КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ

Множественная миелома (лечение рецидивов и рефрактерных форм): обзор литературы и собственные данные. Часть III

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , , , , , , , , , ,

С.С. Бессмельцев

ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии Федерального медико-биологического агентства», Санкт-Петербург, Российская Федерация

РЕФЕРАТ

Использование новых подходов в лечении рецидивов/рефрактерных форм множественной миеломы (ММ) привело к существенному увеличению общей выживаемости больных, достижению качественного ответа и более длительной ремиссии по сравнению с пациентами, получавшими стандартную химиотерапию. Эти изменения связаны главным образом с применением новых препаратов: бортезомиба, талидомида, леналидомида, каждый из которых обладает выраженной противомиеломной активностью. Бортезомиб, талидомид и леналидомид используются в комбинации как с химиотерапевтическими препаратами, так и друг с другом, что существенно повышает эффективность лечения больных ММ. Однако, если больные не отвечают на бортезомиб и иммуномодуляторы, прогноз ухудшается. В настоящее время число препаратов, которые используются при ММ, достаточно большое, причем спектр их все более расширяется. Тем не менее результаты лечения больных с рецидивами/рефрактерными формами ММ не вполне удовлетворительные, что свидетельствует о трудностях разработки эффективных лекарственных средств. Появилось большое количество препаратов второго и третьего поколений, которые становятся все более доступными для клинического применения. Проводятся клинические исследования I, II и III фаз по оценке эффективности карфилзомиба, помалидомида, вориностата, панобиностата, ромидепсина, перифосина, танеспимицина, бендамустина и элотузумаба при рецидивах/рефрактерных формах ММ. В обзоре представлены современные подходы к ведению пациентов с рецидивами и рефрактерным течением ММ, основанные на результатах клинических исследований и собственных данных, целью которых было оптимизировать результаты лечения. Представлена эффективность различных классов новых лекарственных средств, обсуждены все «за» и «против», полученные в доклинических и клинических исследованиях. Подробно освещены побочные эффекты новых препаратов.

Ключевые слова: множественная миелома, рецидив, рефрактерное течение, бортезомиб, талидомид, леналидомид, карфилзомиб, помалидомид, лечение, полная ремиссия, общая выживаемость, нейропатия.

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Лучевая терапия в комбинированном лечении диффузной B-крупноклеточной лимфомы

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , ,

Ю.Н. Виноградова, Н.В. Ильин, Д.В. Ларинов, М.М. Ходжибекова, Н.А. Костеников, Л.И. Корытова

ФГБУ «Российский научный центр радиологии и хирургических технологий» МЗ РФ, Санкт-Петербург, Российская Федерация

РЕФЕРАТ

В исследование включено 86 первичных больных диффузной В-крупноклеточной лимфомой I–IV стадии в возрасте от 18 до 83 лет, получавших лечение по схеме (R)-СНОР и лучевую терапию в ЦНИРРИ (РНЦРХТ) в период с 2000 по 2012 г. Медиана наблюдения составила 42 мес. (диапазон 5–120 мес.). ПЭТ с 18F-ФДГ выполнена 45 больным. У всех пациентов изучали динамику гематологических показателей исходно, до и после лучевой терапии. После комбинированного лечения ремиссия достигнута у 80 (93 %) из 86 больных, полная и неуверенная или неподтвержденная/сомнительная полная — у 86 %, частичная — у 7 %. Прогрессирование заболевания в процессе первичной терапии наблюдали у 6 (7,0 %) пациентов. После этапа лекарственного лечения полная ремиссия констатирована лишь у 56 (65,1 %) пациентов. Дополнительная лучевая терапия способствовала увеличению частоты полного/неуверенного полного ответа на 21,9 %. Генерализованные рецидивы опухоли развились у 2 (2,5 %) из 80 больных. В группах пациентов, получавших облучение в разных режимах фракционирования, частота полного ответа не различалась. Показатели общей 5-летней, безрецидивной и выживаемости без прогрессирования составили 89,7 ± 3,9, 96,6 ± 2,4 и 85,4 ± 4,8 % соответственно. У 20,6 % больных, обследованных после этапа (иммуно-)химиотерапии, результаты ПЭТ-исследования были положительными. В то же время после лучевого этапа все обследованные в эти сроки больные оказались ПЭТ-отрицательными. При лучевой терапии гематологическая токсичность была в основном I–II степени, у 16–58 % больных прерывание лечения не требовалось. Нейтропения и тромбоцитопения встречались чаще при облучении больных 2 раза в день.

