ОПЫТ ПРИМЕНЕНИЯ ИБРУТИНИБА У БОЛЬНЫХ РЕФРАКТЕРНЫМИ ФОРМАМИ И РЕЦИДИВАМИ В-КЛЕТОЧНОГО ХРОНИЧЕСКОГО ЛИМФОЛЕЙКОЗА

Цель исследования. Получение опыта применения ибрутиниба у пациентов с хроническим лимфолейкозом (ХЛЛ) в повседневной клинической практике.

Материалы и методы. С октября 2015 г. по январь 2016 г. в исследование было включено 20 больных с рефрактерными формами и рецидивами ХЛЛ. Всем пациентам было выполнено иммунофенотипическое, цитогенетическое и молекулярное исследования образцов периферической крови. Пациенты принимали ибрутиниб в суточной дозе 420 мг однократно ежедневно в течение года или до прогрессирования. Эффективность лечения оценивали по показателям общей частоты ответов, частоты полных ответов, общей выживаемости.

Результаты. Общая частота ответов составила 100%. Показатель общей выживаемости к сроку в 14 месяцев терапии составил 80%. Частота полных ответов на сроке наблюдения в 14 месяцев после начала терапии составила 60%. Первый эффект наблюдается со стороны лимфоузлов, тогда как изменения гемограммы происходят позднее. Препарат хорошо переносился. Пациентам, которым терапия ибрутинибом была временно приостановлена из-за развившихся осложнений, после их разрешения она была возобновлена в полной дозе.

Заключение. Ибрутиниб является высокоэффективным препаратом для пациентов с рефрактерными формами и рецидивами ХЛЛ, в том числе из группы высокого риска, однако он не является «терапией спасения» и не обладает эффективностью при терминальных состояниях. Ибрутиниб может рассматриваться в качестве «мостика» для молодых пациентов, которым планируется выполнение трансплантации аллогенного костного мозга.

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