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Medicinski podmladak
2019, vol. 70, br. 4, str. 6-12
jezik rada: engleski
vrsta rada: pregledni članak
objavljeno: 28/02/2020
doi: 10.5937/mp70-23520
Creative Commons License 4.0
Prognoza i savremeno lečenje bolesnika sa hroničnom limfocitnom leukemijom
aKlinički centar Srbije, Klinika za hematologiju, Beograd
bKlinički centar Srbije, Klinika za hematologiju, Beograd + Univerzitet u Beogradu, Medicinski fakultet

e-adresa: vladimirota@hotmail.com

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.

Ključne reči

hronična limfocitna leukemija; ibrutinib; venetoklaks; idelalisib; duvelisib

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