Ключевые слова: диффузная В-крупноклеточная лимфома, лучевая терапия, позитронная эмиссионная томография, гематологическая токсичность

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Литература

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Множественная миелома (лечение первичных больных): обзор литературы и собственные данные. Часть II

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , , , , , , ,

С.С. Бессмельцев

ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии Федерального медико-биологического агентства», Санкт-Петербург, Российская Федерация

РЕФЕРАТ

В последние десятилетия в результате широкого применения аутологичной трансплантации гемопоэтических стволовых клеток (аутоТГСК) и новых, весьма эффективных лекарственных средств существенно улучшились показатели выживаемости пациентов с множественной миеломой (ММ) в возрасте до 65 лет (молодые пациенты). У пациентов с ММ в возрасте старше 65 лет традиционно используется комбинация мелфалана и преднизолона (MP). Внедрение новых препаратов, в частности иммуномодулирующих средств (ИМС) и ингибиторов протеасомы, значительно изменило подходы к лечению этого заболевания. У больных с впервые выявленной ММ была изучена эффективность многих двух-, трех- и четырехкомпонентных комбинаций. Установлено, что достижение полной ремиссии (ПР) служит независимым предиктором длительной выживаемости (ВБП, ОВ). Результаты проведенных проспективных исследований свидетельствуют о том, что для достижения высокого значения ПР и увеличения ее продолжительности необходимо индукционное лечение с использованием трехкомпонентных режимов, содержащих бортезомиб или иммуномодуляторы, с последующей аутоТГСК, консолидацией/поддерживающей терапией ИМС или ингибиторами протеасомы. В преобладающем большинстве случаев пожилые пациенты не являются кандидатами на аутоТГСК. Внедрение в лечебную практику новых препаратов — талидомида, бортезомиба, леналидомида — значительно улучшило результаты лечения этих больных. Программы MP + талидомид (MPT), MP + бортезомиб (VMP) и MP + леналидомид с последующей поддерживающей терапией леналидомидом (MPR-R) в настоящее время рассматриваются в качестве новых стандартов лечения пожилых пациентов с ММ. Прогноз ММ зависит от множества факторов, которые следует учитывать до начала терапии. В обзоре представлены современные подходы к ведению пациентов с впервые выявленной ММ, основанные на проводимых в настоящее время исследованиях, цель которых заключается в оптимизации результатов лечения.

Ключевые слова: множественная миелома, бортезомиб, талидомид, леналидомид, лечение, полная ремиссия, общая выживаемость, нейропатия, аутологичная трансплантация гемопоэтических стволовых клеток.

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Маркеры апоптоза в CD34-позитивных клетках при острых лейкозах

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , , , ,

Е.Н. Паровичникова1, Е.Е. Ходунова1, И.В. Гальцева1, С.М. Куликов1, В.В. Троицкая1, Л.А. Кузьмина1, Д.В. Щебляков2, В.Г. Савченко1

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

2 ФГБУ «НИИ эпидемиологии и микробиологии им. почетного академика Н.Ф. Гамалеи» МЗ РФ, Москва, Российская Федерация

РЕФЕРАТ

Цель. Определить экспрессию белков Bcl-2, Bax, CD95, р53 и АПФ (ангиотензинпревращающий фермент) в клетках CD34+ периферической крови (ПК) и костного мозга (КМ) у больных c впервые выявленным острым лейкозом (ОЛ) на разных этапах индукционной терапии.

Материалы и методы. Экспрессию Bcl-2, Bax, р53, CD95 и АПФ определяли в клетках CD34+ ПК и КМ у 23 больных ОЛ (14 — ОМЛ и 9 — ОЛЛ) методом проточной цитофлюориметрии. Образцы ПК и КМ исследовали до начала химиотерапии и в период индукционного лечения: на +8, +21 (только кровь) и +36–38-й дни от начала лечения. В группу контроля включено 8 доноров крови и костного мозга.

