medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-22-1medsovet-7238Research ArticleОНКОГЕМАТОЛОГИЯONCOHEMATOLOGYПрактические аспекты применения эритропоэзстимулирующих препаратов у пациентов онкогематологического профиляPractical aspects of the use of erythropoiesis-stimulating agent in patients with hematological malignancyhttps://orcid.org/0000-0002-8129-8114СемочкинС. В.SemochkinS. V.

Семочкин Сергей Вячеславович – доктор медицинских наук, главный научный сотрудник отделения высокодозной химиотерапии с блоком трансплантации костного мозга, МНИОИ им. П.А. Герцена; профессор кафедры онкологии, гематологии и лучевой терапии педиатрического факультета, РНИМУ им. Н.И. Пирогова.

125284, Москва, 2-й Боткинский проезд, д. 3; 117997, Москва, ул. Островитянова, д. 1

Sergey V. Semochkin - Dr. Sci. (Med.), Chief Researcher of the Department of High-Dose Chemotherapy with Bone Marrow Transplantation Unit, Hertsen Moscow Oncology Research Institute; Professor of the Department of Oncology, Hematology and Radiotherapy of the Pediatric Faculty, Pirogov Russian National Research Medical University.

3, 2nd Botkinskiy Proezd, Moscow, 125834; 1, Ostrovityanov St., Moscow, 117997

semochkin_sv@rsmu.ruМосковский научный-исследовательский онкологический институт имени П.А. Герцена; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияHertsen Moscow Oncology Research Institute; Pirogov Russian National Research Medical UniversityRussian Federation2022061220220227484Copyright © Семочкин С.В., 20222022Семочкин С.В.Semochkin S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7238

Анемия представляет собой один из наиболее частых симптомов онкогематологических заболеваний, а с другой стороны - часто встречающееся осложнение миелосупрессивной противоопухолевой терапии. Для коррекции анемического синдрома в онкологической практике применяются препараты железа, витамины группы В (В12, фолиевая кислота), биологические аналоги человеческого эритропоэтина (ЭПО) и некоторые новые таргетные препараты (леналидомид, луспатерсепт, роксадустат и др.). В целом стимуляторы эритропоэза объединяются в общую группу эритропоэзстимулирующих препаратов (ЭСП). Применение ЭСП позволяет обходиться без заместительной терапии эритроцитной массой (ЭМ) и улучшает качество жизни пациента. В данном обзоре литературы освещены вопросы физиологической регуляции эритропоэза и молекулярные предпосылки клинического применения ЭСП. Представлены исторические сведения по созданию рекомбинантного человеческого эритропоэтина (рч-ЭПО), структурные и биологические характеристики препаратов этой группы стимуляторов эритропоэза. В соответствии с рекомендациями ESMO 2018 г., назначение рч-ЭПО показано пациентам, получающим миелосупрес-сивную химиотерапию с симптомной анемией с Hb < 100 г/л и бессимптомной анемией с Hb < 80 г/л. Рекомендации ASCO/ASH 2019 г. также поддерживают положение не назначать ЭСП пациентам, не получающим химиотерапию. Исключение - МДС низкого риска, когда назначение рч-ЭПО может быть основным методом терапии. Заместительную терапию препаратом железа пациентам, получающим рч-ЭПО, следует назначать вне зависимости от того, есть исходно дефицит железа или нет, поскольку в процессе лечения возникает его функциональный недостаток. Оптимальными кандидатами для терапии рч-ЭПО являются пациенты с МДС низкого риска с уровнем эндогенного ЭПО < 500 мМЕ/мл и невысокой трансфузионной нагрузкой, составляющей менее 2 ед. ЭМ в месяц. Статья иллюстрируется клиническим наблюдением пациента с МДС промежуточного риска по R-IPSS, получавшего эпоэтин альфа. Обсуждаются вопросы профилактики тромбоэмболических осложнений, связанных с применением ЭСП.

Anemia is one of the most common symptoms of hematological malignancy and, on the other hand, a common complication of myelosuppressive anticancer therapy. Iron, vitamin B12, folate, biological analogs of human erythropoietin (EPO), and new targeted drugs (lenalidomide, luspatercept, roxadustat, etc.) are used in clinical practice to correct anemic syndrome in cancer patients. All these activators of erythropoiesis are combined into a single group called erythropoiesis-stimulating agents (ESAs). Issues of physiological regulation of erythropoiesis, historical information on the creation of recombinant human erythropoietin (rh-EPO), structural and biological characteristics of this group of drugs are covered in this literature review. In accordance with ESMO guidelines (2018), rh-EPO is indicated for patients receiving myelosuppressive chemotherapy with symptomatic anemia with Hb < 100 g/L and asymptomatic anemia with Hb < 80 g/L. ESAs are not used in patients not receiving chemotherapy, similarly to ASCO/ASH (2019) guidelines. Iron replacement therapy in patients receiving rh-EPO should be used regardless of whether there is an initial iron deficiency or not, since its functional deficiency occurs during treatment. The low-risk MDS is exception, where rh-EPO may be the mainstay of therapy. Low-risk MDS patients with endogenous EPO levels < 500 mIU/mL and a low transfusion load of less than 2 RBCs per month are optimal candidates for rh-EPO therapy. The article is illustrated by clinical observation of a patient with R-IPSS intermediate-risk MDS treated with epoetin alfa. The problems of prevention of thromboembolic complications associated with the use of ESA are also discussed.

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The authors declare that there are no conflicts of interest present.