Трудности диагностики и терапии Ph-подобных острых лимфобластных лейкозов: описание 3 клинических случаев

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Аннотация

Представлено три клинических наблюдения пациентов с диагнозом В-клеточный острый лимфобластный лейкоз (В-ОЛЛ), у которых при ожидаемом хорошем ответе на терапию по стандартному протоколу лечения В-ОЛЛ констатирована неудача лечения: рефрактерность, персистенция минимальной остаточной болезни (МОБ) и прогрессирование (нарастание МОБ). Достичь ремиссии у этих больных удалось после модификации химиотерапевтического воздействия и включения в программы лечения таргетных и иммунологических препаратов.

Ключевые слова: Ph-подобный острый лимфобластный лейкоз, рефрактерность, ингибиторы тирозинкиназ, блинатумомаб, полностью транс-ретиноевая кислота.

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B-cell acute lymphoblastic leukemia (B-ALL) is a diverse group of malignant blood disorders both with regard to the biological properties of the tumor and to therapeutic approaches. Immunophenotyping, molecular genetic techniques,
whole-genome sequencing characterize B-ALL as a very diverse group for sensitivity to chemotherapy and prognosis.
We present three clinical cases of patients with B-ALL and expected good response to standard therapy, in whom standard protocol treatment failured: refractoriness, persistence of minimal residual disease (MRD), and progression (MRD increase). The remission in these patients was achieved after chemotherapy change to immunological targeted therapy.
Nowadays a unified therapeutic approach to all primary patients of the B-ALL is considered generally outdated. Great efforts are carrying out to develop molecular genetic classifications. The molecular dissection of subtypes of B-ALL goes on, and new protocols for selective treatment with targeting are clearly outlined for each subtype of B-ALL.

Keywords: Ph-like acute lymphoblastic leukemia, refractory, tyrosine kinase inhibitors, blinatumomab, all-trans-retinoic acid.

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Авторы

К.И. ЗАРУБИНА 1, Е.Н. ПАРОВИЧНИКОВА 1, Г.А. БАСХАЕВА 1, А.Е. КРАСИЛЬНИКОВА 1, О.А. ГАВРИЛИНА 1, Б.В. БИДЕРМАН 1, А.Б. СУДАРИКОВ 1, С.Н. БОНДАРЕНКО 2, Ю.О. ДАВЫДОВА 1, И.В. ГАЛЬЦЕВА 1, А.Н. СОКОЛОВ 1, В.В. ТРОИЦКАЯ 1, В.Г. САВЧЕНКО 1

1 ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России, Москва, Россия;
2 НИИ детской онкологии, гематологии и трансплантологии им. Р.М. Горбачевой, Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова, Санкт-Петербург, Россия

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K.I. ZARUBINA 1, E.N. PAROVICHNIKOVA 1, G.A. BASKHAEVA 1, A.E. KRASILNIKOVA 1, O.A. GAVRILINA 1, B.V. BIDERMAN 1, A.B. SUDARIKOV 1, S.N. BONDARENKO 2, Y.O. DAVYDOVA 1, I.V. GALTSEVA 1, A.N. SOKOLOV 1, V.V. TROITSKAYA1, V.G. SAVCHENKO 1

1 National Research Center for Hematology, Moscow, Russia;
2 Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia

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