nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2014-0-1-37-50nodgo-13Research ArticleКлинические рекомендацииClinical recommendationsКлинические рекомендации по профилактике и лечению синдрома лизиса опухоли у детей и подростковClinical guidelines for the prevention and treatment of tumor lysis syndrome in children and adolescentsНовичковаГ. А.NovichkovaG. A.

Москва

Moscow

vadimvadim@inbox.ruПтушкинВадим ВадимовичPtushkinV. V.

Москва

Moscow

vadimvadim@inbox.ruРумянцевА. Г.RumyantsevA. G.

Москва

Moscow

vadimvadim@inbox.ruФГБУ ФНКЦ ДГОИ им. Дмитрия Рогачева Минздрава России; ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава РоссииРоссияFederal 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 RussiaRussian Federation201431032015013750Copyright © Новичкова Г.А., Птушкин В.В., Румянцев А.Г., 20152015Новичкова Г.А., Птушкин В.В., Румянцев А.Г.Novichkova G.A., Ptushkin V.V., Rumyantsev A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/13

Применение эффективной химиотерапии, приводящей к быстрому разрушению неоплазированных клеток, нередко сопровождается крайне опасным осложнением – синдромом лизиса опухоли (СЛО). СЛО характеризуется рядом метаболических расстройств, вызванных массивным высвобождением в кровоток клеточных компонентов вследствие быстрого лизиса. Это осложнение чащевстречается при лекарственном лечении химиочувствительных опухолей – гемобластозов, таких как острый лимфобластный лейкоз или лимфома Беркитта. СЛО также может спонтанно развиваться при массивных опухолях других типов, отличающихся быстрой пролиферацией, даже в отсутствие химиотерапии. В основе патогенеза СЛО лежит перегрузка и декомпенсация систем выведения внутриклеточных метаболитов, включающих нуклеиновые кислоты, белки, фосфор и калий, что может привести к гиперурикемии, гиперкалиемии, гиперфосфатемии, гипокальциемии и уремии. Кристаллизация мочевой кислоты или фосфата кальция в почечных канальцах может нарушить функцию почек и привести к острой почечной недостаточности и даже смерти.

Современные знания о патофизиологии, предрасполагающих факторах и показателях прогноза СЛО позволяют выделить больных группы высокого риска. Разработка действенных методов профилактики в группах высокого риска – гидратация, мониторинг уровня электролитов и мочевой кислоты, назначение препаратов, замедляющих высвобождение мочевой кислоты (аллопуринол) или способствующих ее быстрому разложению (расбуриказа), дают возможность значительно уменьшить число пациентов с этим грозным осложнением.

В настоящих рекомендациях суммированы современные стандарты профилактики СЛО у пациентов с высоким риском развития данного осложнения, а также изложены подходы к лечению развившегося СЛО.

Effective chemotherapy leading to rapid neoplastic cell disintegration is commonly accompanied by the too dangerous complication – tumor lysis syndrome (TLS). The latter is characterized by a number of metabolic disorders caused by the massive release of cell components into the bloodstream due to rapid lysis. This complication is more frequently encountered in the medical treatment of drug-susceptible tumors – hemoblastoses, such as acute lymphoblastic leukemia or Burkitt’s lymphoma. TLS may also spontaneously develop in massive tumors of other types distinguished by rapid proliferation even in the absence of chemotherapy. The basis for TLS pathogenesis is the overload and decompensation of release systems for intracellular metabolites including nucleic acids, proteins, phosphorus, and potassium, which may give rise to hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and uremia. Crystallization of uric acid or calcium phosphate in the renal tubules may impair renal function and lead to acute renal failure and even death.

The current knowledge about the pathophysiology, predisposing factors, and predictors of TLS allow high-risk patients to be identified. The development of effective prevention methods in high-risk groups, such as hydration; monitoring of electrolyte and uric acid levels, use of drugs that delay the release of uric acid (allopurinol) or promote its rapid disintegration (rasburicase) allow a considerable decline in the number of patients with this menacing complication.

These guidelines summarize the current standards for TLS prevention in patients at high risk for this complication and outline approaches to treating evolving TLS.

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The authors declare that there are no conflicts of interest present.