ОБЗОРЫ

Новые возможности лечения рецидивов и рефрактерной множественной миеломы (обзор литературы)

ОБЗОРЫ , , ,

О.М. Вотякова

ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 24, Москва, Российская Федерация, 115478

Для переписки: Ольга Михайловна Вотякова, канд. мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: 8(499)324-92-09; e-mail: omvtk@yandex.ru

Для цитирования: Вотякова О.М. Новые возможности лечения рецидивов и рефрактерной множественной миеломы (обзор литературы). Клиническая онкогематология. 2017;10(4):425–34.

DOI: 10.21320/2500-2139-2017-10-4-425-434

РЕФЕРАТ

Несмотря на улучшение результатов лечения больных с впервые диагностированной множественной миеломой (ММ) благодаря внедрению в клиническую практику новых лекарственных препаратов и высокодозной химиотерапии с аутологичной трансплантацией гемопоэтических стволовых клеток, рецидивы неизбежно наступают у всех больных. Применение иммуномодулирующих препаратов (талидомида, леналидомида) и ингибитора протеасом бортезомиба позволило улучшить результаты лечения рецидивов ММ. Тем не менее развиваются повторные рецидивы и рефрактерность болезни к этим препаратам. Для этой категории больных необходимы новые лечебные стратегии, включая разработку более эффективных агентов среди существующих классов противомиеломных препаратов, исследование рациональной комбинации новых и традиционных лекарственных средств, а также поиск новых мишеней для препаратов, эффективных при ММ. В обзоре представлены основные клинические данные по эффективности и безопасности наиболее перспективных новых ингибиторов протеасом (карфилзомиба, иксазомиба), иммуномодулирующего препарата следующего поколения помалидомида, моноклональных антител (даратумумаба и элотузумаба).

Ключевые слова: ингибиторы протеасом, иммуномодулирующие препараты, моноклональные антитела, множественная миелома.

Получено: 14 марта 2017 г.

Принято в печать: 20 июня 2017 г.

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Нарушенный метаболизм метионина в злокачественных клетках — потенциальная мишень для противоопухолевой терапии

ОБЗОРЫ , , , , , ,

В.С. Покровский1, Д.Ж. Давыдов1, Н.В. Ануфриева2, Д.Д. Жданов3, Е.М. Трещалина1, Т.В. Демидкина2, Е.А. Морозова2

1 ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, лаборатория комбинированной терапии опухолей, Каширское ш., д. 24, Москва, Российская Федерация, 154478

2 ФГБУН «Институт молекулярной биологии им. В.А. Энгельгардта» РАН, ул. Вавилова, д. 32, Москва, Российская Федерация, 119991

3 ФГБУ «НИИ биомедицинской химии им. В.Н. Ореховича», Погодинская ул., д. 10, стр. 8, Москва, Российская Федерация, 119121

Для переписки: Вадим Сергеевич Покровский, д-р мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 154478; тел.: 8(499)324-14-09; e-mail: vadimpokrovsky@yandex.ru

Для цитирования: Покровский В.С., Давыдов Д.Ж., Ануфриева Н.В. и др. Нарушенный метаболизм метионина в злокачественных клетках — потенциальная мишень для противоопухолевой терапии. Клиническая онкогематология. 2017;10(3):324–32.

DOI: 10.21320/2500-2139-2017-10-3-324-332

РЕФЕРАТ

В обзоре представлены особенности клеточного метаболизма метионина, а также известные данные о механизмах развития метиониновой зависимости в злокачественных клетках. Рассмотрены возможности использования безметиониновой диеты для контроля опухолевого роста у больных с различными формами рака. Сгруппированы и обобщены новейшие сведения о метионин-γ-лиазе — ферменте, обеспечивающем элиминацию метионина из плазмы. Раскрыта его роль в качестве потенциального противоопухолевого фермента. Обобщены сведения о продуцентах метионин-γ-лиазы, активности данного фермента, полученного из различных источников, и сведения о моделях опухолей и клеточных культурах, проявляющих метиониновую зависимость.