Результаты. Экспрессия Bcl-2+ на клетках CD34+ КМ у больных ОЛ (ОМЛ, ОЛЛ) на момент диагностики составила 34,8 ± 6 % и была статистически значимо выше, чем в контрольной группе здоровых доноров, — 11,5 ± 1,8 %. На +36–38-й день от начала химиотерапии не выявлено существенных отличий в количестве клеток CD34+/Bcl-2+ КМ и ПК как между больными ОЛ и контрольной группой, так и между группами пациентов с ОМЛ и ОЛЛ. Количество клеток CD34+/Bax+ при ОЛЛ в начале заболевания было статистически значимо выше по сравнению с больными ОМЛ и контрольной группой (p < 0,005). Экспрессия АПФ и р53 в клетках CD34+ у больных ОЛ на момент диагностики и после курса химиотерапии была значимо ниже, чем у здоровых доноров. При исследовании экспрессии CD95 на клетках СD34+ КМ и ПК у больных ОЛ в период индукционного курса и в контрольной группе значимых отличий как между больными ОМЛ и ОЛЛ, так и между больными ОЛ и контрольной группой нами не обнаружено.

Заключение. Выявленные изменения свидетельствуют о дисбалансе про- и антиапоптотических белков-регуляторов у больных ОЛ. После химиотерапии профиль экспрессии этих белков существенно меняется, однако не достигает нормальных значений, как у здоровых доноров.

Ключевые слова: острые лейкозы, программированная клеточная гибель (апоптоз), экспрессия Bcl-2, Bax, р53, CD95 и АПФ.

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Современные методы лечения AL амилоидоза: обзор литературы и собственные данные

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , , ,

А.Г. Смирнова1, С.Н. Бондаренко1, А.А. Кисина2, А.В. Смирнов2, А. Цандер3, Б.В. Афанасьев1

1 Институт детской гематологии, онкологии и трансплантологии им. Р.М. Горбачевой СПбГМУ им. акад. И.П. Павлова, Санкт-Петербург, Российская Федерация

2 Научно-исследовательский институт нефрологии СПбГМУ им. акад. И.П. Павлова, Санкт-Петербург, Российская Федерация

3 Центр трансплантации костного мозга Медицинского университета Гамбург-Эппендорф, Гамбург, Германия

РЕФЕРАТ

AL амилоидоз — достаточно редкое заболевание из группы плазмоклеточных дискразий, имеющее крайне неоднородную клиническую картину и плохой прогноз. В статье представлено краткое описание данной патологии, проведен обзор современных методов лечения, представлены собственные результаты терапии. В исследование включено 46 больных с диагнозом AL амилоидоза, которые получали лечение как с использованием аутологичной трансплантации гемопоэтических стволовых клеток, так и стандартной химиотерапии, включающей комбинацию мелфалана с дексаметазоном и бортезомиба с дексаметазоном.

Ключевые слова: AL амилоидоз, лечение, трансплантация гемопоэтических стволовых клеток, мелфалан, бортезомиб.

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ЛИТЕРАТУРА 

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Международный прогностический индекс при распространенных стадиях лимфомы Ходжкина в условиях современной терапии

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , , , , , ,

К.Д. Капланов1, А.Л. Шипаева1, В.А. Васильева1, Э.Г. Гемджян2, И.В. Матвеева1, Л.С. Трегубова1, Т.Ю. Клиточенко1, К.В. Демиденко1, О.Б. Калашникова1, Г.Ю. Выскуб1, О.Е. Голубева1, О.В. Левина1, В.А. Орлов1, Е.А. Демина3

1 ГБУЗ «Волгоградский областной клинический онкологический диспансер № 1», Волгоград, Российская Федерация

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

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

РЕФЕРАТ

Программа BEACOPP, включая такие интенсифицированные ее варианты, как BEACOPP-14 и ВЕАСОРР-эскалированный, применяется для лечения пациентов с распространенными стадиями лимфомы Ходжкина. Среди прогностических систем, разработанных для распространенных стадий лимфомы Ходжкина, наиболее часто используется международный прогностический индекс (МПИ), в который входит 7 факторов. В оригинальном исследовании МПИ был создан на основании данных больных, получавших MOPP и MOPP-ABVD. Появление режима BEACOPP и его модификаций могло изменить значение некоторых прогностических факторов при лимфоме Ходжкина. В нашем исследовании сделана попытка оценить прогностическое значение этих факторов у больных с распространенными стадиями лимфомы Ходжкина в условиях современного лечения.

