OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press46210.17650/1818-8346-2021-16-1-36-46QUALITY OF LIFE AND FOLLOW-UPКАЧЕСТВО ЖИЗНИ И ДИСПАНСЕРНОЕ НАБЛЮДЕНИЕ ОНКОГЕМАТОЛОГИЧЕСКИХ БОЛЬНЫХSecond tumors in children with hematological malignanciesПроблема развития вторых опухолей у детей с гемобластозамиhttps://orcid.org/0000-0002-0678-1720SusulevaN. A.СусулеваН. А.
Russian Federation

Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993; 24 Kashirskoe Shosse, Moscow 115478.

125993 Москва, ул. Баррикадная, 2 / 1, стр. 1; 115478 Москва, Каширское шоссе, 24.

https://orcid.org/0000-0002-1469-2365ValievT. T.ВалиевТ. Т.
Russian Federation

Timur Teymurazovich Valiev.

Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993; 24 Kashirskoe Shosse, Moscow 115478.

Валиев Тимур Теймуразович.

125993 Москва, ул. Баррикадная, 2 / 1, стр. 1; 115478 Москва, Каширское шоссе, 24.

timurvaliev@mail.ruMartynovaN. S.МартыноваН. С.
Russian Federation

Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993; 24 Kashirskoe Shosse, Moscow 115478.

125993 Москва, ул. Баррикадная, 2 / 1, стр. 1; 115478 Москва, Каширское шоссе, 24.

https://orcid.org/0000-0001-6734-7832MikhaylovaS. N.МихайловаС. Н.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478.

115478 Москва, Каширское шоссе, 24.

Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaРоссийская медицинская академия непрерывного профессионального образованияN.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaНациональный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава России1404202116136461404202114042021https://oncohematology.abvpress.ru/ongm/article/view/462

Background. Hemoblastoses treatment success in children made it possible to cure the vast majority of patients. The follow-up period exceeds tens of years, during which the problem of second tumors (ST) becomes urgent.  The objective of the study was to characterize ST in patients who underwent a malignant tumor of hematopoietic and lymphoid tissues at the age of 0 to 18 years.

Materials and methods. The study included 64 patients with ST development in the period from 1 to 38 years.

Results. Most frequently ST developed after treatment of Hodgkin's lymphoma (45.3 %) and acute lymphoblastic leukemia (35.9 %), supported by high cumulative doses of alkylating agents and radiation therapy. Among STs, in 35.9 % of cases, thyroid cancer was diagnosed, in 10.9 % - acute leukemia, in 9.4 % - tumors of the central nervous system.  The results of ST treatment are significantly worse than those of primary tumors. Thus, of 64 patients with ST, 46 (71.9 %) are alive, death from ST progression was noted in 18 (28.1 %) cases.

Conclusion. Improvement of modern treatment protocols aimed at reducing the indications for radiation therapy and cumulative doses of alkylating agents, along with the development of effective follow-up programs for children cured of hematological malignancies, will probably help reduce the ST incidence.

Введение. Совершенствование методов терапии гемобластозов у детей привело к тому, что в большинстве случаев болезнь удается излечить. Катамнестический период наблюдения превышает десятки лет, в течение которых становится актуальной проблема развития вторых опухолей (ВО).

Цель исследования - характеристика ВО у пациентов, перенесших в возрасте от 0 до 18 лет злокачественную опухоль гемопоэтической и лимфоидной тканей.

Материалы и методы. В исследование были включены 64 пациента с развитием ВО в сроки от 1 года до 38 лет.

Результаты. Наиболее часто ВО развивались после терапии лимфомы ходжкина (45,3 %) и острого лимфобластного лейкоза (35,9 %), чему способствовали высокие кумулятивные дозы алкилирующих препаратов и проводимая лучевая терапия. Среди ВО в 35,9 % случаев диагностирован рак щитовидной железы, в 10,9 % - острые лейкозы, в 9,4 % - опухоли центральной нервной системы.

Результаты лечения ВО существенно хуже, чем первичных опухолей. Так, из 64 пациентов с ВО живы 46 (71,9 %), смерть от прогрессирования ВО отмечена в 18 (28,1 %) случаях.

Заключение. Совершенствование современных программ лечения гемобластозов, направленное на редукцию показаний к лучевой терапии и уменьшение суммарных курсовых доз алкилирующих агентов, наряду с разработкой эффективных катамнестических программ наблюдения за детьми, излеченными от гемобластозов, вероятно, поможет снизить частоту развития ВО.

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