OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press42710.17650/1818-8346-2020-15-3-12-26DIAGNOSIS AND TREATMENT OF HEMOBLASTOSESДИАГНОСТИКА И ЛЕЧЕНИЕ ГЕМОБЛАСТОЗОВPediatric acute lymphoblastic leukemia treatment protocols improvement: emphasis on minimal residual diseaseСовершенствование программ терапии острого лимфобластного лейкоза у детей: акцент на минимальную остаточную болезньhttps://orcid.org/0000-0002-8350-4153ShervashidzeM. A.ШервашидзеМ. А.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478, Russia

Мери Алексеевна Шервашидзе

Россия, 115478 Москва, Каширское шоссе, 24

shervashidze85@gmail.comhttps://orcid.org/0000-0002-1469-2365ValievT. T.ВалиевТ. Т.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478, Russia

Россия, 115478 Москва, Каширское шоссе, 24

Pediatric Oncology and Hematology Research Institute, N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaНИИ детской онкологии и гематологии ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава России1610202015312261410202014102020https://oncohematology.abvpress.ru/ongm/article/view/427

Treatment of acute lymphoblastic leukemia (ALL) in children during the last 50 years has changed significantly, which has increased the survival of patients from 10–15 % in the early 60s to 80–85 % by the mid-2000s. Such results have been achieved through the development of new polychemotherapy regimens, the introduction of neuroleukemia prophylaxis, the strengthening of standard chemotherapy by increasing the dose and / or frequency of chemotherapeutic drugs administration, and the definition of criteria for patient stratification into prognostic risks groups and the development of principles of risk-adopted therapy.

However, inspite of the overall success of pediatric acute lymphoblastic leukemia therapy, some variants of acute lymphoblastic leukemia associated with poor prognosis, especially acute lymphoblastic leukemia with BCR-ABL1 and MLL rearrangements. Besides the prolonged persistence of minimal residual disease is also an unfavorable prognostic factor requiring therapy intensification.

In the current issue we present the main steps in the evolution of programmed chemotherapy of children with acute lymphoblastic leukemia. Great attention was paid for modern risk-stratifying criteria with an emphasis on minimal residual disease.

Лечение острого лимфобластного лейкоза у детей за последние 50 лет претерпело существенные изменения, что позволило повысить выживаемость больных с 10–15 % в начале 1960‑х годов до 80–85 % к середине 2000‑х. Подобных результатов удалось добиться благодаря развитию новых режимов полихимиотерапии, введению профилактики нейролейкоза, усилению стандартной химиотерапии путем увеличения дозы и / или частоты введения химиопрепаратов, а также определению критериев стратификации больных на прогностические группы риска и разработке принципов риск-адаптированной терапии.

Несмотря на общий успех терапии, при отдельных вариантах острого лимфобластного лейкоза прогноз заболевания остается плохим, что особенно показательно при обнаружении BCR-ABL1 и MLL. Кроме этого, длительная персистенция минимальной остаточной болезни также является неблагоприятным прогностическим фактором, требующим интенсификации терапии.

В настоящей статье представлены основные этапы эволюции программной химиотерапии острого лимфобластного лейкоза у детей, большое внимание уделено современным риск-стратифицирующим критериям с акцентом на минимальную остаточную болезнь.

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