В исследование были включены все пациенты с впервые выявленной лимфомой Ходжкина, имевшие распространенные стадии (n = 172) и получавшие лечение в отделении гематологии ГБУЗ «Волгоградский областной клинический онкологический диспансер № 1» за 7 лет (с 2003 по 2010 г.). Интенсифицированные варианты BEACOPP получило 64 (37 %) больных, BEACOPP-стандартный — 84 (49 %), ABVD — 24 (14 %).

Больные прослежены до 30.06.2012 г.

Оценены результаты терапии в группах по МПИ, а также проанализировано значение каждого из параметров МПИ в отдельности.

Наибольшие различия в общей 3- и 4-летней выживаемости отмечены между группами с МПИ 0–1 и МПИ ³ 2: для МПИ 0–1 3- и 4-летняя выживаемость равна 93 %, для группы МПИ ³ 2 3-летняя выживаемость равна 81 %, а 4-летняя — 75 % (p = 0,05). Статистически значимый отрицательный вклад в 3-летнюю общую выживаемость в этих группах внесли такие факторы МПИ, как возраст старше 45 лет (87 vs 70 % соответственно; относительный риск [ОР] 3,0; 95%-й доверительный интервал [95% ДИ] 1,7–7,0; p = 0,01) и концентрация альбумина менее 40 г/л (88 vs 79 %; ОР 2,8; 95% ДИ 1,2–6,8; p = 0,02).

Общая 3-летняя выживаемость у мужчин (n = 91) составила 80 %, у женщин (n = 81) — 88 % (p = 0,09). Не отмечено влияния на общую и свободную от неудач терапии выживаемость таких составляющих МПИ, как концентрация гемоглобина, число лимфоцитов и лейкоцитов крови и IV стадия.

Многомерный анализ также показал наибольшую значимость для общей выживаемости возраста (ОР 3,6; 95% ДИ 1,8–7,0; p = 0,001) и концентрации альбумина (ОР 2,6; 95% ДИ 1,1–6,0; p = 0,036).

Ключевые слова: лимфома Ходжкина, распространенные стадии, международный прогностический индекс (МПИ), общая выживаемость, выживаемость, свободная от неудач терапии, BEACOPP, ABVD.

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Иммунофенотипические и цитогенетические особенности опухолевых клеток у больного хроническим лимфоцитарным лейкозом, имевшего длительный контакт с источником радиации

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , , , ,

С.Н. Колюбаева1, И.А. Сухина1, В.Ю. Никитин1, Т.В. Исакова1, А.С. Поляков1, С.Н. Малахова1, Л.А. Мякошина2, Ю.Н. Виноградова2, Н.В. Ильин2

1 Военно-медицинская академия имени С.М. Кирова, Санкт-Петербург, Российская Федерация

2 ФГУ «Российский научный центр радиологии и хирургических технологий» МЗ РФ, Санкт-Петербург, Российская Федерация

РЕФЕРАТ

В работе приводятся иммунологические и цитогенетические характеристики опухолевых клеток пациента с хроническим лимфоцитарным лейкозом (ХЛЛ), имевшего в анамнезе длительный контакт с источником ионизирующей радиации. Методом дифференциальной окраски хромосом с использованием митогенов в крови выявлено 2 % клеток с кариотипом 47,XY, +12. Наличие 0,67–0,73 % метафаз с дицентрическими хромосомами подтвердило воздействие радиации на пациента. Методом флюоресцентной гибридизации in situ (FISH) выявлено большое число клеток с трисомией хромосомы 12 как в костном мозге, так и периферической крови. Возможность анализировать специфичные для ХЛЛ повреждения в интерфазных ядрах — преимущество метода FISH по сравнению со стандартным цитогенетическим исследованием. Иммунофенотипирование позволило выявить отличия от «классического» ХЛЛ, заключающиеся в одновременной экспрессии CD22 и CD79b, а также экспрессии CD38 на поверхности большинства опухолевых клеток.

