nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.21682/2311-1267-2020-7-2-94-111nodgo-608Research ArticleПРАКТИЧЕСКИЕ ВОПРОСЫ ДЕТСКОЙ ОНКОЛОГИИ-ГЕМАТОЛОГИИPRACTICAL QUESTIONS OF PEDIATRIC ONCOLOGY-HEMATOLOGYХроническая реакция «трансплантат против хозяина» после аллогенной трансплантации гемопоэтических стволовых клеток: основные характеристики, патогенетические механизмы, стратегии терапии и проблемы клинической практикиChronic “graft versus host” disease after allogeneic hematopoietic stem cell transplantation: basic characteristics, pathogenetic mechanisms, treatment strategies and problems of clinical practicehttps://orcid.org/0000-0003-2395-4045МачневаЕ. Б.MachnevaE. B.

Елена Борисовна Мачнева, к.м.н., врач-гематолог отделения детской трансплантации костного мозга и гемопоэтических стволовых клеток НИИ детской онкологии и гематологии; врач-гематолог отделения трансплантации костного мозга

115478, Москва, Каширское шоссе, 23

Россия, 117997, Москва, Ленинский просп., 117

E.B. Machneva, Cand. of Sci. (Med.), Hematologist Department of Pediatric Bone Marrow and Hematopoietic Stem Cell Transplantation of the Research Institute of Pediatric Oncology and Hematology; Hematologist Department of Bone Marrow Transplantation

23 Kashirskoe Shosse, Moscow, 115478, Russia

117 Leninskiy Prosp., Moscow, 117997, Russia

lena.machneva@yandex.ruhttps://orcid.org/0000-0002-3822-8786ПанаринаВ. Ю.PanarinaV. Yu.

клинический ординатор НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Clinical Resident of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

veronicapanarina@yandex.ruhttps://orcid.org/0000-0003-1091-1521АлиевТ. З.AlievT. Z.

врач-детский онколог отделения детской трансплантации костного мозга и гемопоэтических стволовых клеток НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Pediatric Oncologist Department of Pediatric Bone Marrow and Hematopoietic Stem Cell Transplantation of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

timaliev118@gmail.comhttps://orcid.org/0000-0002-7439-4431ШевцовД. В.ShevtsovD. V.

врач-детский онколог отделения детской трансплантации костного мозга и гемопоэтических стволовых клеток НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Pediatric Oncologist Department of Pediatric Bone Marrow and Hematopoietic Stem Cell Transplantation of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

denis.shevtsov86@gmail.comhttps://orcid.org/0000-0002-5489-1879СулеймановаА. М.SuleymanovaA. M.

врач-детский онколог отделения детской трансплантации костного мозга и гемопоэтических стволовых клеток НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Pediatric Oncologist Department of Pediatric Bone Marrow and Hematopoietic Stem Cell Transplantation of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

a.sulejmanova@ronc.ruhttps://orcid.org/0000-0002-2652-8642КонстантиноваВ. В.KonstantinovaV. V.

врач-гематолог отделения трансплантации костного мозга

Россия, 117997, Москва, Ленинский просп., 117

Hematologist Department of Bone Marrow Transplantation

117 Leninskiy Prosp., Moscow, 117997, Russia

veronika_md@mail.ruhttps://orcid.org/0000-0003-4170-7152БуряА. Е.BuryaA. E.

врач-гематолог отделения трансплантации костного мозга

Россия, 117997, Москва, Ленинский просп., 117

Hematologist Department of Bone Marrow Transplantation

117 Leninskiy Prosp., Moscow, 117997, Russia

burya.a.e@gmail.comhttps://orcid.org/0000-0001-7939-5129СтепанянН. Г.StepanyanN. G.

врач-трансфузиолог отделения детской трансплантации костного мозга и гемопоэтических стволовых клеток НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Transfusiologist Department of Pediatric Bone Marrow and Hematopoietic Stem Cell Transplantation of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

nara19922@yandex.ruhttps://orcid.org/0000-0002-0566-053XСкворцоваЮ. В.SkvortsovaYu. V.

д.м.н., заместитель заведующего отделением трансплантации гемопоэтических стволовых клеток № 2

Россия, 117997, Москва, ул. Саморы Машела, 1

Dr. of Sci. (Med.), Hematologist, Deputy Head of the Department of Hematopoietic Stem Cell Transplantation No. 2

1 Samory Mashela St., Moscow, 117997, Russia

yuscvo@mail.ruhttps://orcid.org/0000-0003-3797-5808СидороваН. В.SidorovaN. V.

