ИССЛЕДОВАНИЕ МИНИМАЛЬНОЙ ОСТАТОЧНОЙ БОЛЕЗНИ У ПАЦИЕНТОВ С ОСТРЫМИ МИЕЛОИДНЫМИ ЛЕЙКОЗАМИ МЕТОДОМ МНОГОЦВЕТНОЙ ПРОТОЧНОЙ ЦИТОФЛУОРИМЕТРИИ (ОБЗОР ЛИТЕРАТУРЫ)

Пациенты с острым миелоидным лейкозом (ОМЛ) имеют высокий риск развития рецидива, и определение наличия остаточных опухолевых клеток в период ремиссии позволяет прогнозировать его наступление. С высокой вероятностью развития рецидива также ассоциировано медленное снижение количества бластных клеток после курсов индукции ремиссии. Для диагностики минимальной остаточной болезни (МОБ) используют два наиболее чувствительных метода: молекулярный (полимеразная цепная реакция – ПЦР, капельная цифровая ПЦР, секвенирование нового поколения) и иммунофенотипический (многоцветная проточная цитофлуориметрия – МПЦ), которые имеют как преимущества, так и недостатки. Молекулярный метод более чувствителен, однако для получения результата требуется больше времени (от нескольких дней). Определение МОБ методом ПЦР применимо у 40–50 % пациентов с ОМЛ, а методом МПЦ – у 90 %. Метод МПЦ основан на выявлении сочетания антигенов, характерного для опухолевых клеток и не обнаруживаемого на нормальных гемопоэтических клетках. К недостаткам данного метода можно отнести смену иммунофенотипа опухолевого клона в ходе лечения, недостаточное различие антигенных профилей опухолевых и нормальных клеток, а также трудности в оценке МОБ-статуса при низкой клеточности образца костного мозга или крови. У пациентов с ОМЛ в ходе многочисленных исследований было доказано влияние МОБ, исследованной методом МПЦ, на долгосрочные результаты лечения. Определение МОБ-статуса на раннем сроке позволяет оценить химиочувствительность опухоли и эффективность проводимой терапии. Несмотря на различные подходы в детекции МОБ, ее пороги и сочетания моноклональных антител, отсутствие стандартизации, «положительные» значения на ранних или более поздних этапах терапии ухудшают безрецидивную и общую выживаемость) пациентов с ОМЛ. До сих пор не разработаны принципы МОБ-направленной терапии, однако имеются протоколы по применению таргетных препаратов в сочетании со стандартной химиотерапией, что позволяет существенно снизить показатели МОБ. Доказано, что интенсификация лечения не оказывает влияния на количественное значение МОБ и отдаленные результаты терапии. Необходимы новые проспективные исследования, направленные на поиск универсальных маркеров МОБ, создание стандартизированной панели моноклональных антител и разработку эффективной терапии в соответствии со значениями МОБ.

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