Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya3358810.26442/00403660.2019.07.000323Editorial articleПередовая статьяResearch ArticleCNS involvement and the feasibility of intratecal chemotherapy administration in patients with a nodal form of diffuse large B-cell lymphoma not otherwise specified. Data of prospective studyВовлечение центральной нервной системы и целесообразность профилактики рецидива в центральную нервную систему у больных нодальной формой диффузной В-клеточной крупноклеточной лимфомы (неспецифицированной). Данные проспективного исследованияMagomedovaA UМагомедоваАминат Умарасхабовна

д.м.н., в.н.с. отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0003-4363-8275

maminat@mail.ruMisyurinaA EМисюринаАнна Евгеньевна

к.м.н., врач-гематолог, отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-9535-6688

MangasarovaJ KМангасароваЯна Константиновна

к.м.н., врач-гематолог отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-0450-7453

GorenkovaL GГоренковаЛилия Гамильевна

врач-гематолог отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-3967-9183

MargolinO VМарголинОлег Викторович

врач-гематолог отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-6211-5677

FastovaE AФастоваЕкатерина Александровна

аспирантка отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-2822-0844

KravchenkoS KКравченкоСергей Кириллович

к.м.н., зав. отд. ИВХТ с КС и ДС ФГБУ «НМИЦ гематологии» Минздрава России; ORCID: 0000-0002-7721-2074

National Research Center for Hematology, Department of Intensive High-Dose Chemotherapy with Round-the-Clock and Day Hospital (IVHT with CS and DS)ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России15072019917VOL 91, NO7 (2019)ТОМ 91, №7 (2019)354016042020Copyright ©; 2019, Consilium MedicumCopyright ©; 2019, ООО "Консилиум Медикум"2019Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/33588

Aim of the issue was to determine indications for intratecal chemotherapy drugs administration to prevent relapse of diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) involvement. Materials and methods. Since January 2009 to December 2018 102 patients with primary nodal DLBCL over 18 years old were treated in the National Research Center for Hematology, Moscow, Russian Federation. Diagnosis were established in all cases according to histological and immunohistochemical studies which made it possible to exclude the transformation of mature B-cell lymphoma into DLBCL. Results. Isolated leptomeningeal involvement of CNS in the debut of the disease was detected in 1 (0.98%) out of 102 patients with DLBCL. Focal brain tissue involvement was not detected in any patient. More than half of the patients (54%) had a high risk of disease recurrence or progression with CNS involvement: in 8 (7.8%) patients had kidney/adrenal involvement, in the same proportion - bone marrow involvement, paranasal sinuses involvement - in 5 (4.9 %), epidural space - in 7 (6.9%) and breast - in 5 (4.9%) of patients. In 82 (80%) patients, a non-GCB (postgerminal differentiation of B-cell analog) molecular subtype of DLBCL was determined. Conclusion. The introduction of chemotherapy drugs into the spinal canal is recommended in isolated cases of leptomeningeal involvement of CNS at the time of DLBCL onset and is carried out according to standard recommendations. Prevention of relapse with involvement of central nervous system using intratecal chemotherapy in patients with nodal form of DLBCL is not indicated due to the absence of cases with disease progression or recurrence into CNS when patients were treated with R-m-NHL-BFM-90, R-DA-EPOCH and R-CHOP protocol.

Целью работы является определение показаний к проведению профилактики рецидива диффузной В-клеточной крупноклеточной лимфомы (ДВККЛ) с вовлечением центральной нервной системы (ЦНС) путем введения химиопрепаратов в спинномозговой канал. Материалы и методы. С января 2009 по декабрь 2018 г. в ФГБУ «НМИЦ гематологии» Минздрава России проводилось лечение 102 больным первичной нодальной ДВККЛ старше 18 лет. Всем больным проводили гистологическое и иммуногистохимическое исследования, позволившие исключить трансформацию зрелоклеточной лимфомы в ДВККЛ. Результаты. Вовлечение оболочек головного мозга/нейролейкемия в дебюте заболевания диагностировано у 1 (0,98%) больного. Очагового вовлечения вещества головного мозга не выявлено ни у одного пациента. Более половины больных (54%) имели высокий риск развития рецидива или прогрессии с вовлечением ЦНС: у 8 (7,8%) больных отмечалось вовлечение почек/надпочечников, в таком же проценте - костного мозга, параназальных синусов - у 5 (4,9%), эпидурального пространства - у 7 (6,9%) и молочных желез - у 5 (4,9%) больных. У 82 (80,1%) пациентов определен постгерминальный (из В-клеток постгерминальной дифференцировки - non-GCB) молекулярный подтип ДВККЛ. Заключение. Введение химиопрепаратов в спинномозговой канал показано в единичных случаях, когда в момент манифестации ДВККЛ у больных выявляется вовлечение оболочек/нейролейкемия, и проводится согласно стандартным рекомендациям. Профилактическое введение цитостатических препаратов в спинномозговой канал не показано ввиду отсутствия рецидивов ДВККЛ с вовлечением ЦНС у больных, проходивших лечение как по протоколу m-NHL-BFM-90, так и R-CHOP, R-DA-EPOCH.

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