ангиоиммунобластная Т-клеточная лимфома

Т-клеточные лимфомы: возможности терапии при ограниченном выборе

МОЙ ВЫБОР , , , ,

В.А. Доронин

ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва, Российская Федерация

РЕФЕРАТ

Периферические и кожные Т-клеточные лимфомы (ПТКЛ и КТКЛ) представляют собой особую группу неходжкинских лимфом (НХЛ) с широким спектром молекулярных и генетических особенностей, а также разнообразными симптомами и клиническими проявлениями. Разнородность и редкость этих заболеваний создают трудности при проведении клинических исследований, а прогресс в лечении идет гораздо медленнее, чем при более распространенных В-клеточных НХЛ. Вследствие этого для Т-клеточных лимфом до настоящего времени не существует стандартов терапии. Лечение часто проводится в рамках клинических исследований. В статье рассматриваются оптимальные возможности терапии ПТКЛ и КТКЛ, обсуждаются также новые варианты лечения.

Ключевые слова: Т-клеточные лимфомы, периферическая Т-клеточная лимфома неуточненная, ангиоиммунобластная Т-клеточная лимфома, анапластическая крупноклеточная лимфома, кожные Т-клеточные лимфомы.

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Длительные режимы цитостатической терапии ангиоиммунобластной Т-клеточной лимфомы

КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ ЛИМФОИДНЫХ ОПУХОЛЕЙ ,

Н.Г. Чернова1, Ю.Е. Виноградова2, Ю.В. Сидорова1, И.Б. Капланская1, Е.А. Гилязитдинова1, Л.Г. Горенкова1, Д.С. Марьин1, А.М. Кременецкая1, А.И. Воробьев1, С.К. Кравченко1

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

2 ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова», Москва, Российская Федерация

РЕФЕРАТ

Введение. Применяемая в настоящее время СНОР-подобная терапия малоэффективна при ангиоиммунобластной Т-клеточной лимфоме (АИТЛ), что диктует необходимость поиска новых лечебных программ.

Цель. Определить рациональные подходы к диагностике и лечению АИТЛ.

Материалы и методы. В ФГБУ «Гематологический научный центр» МЗ РФ под наблюдением находилось 15 пациентов с АИТЛ. Медиана возраста — 61 год (диапазон 29–77 лет), мужчин — 11, женщин — 4. У всех больных установлена IV стадия распространения опухоли. Поражение костного мозга наблюдалось у 14 (93 %) пациентов, легких — у 9 (60 %), селезенки — у 12 (80 %), печени — у 9 (60 %), кожи — у 6 (40 %).

Результаты. У 11 больных применялся режим длительной цитостатической терапии на разных этапах течения АИТЛ. За основу лечения был взят раздел поддерживающей терапии из программ, разработанных для острых лимфобластных лейкозов: GMALL 2002 и ОЛЛ-2009. Иными словами, в качестве режима длительного цитостатического воздействия использовался только этап поддерживающей терапии этих протоколов. У 8 (55 %) больных достигнута полная ремиссия заболевания. Медиана наблюдения в этой группе составила 33 мес.

Заключение. Лечение больных АИТЛ короткими программами полихимиотерапии типа CHOP («импульсное» воздействие) недостаточно эффективно. Применение длительной цитостатической терапии более целесообразно, т. к. чаще позволяет достичь полные и частичные ремиссии.

Ключевые слова: ангиоиммунобластная Т-клеточная лимфома, длительная цитостатическая терапия.

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