С.В. Грицаев, И.И. Кострома, А.А. Жернякова
ФГБУ «Российский НИИ гематологии и трансфузиологии ФМБА», ул. 2-я Советская, д. 16, Санкт-Петербург, Российская Федерация, 191024
Для переписки: Сергей Васильевич Грицаев, д-р мед. наук, ул. 2-я Советская, д. 16, Санкт-Петербург, Российская Федерация, 191024; тел.: +7(812)717-54-68; e-mail: gritsaevsv@mail.ru
Для цитирования: Грицаев С.В., Кострома И.И., Жернякова А.А. Клиническая эффективность хелаторной терапии у пациентов с миелодиспластическим синдромом низкого риска. Клиническая онкогематология. 2019;12(2):120–4.
DOI: 10.21320/2500-2139-2019-12-2-120-124
РЕФЕРАТ
В обзоре литературы представлены данные, свидетельствующие о возможности улучшения показателей крови и выживаемости у больных с миелодиспластическим синдромом низкого риска с трансфузионной зависимостью при назначении хелаторов железа. Адекватность дозы и длительность терапии — основные условия клинической эффективности хелаторов. Снижению токсических осложнений может способствовать перевод больного на прием новой формулы деферазирокса, не требующей предварительного растворения в жидкости.
Ключевые слова: миелодиспластический синдром, низкий риск, трансфузионная зависимость, хелаторы железа, выживаемость.
Получено: 20 августа 2018 г.
Принято в печать: 2 февраля 2019 г.
ЛИТЕРАТУРА
-
Greenberg P, Cox C, LeBeau MM, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997;89(6):2079–88.
-
Bennett JM. Consensus statement on iron overload in myelodysplastic syndromes. Am J Hematol. 2008;83(11):858–61. doi: 10.1002/ajh.21269.
-
Malcovati L, Porta MG, Pascutto C, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol. 2005;23(30):7594–603. doi: 1200/JCO.2005.01.7038.
-
Steensma DP, Bennett JM. The myelodysplastic syndromes: Diagnosis and treatment. Mayo Clin Proc. 2006;81(1):104–30. doi: 10.4065/81.1.104.
-
Mitchell M, Gore SD, Zeidan AM. Iron chelation therapy in myelodysplastic syndromes: where do we stand? Expert Rev Hematol. 2013;6(4):397–410. doi: 10.1586/17474086.2013.814456.
-
Gattermann N, Jarisch A, Schlag R, et al. Deferasirox treatment of iron-overloaded chelation-naive and prechelated patients with myelodysplastic syndromes in medical practice: results from the observational studies eXtend and eXjange. Eur J Haematol. 2012;88(3):260–8. doi: 10.1111/j.1600-0609.2011.01726.x.
-
List AF, Baer MR, Steensma DP, et al. Deferasirox reduces serum ferritin and labile plasma iron in RBC transfusion-dependent patients with myelodysplastic syndrome. J Clin Oncol. 2012;30(17):2134–9. doi: 10.1200/JCO.2010.34.1222.
-
Greenberg PL, Koller CA, Cabantchik ZI, et al. Prospective assessment of effects on iron-overload parameters of deferasirox therapy in patients with myelodysplastic syndromes. Leuk Res. 2010;34(12):1560–5. doi: 10.1016/j.leukres.2010.06.013.
-
Remacha AF, Arrizabalaga B, Del Canizo C, et al. Iron overload and chelation therapy in patients with low-risk myelodysplastic syndromes with transfusion requirements. Ann Hematol. 2010;89(2):147–54. doi: 10.1007/s00277-009-0794-7.
-
Rose C, Brechignac S, Vassilief D, et al. Does iron chelation therapy improve survival in regularly transfused lower risk MDS patients? A multicenter study by the GFM (Groupe Francophone des Myelodysplasies). Leuk Res. 2010;34(7):864–70. doi: 10.1016/j.leukres.2009.12.004.
-
Malcovati L. Impact of transfusion dependency and secondary iron overload on the survival of patients with myelodysplastic syndromes. Leuk Res. 2007;31(Suppl 3):S2–6. doi: 10.1016/S0145-2126(07)70459-9.
-
Kohgo Y, Ikuta K, Ohtake T, et al. Body iron metabolism and pathophysiology of iron overload. Int J Hematol. 2008;88(1):7–15. doi: 10.1007/s12185-008-0120-5.
-
Andrews NC. Closing the iron gate. N Engl J Med. 2012;366(4):376–7. doi: 10.1056/NEJMcibr1112780.