Ключевые слова: метионин-γ-лиаза, метионин, метиониновая зависимость, злокачественные клетки, рак, противоопухолевые ферменты, противоопухолевая терапия.

Получено: 16 декабря 2016 г.

Принято в печать: 6 марта 2017 г.

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Цитогенетические и молекулярно-генетические факторы прогноза острых лимфобластных лейкозов

ОБЗОРЫ , , , ,

А.В. Мисюрин

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

Для переписки: Андрей Витальевич Мисюрин, канд. биол. наук, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; e-mail: and@genetechnology.ru

Для цитирования: Мисюрин А.В. Цитогенетические и молекулярно-генетические факторы прогноза острых лимфобластных лейкозов. Клиническая онкогематология. 2017;10(3):317–23.

DOI: 10.21320/2500-2139-2017-10-3-317-323

РЕФЕРАТ

В обзоре представлены характерные и воспроизводимые при острых лимфобластных лейкозах (ОЛЛ) перестройки хромосом, которые можно обнаружить при стандартном цитогенетическом исследовании (окраска на G-полосы) или методом FISH. Более тонкие генетические изменения, недоступные для наблюдения цитогенетиков, выявляются с помощью современных методов молекулярно-биологической диагностики. Показано прогностическое значение цитогенетических и молекулярно-генетических маркеров ОЛЛ. Представлен минимальный набор клинически значимых молекулярных маркеров, которые целесообразно исследовать при ОЛЛ.

Ключевые слова: острый лимфобластный лейкоз, хромосомная аномалия, химерный онкоген, экспрессия гена, мутация гена.

Получено: 3 декабря 2016 г.

Принято в печать: 8 марта 2017 г.

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Молекулярно-генетические нарушения в патогенезе опухолей системы крови и соответствующие им изменения сигнальных систем клетки

ОБЗОРЫ , , ,

Л.Р. Тилова1, А.В. Савинкова1, Е.М. Жидкова1,2, О.И. Борисова1,3, Т.И. Фетисов1,4, К.А. Кузин1, О.А. Власова1, А.С. Антипова3, О.Ю. Баранова3, К.И. Кирсанов1, Г.А. Белицкий1, М.Г. Якубовская1, Е.А. Лесовая1,5

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

2 Московский технологический университет, пр-т Вернадского, д. 78, Москва, Российская Федерация, 119454

3 НИИ клинической онкологии, ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Каширское ш., д. 23, Moсква, Российская Федерация, 115478

4 Первый Московский государственный медицинский университет им. И.М. Сеченова, ул. Трубецкая, д. 8, корп. 2, Москва, Российская Федерация, 119991

5 Рязанский государственный медицинский университет им. И.П. Павлова, ул. Высоковольтная, д. 9, Рязань, Российская Федерация, 390026

Для переписки: Екатерина Андреевна Лесовая, канд. биол. наук, Каширское ш., д. 24, стр. 15, Moсква, Российская Федерация, 115478; тел.: 8(910)471-41-28; e-mail: lesovenok@yandex.ru

Для цитирования: Тилова Л.Р., Савинкова А.В., Жидкова Е.М. и др. Молекулярно-генетические нарушения в патогенезе опухолей системы крови и соответствующие им изменения сигнальных систем клетки. Клиническая онкогематология. 2017;10(2):235–49.

