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современные представления об этиологии, патогенезе, диагностике и методах лечения первичной диффузной в-клеточной крупноклеточной лимфомы центральной нервной системы

https://doi.org/10.17650/1818-8346-2013-8-2-8-21

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Аннотация

В настоящей статье представлены современные сведения об этиологии, патогенезе, методах диагностики и принципах лечения первичной диффузной В-клеточной крупноклеточной лимфомы центральной нервной системы (ДВККЛ ЦНС). На основании результатов обзора литературы и собственного опыта нами предложен алгоритм диагностики ДВККЛ ЦНС. Основными методами диагностики являются магнитно-резонансная томография и стереотаксическая биопсия очага поражения с последующим гистологическим и иммуногистохимическим исследованием биоптата. Наиболее частой первой линией терапии этих больных в настоящее время является химиотерапия (ХТ) высокодозным метотрексатом. Вместе с тем, прогноз длительной выживаемости остается неудовлетворительным. Неблагоприятными факторами являются: возраст старше 60 лет, многоочаговость поражения, неврологическая симптоматика и наличие предшествующей терапии (глюкокортикостероиды или хирургическая резекция). У значительной части больных проведение курса высокодозной ХТ сопряжено с риском серьезных осложнений. Отсутствие нейротоксичности при интратекальном применении моноклональных антител (ритуксимаб) и их использование в комбинации с метотрексатом в редуцированных дозах делает этот метод лечения альтернативой у пожилых больных ДВККЛ ЦНС. Улучшение результатов в будущем может быть достигнуто при стратификации больных и применении риск-адаптированной стратегии лечения.

Об авторах

C. В. Волошин
ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА России
Россия


Ю. А. Криволапов
ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России
Россия


А. В. Шмидт
ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА России
Россия


В. А. Шуваев
ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА России
Россия


М. С. Фоминых
ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА России
Россия


К. М. Абдулкадыров
ФГБУ «Российский научно-исследовательский институт гематологии и трансфузиологии» ФМБА России
Россия


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Для цитирования:


Волошин C.В., Криволапов Ю.А., Шмидт А.В., Шуваев В.А., Фоминых М.С., Абдулкадыров К.М. современные представления об этиологии, патогенезе, диагностике и методах лечения первичной диффузной в-клеточной крупноклеточной лимфомы центральной нервной системы. Онкогематология. 2013;8(2):8-21. https://doi.org/10.17650/1818-8346-2013-8-2-8-21

For citation:


Voloshin S.V., Krivolapov Y.A., Shmidt A.V., Shuvaev V.A., Fominykh M.S., Abdulkadyrov K.M. Contemporary conceptions of etiology, pathogenesis, management and treatment of primary diffuse large b-cell central nervous system lymphoma. Oncohematology. 2013;8(2):8-21. (In Russ.) https://doi.org/10.17650/1818-8346-2013-8-2-8-21

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