bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.35754/0234-5730-2026-71-1-120-133bloodjour-733Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCASE REPORTSКлональная эволюция при острых миелоидных лейкозах: современные представления и собственные наблюденияClonal evolution of AML: current conceptions and clinical observationshttps://orcid.org/0000-0002-4799-9398ШатиловаА. А.ShatilovaА. А.

Шатилова Алексина Алексеевна, кандидат медицинских наук, младший научный сотрудник Института цитологии РАН; гематолог; старший преподаватель 

194064, г. Санкт-Петербург 

197341, г. Санкт-Петербург 

236005, г. Калининград 

236016, г. Калининград 

Alexina A. Shatilova, Cand. Sci. (Med.), junior researcher; hematologist; senior teacher

194064, Saint-Petersburg 

197341, Saint-Petersburg 

236005, Kaliningrad

236016, Kaliningrad 

alexina-96@list.ruhttps://orcid.org/0000-0002-0559-9556ГиршоваЛ. Л.GirshovaL. L.

Гиршова Лариса Леонидовна, кандидат медицинских наук, гематолог 

197341, г. Санкт-Петербург

Larisa L. Girshova, Cand. Sci. (Med.), hematologist 

197341, Saint-Petersburg

lgirshova@gmail.comhttps://orcid.org/0000-0002-7158-4846БудаеваИ. Г.BudaevaI. G.

Будаева Ирина Гармаевна, гематолог 

197341, г. Санкт-Петербург

Irina G. Budaeva, hematologist 

197341, Saint-Petersburg

irina2005179@mail.ruhttps://orcid.org/0000-0003-4323-7174ДемидовО. Н.DemidovO. N.

Демидов Олег Николаевич, доктор медицинских наук, ведущий научный сотрудник 

194064, г. Санкт-Петербург 

Oleg N. Demidov, Dr. Sci. (Med.), leading scientist

194064, Saint-Petersburg 

demidov.on@mail.ruhttps://orcid.org/0000-0003-3985-9552БелоцерковскаяЕ. В.BelotserkovskayaE. V.

Белоцерковская Екатерина Васильевна, кандидат биологических наук, старший научный сотрудник

194064, г. Санкт-Петербург 

Ekaterina V. Belotserkovskaya, Cand. Sci. (Med.), senior scientist 

194064, Saint-Petersburg 

belotserkovskaya.ev@gmail.comИнститут цитологии РАН ; ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Министерства здравоохранения Российской Федерации ; ГБУЗ КО «Центральная городская клиническая больница» ; ОНК «Институт медицины и наук о жизни (МЕДБИО)» ФГАОУ ВО «Балтийский федеральный университет им. И. Канта»РоссияInstitute of Cytology RAS ; VA Almazov National Medical Research Center ; Central Municipal Hospital ; Institute of Medicine and Life Sciences (MEDBIO), Immanuel Kant Baltic Federal University (IKBFU)Russian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияVA Almazov National Medical Research CenterRussian FederationИнститут цитологии РАНРоссияInstitute of Cytology RASRussian Federation202607042026711120133Copyright © Шатилова А.А., Гиршова Л.Л., Будаева И.Г., Демидов О.Н., Белоцерковская Е.В., 20262026Шатилова А.А., Гиршова Л.Л., Будаева И.Г., Демидов О.Н., Белоцерковская Е.В.Shatilova А.А., Girshova L.L., Budaeva I.G., Demidov O.N., Belotserkovskaya E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/733Введение

Введение. Острый миелоидный лейкоз (ОМЛ) характеризуется сложной клональной структурой, формирующейся в результате клональной эволюции. Изучение клональной эволюции продиктовано необходимостью повышения эффективности терапевтических стратегий ОМЛ.

Цель

Цель: обобщить представление о клональной эволюции ОМЛ и показать клональную эволюцию в условиях реальной клинической практики на примере 3 клинических наблюдений.

Основные сведения

Основные сведения. Представлено описание клинических наблюдений клональной эволюции ОМЛ у 3 больных с впервые выявленным ОМЛ. Молекулярно-генетический анализ генов FLT3 и NPM1 выполнили с использованием коммерческих наборов. Рассмотрены основные модели клональной эволюции ОМЛ: линейная и ветвящаяся. Представлены данные изучения лейкозных стволовых клеток. Клональная эволюция показана на примере 3 клинических наблюдений, даны разъяснения и рекомендации по подбору терапии. Клональная эволюция ОМЛ представляет собой длительный и непрерывный процесс, в результате которого складывается сложноветвящийся паттерн молекулярно-генетических поломок с участием стволовой лейкозной клетки. В этой связи на всех этапах развития ОМЛ (дебют, ремиссия, рецидив) необходимо диагностировать максимальное число молекулярно-генетических маркеров. Лечение с учетом знания закономерностей клональной эволюции позволит повысить эффективность терапии.

Introduction

Introduction. Acute myeloid leukemia (AML) is characterized by a complex clonal structure formed as a result of clonal evolution. The study of clonal evolution is dictated by the need to improve the effectiveness of therapeutic strategies for AML.

Aim

Aim: to review the current understanding of the clonal evolution of AML and analyze clonal evolution in real clinical practice using the example of three clinical cases.

Main findings

Main findings. A description of clinical cases with AML clonal evolution included 3 patients with newly diagnosed AML. Molecular genetic analysis of FLT3 and NPM1 genes was performed using commercial kits. The article reviews the main models of clonal evolution of AML: linear and parallel. The data from the study of leukemic stem cells are presented. Clonal evolution is demonstrated using the example of three clinical observations, explanations and recommendations for the selection of therapy are given. The clonal evolution of AML is a long and continuous process, which results in the formation of a complex branching pattern of molecular genetic breakdowns involving the leukemia stem cells. In this regard, at all stages of AML development (onset, remission, relapse), it is necessary to diagnose the maximum number of molecular genetic markers. Treatment taking into account knowledge of the patterns of clonal evolution is likely to improve the effectiveness of therapy.

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The authors declare that there are no conflicts of interest present.