-
Gardenghi S, Marongiu MF, Ramos P, et al. Ineffective erythropoiesis in beta-thalassemia is characterized by increased iron absorption mediated by down-regulation of hepcidin and up-regulation of ferroportin. 2007;109(11):5027–35. doi: 10.1182/blood-2006-09-048868.
-
Andrews NC. Disorders of iron metabolism. N Engl J Med. 1999;341(26):1986–95. doi: 10.1056/NEJM199912233412607.
-
Takatoku M, Uchiyama T, Okamoto S, et al. Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality. Eur J Haematol. 2007;78(6):487–94. doi: 10.1111/j.1600-0609.2007.00842.x.
-
Gattermann N. Iron overload in myelodysplastic syndromes. Int J Hematol. 2018;107(1):55–63. doi: 10.1007/s12185-017-2367-1.
-
Lyons R, Marek B, Paleyc C, et al. Relation between chelation and clinical outcomes in lower-risk patients with myelodysplastic syndromes: Registry analysis at 5 years. Leuk Res. 2017;56:88–95. doi: 10.1016/j.leukres.2017.01.033.
-
Leitch H, Parmar A, Wells R, et al. Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis. Br J Haematol. 2017;179(1):83–97. doi: 10.1111/bjh.14825.
-
Mainous A, Tanner R, Hulihan M, et al. The impact of chelation therapy on survival in transfusional iron overload: a meta-analysis of myelodysplastic syndrome. Br J Haematol. 2014;167(5):720–3. doi: 10.1111/bjh.13053.
-
Abraham I, Yami M, Yun S et al. Survival outcomes in iron chelated and non-chelated patients with lower-risk myelodysplastic syndromes: Review and pooled analysis of observational studies. Leuk Res. 2017;57:104–8. doi: 10.1016/j.leukres.2017.03.007.
-
Gattermann N, Finelli C, Della Porta M, et al. Hematologic responses to deferasirox therapy in transfusion-dependent patients with myelodysplastic syndromes. Haematologica. 2012;97(9):1364–71. doi: 10.3324/haematol.2011.048546.
-
Pullarkat V. Objectives of iron chelation therapy in myelodysplastic syndromes: more than meets the eye? Blood. 2009;114(26):5251–5. doi: 10.1182/blood-2009-07-234062.
-
Zeidan AM, Hendrick F, Friedmann E, et al. Deferasirox therapy is associated with reduced mortality risk in a medicare population with myelodysplastic syndromes. J Comp Eff Res. 2015;4(4):327–40. doi: 10.2217/cer.15.20.
-
Improta S, Villa MR, Volpe A, et al. Transfusion-dependent low-risk myelodysplastic patients receiving deferasirox: Long-term follow-up. Oncol Lett. 2013;6(6):1774–8. doi: 10.3892/ol.2013.1617.
-
Breccia M, Voso M, Spiriti M, et al. An increase in hemoglobin, platelets and white blood cells levels by iron chelation as single treatment in multitransfused patients with myelodysplastic syndromes: clinical evidences and possible biological mechanisms. Ann Hematol. 2015;94(5):771–7. doi: 10.1007/s00277-015-2341-z.
-
Delforge M, Selleslag D, Beguin Y, et al. Adequate iron chelation therapy for at least six months improves survival in transfusion-dependent patients with lower risk myelodysplastic syndromes. Leuk Res. 2014;38(5):557–63. doi: 10.1016/j.leukres.2014.02.003.
-
Cermak J, Jonasova A, Vondrakova J, et al. A comparative study of deferasirox and deferiprone in the treatment of iron overload in patients with myelodysplastic syndromes. Leuk Res. 2013;37(12):1612–5. doi: 10.1016/j.leukres.2013.07.021.
-
Nolte F, Angelucci E, Breccia M, et al. Updated recommendations on the management of gastrointestinal disturbances during iron chelation therapy with deferasirox in transfusion dependent patients with myelodysplastic syndrome – emphasis on optimized dosing schedules and new formulations. Leuk Res. 2015;39(10):1028–33. doi: 10.1016/j.leukres.2015.06.008.
-
Taher AT, Origa R, Perrotta S, et al. New film-coated tablet formulation of deferasirox is well tolerated in patients with thalassemia or lower-risk MDS: Results of the randomized, phase II ECLIPSE study. Am J Hematol. 2017;92(5):420–8. doi: 10.1002/ajh.24668.
-
Джадену® (инструкция по медицинскому применению). Швейцария: Novartis pharma, AG. Доступно по: https://www.vidal.ru/drugs/dzhadenu. Ссылка активна на11.2018. [Dzhadenu® (package insert). Switzerland: Novartis pharma, AG. Available from: https://www.vidal.ru/drugs/dzhadenu. (accessed 30.11.2018) (In Russ)]