DOI: 10.21320/2500-2139-2017-10-2-235-249

РЕФЕРАТ

Заболевания системы крови включают широкую группу злокачественных опухолей кроветворной и лимфоидной тканей, в основе патогенеза которых лежат генетические изменения, специфические для каждой отдельной разновидности нозологий. Одной из характерных особенностей онкогематологических заболеваний является высокая частота хромосомных аномалий (делеции, транслокации, инсерции). Кроме того, наблюдаются также мутации отдельных генов или блокирование нормальной регуляции функционирования генов в связи с эпигеномными событиями. Прогрессирование онкогематологических заболеваний может быть обусловлено накоплением различных генетических нарушений. Современная классификация опухолей кроветворной и лимфоидной тканей основана на анализе клинических данных, морфологических и функциональных признаков опухолевых клеток и выявлении специфических цитогенетических и молекулярно-генетических нарушений. К настоящему времени установлено большое количество генетических нарушений, характерных для конкретных типов злокачественных новообразований системы крови. Это позволяет оптимизировать лечебную тактику, а также разрабатывать, тестировать и вводить в клиническое использование ряд таргетных препаратов. К ним относятся препараты на основе моноклональных антител (ритуксимаб, алемтузумаб и др.), низкомолекулярные соединения (иматиниб, бортезомиб, карфилзомиб). Для разработки новых таргетных молекул или же перепрофилирования уже известных химиопрепаратов не только полезна информация об аномалиях при каждом типе гематологической опухоли, но и понимание изменений в эфферентных путях передачи сигнала в клетке, которые затрагивают данное нарушение. В настоящем обзоре рассматриваются генетические нарушения при заболеваниях, обозначенных в международной классификации ВОЗ опухолей кроветворной и лимфоидной тканей 2008 г. и дополненной в 2016 г., и соответствующие изменения в сигнальных путях, связанные со злокачественной трансформацией клеток кроветворной системы.

Ключевые слова: опухоли кроветворной и лимфоидной тканей, хромосомные аномалии, нарушения сигнальных путей, классификация ВОЗ.

Получено: 29 сентября 2016 г.

Принято в печать: 16 января 2017 г.

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Цитогенетические и молекулярно-генетические факторы прогноза острых миелоидных лейкозов

ОБЗОРЫ , , , ,

А.В. Мисюрин

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

Для переписки: Андрей Витальевич Мисюрин, канд. биол. наук, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; e-mail: and@genetechnology.ru

Для цитирования: Мисюрин А.В. Цитогенетические и молекулярно-генетические факторы прогноза острых миелоидных лейкозов. Клиническая онкогематология. 2017;10(2):227–34.

DOI: 10.21320/2500-2139-2017-10-2-227-234

РЕФЕРАТ

В обзоре приведены данные о диагностическом и прогностическом значении цитогенетических и молекулярно-генетических маркеров острых миелоидных лейкозов (ОМЛ). Показано, что в ряде случаев выделенные ранее на основе клинико-морфоцитохимических характеристик варианты ОМЛ можно разграничить благодаря обнаружению специфических генетических и хромосомных дефектов. Тем не менее, некоторые одинаковые повторяющиеся хромосомные аномалии могут быть обнаружены у больных ОМЛ, заболевание у которых согласно клинико-морфоцитохимическим признакам можно отнести к разным вариантам миелоидного лейкоза. В настоящее время признается, что изменение кариотипа является определяющим фактором прогноза, имеющим более существенное значение, чем критерии, основанные на морфологических и цитохимических признаках. В связи с этим выбор риск-адаптированной программы лечения ОМЛ следует проводить с учетом результатов цитогенетического исследования. В обзоре особый раздел посвящен известным к настоящему времени мутациям генов, которые могут влиять на результаты лечения ОМЛ.

Ключевые слова: ОМЛ, хромосомная аномалия, химерный онкоген, экспрессия гена, мутация гена.

Получено: 16 сентября 2016 г.

Принято в печать: 3 января 2017 г.

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Миелоидные супрессорные клетки при некоторых онкогематологических заболеваниях

ОБЗОРЫ , , , ,

А.В. Пономарев

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

Для переписки: Александр Васильевич Пономарев, аспирант, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; e-mail: kl8546@yandex.ru

Для цитирования: Пономарев А.В. Миелоидные супрессорные клетки при некоторых онкогематологических заболеваниях. Клиническая онкогематология. 2017;10(1):29–38.

DOI: 10.21320/2500-2139-2017-10-1-29-38

РЕФЕРАТ

Миелоидные супрессорные клетки — это незрелые клетки миелоидного происхождения, обладающие иммуносупрессивными свойствами. В обзоре приведена характеристика миелоидных супрессорных клеток, в т. ч. варианты фенотипа, механизмы супрессивного воздействия на иммунную систему, механизмы рекрутирования опухолью миелоидных супрессоров. Дано краткое описание работ, в которых исследовались миелоидные супрессоры при онкогематологических заболеваниях, включая множественную миелому, лимфомы и лейкозы.

