Összefoglaló. A hajas sejtes leukémia (HCL) egy indolens lefolyású ritka B-sejtes lymphoma. Diagnosztikájában jellegzetes morfológiai képén túlmenően a sejtek felszínén megtalálható markerek azonosítása áramlási citometriával, valamint a betegségben előforduló specifikus fehérjék immunhisztokémiai detektálása jelenti a rutineljárást. Kiemelt szerepet tölt be a differenciáldiagnosztikában a BRAF V600E mutációjának a kimutatása, melyre ma már számos módszer áll rendelkezésre, mint például az immunhisztokémia, pyroszekvenálás, allélspecifikus PCR vagy a droplet digitalis PCR. A tumorsejtek jelátviteli rendszerében és szabályozásában azonban a BRAF mutációjának következtében kialakuló folyamatos aktivitása mellett egyéb mechanizmusok is szerepet játszhatnak, többek között növekedési faktorok, interleukinek, adhéziós fehérjék vagy éppen mikro-RNS-ek. A patomechanizmus egyre részletesebb megismerése érdekében egyéb daganatokhoz hasonlóan a HCL-ben is aktív kutatások folynak a genetikai háttér feltérképezésére új generációs szekvenálás segítségével. Leírtak már nagy százalékban előforduló mutációkat a CDKN1B-, KLF2- és KMT2C-gének esetében, továbbá egyéb génekben is alacsonyabb előfordulási aránnyal. Genetikailag, sőt klinikai manifesztáció és terápiás válasz alapján is jelentős eltérések láthatóak a klasszikus és variáns HCL-es betegek között, elkülönítésük épp ezért rendkívül fontos. Míg a klasszikus esetben első vonalban alkalmazott purin nukleozid analógok kiemelkedő válaszreakciót képesek kiváltani, a variáns HCL-es betegek gyakran refrakterek a kezelésre, és esetükben a célzott BRAF-gátlók szintén hatástalanok. Számos klinikai kutatás zajlik a jelenleg is alkalmazott terápiás szerek optimalizálása, kombinációban történő alkalmazása, valamint egyéb lymphoid daganatokban alkalmazott gyógyszerek és új támadáspontok ellen tervezett molekuláknak a HCL kezelésébe történő bevonása céljából.
Summary. Hairy cell leukemia (HCL) is a rare indolent B-cell malignancy. In addition to characteristic morphology of HCL cells, the identification of the cellular surface markers and the expression of specific proteins by flow cytometry and immunohistochemistry are routine procedure in HCL diagnosis. Detection of BRAF V600E mutation plays key role in differential diagnosis of HCL which can be detected by several novel methods, such as immunohistochemistry, pyrosequencing, allele specific PCR or droplet digital PCR. Beside the BRAF mutation there can be other mechanisms causing constitutive activity in the signaling pathway and regulating the tumor cells such as growth factors, interleukins, adhesion proteins and micro-RNAs as well. Like in other malignancies, in order to clarify the pathomechanism, the genetic background of HCL is also actively investigated by next-generation sequencing. Frequent mutations were described in CDKN1B, KLF2 and KMT2C genes, moreover in other genes with lower incidence rate, as well. Genetically, and even in clinical manifestation and therapeutic response, significant differences can be found between patients with classical and variant HCL. While classical type has outstanding response for the first-line treatment with purine analogues, patients with variant HCL are often refractory to the treatment, and the BRAF inhibitors prove to be ineffective. Therefore, it is really important to distinguish these two entities. Several clinical studies are still in progress for the optimization and application of combining the currently applied therapeutic agents, furthermore other drugs that used in lymphoid malignancies are under investigation. New target molecules are also designed as novel therapeutic opportunity in HCL treatment.
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