nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.21682/2311-1267-2019-6-2-11-19nodgo-493Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESСовременные представления о терапии острого лейкоза у детей до 1 годаModern views on the treatment of acute leukemia in children under 1 yearhttps://orcid.org/0000-0001-7263-4326ПаинаО. В.PainaO. V.

Олеся Владимировна Паина

Кандидат медицинских наук, заведующая отделением трансплантации костного мозга для детей № 1 

197022, Санкт-Петербург, ул. Рентгена, 12

Cand. of Sci. (Med.), Head of the 1st Pediatric Transplant Department

12 Rentgena St., Saint Petersburg, 197022

paina@mail.ruhttps://orcid.org/0000-0001-5077-9225СеменоваЕ. В.SemenovaE. V.

Доктор медицинских наук, профессор кафедры гематологии, трансфузиологии и трансплантологии

197022, Санкт-Петербург, ул. Рентгена, 12

Dr. of Sci. (Med.), Professor for Hematology, Transfusiology and Transpantation Chair

12 Rentgena St., Saint Petersburg, 197022

alena-semenova@yandex.ruhttps://orcid.org/0000-0001-5861-7319МарковаИ. В.MarkovaI. V.

Заместитель директора по связям с общественностью

197022, Санкт-Петербург, ул. Рентгена, 12

Deputy Director of public relations 

12 Rentgena St., Saint Petersburg, 197022

markov.i@mail.ruhttps://orcid.org/0000-0003-2594-7703ЗубаровскаяЛ. С.ZubarovskayaL. S.

Доктор медицинских наук, профессор кафедры гематологии, трансфузиологии и трансплантологии

197022, Санкт-Петербург, ул. Рентгена, 12

Dr. of Sci. (Med.), Professor for Hematology, Transfusiology and Transpantation Chair 

12 Rentgena St., Saint Petersburg, 197022

zubarovskaya_ls@mail.ruhttps://orcid.org/0000-0002-1235-4530АфанасьевБ. В.AfanasyevB. V.

Доктор медицинских наук, профессор, директор НИИ ДОГиТ им. Р.М. Горбачевой, заведующий кафедрой гематологии, трансфузиологии и трансплантологии ПСПбГМУ им. акад. И.П. Павлова

197022, Санкт-Петербург, ул. Рентгена, 12

Dr. of Sci. (Med.), Professor, Director of Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, Head of Hematology, Transfusiology and Transpantation Chair at I.P. Pavlov Saint-Petersburg First State Medical University

12 Rentgena St., Saint Petersburg, 197022

bmt-director@1spbgmu.ruНаучно-исследовательский институт детской гематологии, онкологии и трансплантологии им. Р.М. ГорбачевойРоссияRaisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and TransplantationRussian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава РоссииРоссияFirst Pavlov State Medical University of St. Petersburg, Ministry of Health of RussiaRussian FederationНаучно-исследовательский институт детской гематологии, онкологии и трансплантологии им. Р.М. Горбачевой ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава РоссииРоссияRaisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg, Ministry of Health of RussiaRussian Federation201921042019621119Copyright © Паина О.В., Семенова Е.В., Маркова И.В., Зубаровская Л.С., Афанасьев Б.В., 20192019Паина О.В., Семенова Е.В., Маркова И.В., Зубаровская Л.С., Афанасьев Б.В.Paina O.V., Semenova E.V., Markova I.V., Zubarovskaya L.S., Afanasyev B.V.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/493

Острый лейкоз у детей до 1 года имеет особенности клинических проявлений по сравнению с заболеваниями, возникающими в более старших возрастных группах. Прогностическое значение острого лимфобластного (ОЛЛ) и острого миелоидного лейкозов у детей до 1 года различно. У младенцев с ОЛЛ отмечается наличие дополнительных независимых факторов риска, усугубляющих прогноз. Клинические исследования в области младенческого острого лейкоза развиваются, внося существенный вклад в понимание биологии онкогенеза и терапии. Выполнено сравнение терапии различных исследовательских групп: POG, CCG, COG (США), JPLSG (Япония), Interfant (BFM, исследователи из Новой Зеландии, Австралии и США). Различия в выводах исследовательских работ привели к расхождению в отношении роли аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК) в современных протоколах для младенцев. В НИИ ДОГиТ им. Р.М. Горбачевой 10-летняя общая выживаемость (ОВ) после алло-ТГСК в группе детей с младенческим лейкозом высокой группы риска составила 55 %, в группе больных с перестройкой гена MLL – 53 % против 59 % без его вовлечения. Результаты алло-ТГСК зависели от стадии заболевания в момент ее проведения, в I–II полной ремиссии (ПР) 5-летняя ОВ составила 79 % (n = 35), в III–IV ПР или прогрессии – 16 % (n = 20).

Acute leukemias in children aged under 1 year has different clinical manifestations as compared to patients of older age groups. The prognostic values of ALL and AML in children under 1 year are different. In ALL there are additional independent risk factors which worsen the prognosis. Clinical researches in the field of infant acute leukemia is still under develop and making a significant contribution to the understanding of the biology of leukemogenesis and therapy. The results of therapy in different research groups were comprised: POG, CCG, COG (USA), JPLSG (Japan), Interfant (BFM, researchers from New Zealand, Australia and the USA). The difference of the results led to discrepancy regarding the role of allo-HSCT in the infants treatment. In Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, the 10-year OS after allo-HSCT in the pediatric group with high-risk infant leukemias was 55 %, in the group of patients with restructuring of the MLL gene – 53 % versus 59 % without MLL gene. The results of allo-HSCT depended on the disease stage at the time of treatment, in I–II CR 5-year OS was 79 % (n = 35), in III–IV CR or progression –16 % (n = 20).

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