Консолидирующая высокодозная химиотерапия с трансплантацией аутологичных гемопоэтических стволовых клеток в первой ремиссии диффузной В-клеточной крупноклеточной лимфомы


DOI: https://dx.doi.org/10.18565/pharmateca.2021.7.42-50

А.К. Ковязин (1), Л.В. Филатова (1, 2), И.С. Зюзгин (1), М.С. Моталкина (1), Ю.А. Чудиновских (1), Е.В. Черкасова (1), С.А. Волчёнков (1), С.А. Шалаев (1), И.В. Ишматова (1), А.А. Зверькова (1), Т.Ю. Семиглазова (1, 2)

1) Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова, Санкт-Петербург, Россия; 2) Северо-Западный государственный медицинский университет им. И.И. Мечникова, Санкт-Петербург, Россия
Стандартным методом лечения диффузной В-клеточной крупноклеточной лимфомы (ДВККЛ) является иммунохимиотерапия по схеме R-CHOP. Полностью излечиваются терапией 1-й линии около 60% пациентов, первично-резистентные формы составляют около 15%, рецидив заболевания с наибольшей частотой в первые два года от установления диагноза происходит у 25% пациентов. Результаты лечения пациентов с ДВККЛ высокого риска (aaIPI) неоптимальны. Продолжается поиск достижения полной длительной ремиссии при проведении терапии 1-й линии. Преимущество высокодозной химиотерапии (ВДХТ) с трансплантацией аутологичных гемопоэтических стволовых клеток (ауто-ТГСК) в 1-й линии ДВККЛ остается неоднозначным. Мета-анализ рандомизированных и ретроспективных исследований выявил только кратковременное улучшение выживаемости при проведении ВДХТ с ауто-ТГСК в 1-й линии пациентам с ДВККЛ высокого промежуточного и высокого рисков. Преимущества ВДХТ с ауто-ТГСК в отношении долговременной выживаемости отмечены только в ретроспективных исследованиях при достижении полного ответа (ПЭТ-КТ) после индукционной химиотерапии (ХТ). Проведение ранней консолидации ВДХТ с ауто-ТГСК пациентам с ДВККЛ высокого риска с учетом только клинических факторов не приводит к улучшению выживаемости и увеличивает риск нежелательных явлений 3–4-й степеней. Выявление клинических, морфологических и генетических факторов эффективности противоопухолевой терапии и прогноза позволит определить оптимальную стратегию терапии ДВККЛ. Необходимы дальнейшие проспективные исследования предиктивных и прогностических факторов для выделения пациентов, у которых ранняя консолидация ВДХТ с ауто-ТГСК первой полной ремиссии может стать оптимальным методом выбора терапии.

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Об авторах / Для корреспонденции


Автор для связи: Л.В. Филатова, д.м.н., доцент, ведущий науч. сотр. научного отдела инновационных методов терапевтической онкологии и реабилитации, НМИЦ онкологии им. Н.Н. Петрова; профессор кафедры онкологии СЗГМУ им. И.И. Мечникова, Санкт-Петербург, Россия; тел. +7 (812) 596-65-29; Larisa_Filatova@list.ru
Адрес: 197758, Россия, Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68


ORCID: 
А.К. Ковязин, https://orcid.org/0000-0001-5091-3711 
Л.В. Филатова, https://orcid.org/0000-0002-0728-4582
Т.Ю. Семиглазова, https://orcid.org/0000-0002-4305-6691


Бионика Медиа