХЛ. Первичное поражение ЖКТ встречается у 2/3 пациентов. Целью настоящей работы было определить клинические особенности и результаты лечения осложненных форм НХЛ тонкой и толстой кишки.

Методы. НХЛ тонкой и толстой кишки исследованы у 189 больных, наблюдавшихся в ФГБНУ «РОНЦ им. Н.Н. Блохина» за период с 1985 по 2010 г. Поражение толстой кишки наблюдалось у 64 пациентов, тонкой — у 125.

Результаты. Оперативные вмешательства по поводу кишечной непроходимости, кровотечения или перфорации полого органа выполнены у 92 пациентов с первичным или вторичным поражением тонкой или толстой кишки, что составило 48,7 %. Поражение кишечника было первичным в 58,9 % случаев, вторичным — в 41 %.

Заключение. У больных НХЛ ЖКТ развитие осложнений ухудшает показатели общей выживаемости. Пациенты с поражением тонкой или толстой кишки нуждаются в особом подходе к диагностике и лечению НХЛ в связи с высоким риском развития хирургических осложнений.


Ключевые слова: лимфома, тонкая кишка, толстая кишка, онкогематология, неходжкинские лимфомы.

Получено: 30 января 2014 г.

Принято в печать: 12 февраля 2015 г.

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