эритропоэтины

Анемии в онкологии: современные возможности поддерживающей терапии

ПОДДЕРЖИВАЮЩАЯ ТЕРАПИЯ , , , ,

А.В. Снеговой, В.Б. Ларионова, Л.В. Манзюк, И.Б. Кононенко

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

Для переписки: Антон Владимирович Снеговой, канд. мед. наук, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: +7(499)324-41-09; e-mail: anvs2012@gmail.com

Для цитирования: Снеговой А.В., Ларионова В.Б., Манзюк Л.В., Кононенко И.Б. Анемии в онкологии: современные возможности поддерживающей терапии. Клиническая онкогематология. 2016;9(3):326-35.

DOI: 10.21320/2500-2139-2016-9-3-326-35

РЕФЕРАТ

Развитие анемии в период химио- или химиолучевой терапии злокачественных опухолей является серьезным нежелательным явлением, отрицательно влияющим на качество жизни и эффективность проводимого лечения. В связи с этим ведущие консенсусные комиссии NCCN, ESMO, ASCO, RUSSCO разработали и постоянно обновляют рекомендации по диагностике и лечению анемии у онкологических больных. В статье представлены современные данные о патогенезе и методах лечения анемии у онкологических больных, в т. ч. использование стимуляторов эритропоэза: рекомбинантных эритропоэтинов и внутривенных препаратов железа, витаминов, трансфузий эритроцитной массы.

Ключевые слова: рак, анемия, эритропоэтины, препараты железа для внутривенного введения, трансфузия эритроцитной массы.

Получено: 29 февраля 2016 г.

Принято в печать: 31 марта 2016 г.

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Анемии и дефицит железа у онкологических больных

АНЕМИИ , , , , , ,

В.В. Птушкин

ФГБУ «ФНКЦ Детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздравсоцразвития, Москва, Российская Федерация

РЕФЕРАТ

Многочисленные исследования последних лет показали, что анемии являются частым осложнением онкологических заболеваний, и особенно при проведении химиотерапии. Снижение содержания гемоглобина в крови сопровождается слабостью, уменьшением толерантности к физической и умственной нагрузкам с закономерным ухудшением качества жизни. Кроме того, анемия ассоциируется с ухудшением показателей выживаемости онкологических больных. Опухолевая анемия помимо прочих механизмов может быть обусловлена продукцией провоспалительных цитокинов, обладающих негативным влиянием на различные этапы продукции эритроцитов в костном мозге, длительность их жизни и обмен железа. Применение эритропоэтинов у онкологических больных с анемией вызывает повышение уровня гемоглобина и сокращение потребности в заместительных гемотрансфузиях, однако повышает риск тромбозов. Повышение продукции провоспалительных цитокинов у онкологических пациентов снижает доступность железа для эффективного эритропоэза. В настоящем обзоре обобщены клинические последствия дефицита железа и анемии у онкологических больных, обсуждаются механизмы нарушения гомеостаза железа, а также диагностика этого состояния и его лечение. Представлены данные клинических исследований, в которых оценивается эффективность различных препаратов железа с или без сопутствующей терапии эритропоэтинами.

Ключевые слова: Анемия, рак, эритропоэтины, препараты железа, карбоксимальтозат железа, ферритин, трансферрин

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