Ключевые слова: миелоидные супрессоры, супрессорные клетки миелоидного происхождения, множественная миелома, лимфомы, лейкозы.

Получено: 8 сентября 2016 г.

Принято в печать: 3 декабря 2016 г.

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ЛИТЕРАТУРА

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Эритроферрон: современные представления о значении в регуляции обмена железа

ОБЗОРЫ , ,

В.Т. Сахин1, Н.В. Кремнева1, А.В. Гордиенко2, О.А. Рукавицын3

1 ФГКУ «1586 Военный клинический госпиталь» МО РФ, ул. Маштакова, д. 4, Подольск, Московская область, Российская Федерация, 142110

2 ФГБВОУ ВПО «Военно-медицинская академия им. С.М. Кирова» МО РФ, ул. Академика Лебедева, д. 6, Санкт-Петербург, Российская Федерация, 194044

3 ФГКУ «Главный военный клинический госпиталь им. Н.Н. Бурденко» МО РФ, Госпитальная пл., д. 3, Москва, Российская Федерация, 105229

Для переписки: Валерий Тимофеевич Сахин, канд. мед. наук, ул. Маштакова, д. 4, Подольск, Московская область, Российская Федерация, 142110; тел.: +7(916)314-31-11; e-mail: SahinVT@yandex.ru

Для цитирования: Сахин В.Т., Кремнева Н.В., Гордиенко А.В., Рукавицын О.А. Эритроферрон: современные представления о значении в регуляции обмена железа. Клиническая онкогематология. 2017;10(1):25–8.

DOI: 10.21320/2500-2139-2017-10-1-25-28

РЕФЕРАТ

В статье приведены данные о результатах экспериментальных и клинических исследований, в которых изучались значение и механизм действия предполагаемых эритроидных регуляторов уровня гепсидина. Показано, что участие фактора дифференциации роста 15 и гомолога-1 белка скрученной гаструляции в регуляции уровня гепсидина в организме человека до сих пор до конца не подтверждено. Представлены данные, подтверждающие важное значение эритроферрона в патогенезе анемий вследствие кровопотери, гемолиза, наследственных анемий с неэффективным эритропоэзом. Продемонстрировано, что наибольшее значение в регуляции уровня гепсидина эритроферрон имеет при патологических и стрессовых состояниях и не играет ведущую роль при эритропоэзе в нормальных условиях. Эритроферрон вызывает супрессию синтеза гепсидина за счет непосредственного воздействия на клетки печени через неизвестный пока рецепторный клеточный путь.

Ключевые слова: анемия хронических заболеваний, гепсидин, эритроферрон.

Получено: 14 сентября 2016 г.

Принято в печать: 13 ноября 2016 г.

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Первичная медиастинальная (тимическая) В-крупноклеточная лимфома

ОБЗОРЫ , , , , ,

Г.С. Тумян, И.З. Заводнова, М.Ю. Кичигина, Е.Г. Медведовская

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

Для переписки: Гаяне Сергеевна Тумян, д-р мед. наук, Каширское ш., д. 24, Moсква, Российская Федерация, 115478; тел.: +7(499)324-98-29; e-mail: gaytum@mail.ru

Для цитирования: Тумян Г.С., Заводнова И.З., Кичигина М.Ю., Медведовская Е.Г. Первичная медиастинальная (тимическая) В-крупноклеточная лимфома. Клиническая онкогематология. 2017;10(1):13–24.

DOI: 10.21320/2500-2139-2017-10-1-13-24

РЕФЕРАТ

Первичная медиастинальная (тимическая) В-крупноклеточная лимфома (ПМВКЛ) относится к первичным экстранодальным опухолям и происходит из В-клеток мозгового слоя тимуса. Болезнь чаще встречается у молодых женщин и проявляется преимущественно местнораспространенным характером роста в пределах переднего верхнего средостения с частым вовлечением органов грудной клетки. ПМВКЛ имеет специфические иммуноморфологическую и генетическую характеристики, которые позволяют идентифицировать ее от остальных, сходных по проявлениям заболеваний: диффузной В-крупноклеточной лимфомы, лимфомы Ходжкина с нодулярным склерозом и медиастинальной лимфомы «серой зоны». Стандартом лечения ПМВКЛ является иммунохимиотерапия с последующим облучением остаточной опухоли в средостении. К настоящему времени преимуществ одного лекарственного режима перед другим в рамках контролируемых исследований не показано. Применение новых методов визуализации (ПЭТ/КТ) позволяют надеяться на возможность отказа от лучевой терапии у определенной части больных ПМВКЛ без ухудшения показателей отдаленной выживаемости.

