КОМПЛЕКСНАЯ ОЦЕНКА РИСКА ТРОМБОЦИТОПЕНИИ У ОНКОЛОГИЧЕСКИХ ПАЦИЕНТОВ: ОТ ПРЕДИКТОРОВ К ПЕРСОНАЛИЗИРОВАННОЙ ТЕРАПИИ
Ключевые слова:
тромбоцитопения, онкология, незрелая фракция тромбоцитов, тромбопоэтин, молекулярно-генетические маркерАннотация
Представленное исследование фокусируется на мультипараметрической оценке риска тромбоцитопении в онкологической когорте с использованием современных диагностических методологий. Описан комплексный алгоритм прогнозирования, интегрирующий клинико-лабораторные и молекулярно-генетические предикторы. Цель статьи заключается в систематизации диагностических подходов к оценке риска развития тромбоцитопении с позиции многофакторного анализа в паллиативной онкологии. В статье представлен концептуальный подход, который включает еоличественную оценку исходного тромбоцитарного резерва, аализ генетической предрасположенности, оценку функционального потенциала тромбоцитарного звена и молекулярно-генетическую стратификацию рисков
Библиографические ссылки
Kuter DJ. Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies. Haematologica. 2022;107(6):1243-1258.
Elting LS, Rubenstein EB, Martin CG, et al. Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia. J Clin Oncol. 2001;19(4):1137-1146.
Ghanima W, Cooper N, Rodeghiero F, et al. Thrombopoietin receptor agonists: ten years later. Haematologica. 2019;104(6):1112-1123.
Briggs C, Kunka S, Hart D, et al. Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia. Br J Haematol. 2004;126(1):93-99.
Schwenkglenks M, Jackisch C, Constenla M, et al. Risk factors for chemotherapy-induced thrombocytopenia in patients with solid tumors: a pooled analysis. Support Care Cancer. 2011;19(1):33-40.
Weycker D, Hatfield M, Grossman A, et al. Risk and consequences of chemotherapy-induced thrombocytopenia in US clinical practice. BMC Cancer. 2019;19(1):151.
Elting LS, Escalante CP, Cooksley C, et al. Outcomes and cost of deep venous thrombosis among patients with cancer. Arch Intern Med. 2004;164(15):1653-1661.
Gerber DE, Seidlin M, Onstad M, et al. Incidence of and risk factors for venous thromboembolism in patients with solid tumors treated with chemotherapy. Cancer. 2013;119(14):2507-2514.
Soff GA. Angiogenesis inhibitors and thrombotic risk in cancer patients. Thromb Res. 2016;140 Suppl 1:S109-S115.
Khorana AA, Francis CW, Culakova E, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5(3):632-634.
Simanek R, Vormittag R, Hassler MR, et al. Venous thromboembolism and survival in patients with high-grade glioma. Neuro Oncol. 2007;9(2):89-95.
Innocenti F, Undevia SD, Iyer L, et al. Genetic variants in the UDP-glucuronosyltransferase 1A1 gene predict the risk of severe neutropenia of irinotecan. J Clin Oncol. 2004;22(8):1382-1388.
Low SK, Kiyotani K, Mushiroda T, et al. Association study of genetic polymorphism in ABCC4 with cyclophosphamide-induced adverse drug reactions in breast cancer patients. J Hum Genet. 2009;54(10):564-571.
Gieger C, Radhakrishnan A, Cvejic A, et al. New gene functions in megakaryopoiesis and platelet formation. Nature. 2011;480(7376):201-208.
Coombs CC, Zehir A, Devlin SM, et al. Therapy-related clonal hematopoiesis in patients with non-hematologic cancers is common and associated with adverse clinical outcomes. Cell Stem Cell. 2017;21(3):374-382.
Stanworth SJ, Estcourt LJ, Powter G, et al. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med. 2013;368(19):1771-1780.
Slichter SJ, Kaufman RM, Assmann SF, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 2010;362(7):600-613.
Rebulla P, Finazzi G, Marangoni F, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl J Med. 1997;337(26):1870-1875.
Friedmann AM, Sengul H, Lehmann H, et al. Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? Transfus Med Rev. 2002;16(1):34-45.
Ranucci M, Baryshnikova E, Pistuddi V, et al. The effectiveness of 10 years of interventions to control postoperative bleeding in adult cardiac surgery. Interact Cardiovasc Thorac Surg. 2019;28(2):196-202.
Görlinger K, Dirkmann D, Hanke AA, et al. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery. Anesthesiology. 2011;115(6):1179-1191.
