ТОКСИЧНОСТЬ И ЭФФЕКТИВНОСТЬ ТИРОЗИНКИНАЗНЫХ ИНГИБИТОРОВ В СОЧЕТАНИИ С ХИМИОТЕРАПИЕЙ ПРИ РЕЗИСТЕНТНОМ ТЕЧЕНИИ ОСТРОГО Ph-ПОЗИТИВНОГО ЛИМФОБЛАСТНОГО ЛЕЙКОЗА (ОБЗОР ЛИТЕРАТУРЫ И КЛИНИЧЕСКИЙ СЛУЧАЙ)

В основе широкого спектра токсических осложнений терапии ингибиторами BCR-ABL-тирозинкиназы лежит нецелевое ингибирование других протеинкиназ. Этот факт приобретает особенное значение при лечении больных Ph-позитивным лимфобластным лейкозом, в протоколы лечения которых входят, помимо ингибиторов тирозинкиназ, цитостатические препараты. Они усугубляют миелотоксичность и, как следствие, связанные с ней инфекционные и тромбогеморрагические осложнения, а также создают условия для сложных межлекарственных взаимодействий, опосредующих проявления сочетанной токсичности. Представлено описание клинического наблюдения за больной с рецидивирующим течением Ph-позитивного острого лимфобластного лейкоза, патогенетическое лечение которой сопровождалось развитием многочисленных осложнений, особенно ярко проявившихся при терапии ингибиторами тирозинкиназ II и III поколения в рецидиве заболевания.

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