Амилоидоз легких цепей иммуноглобулинов (AL-амилоидоз)

Автор: Пирогова О.В.

Журнал: Вестник гематологии @bulletin-of-hematology

Статья в выпуске: 4 т.19, 2023 года.

Бесплатный доступ

Амилоидозы — это общий термин для группы заболеваний, обусловленных неправильной агрегацией белков и их отложением в органах и тканях в виде нерастворимых белковых фибрилл. Осно- вой амилоида является фибрилла, построенная из скрученных белковых протофиламентов. Системный амилоидоз легких цепей (AL) — одна из форм плазмоклеточных дискразий, характеризующихся гиперпродукцией свободных легких цепей иммуноглобулина клональными плазматическими клетками или В-лимфоцитами. В этом обзоре описывается история открытия, этапов диагностики и изменения подходов к терапии AL-амилоидоза. Выживаемость при AL-амилоидозе зависит от спектра вовлеченных в процесс органов, тяжести их поражения и гематологического ответа на лечение. Фибриллы легких цепей инфильтрируют миокард, препятствуют межклеточному взаимодействию, что приводит к повреждению клеток и внезапной сердечной смерти. Вот почему поражение сердца является основным предиктором исхода заболевания. Современный подход к диагностике и лечению основан на выделении наиболее уязвимой группы больных с IIIb стадией поражения сердца. Основной целью терапии является быстрое и глубокое подавление продукции амилоидогенных легких цепей. Терапия мелфаланом и аутологичная трансплантация гемопоэтических стволовых клеток долгое время считались стандартом лечения AL-амилоидоза, но добавление таргетных препаратов — бортезомиба, даратумумаба и венетоклакса кардинально повысило эффективность лечения.

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AL-амилоидоз, плазматические клетки, бортезомиб, даратумумаб, аутологичная трансплантация гемопоэтических стволовых клеток

Короткий адрес: https://sciup.org/170199873

IDR: 170199873

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