Psaila B, Bussel JB, Linden MD, et al. In vivo effects of eltrombopag on platelet function in immune thrombocytopenia: no evidence of platelet activation. Blood. 2012;119(17):4066-4072.
Levi M, Toh CH, Thachil J, et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol. 2009;145(1):24-33.
Taylor FB Jr, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86(5):1327-1330.
George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med. 2014;371(7):654-666.
Carrier M, Khorana AA, Moretto P, et al. Lack of evidence to support thromboprophylaxis in hospitalized medical patients with cancer. Am J Med. 2014;127(1):82-86.
Briggs C, Kunka S, Machin SJ. The most important new red cell parameters that analyzers can provide. Int J Lab Hematol. 2009;31(5):481-491.
Briggs C, Kunka S, Hart D, et al. Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia. Br J Haematol. 2004;126(1):93-99.
Abe Y, Wada H, Tomatsu H, et al. A simple technique to determine thrombopoiesis level using immature platelet fraction (IPF). Thromb Res. 2006;118(4):463-469.
Abe Y, Nagata S, Suzuki H, et al. Immature platelet fraction as a predictor of platelet recovery after chemotherapy. Int J Lab Hematol. 2016;38(6):e108-e111.
Takami A, Shibayama M, Orito M, et al. Immature platelet fraction for prediction of platelet engraftment after allogeneic stem cell transplantation. Bone Marrow Transplant. 2007;39(8):501-507.
Kaushansky K. The molecular mechanisms that control thrombopoiesis. J Clin Invest. 2005;115(12):3339-3347.
Kosugi S, Kurata Y, Tomiyama Y, et al. Circulating thrombopoietin level in chronic immune thrombocytopenic purpura. Br J Haematol. 1996;93(3):704-706.
Emmons RV, Reid DM, Cohen RL, et al. Human thrombopoietin levels are high when thrombocytopenia is due to megakaryocyte deficiency and low when due to increased platelet destruction. Blood. 1996;87(10):4068-4071.
Nichol JL, Hokom MM, Hornkohl A, et al. Megakaryocyte growth and development factor. Analyses of in vitro effects on human megakaryopoiesis and endogenous serum levels during chemotherapy-induced thrombocytopenia. J Clin Invest. 1995;95(6):2973-2978.
Thiele J, Kvasnicka HM, Facchetti F, et al. European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica. 2005;90(8):1128-1132.
Barraco F, Steidl U, Valent P, et al. Bone marrow cellularity and megakaryocyte morphology in primary myelofibrosis. Am J Hematol. 2015;90(11):E201-E202.
Della Porta MG, Malcovati L, Boveri E, et al. Clinical relevance of bone marrow fibrosis and CD34-positive cell clusters in primary myelodysplastic syndromes. J Clin Oncol. 2009;27(5):754-762.
Thiele J, Kvasnicka HM, Zankovich R, et al. The value of bone marrow histology in differentiating between early stage Polycythemia vera and secondary (reactive) polycythemias. Haematologica. 2001;86(4):368-374.
Bejar R, Stevenson K, Abdel-Wahab O, et al. Clinical effect of point mutations in myelodysplastic syndromes. N Engl J Med. 2011;364(26):2496-2506.
Elting LS, Rubenstein EB, Martin CG, et al. Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thromocytopenia. J Clin Oncol. 2001;19(4):1137-1146.
Zucker ML, Murphy CA, Rachel JM, et al. Immature platelet fraction as a predictor of platelet recovery following hematopoietic progenitor cell transplantation. Lab Hematol. 2006;12(3):125-130.
Estcourt LJ, Birchall J, Allard S, et al. Guidelines for the use of platelet transfusions. Br J Haematol. 2017;176(3):365-394.
Alkhathami, A. G., Altalbawy, F. M. A., Rizaev, J. A., Jeddoa, Z. M. A., & Jabir, M. S. (2025). An overview of lncRNA GAPLINC's role in human cancer growth and metastasis. Archives of Biochemistry and Biophysics, 110506.
Irgashev, K. N., & Rizaev, J. A. (2025). Optimization of clinical outcomes in the rehabilitation of patients with non-caries dental lesions manifesting as pathological abrasion. Medical Research Journal, 1(1), 146–151.
Shakhanova, S. S., Abdurakhmonov, J. A., & Rakhimov, N. M. (2023). Targeted therapy in the palliative treatment of platinum-resistant recurrent ovarian cancer complicated by ascites. The American Journal of Medical Sciences and Pharmaceutical Research, 5(8), 1.
Rizaev, J. A., Rahimov, N. M., & Shakhanova, S. S. (2023). Prostate cancer morbidity and mortality among men in high-risk areas. Eurasian Medical Research Periodical, 18, 101–104.
