OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press76610.17650/1818-8346-2009-0-3-4-14HEMATOLOGIC MALIGNANCIES: TREATMENT, SUPPORTIVE CAREГЕМОБЛАСТОЗЫ: ЛЕЧЕНИЕ, СОПРОВОДИТЕЛЬНАЯ ТЕРАПИЯCombined chemoimmunotherapy of patients with mature B-cell non-Hodgkin lymphomas age group until 18 years: results of multicenter study NHL 2004 m with rituximab and modified B-NHL BFM 90 protocol applicationsКомбинированная химиоиммунотерапия больных неходжкинскими лимфомами из зрелых В-клеток возрастной группы до18 лет: результаты многоцентрового исследования НХЛ 2004 м с применением ритуксимаба и модифицированного протокола В-НХЛ БФМ 90SamochatovaE. V.СамочатоваЕ. В.
Russian Federation

Moscow

Елена Владимировна Самочатова

Москва

samochatova@niidg.ruSchelikhovaL. N.ШелиховаЛ. Н.
Russian Federation

Moscow

Москва

BelogurovaM. B.БелогуроваМ. Б.
Russian Federation

St-Petersburg

Санкт-Петербург

SchamardinaA. V.ШамардинаА. В.
Russian Federation

N. Novgorod

Нижний Новгород

BascharovaE. V.БашароваЕ. В.
Russian Federation

Chelyabinsk

Челябинск

LitvinovD. V.ЛитвиновД. В.
Russian Federation

Moscow

Москва

MyakovaN. V.МяковаН. В.
Russian Federation

Moscow

Москва

FechinaL. G.ФечинаЛ. Г.
Russian Federation

Yekaterinburg

Екатеринбург

ChlebnikovaO. P.ХлебниковаО. П.
Russian Federation

Yekaterinburg

Екатеринбург

InuschkinaE. V.ИнюшкинаЕ. В.
Russian Federation

Balashicha

Балашиха

RiskalO. V.РыскальО. В.
Russian Federation

Perm

SchammasovP. Z.ШаммасовР. З.
Russian Federation

Kazan

Казань

YunusovaI. M.ЮнусоваИ. М.
Russian Federation

Makhachkala

Махачкала

UmnovaS. Yu.УмноваС. Ю.
Russian Federation

Irkutsk

KonovalovD. M.КоноваловД. М.
Russian Federation

Moscow

Москва

TalalaevA. G.ТалалаевА. Г.
Russian Federation

Moscow

Москва

RoumiantsevaJ. V.РумянцеваЮ. В.
Russian Federation

Moscow

Москва

MaschanA. A.МасчанА. А.
Russian Federation

Moscow

Москва

Federal Research Center of Pediatric Hematology, Oncology and ImmunologyФГУ Федеральный научно-клинический центр детской гематологии, онкологии и иммунологииRussian Children Clinical HospitalРоссийская детская клиническая больницаMunicipal Clinical Hospital № 31Городская клиническая больница № 31Regional Children Clinical HospitalОбластная детская клиническая больницаFederal Research Center of Pediatric Hematology, Oncology and ImmunologyРоссийская детская клиническая больницаRussian Children Clinical HospitalОбластная детская клиническая больницаRegional Children Clinical HospitalМосковский областной онкологический диспансерMoscow District Oncology DispanserПермская краевая детская клиническая больницаRegional Children Clinical HospitalРеспубликанская детская клиническая больницаRepublic Children Clinical HospitalРеспубликанская детская клиническая больницаRepublic Children Clinical HospitalИркутская государственная областная детская клиническая больницаRegional Children Clinical HospitalФГУ Федеральный научно-клинический центр детской гематологии, онкологии и иммунологииFederal Research Center of Pediatric Hematology, Oncology and ImmunologyКафедра патологической анатомии педиатрического факультета Российского государственного медицинского университетаPathology Department, Pediatric faculty of the Russian State Medical UniversityФГУ Федеральный научно-клинический центр детской гематологии, онкологии и иммунологииResearch Center of Pediatric Hematology, Oncology and ImmunologyФГУ Федеральный научно-клинический центр детской гематологии, онкологии и иммунологииResearch Center of Pediatric Hematology, Oncology and Immunology27082009341427112022271120222009https://oncohematology.abvpress.ru/ongm/article/view/766