Ключевые слова: первичная медиастинальная (тимическая) В-крупноклеточная лимфома, первичные экстранодальные лимфомы, диагностика, патогенез, иммуноморфологическая и генетическая характеристики, лечение.

Получено: 22 августа 2016 г.

Принято в печать: 17 декабря 2016 г.

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Отдельные аспекты аутологичной трансплантации гемопоэтических стволовых клеток при множественной миеломе

ОБЗОРЫ , , ,

С.В. Грицаев, А.А. Кузяева, С.С. Бессмельцев

ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии ФМБА», 2-я Советская ул., д. 16, Санкт-Петербург, Российская Федерация, 191024

Для переписки: Сергей Васильевич Грицаев, д-р мед. наук, 2-я Советская ул., д. 16, Санкт-Петербург, Российская Федерация, 191024; тел.: +7(812)717-58-57; e-mail: gritsaevsv@mail.ru

Для цитирования: Грицаев С.В., Кузяева А.А., Бессмельцев С.С. Отдельные аспекты аутологичной трансплантации гемопоэтических стволовых клеток при множественной миеломе. Клиническая онкогематология. 2017;10(1):7–12.

DOI: 10.21320/2500-2139-2017-10-1-7-12

РЕФЕРАТ

В обзоре рассматриваются отдельные вопросы режимов мобилизации и режимов кондиционирования, а также проведения аутологичной трансплантации гемопоэтических стволовых клеток (аутоТГСК) у больных с множественной миеломой. Цель — определить на этой основе новые научные направления по повышению эффективности аутоТГСК.

Ключевые слова: множественная миелома, аутологичная трансплантация гемопоэтических стволовых клеток, режим мобилизации, режим кондиционирования.

Получено: 13 июля 2016 г.

Принято в печать: 12 ноября 2016 г.

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Гипометилирующие препараты в онкогематологии

ОБЗОРЫ , , , , , ,

А.Д. Ширин, О.Ю. Баранова

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

Для переписки: Антон Дмитриевич Ширин, канд. мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: +7(499)324-28-24; e-mail: shirin-anton@mail.ru

Для цитирования: Ширин А.Д., Баранова О.Ю. Гипометилирующие препараты в онкогематологии. Клиническая онкогематология. 2016;9(4):369–82.

DOI: 10.21320/2500-2139-2016-9-4-369-382

РЕФЕРАТ

В обзоре описываются эпигенетические процессы, включая метилирование ядерной и митохондриальной ДНК, а также РНК. Рассматриваются механизмы деметилирования и препараты, обладающие этим свойством. Широко освещаются результаты многочисленных крупных рандомизированных исследований, посвященных изучению гипометилирующих средств (азануклеозидов). Особое внимание уделяется результатам терапии азануклеозидами у пациентов с острыми миелоидными лейкозами. В статье описаны некоторые прогностические системы и алгоритм лечения миелодиспластических синдромов. К настоящему времени в России одобрено к клиническому применению два азануклеозида: азацитидин (для п/к введения) и децитабин (для в/в введения). В зарубежных работах анализируется опыт применение децитабина внутрь и подкожно. Остается открытым вопрос об использовании гипометилирующих препаратов не по прямым показаниям (off-label). Кратко описываются проводимые новые клинические исследования с включением азануклеозидов.

Ключевые слова: эпигенетика, острые миелоидные лейкозы, миелодиспластические синдромы, азацитидин, децитабин, гипометилирующие препараты, азануклеозиды.

Получено: 10 мая 2016 г.

Принято в печать: 20 мая 2016 г.

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