OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press610.17650/1818-8346-2014-9-1-11-18HEMATOLOGIC MALIGNANCIES: DIAGNOSIS, TREATMENT, SUPPORTIVE CAREГЕМОБЛАСТОЗЫ: ДИАГНОСТИКА, ЛЕЧЕНИЕ, СОПРОВОДИТЕЛЬНАЯ ТЕРАПИЯTreatment of advanced Hodgkin lymphomas in adolescents and young adults: efficacy and toxicity issuesЛечение распространенных форм лимфомы Ходжкина у подростков и молодых взрослых. Проблема эффективности и токсичностиLarinaYu. V.ЛаринаЮ. В.
Russian Federation
MinenkoS. V.МиненкоС. В.
Russian Federation
BiyachuevE. R.БиячуевЭ. Р.
Russian Federation
PshonkinA. V.ПшонкинА. В.
Russian Federation
KhuazhevaN. K.ХуажеваН. К.
Russian Federation
PtushkinV. V.ПтушкинВ. В.
Russian Federation
vadimvadim@inbox.ruFederal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Ministry of Health of RussiaФГБУ «Федеральный научно-клинический центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава РоссииS. P. Botkin City Clinical Hospital, Moscow Healthcare DepartmentГУЗ «Городская клиническая больница им. С. П. Боткина» Департамента здравоохранения г. МосквыFederal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Ministry of Health of Russia N. I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaФГБУ «Федеральный научно-клинический центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава России ГБОУ ВПО «Российский национальный исследовательский университет им. Н. И. Пирогова» Минздрава России210720149111182107201421072014https://oncohematology.abvpress.ru/ongm/article/view/6

Hodgkin’s lymphoma (HL) is highly sensitive to chemo- and radiotherapy. Long-term tumor-free survival in patients with early stages is close to 95–98 %. Therapy results in patients with advanced stages is worse that requires an intensification of treatment and creates the issuesof late toxicity prevention. These problems are especially relevant in young adults with a life expectancy of 40 years or more. Escalated BEACOPP protocol developed by the German study group allows to achieve cure the majority of patients with advanced-stage Hodgkin’s lymphoma, but this regime has significant toxicity. It causes infertility in almost all patients. BEACOPP-14 with comparable activity contains less cumulative doses of potentially gonadotoxic alkylating agents. Efficacy and toxicity of this regime has been analyzed in 29 patients with prognostically unfavorable stages of HL (m – 13, f – 16) received 8 courses BEACOPP-14 without a dose reduction of cytostatics. The median age of patients was 24 (20–35) years. With a median follow-up of 32.8 (4–66) months, event-free survival was 92.8 %, disease-free – 96.2 %, and overall survival – 95.2 %. Of the 16 women included in the study, the menstrual cycle was restored in 14 patients during 3–6 months. 2 patients were not evaluated because of switch to more intensive chemotherapy in the early stages of treatment. Of the remaining 14 patients pregnancy occurred in 3 (18.7 %), delivery – in 2, abortion – in 1. Delivery was term, children born healthy. Most of the patients according to the doctors’ recommendations protects and continues to avoid pregnancy for 2 years after treatment. The data indicate a potentially less reproductive damaging of BEACOPP-14 in females retaining high anti-tumor efficacy.

Лимфома Ходжкина (ЛХ) высоко чувствительна к химиорадиотерапии. Долговременная выживаемость без опухоли у пациентов с ранними стадиями приближается к 95–98 %. Результаты лечения больных с распространенными стадиями хуже, что требует интенсификации лечения и ставит вопросы предотвращения поздней токсичности специфического лечения. Особенно они актуальны в группе молодых больных с предполагаемым сроком дожития 40 и более лет. Разработанный германской группой по изучению ЛХ протокол ВЕАСОРР-эскалированный позволяет добиться излечения у подавляющего большинства пациентов с распространенными стадиями ЛХ, однако токсичность этого режима существенна. Он вызывает бесплодие практически у всех пациентов. Режим ВЕАСОРР-14 при сопоставимой активности содержит меньшие кумулятивные дозы алкилирующих агентов, потенциально обладающих гонадотоксическим действием. Эффективность и токсичность данного режима была проанализирована на материале 29 пациентов с прогностически неблагоприятными стадиями ЛХ (мужчин – 13, женщин – 16), получивших по 8 курсов BEACOPP-14 без редукции доз цитостатиков. Средний возраст пациентов составил 24 (20–35) года. При медиане наблюдения 32,8 (4–66) мес бессобытийная выживаемость составила 92,8 %, безрецидивная – 96,2 % и общая выживаемость – 95,2 %. Из 16 женщин, включенных в исследование, менструальный цикл восстановился у 14 пациенток в сроки от 3 до 6 мес. Две пациентки не были оценены в связи с переходом на более интенсивную химиотерапию в ранние сроки лечения. Из оставшихся 14 пациенток беременность имела место у 3 (18,7 %), роды – у 2, аборт – у 1. Роды срочные, дети родились здоровыми. Бóльшая часть больных по рекомендации врачей предохранялась и продолжает предохраняться от беременности в течение 2 лет после окончания лечения. Полученные данные свидетельствуют о потенциально меньшем повреждающем репродукцию у женщин действии ВЕАСОРР-14 при сохранении высокой противоопухолевой эффективности.

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