костный мозг

История вопроса о роли биопсии костного мозга в системе стадирования классической лимфомы Ходжкина и современный взгляд в эру ПЭТ-КТ (обзор литературы)

ОБЗОРЫ , ,

А.А. Даниленко, Н.А. Фалалеева, С.В. Шахтарина

Медицинский радиологический научный центр им. А.Ф. Цыба — филиал ФГБУ «НМИЦ радиологии» Минздрава России, ул. Королева, д. 4, Обнинск, Калужская область, Российская Федерация, 249036

Для переписки: Анатолий Александрович Даниленко, д-р мед. наук, ул. Королева, д. 4, Обнинск, Российская Федерация, 249036; тел.: +7(909)250-18-10; e-mail: danilenkoanatol@mail.ru

Для цитирования: Даниленко А.А., Фалалеева Н.А., Шахтарина С.В. История вопроса о роли биопсии костного мозга в системе стадирования классической лимфомы Ходжкина и современный взгляд в эру ПЭТ-КТ (обзор литературы). Клиническая онкогематология. 2023;16(4):351–60.

DOI: 10.21320/2500-2139-2023-16-4-351-360

РЕФЕРАТ

Стадирование лимфомы Ходжкина представляет собой основу для выбора оптимальной программы лечения. Неотъемлемой частью стадирования в течение долгого времени оставалась оценка костного мозга. Исследование вовлеченности костного мозга в опухолевый процесс включает в себя применение методов лучевой диагностики и морфологического исследования его образцов, получаемых методом трепанобиопсии. На протяжении пяти десятилетий использования трепанобиопсии отношение онкологов и гематологов к этой инвазивной и болезненной манипуляции остается противоречивым — от полного отрицания до необходимости проведения ее каждому или большинству пациентов. Данный обзор посвящен истории вопроса и целесообразности применения трепанобиопсии у больных классической лимфомой Ходжкина.

Ключевые слова: лимфома Ходжкина, костный мозг, трепанобиопсия.

Получено: 26 марта 2023 г.

Принято в печать: 2 сентября 2023 г.

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Статистика Plumx русский

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Значение дополнительных иммунологических маркеров в диагностике минимальной остаточной болезни при множественной миеломе

ЛИМФОИДНЫЕ ОПУХОЛИ , , , ,

Е.Э. Толстых1, О.С. Чувадар2, А.А. Семенова1, Н.А. Купрышина1, О.П. Колбацкая1, Ю.И. Ключагина1, О.А. Коломейцев1, Г.С. Тумян1, Н.Н. Тупицын1

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

2 ООО «Центр клинической онкологии и гематологии», ул. Семашко, д. 4а, Симферополь, Республика Крым, Российская Федерация, 295026

Для переписки: Николай Николаевич Тупицын, д-р мед. наук, профессор, Каширское ш., д. 24, Москва, Российская Федерация, 115478; тел.: +7(925)537-15-82; e-mail: nntca@yahoo.com

Для цитирования: Толстых Е.Э., Чувадар О.С., Семенова А.А. и др. Значение дополнительных иммунологических маркеров в диагностике минимальной остаточной болезни при множественной миеломе. Клиническая онкогематология. 2022;15(4):388–95.

DOI: 10.21320/2500-2139-2022-15-4-388-395

РЕФЕРАТ

Актуальность. Известно, что популяция неопухолевых плазматических клеток в костном мозге здоровых лиц весьма гетерогенна. Среди них может обнаруживаться небольшое количество плазмоцитов CD19–, CD56+, CD45–, отличающих их от основной массы нормальных клеток плазмоцитарного ряда отсутствием экспрессии CD19, CD45 и наличием экспрессии CD56. Именно это обстоятельство вносит определенные сложности в мониторинг минимальной остаточной болезни (МОБ) при множественной миеломе (ММ), поскольку необходимо проводить сопоставление аберрантных и нормальных плазматических клеток. По этой причине представляется чрезвычайно актуальным исследование ряда дополнительных диагностических маркеров: CD27, CD28, CD117 и CD81.

Цель. Изучение роли дополнительных диагностических маркеров (CD27, CD28, CD117 и CD81) МОБ у больных ММ на различных этапах течения заболевания.

Материалы и методы. В настоящее исследование включено 62 больных ММ в возрасте 31–76 лет (медиана 58 лет); женщин было 25, мужчин — 37. Анализу подвергнуты морфологические и иммунофенотипические особенности плазматических клеток костного мозга. Методом определения МОБ служила 8-цветная проточная цитометрия на проточном цитометре FACSCanto II (США) в соответствии с критериями EuroFlow.

