ФАРМАТЕКА » Первичная медиастинальная В-клеточная лимфома: эволюция и перспективы первой линии терапии. Обзор литературы

Первичная медиастинальная В-клеточная лимфома: эволюция и перспективы первой линии терапии. Обзор литературы

DOI: https://dx.doi.org/10.18565/pharmateca.2023.6-7.6-15

Крамынин Л.А., Филатова Л.В., Зюзгин И.С., Моталкина М.С., Елхова С.С., Добровольская Е.В., Ковязин А.К., Семиглазова Т.Ю.
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

Первичная медиастинальная В-клеточная лимфома – агрессивная неходжкинская лимфома, занимающая пограничное положение между диффузной крупноклеточной В-клеточной лимфомой и классической лимфомой Ходжкина. По причине редкой встречаемости и малого количества проспективных клинических исследований единые стандарты терапии первичной медиастинальной В-клеточной лимфомы не определены. Исход при рефрактерном или рецидивирующем течении остается крайне неблагоприятным, поэтому выбор оптимального режима первой линии терапии особенно актуален. Первая линия терапии представлена двумя основными режимами: R-CHOP и DA-EPOCH-R, доказавшими свою эффективность в ретроспективных исследованиях. С учетом агрессивного течения лимфомы более интенсивные подходы к терапии остаются наиболее предпочтительными. После индукционной терапии R-CHOP следует консолидация лучевой терапией или альтернативными режимами (R-ICE). Режим DA-EPOCH-R не требует консолидирующего облучения средостения. После окончания лекарственного лечения с целью дифференцировки остаточной опухолевой ткани от фиброзных и воспалительных изменений в средостении и определения показаний к последующей лучевой терапии выполняется ПЭТ-КТ, которая, однако, имеет большой процент ложноположительных результатов. Инициированные клинические исследования помогут определить обоснованность консолидирующей лучевой терапии после ритуксимаб-содержащих режимов при полном метаболическом ответе, целесообразность применения ПЭТ-КТ в качестве дифференциально-диагностического метода, преимущество режима DA-EPOCH или R-CHOP, а также необходимость применения иммуноконъюгатов, ингибиторов иммунных контрольных точек в комбинации со стандартной терапией с целью улучшения отдаленных результатов лечения.

Ключевые слова: первая линия терапии, первичная медиастинальная В-клеточная лимфома

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Об авторах / Для корреспонденции

Автор для связи: Лариса Валентиновна Филатова, д.м.н., доцент, ведущий науч. сотр. научного отдела инновационных методов терапевтической онкологии и реабилитации, Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова, Санкт-Петербург, Россия; larisa_filatova@list.ru

ORCID:
Л.А. Крамынин (Leonid A. Kramynin), https://orcid.org/0000-0003-4542-8353
Л.В. Филатова (Larisa V. Filatova), https://orcid.org/0000-0002-0728-4582
С.С. Елхова (Svetlana S. Elkhova), https://orcid.org/0000-0002-1691-0549
А.К. Ковязин (Aleksei K. Koviazin), https://orcid.org/0000-0001-5091-3711
Т.Ю. Семиглазова (Tatiana Yu. Semiglazova), https://orcid.org/0000-0002-4305-6691

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