Сопроводительная терапия при множественной миеломе: практические рекомендации

ПРАКТИЧЕСКИЕ РЕКОМЕНДАЦИИ

М.В. Соловьев, М.В. Соловьева, Л.П. Менделеева

ФГБУ «НМИЦ гематологии» Минздрава России, Новый Зыковский пр-д, д. 4, Москва, Российская Федерация, 125167

Для переписки: Максим Валерьевич Соловьев, канд. мед. наук, Новый Зыковский пр-д, д. 4, Москва, Российская Федерация, 125167; e-mail: maxsolovej@mail.ru

Для цитирования: Соловьев М.В., Соловьева М.В., Менделеева Л.П. Сопроводительная терапия при множественной миеломе: практические рекомендации. Клиническая онкогематология. 2023;16(4):426–48.

DOI: 10.21320/2500-2139-2023-16-4-426-448

РЕФЕРАТ

Сопроводительная терапия приобретает все более важную роль в современном алгоритме лечения множественной миеломы (ММ). Внедрение в клиническую практику инновационных препаратов, а также трансплантационных методик существенно улучшило показатели безрецидивной и общей выживаемости. Однако в подавляющем большинстве случаев ММ по-прежнему остается неизлечимой злокачественной плазмоклеточной опухолью. Терапия ММ, проводимая зачастую в непрерывном режиме, характеризуется последовательной сменой таргетных препаратов, интеграцией глюкокортикостероидов и традиционных цитостатических агентов в программное лечение. Все это в совокупности с иммунодефицитом, поражением костных структур и миеломной нефропатией приводит к высокому риску развития нежелательных явлений и кумулятивной токсичности лечения. Вместе с тем поддержание качества жизни — одна из основных целей на всех этапах лечения ММ. Учитывая особенности клинических симптомов, нюансы таргетной терапии и связанные с противоопухолевым воздействием нежелательные явления, актуальной остается дальнейшая разработка алгоритмов сопроводительной терапии ММ. Их основные задачи заключаются в профилактике осложнений лечения, снижении частоты развития нежелательных явлений, уменьшении клинических проявлений побочных эффектов и разработке стратегии лечения кумулятивной токсичности. Знания о сопроводительной терапии в современном алгоритме программного лечения ММ представляют не меньшую ценность, чем информация о противоопухолевых препаратах и их эффективности. В настоящей работе представлены обобщенный собственный опыт и рекомендации, основанные в большинстве своем на результатах клинических исследований или мнениях экспертных организаций. Практические рекомендации по сопроводительной терапии симптоматической ММ предлагаются по следующим направлениям: профилактика скелетных осложнений, тромбозов, инфекций, купирование тошноты и рвоты, вакцинация, премедикация и алгоритм введения моноклональных антител, обезболивание, лечение периферической полинейропатии, коррекция вторичного иммунодефицита, нутритивная поддержка, оценка и методы преодоления утомляемости.

Ключевые слова: множественная миелома, сопроводительная терапия.

Получено: 22 июня 2023 г.

Принято в печать: 8 сентября 2023 г.

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