Ремиссия без лечения у больных хроническим миелолейкозом: обзор литературы
Аннотация
Терапия ингибиторами тирозинкиназ радикально изменила течение хронического миелолейкоза, значительно повысив выживаемость и снизив риск прогрессирования заболевания. У 50–70 % пациентов удается достичь низкого или неопределяемого уровня минимальной остаточной болезни – глубокого молекулярного ответа. Длительная терапия ингибиторами тирозинкиназ примерно у трети больных сопровождается развитием токсичности и снижает качество жизни, что определяет актуальность вопроса безопасного прекращения лечения. В условиях клинических исследований у больных с длительным глубоким молекулярным ответом показана возможность сохранения ремиссии без лечения примерно в 40–60 % случаев; при этом все пациенты с молекулярным рецидивом вновь достигают ремиссии после возобновления терапии ингибиторами тирозинкиназ. В настоящее время проводится поиск клинических и молекулярногенетических факторов для определения групп пациентов, имеющих наибольшую вероятность сохранения ремиссии без лечения. Предполагается, что прекращение терапии ингибиторами тирозинкиназ может улучшить качество жизни пациентов, однако в 30 % случаев наблюдается синдром отмены, проявляющийся возникновением или ухудшением ранее существующего болевого синдрома в суставах, мышцах и костях. Механизмы развития этого явления на данный момент неясны. Таким образом, многие вопросы, касающиеся ремиссии без лечения, требуют изучения, что определяет важность проведения клинических исследований в этой области.
Об авторах
А. Н. Петрова
ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России
Россия
Россия
Анна Николаевна Петрова
125167 Москва, Новый Зыковский проезд, 4
Е. Ю. Челышева
ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России
Россия
Россия
125167 Москва, Новый Зыковский проезд, 4
А. Г. Туркина
ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России
Россия
Россия
125167 Москва, Новый Зыковский проезд, 4
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Для цитирования:
Петрова А.Н., Челышева Е.Ю., Туркина А.Г. Ремиссия без лечения у больных хроническим миелолейкозом: обзор литературы. Онкогематология. 2019;14(3):12-22. https://doi.org/10.17650/1818-8346-2019-14-3-12-22
For citation:
Petrova A.N., Chelysheva E.Yu., Turkina A.G. Treatment-free remission in patients with chronic myeloid leukemia: literature review. Oncohematology. 2019;14(3):12-22. (In Russ.) https://doi.org/10.17650/1818-8346-2019-14-3-12-22
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