Результаты. Иммунофенотип плазматических клеток на этапе первичной диагностики ММ оценен у всех 62 больных с использованием двух 8-цветных панелей, рекомендованных консорциумом EuroFlow (2012). В соответствии с данными первичного иммунофенотипирования МОБ определялась на основании изучения как основных диагностических маркеров плазматических клеток (CD38, CD138, CD45, CD56, CD19), так и дополнительных (CD27, CD28, CD117 и CD81). Исследование проводилось в основном после индукционной терапии по достижении ремиссии. Установлено, что частота МОБ-положительных результатов при пороговом уровне аберрантных плазматических клеток более 0,01 % была следующей: по CD27 — 91 %, CD28 — 90,6 %, CD117 — 87 %, CD81 — 96,7 %. Соответственно МОБ-отрицательные случаи по маркеру CD27 составили 9 %, CD28 — 9,4 %, CD117 — 13 %, CD81 — 3,3 %.

Заключение. Применение комплекса дополнительных маркеров CD27, CD28, CD117, CD81 позволяет более достоверно с учетом экспрессии основных антигенов CD38, CD138, CD45, CD56, CD19 установить МОБ-статус при ММ: отрицательный либо положительный.

Ключевые слова: множественная миелома, минимальная остаточная болезнь, плазматические клетки, костный мозг, многоцветная проточная цитометрия.

Получено: 2 марта 2022 г.

Принято в печать: 30 августа 2022 г.

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Биология ниши гемопоэтических стволовых клеток

ОБЗОРЫ , , ,

Н.Ю. Семенова, С.С. Бессмельцев, В.И. Ругаль

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

Для переписки: С.С. Бессмельцев, д-р мед. наук, профессор, 2-я Советская ул., д. 16, Санкт-Петербург, Российская Федерация, 191024; тел.: +7(812)717-67-80; e-mail: bsshem@hotmail.com

Для цитирования: Семенова Н.Ю., Бессмельцев С.С., Ругаль В.И. Биология ниши гемопоэтических стволовых клеток. Клин. онкогематол. 2014; 7(4): 501–510.

РЕФЕРАТ

В статье представлены современные данные о роли стромальной ниши костного мозга в регуляции гемопоэтических стволовых клеток (ГСК). Отражены этапы формирования концепции гемопоэтической ниши. Дана характеристика стромальных клеточных элементов, образующих нишу, и освещены механизмы регуляции ГСК. Обсуждаются вопросы роли ниши в лейкозной трансформации ГСК. Представлены сведения о структурных изменениях ниши при нарушении развития ГСК.

Ключевые слова: гемопоэтические стволовые клетки, костный мозг, ниша гемопоэтических стволовых клеток, микроокружение.

Принято в печать: 1 сентября 2014 г.

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Основные закономерности ангиогенеза при онкогематологических заболеваниях

ОБЗОРЫ , , ,

А.А. Вартанян

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

РЕФЕРАТ

Концепция о том, что VEGF-индуцируемый ангиогенез — фактор, лимитирующий рост солидных опухолей, сегодня считается общепринятой. Исследования последних лет показывают, что ангиогенез также необходимое условие прогрессии онкогематологических заболеваний. Процесс ветвления близлежащих сосудов в костном мозге начинается с выброса опухолевыми клетками растворимых активаторов ангиогенеза. Основным медиатором, стимулирующим формирование микрососудов в костном мозге, считается VEGF. С другой стороны, повышенная секреция VEGF приводит к высвобождению клетками микроокружения GM-CSF, G-CSF, IL-6, PlGF, HGF, IGF, цитокинов, способствующих выживанию и пролиферации злокачественных миелоидных и лимфоидных клеток. Увеличение уровня VEGF в плазме онкогематологических больных считается неблагоприятным прогностическим фактором течения болезни.

В настоящем обзоре обсуждаются основные закономерности формирования аутокринного и паракринного пула VЕGF, ангиогенез-зависимая и -независимая функции VEGF, а также результаты клинического изучения антиангиогенных препаратов в онкогематологии.

Ключевые слова: онкогематология, костный мозг, ангиогенез, антиангиогенная терапия.

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Смешанный химеризм после аллогенной трансплантации костного мозга: собственные клинические наблюдения

ТРАНСПЛАНТАЦИЯ КОСТНОГО МОЗГА , , , ,

К.Н. Мелкова, Н.В. Горбунова, Т.З. Чернявская

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

РЕФЕРАТ

Мониторирование химеризма после аллогенной трансплантации костного мозга (аллоТКМ) количественной полимеразной цепной реакции (ПЦР) важно для оценки эффективности трансплантации, раннего выявления рецидивов опухоли и своевременной коррекции терапии. В настоящей публикации представлены клинические примеры смешанного химеризма после аллоТКМ.

Ключевые слова: аллогенная трансплантация, химеризм, смешанный химеризм, костный мозг, гемопоэтические стволовые клетки

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