• Особливості мієлодиспластичного синдрому та гострої мієлоїдної лейкемії, індукованих лікуванням, у дітей, які лікувалися з приводу гострої лімфобластної лейкемії: власні спостереження

Особливості мієлодиспластичного синдрому та гострої мієлоїдної лейкемії, індукованих лікуванням, у дітей, які лікувалися з приводу гострої лімфобластної лейкемії: власні спостереження

SOVREMENNAYA PEDIATRIYA.2018.4(92):69-80; doi 10.15574/SP.2018.92.69

Дорош О. І., Мих А. М., Степанюк А. І., Козлова О. І., Скоропад Л. Л., Середич Л. П., Цимбалюк-Волошин І. П.
КЗ ЛОР «Західноукраїнський спеціалізований дитячий медичний центр», м. Львів, Україна
Львівський національний медичний університет імені Данила Галицького, Україна

Наведено два клінічні випадки вторинних, індукованих лікуванням, гемобластозів — treatment-related myelodysplastic syndrome (t-MDS)/treatment-related acute myeloid leukemia (AML) — t-MDS/t-AML, які порівнювалися з даними інших світових досліджень. Двоє хлопців із попередньо діагностованою гострою лімфобластною лейкемією (ГЛЛ) отримували терапію за програмою ALL IC-BFM-2002, згідно з належністю до терапевтичних груп середнього та високого ризику (ГСР, ГВР). У одного з них, який належав до ГСР, виник вторинний мієлодисплатичний синдром (МДС) із моносомією 7, що згодом трансформувався у вторинну гостру мієлоїдну лейкемію (ГМЛ). Хворому проведено алогенну трансплантацію гемопоетичних клітин (ало-ТГПСК) пуповинної крові. Пацієнт помер від посттрансплантаційних ускладнень. У другого хворого із ГВР зареєстровано вторинну ГМЛ з транслокацією t(9.11) (p22; q23). Йому виконано ало-ТГПСК. Пацієнт перебуває у клініко-гематологічній ремісії ГЛЛ 77 міс. та t-AML — 49 місяців. t-MDS/t-AML реєструвалися на тлі підтримуючої хіміотерапії ГЛЛ через 20 міс. у осіб чоловічої статі із наявністю хромосомних аномалій, мали здатність до прогресування під час стандартної хіміотерапії та розвитку важких інфекційно-токсичних ускладнень на ґрунті цитопенії. Трансплантація гемопоетичних клітин є єдиним лікувальним режимом у пацієнтів із t-MDS/t-AML.
Ключові слова: гостра лімфобластна лейкемія, індуковані лікуванням мієлодистпластичний синдром та гостра мієлоїдна лейкемія, вторинні неоплазії, діти.

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