Ключевые слова: хронический лимфоцитарный лейкоз, радиационно-специфичные повреждения, дицентрические хромосомы, флюоресцентная гибридизация in situ, трисомия 12, облучение

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ЛИТЕРАТУРА

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MALT-лимфома с поражением легкого: клиническое наблюдение и обзор литературы

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , ,

А.К. Морозова, Н.Г. Габеева, Е.Е. Звонков

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

РЕФЕРАТ

В статье описывается редкое клиническое наблюдение MALT-лимфомы легкого, а также представлен обзор литературы. У больной пожилого возраста с MALT-лимфомой легкого была успешно проведена химиотерапия по программе R-B (ритуксимаб + бендамустин). После 6 курсов R-B получена стойкая ремиссия опухоли при минимальной токсичности и хорошей переносимости лечения.

Ключевые слова: MALT-лимфома легкого, химиотерапия, бендамустин.

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ЛИТЕРАТУРА

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Мантийноклеточная лимфома: программное лечение первичных больных в возрасте до 65 лет

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , ,

В.И. Воробьев1, С.К. Кравченко1, Э.Г. Гемджян1, Ю.Ю. Лорие2, А.У. Магомедова1, А.Л. Меликян1, Я.К. Мангасарова1, Д.С. Марьин1, Е.И. Дубровин1, Т.Н. Обухова1, С.А. Махиня1, В.А. Жеребцова3, М.А. Вернюк4, Н.Г. Тюрина4, В.Г. Савченко1

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

2 Московский онкологический диспансер № 3, Российская Федерация

3 ФГБУ «Центральная клиническая больница с поликлиникой Управления делами президента РФ», Москва, Российская Федерация

4 МНИОИ им. П.А. Герцена, Москва, Российская Федерация

РЕФЕРАТ

Введение. Лимфома из клеток мантийной зоны (ЛКМЗ) — это агрессивная В-клеточная опухоль, которая диагностируется преимущественно у мужчин старшей возрастной группы. Использование высоких доз цитарабина (12 г/м2 на курс; J. Romanguera, 2005), аутологичной трансплантации гемопоэтических стволовых клеток (аутоТГСК)и ритуксимаба на всех этапах терапии является наиболее эффективным лечебным подходом у пациентов моложе 65 лет. Уменьшение дозы цитарабина до 4 г/м2 на курс значительно ухудшает показатели выживаемости без прогрессирования. Высокая эффективность гемцитабин/оксалиплатин-содержащих режимов и иринотекана в лечении рецидивов ЛКМЗ допускает их использование в первой линии терапии.

Цель. Оценить эффективность и токсичность схем терапии R-EPOCH/R-GIDIOX и R-EPOCH/R-HD-Met-AraC у первичных пациентов с ЛКМЗ, рекрутируемых для выполнения аутоТГСК.

Пациенты и методы. С мая 2008 г. в исследование включен 41 пациент с цитогенетически доказанной ЛКМЗ. Медиана возраста 54 года (диапазон 29–64 года), мужчин — 73 %, женщин — 27 %. MIPIb: 29,3 % — низкого, 36,6 % — промежуточного и 34,1 % — высокого риска. После первого курса по схеме R-EPOCH (W. Wilson, 2003) в зависимости от развившейся токсичности пациенты были разделены на две группы. При отсутствии гематологической токсичности IV степени более 3 дней, серьезных инфекционных осложнений или признаков почечной недостаточности пациентам в дальнейшем проводилась терапия по схеме R-HD-Met-AraC (ритуксимаб 375 мг/м2 в 0-й день, метотрексат 1000 мг/м2 в течение 24 ч в 1-й день, цитарабин 3000 мг/м2 2 раза в сутки во 2–3-й день). При развитии одного из перечисленных выше осложнений пациентам после первого курса R-EPOCH проводился курс полихимиотерапии (ПХТ) по схеме R-GIDIOX (ритуксимаб 375 мг/м2 в 0-й день, гемцитабин 800 мг/м2 в 1-й и 4-й дни, оксалиплатин 120 мг/м2 во 2-й день, иринотекан 100 мг/м2 в 3-й день, дексаметазон 10 мг/м2 в/в в 1–5-й день, ифосфамид 1000 мг/м2 в 1–5-й день). В дальнейшем данные курсы ПХТ чередовались: пациенты получали лечение по схеме R-EPOCH/R-HD-Met-AraC или R-EPOCH/R-GIDIOX соответственно. В зависимости от времени достижения полной ремиссии (ПР) проводилось 6–8 курсов терапии и выполнялась аутоТГСК (BEAM-R). С целью «очистки» непосредственно перед сбором гемопоэтических стволовых клеток и перед аутоТГСК вводили ритуксимаб в дозе 375 мг/м2. Пациентам с резидуальной опухолью после аутоТГСК проводилась локальная лучевая терапия, в дальнейшем — поддерживающая терапия ритуксимабом в дозе 375 мг/м2 1 раз в 3 мес. в течение 3 лет. Протокол одобрен местным этическим комитетом. Оценка бессобытийной и общей выживаемости проводилась от момента начала терапии. Эффективность терапии оценивалась согласно критериям B. Cheson (2007). С ноября 2011 г. всем пациентам проводится профилактика нейролейкоза (включая больных, которым аутоТГСК была выполнена после ноября 2010 г.). Проанализирована токсичность 124 курсов R-EPOCH, 87 курсов R-HD-Met-AraC и 51 курса R-GIDIOX.