Therapy results of 61 patients (children and adolescents, 2—17 years of age; a median — 8.76 years) with B-cells non-Hodgkin lymphomas III—IV stage and B-cell acute leukemia (B-NHL/B-ALL), treating according to protocol with polichemotherapy and monoclonal antibodies against B-cell receptor CD20 — rituximab (Mabthera, Hoffmann La Roche) applications, are presented. The protocol consist of cytoreductive phase and 6 polychemotherapy courses, similar to original protocol B-NHL-BFM 90, with exception of decreasing methotrexate dosage in 2 first courses from 5 to 1 g/m2/24 hours. Rituximab — 375 mg/m2 IV — in Day 0 first 4 courses was given.

Four patients have died within first 3 weeks of therapy, 2 were primary refractory patients and 55 patients have achieved complete remissions. There was no case of remission death; relapse has developed only at one patient (neuroleukemia in patient with Burkitt lymphoma). 54 patients (88%) are in continuous complete remission. Overall and event-free survival rate were 0,90±0,04 with median follow-up after therapy ending 34 months (12—53 months). Authors discuss tactics of such combined therapy, features of remission registration, considering that at third of patients, residual mass was long-term detected, and for which assessment besides CT/MRT a positron-emission tomography (PET) and/or a repeated biopsy were done. Also it is possible to conclude that with use of target therapy chemotherapy intensity of such tumors can be reduced. Authors concluded that in cases of target therapy efficacy criteria should be modified, and it is necessary to use as much as possible informative technique to remission control (PET, minimal residual disease assessment with use of molecular-genetic methods).

В статье представлены результаты лечения 61 больного (дети и подростки 2—17 лет, медиана 8,76 года) В-клеточными неходжкинскими лимфомами (В-НХЛ) III—IV стадий и острым В-клеточным лейкозом (В-ОЛЛ) по протоколу, включающему полихимиотерапию (ПХТ) и моноклональные антитела к рецептору В-клеток СD20 — ритуксимаб (Мабтера, «Ф. Хоффманн-Ля Рош Лтд»). Протокол состоит из циторедуктивной фазы и 6 курсов ПХТ, аналогичных оригинальному протоколу B-NHL-BFM 90 за исключением 2 первых курсов, в которых доза метотрексата снижена с 5 до 1 г/м2/сут. Ритуксимаб в дозе 375 мг/м2 внутривенно вводился в день 0 первых 4 курсов ПХТ.

Четыре больных умерли в течение первых 3 нед терапии, у 2 констатирована первичная рефрактерность, ремиссии достигли 55 пациентов. Не было ни одного случая смерти больных, достигших ремиссии, рецидив (нейролейкоз у больного лимфомой Беркитта) развился только у 1 пациента. Длительная ремиссия продолжается у 54 (88%) больных. Показатели общей и бессобытийной выживаемости составили 0,9±0,04 при медиане наблюдения после окончания терапии 34 (12—53) мес. Авторы обсуждают тактику проведения такой комбинированной терапии, особенности констатации ремиссии, при том что у 1/3 больных при локальном контроле длительно выявлялось остаточное образование, для оценки которого проводились, кроме компьютерной и магнитно-резонансной томографии, позитронно-эмиссионная томография (ПЭТ) и/или повторная биопсия. Также есть основания для заключения, что при использовании таргетной терапии интенсивность химиотерапии при лечении таких опухолей может быть уменьшена. Авторы установили, что в случае применения таргетной терапии критерии оценки эффекта должны быть изменены, а для контроля ремиссии необходимо использовать максимально информативные методики (ПЭТ, оценка минимальной остаточной болезни на молекулярно-генетическом уровне).

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