Особенности миелодиспластического синдрома и острой миелоидной лейкемии у детей, обусловленных лечением острой лимфобластной лейкемии: собственные наблюдения
DOI:
https://doi.org/10.15574/SP.2018.92.69Ключевые слова:
острая лимфобластная лейкемия, индуцированные лечением миелодиспластический синдром и острая миелоидная лейкемия, вторичные неоплазии, детиАннотация
Представлены два клинических случая вторичных, вызванных лечением гемобластозов, неоплазий — treatment-related myelodysplastic syndrome (t-MDS)/treatment-related acute myeloid leukemia (AML) — t-MDS/t-AML в сравнении с ранее опубликованными данными других исследователей. Два мальчика, у которых была первично диагностирована острая лимфобластная лейкемия (ОЛЛ), получали лечение по программе ALL IC-BFM-2002 соответственно принадлежности к терапевтическим группам среднего и высокого риска (ГСР, ГВР). У больного из ГСР возник вторичный миелодиспластический синдром (МДС) с моносомией 7, который впоследствии трансформировался во вторичную острую миелоидную лейкемию (ОМЛ); после алогенной трансплантации гемопоэтических клеток (ало-ТГПСК) пуповинной крови возникли осложнения, от которых пациент умер. У другого больного из ГВР зарегистрирована вторичная ОМЛ с транслокацией t(9.11) (p22; q23). Проведена ало-ТГПСК; пациент пребывает в клинико-гематологической ремисии ОЛЛ 77 месяцев и t-AML — 49 месяцев. t-MDS/t-AML регистрировались на фоне поддерживающей химиотерапии ОЛЛ через 20 месяцев у лиц мужского пола при наличии хромосомных аномалий, имели предрасположенность к прогрессированию во время стандартой химиотерапии и развитию тяжелых инфекционно-токсических осложнений на фоне цитопении. Трансплантация гемопоэтических клеток является единственным лечебным режимом для пациентов с t-MDS/t-AML.Библиографические ссылки
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