СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ЛЕЧЕНИЯ ХРОНИЧЕСКОГО ЛИМФОЦИТАРНОГО ЛЕЙКОЗА

Цель исследования – систематизировать опубликованные данные об эффективности препаратов, применяемых для лечения больных хроническим лимфоцитарным лейкозом.

Материал и методы. Поиск информации проводился в библиотечных ресурсах medline, pubmed. В обзоре использованы материалы 93 статей, содержание которых в наибольшей мере соответствовало цели обзора.

Результаты. Кратко представлены общие сведения о заболевании, его биологических особенностях, критериях установления диагноза, стадировании, основаниях для начала противоопухолевой терапии, критериях оценки ее эффективности. Основное внимание в обзоре уделено противоопухолевым препаратам, применяющимся для лечения больных  хроническим лимфоцитарным лейкозом как в виде монотерапии, так и в комбинациях. Рассмотрены препараты, относящиеся к классам цитостатиков, моноклональных антител, а также препараты, воздействующие на сигнальные пути В-клеточного рецептора,  ингибиторы Bcl-2, иммуномодуляторы. Золотым стандартом терапии первой линии  остается схема RFc. При положительном тесте Кумбса равноценной по эффективности альтернативой схеме Fc является бендамустин. Использование хлорбутина ограничено ситуациями, при которых целью терапии является паллиативное лечение пожилых людей с серьезными сопутствующими заболеваниями. В последующих линиях терапии  все большее место начинают занимать препараты молекулярного действия.

Заключение. В течение последних двух десятилетий были достигнуты значительные успехи в понимании биологических особенностей хронического лимфоцитарного лейкоза, синтезировано несколько десятков новых лечебных препаратов таргетного действия, часть из которых проходит клиническое тестирование, что может существенно улучшить результаты лечения больных с неблагоприятными характеристиками  хронического лимфоцитарного лейкоза и серьезными сопутствующими заболеваниями. В обзоре рассмотрены новые препараты, эффективность и безопасность которых уже апробирована в клинических условиях.

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