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ВЫВОДЫ


  1. Эффективность терапии больных бластным кризом хронического миелолейкоза повышается, при включении в схемы лечения препаратов, к которым бластные клетки более чувствительны in vitro.

  2. Чувствительность бластных клеток к различным цитостатическим препаратам широко варьирует при ее исследовании in vitro. Опухолевые клетки больных с лимфоидным вариантом бластного криза более чувствительны к винкристину и преднизолону (p<0,05), к рубомицину и карбоплатину (p>0,05), чем при нелимфоидном варианте заболевания.

  3. Исследование лекарственной чувствительности к цитостатическим препаратам in vitro, особенно к иматиниб мезилату, имеет прогностическое значение для ответа на терапию. При нелимфоидном варианте бластного криза опухолевые клетки более чувствительны in vitro к иматиниб мезилату и 6-меркаптопурину (p>0,05). В процессе терапии достоверно снижается чувствительность нелимфоидных бластных клеток in vitro к цитозару и идарубицину.

  4. У больных с нелимфоидным вариантом бластного криза хронического миелолейкоза монотерапия иматинибом имеет преимущество перед полихимиотерапией, как по частоте гематологических (83% vs 35%) и цитогенетических (19% vs 0%), так и по выживаемости (487 дней vs 227 дней).

  5. При лимфоидном варианте бластного криза индукционная полихимиотерапия имеет преимущество перед монотерапией иматинибом. Медиана выживаемости больных, получавших ПХТ в качестве терапии I линии, достоверно выше медианы выживаемости пациентов, получавших терапию иматиниб мезилатом (313 vs 231 день).

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