Младенческий острый лимфобластный лейкоз: опыт прошлого и терапия будущего

Младенческий острый лимфобластный лейкоз (ОЛЛ) — редкая и биологически уникальная форма злокачественных заболеваний крови у детей первого года жизни, характеризующаяся агрессивным клиническим течением и неблагоприятным прогнозом, особенно при наличии перестроек гена KMT2A. В статье представлен обзор современных данных о клинических, иммунологических и молекулярно-генетических особенностях младенческого ОЛЛ из предшественников В-клеток. Подробно рассмотрены механизмы эпигенетической дисрегуляции и потенциальные мишени для таргетной терапии. Обсуждены эволюция подходов к стратификации пациентов на группы риска, роль минимальной остаточной болезни, а также результаты международных кооперированных исследований, направленных на повышение эффективности лечения. Особое внимание уделено внедрению иммунотерапевтических препаратов — блинатумомаба и Т-клеток с химерным антигенным рецептором (CAR-Т) — их эффективности в контроле заболевания. Обсуждены ограниченная роль трансплантации гемопоэтических стволовых клеток и современные тенденции к сужению показаний к ее применению. В заключение подчеркнуто значение интеграции генетических и динамически изменяющихся лабораторных параметров для персонализации терапии и обозначены перспективы дальнейшего улучшения исходов лечения младенцев с данным заболеванием.

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