nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.21682/2311-1267-2022-9-2-85-92nodgo-833Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL CASESПрименение многоступенчатой иммунотерапии для достижения ремиссии перед гаплоидентичной трансплантацией гемопоэтических стволовых клеток у пациентов с острым лимфобластным лейкозом и лечение осложнений данной терапии в раннем посттрансплантационном периоде: обзор литературы и клинический случайThe use of multistage immunotherapy to achieve remission before haploidentical hematopoietic stem cell transplantation in patients with acute lymphoblastic leukemia and the treatment of complications of this therapy in the early post-transplant period: a review of the literature and a clinical casehttps://orcid.org/0000-0003-3225-8412СергеенкоК. А.SergeenkoK. A.

Карина Андреевна Сергеенко, врач-ординатор кафедры детской онкологии им. акад. Л.А. Дурнова

125993, Москва, ул. Баррикадная, 2/1, стр. 1

Resident of the Pediatric Oncology Department named after Academician L.A. Durnov

ld. 1, 2/1 Barrikadnaya St., Moscow, 125993

karina_s19@mail.ruhttps://orcid.org/0000-0003-1091-1521АлиевТ. З.AlievT. Z.

врач-детский онколог отделения детской онкологии и гематологии с блоком трансплантации костного мозга НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Pediatric Oncologist Department of Pediatric Oncology and Hematology with a Bone Marrow Transplant Unit of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478

timaliev118@gmail.comhttps://orcid.org/0000-0003-0179-2479КостареваИ. О.KostarevaI. O.

врач-детский онколог отделения детской онкологии и гематологии с блоком трансплантации костного мозга

115478, Москва, Каширское шоссе, 23

Pediatric Oncologist Department of Pediatric Oncology and Hematology with a Bone Marrow Transplant Unit of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478

kostareva_92@mail.ruhttps://orcid.org/0000-0003-0600-8962ЛозованЮ. В.LozovanYu. V.

врач-педиатр отделения детской онкологии и гематологии с блоком трансплантации костного мозга

115478, Москва, Каширское шоссе, 23

Pediatrician Department of Pediatric Oncology and Hematology with a Bone Marrow Transplant Unit of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478

lyuriimd@mail.ruhttps://orcid.org/0000-0001-9112-5973МаловаМ. Д.MalovaM. D.

врач-детский онколог научно-консультативного отделения НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Pediatric Oncologist Scientific Advisory Division Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478

maria_malova@bk.ruhttps://orcid.org/0000-0002-3005-2085БатмановаН. А.BatmanovaN. A.

к.м.н., заведующая отделением детской онкологии и гематологии (химиотерапия гемобластозов) № 2 НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Cand. of Sci. (Med.), Head of the Department of Pediatric Oncology and Hematology (Chemotherapy of Hemoblastosis) No. 2 of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478

batmanova_nataly@mail.ruhttps://orcid.org/0000-0002-1469-2365ВалиевТ. Т.ValievT. T.

д.м.н., заведующий отделением детской онкологии и гематологии (химиотерапия гемобластозов) № 1 НИИ детской онкологии и гематологии

115478, Москва, Каширское шоссе, 23

Dr. of Sci. (Med.), Head of the Department of Pediatric Oncology and Hematology (Chemotherapy of Hemoblastosis) No. 1 of the Research Institute of Pediatric Oncology and Hematology

23 Kashirskoe Shosse, Moscow, 115478

timurvaliev@mail.ruhttps://orcid.org/0000-0003-2395-4045МачневаЕ. Б.MachnevaE. B.

к.м.н., врач-гематолог отделения детской онкологии и гематологии с блоком трансплантации костного мозга НИИ детской онкологии и гематологии

SPIN-код: 6143-8644

115478, Москва, Каширское шоссе, 23

117997, Москва, Ленинский просп., 117

Cand. of Sci. (Med.), Hematologist Department of Pediatric Oncology and Hematology with a Bone Marrow Transplant Unit of the Research Institute of Pediatric Oncology and Hematology

SPIN-code: 6143-8644

23 Kashirskoe Shosse, Moscow, 115478

117 Leninskiy Prosp., Moscow, 117997

lena.machneva@yandex.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

SPIN-код: 3803-6370

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

k.kirgizov@ronc.ruФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional Education, 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 FederationФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; Российская детская клиническая больница 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 Federation202216082022928592Copyright © Сергеенко К.А., Алиев Т.З., Костарева И.О., Лозован Ю.В., Малова М.Д., Батманова Н.А., Валиев Т.Т., Мачнева Е.Б., Киргизов К.И., 20222022Сергеенко К.А., Алиев Т.З., Костарева И.О., Лозован Ю.В., Малова М.Д., Батманова Н.А., Валиев Т.Т., Мачнева Е.Б., Киргизов К.И.Sergeenko K.A., Aliev T.Z., Kostareva I.O., Lozovan Y.V., Malova M.D., Batmanova N.A., Valiev T.T., Machneva E.B., Kirgizov K.I.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/833

Несмотря на улучшение понимания биологии заболевания и использование многокомпонетной химиотерапии, прогноз для детей с рецидивирующим или рефрактерным В-линейным острым лимфобластным лейкозом (В-ОЛЛ) остается плохим. В настоящее время единственным радикальным методом лечения для таких пациентов является аллогенная трансплантация гемопоэтических стволовых клеток (алло-ТГСК), которая может быть выполнена после достижения иммуногематологической ремиссии. Проведение высокоинтенсивных блоков полихимиотерапии (ПХТ) для достижения отрицательных значений минимальной остаточной болезни (МОБ) часто ограничено ввиду высокой токсичности. Разработанные моноклональные антитела, нацеленные на антигены клеточной поверхности, такие как CD19 и CD20, активно используются у детей с рецидивом/рефрактерным течением В-ОЛЛ в рамках «бридж-терапии», позволяющей достичь МОБ-негативного статуса без применения интенсивной ПХТ. Однако для улучшения прогноза этих пациентов необходимы новые стратегии. Препарат Инотузумаб озогамицин продемонстрировал эффективность при рецидивах В-ОЛЛ и активно используется для достижения отрицательного МОБ-статуса перед этапом алло-ТГСК у детей. В представленной статье помимо краткого обзора литературы продемонстрирован клинический опыт применения данного препарата.

Despite improved understanding of the biology of the disease and the use of multicomponent chemotherapy, the prognosis for children with relapsed or refractory B-line acute lymphoblastic leukemia (B-ALL) remains poor. Currently, the only definitive treatment for these patients is allogeneic hematopoietic stem cell transplantation (allo-HSCT), which can be performed after achieving immunohematological remission. Conducting highintensity polychemotherapy (PCT) blocks to achieve negative values of minimal residual disease (MRD) is often limited due to high toxicity. The developed monoclonal antibodies targeting cell surface antigens, such as CD19 and CD20, are actively used in children with relapsed/refractory B-ALL as part of “bridge therapy”, which allows achieving MRD-negative status without the use of intensive chemotherapy. However, new strategies are needed to improve the prognosis of these patients. The drug Inotuzumab ozogamicin has demonstrated efficacy in relapses of B-ALL and is actively used to achieve a negative MRD status before the allo-HSCT stage in children. In the presented article, in addition to a brief review of the literature, clinical experience with the use of this drug is demonstrated.

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