заведующая отделением детской трансплантации костного мозга и гемопоэтических стволовых клеток НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Head of the Department of Pediatric Bone Marrow and Hematopoietic Stem Cell Transplantation of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

valerevna25@mail.ruhttps://orcid.org/0000-0002-3067-1601ОсмановЕ. А.OsmanovE. A.

д.м.н., профессор, заведующий отделом гематологии и трансплантации костного мозга НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Dr. of Sci. (Med.), Professor, Head of the Department of Hematology and Bone Marrow Transplantation of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

89031538878@mail.ruhttps://orcid.org/0000-0002-2945-284XКиргизовК. И.KirgizovK. I.

к.м.н., заместитель директора по научной и образовательной работе НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Cand. of Sci. (Med.), Deputy Director for Scientific and Educational Work of Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478, Russia

k.kirgizov@ronc.ruhttps://orcid.org/0000-0001-6131-1783ВарфоломееваС. Р.VarfolomeevaS. R.

д.м.н., профессор, заместитель директора по научной и лечебной работе – директор НИИ детской онкологии и гематологии аппарата управления

115478, Москва, Каширское шоссе, 23

Dr. of Sci. (Med.), Professor, Deputy Director for Research and Clinical Work – Director of the Research Institute of Pediatric Oncology and Hematology; Executive Director of Regional Public Organization National Society of Pediatric Hematologists and Oncologists

23 Kashirskoe Shosse, Moscow, 115478, Russia

s.varfolomeeva@ronc.ruФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; РДКБ ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РоссииРоссияN.N. Blokhin National Medical Research Centre of Oncology, Ministry of Health of Russia; Russian Children’s Clinical Hospital of the N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN.N. Blokhin National Medical Research Centre of Oncology, Ministry of Health of RussiaRussian FederationРДКБ ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РоссииРоссияRussian Children’s Clinical Hospital of the N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaRussian FederationФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава РоссииРоссияDmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Health of RussiaRussian Federation2020040720207294111Copyright © Мачнева Е.Б., Панарина В.Ю., Алиев Т.З., Шевцов Д.В., Сулейманова А.М., Константинова В.В., Буря А.Е., Степанян Н.Г., Скворцова Ю.В., Сидорова Н.В., Османов Е.А., Киргизов К.И., Варфоломеева С.Р., 20202020Мачнева Е.Б., Панарина В.Ю., Алиев Т.З., Шевцов Д.В., Сулейманова А.М., Константинова В.В., Буря А.Е., Степанян Н.Г., Скворцова Ю.В., Сидорова Н.В., Османов Е.А., Киргизов К.И., Варфоломеева С.Р.Machneva E.B., Panarina V.Y., Aliev T.Z., Shevtsov D.V., Suleymanova A.M., Konstantinova V.V., Burya A.E., Stepanyan N.G., Skvortsova Y.V., Sidorova N.V., Osmanov E.A., Kirgizov K.I., Varfolomeeva S.R.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/608

Аллогенная трансплантация гемопоэтических стволовых клеток (ТГСК) является эффективным методом терапии многих тяжелых заболеваний. Метод постоянно совершенствуется, однако по-прежнему остается высоким число осложнений ТГСК, среди которых одним из наиболее тяжелых является хроническая реакция «трансплантат против хозяина» (РТПХ). Хроническая РТПХ является иммунопатологическим процессом и проявляется мультисистемным поражением с нарушением функции органов. В настоящее время большого прогресса достигло изучение деталей патогенеза этой патологии, однако остается еще много неизвестных аспектов, прояснение которых могло бы улучшить возможности терапии хронической РТПХ. В статье представлены основные характеристики хронической РТПХ, факторы риска ее развития, классификация, клинические проявления, современные представления о ее патогенезе, стандартные и альтернативные методы терапии, перспективы изучения новых терапевтических стратегий. На клиническом примере продемонстрированы основные проблемы профилактики и лечения хронической РТПХ у детей, с которыми сталкиваются в своей практической работе врачи трансплантологических центров.

Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for different spectrum of diseases. This type of treatment is constantly improving, but HSCT remains a risky procedure with various possible complications, the main is – chronic “graft versus host” disease (cGVHD). сGVHD is immune disregulation, and characterized by a variety of clinical manifestations that reflect the multiple underlying pathophysiology mechanisms. The study of cGVHD has now made great progress, but there’s still a lot of questions. General characteristics, risk-factors of development, clinical manifestations, pathogenesis of cGVHD will be discussed in this article. Clinical case presented in this article explains usage of basic and novel agents for cGVHD treatment, prevention criterions for treatment of cGVHD in children.

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