Результаты. Медиана наблюдения составила 22 мес. (диапазон 4–60 мес.). К апрелю 2013 г. 35 пациентам выполнена аутоТГСК: 21 — из группы R-HD-Met-AraC и 14 — из группы R-GIDIOX. Вследствие развития острой почечной недостаточности и септического шока 1 больной умер на этапе индукции после первого курса по схеме R-HD-Met-AraC. Поддерживающая терапия ритуксимабом завершена у 5 больных. У всех пациентов, получивших высокодозную индукцию по схеме R-EPOCH/R-HD-Met-AraC, достигнута ПР заболевания. В группе R-EPOCH/R-GIIDOX противоопухолевый ответ достигнут в 93 % случаев: ПР — у 12 из 15 пациентов, ЧР — у 2 из 15, прогрессирование заболевания — у 1 из 15. Основной негематологической токсичностью курсов R-GIDIOX стала печеночная недостаточность; повышение активности аминотрансфераз до I–II и III–IV степени наблюдалось в 64,7 и 7,8 % случаев соответственно, но без клинических проявлений. У 27 из 31 больного использованы стволовые клетки периферической крови, в 4 случаях выполнены эксфузии костного мозга. Гематологическая токсичность курсов R-GIDIOX: лейкопения IV степени — 74,5 % случаев (медиана продолжительности 5 дней, диапазон 1–13 дней), тромбоцитопения IV степени — 39,2 %. Ожидаемая 5-летняя общая выживаемость в группах R-GIDIOX и R-HD-Met-AraC составила 93 ± 7 и 79 % ± 12 % соответственно; бессобытийная выживаемость — 59 % ± 19 и 74 % ± 12 % соответственно.

Заключение. Схема R-HD-Met-AraC высокотоксична, и ее использование возможно только у 2/3 пациентов моложе 65 лет. Схема ПХТ R-GIDIOX менее токсична, чем R-HD-Met-AraC, а ее эффективность сравнима по частоте достижения ПР и мобилизации необходимого количества аутоГСК. Это позволяет рекомендовать применение гемцитабин/оксалиплатин-содержащих режимов в тех случаях, когда использование высоких доз метотрексата и цитарабина сопряжено с высоким риском угрожающих жизни осложнений.

Ключевые слова: лимфома из клеток мантийной зоны, лечение, аутоТГСК, поддерживающая терапия.

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ЛИТЕРАТУРА

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Лимфома Ходжкина и «новый старый» бендамустин

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ , , ,

С.С. Шкляев, В.В. Павлов

ФГБУ МРНЦ МЗ РФ, Обнинск, Российская Федерация

РЕФЕРАТ

Лимфома Ходжкина — злокачественная опухоль, которая с течением времени превратилась из фатальной неизлечимой болезни в успешно вылечиваемую в подавляющем большинстве случаев. Тем не менее прогноз у пациентов с рефрактерным и рецидивирующим течением заболевания нередко плохой и угрожающий жизни, в особенности в тех случаях, когда прогрессирование опухоли продолжается после высокодозной химиотерапии с трансплантацией аутологичных гемопоэтических стволовых клеток или, у некоторых пациентов, даже после аллогенной трансплантации костного мозга. Бендамустин — «новый старый» цитостатический препарат, который может эффективно применяться при лечении таких больных. Представляемый нами обзор литературы отводит важное место целому ряду новых возможных вариантов лечения лимфомы Ходжкина с применением бендамустина.

Ключевые слова: лимфома Ходжкина, рефрактерное и рецидивирующее течение, лечение, бендамустин.

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