PROGNOZA I SAVREMENO LEČENJE BOLESNIKA SA HRONIČNOM LIMFOCITNOM LEUKEMIJOM

Vladimir D Otašević; Biljana Mihaljević; Darko Antić

doi:10.5937/mp70-23520

Vladimir D Otašević Klinika za hematologiju KCS, odeljenje Lifmomi I
Biljana Mihaljević Klinika za hematologiju KCS, odeljenje Lifmomi I
Darko Antić Klinika za hematologiju KCS, odeljenje Lifmomi I

DOI: https://doi.org/10.5937/mp70-23520

Sažetak

Hronična limfocitna leukemija (HLL) najčešća je leukemija u zapadnim zemljama, čineći 30% leukemija u Evropi i Sjedinjenim Američkim Državama. Ujedno predstavlja jedno od najaktivnijih polja u hematologiji po pitanju kliničkih istraživanja. Približno 80% obolelih ima neku hromozomsku alteraciju, od kojih su najčešće i najvažnije: delecija dugog kraka hromozoma 13 (del13q14), delecija dugog kraka hromozoma 11 (del11q22-q23), trizomija hromozoma 12, delecija kratkog kraka hromozoma 17 (del17p) i/ili mutacija tumorskog supresorskog gena TP53. Primena novih terapijskih agensa u lečenju HLL značajno je produžila preživljavanje i poboljšala kvalitet života bolesnika obolelih od HLL. Ibrutinib, inhibitor Brutonove kinaze (BTK), odobren je kao prva linija terapije kod HLL bolesnika sa del17p ili mutacijom TP53, a takođe je odobren za lečenje relapsne/refraktarne HLL (R/R HLL). Primena venetoklaksa, visokoselektivnog inhibitora antiapoptoznog proteina bcl-2, indikovana je kod R/R HLL bolesnika, rezistentnih na ibrutinib ili nepodobnih za ibrutinib (primena antikoagulantne terapije; povećan rizik od krvarenja). Inhibitori fosfatidilinozitol 3-kinaza (PI3K), idelalisib (u kombinaciji sa rituksimabom) i duvelisib (monoterapija) odobreni su za lečenje R/R bolesnika sa HLL. Inhibitori PI3K retko se upotrebljavaju u lečenju R/R HLL bolesnika pre ibrutiniba ili venetoklaksa, pre svega zbog nepovoljnog bezbednosnog profila. Rezultat primene novih agensa u lečenju HLL je produženje ukupnog preživljavanja i preživljavanja bez progresije, posebno kod bolesnika sa markerima loše prognoze.

Biografije autora

Vladimir D Otašević, Klinika za hematologiju KCS, odeljenje Lifmomi I

klinički lekar na specijalizaciji interne medicine, doktorand Medicinskog fakulteta u Beogradu, smer biologija tumora i oksidativna oboljenja

Biljana Mihaljević, Klinika za hematologiju KCS, odeljenje Lifmomi I

specijalista interne medicine, subspecijalista hematologije, profesor na Katedri za internu medicinu Medicinskog fakulteta Univerziteta u Beogradu, direktor Klinike za hematologiju KCS

Darko Antić, Klinika za hematologiju KCS, odeljenje Lifmomi I

specijalista interne medicine, subspecijalista hematologije, docent na Katedri za internu medicinu Medicinskog fakulteta Univerziteta u Beogradu, zamenik direktora Klinike za hematologiju KCS

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