Перспективы использования мелатонина в клинической онкологииPerspectives of melatonin use in clinical oncology www.malignanttumours.org • № 4 -2016 г. (20) • MALIGNANT TUMOURSАннотация В 21-м веке достигнуты значительные успехи в лекарственном лечении злокачественных опухолей. Применение новых препаратов позволяет увеличить время до прогрессирования заболевания, продолжительность жизни больных, улучшить ее качество. В последнее время активно изучается противоопухолевая активность гормона эпифиза мелатонина. Этой теме посвящены многочисленные опыты in vitro/ in vivo, в которых показана способность мелатонина тормозить злокачественный рост и потенцировать действие цитостатиков. В данном обзоре освещены данные о использовании мелатонина при лечении пациентов с солидными опухолями. Мелатонин использовался как в монотерапии, так и в комбинации с химиотерапией и иммунотерапией. Согласно результатам этих исследований применение мелатонина приводит к увеличению объективных ответов и общей выживаемости пациентов и к снижению частоты побочных эффектов химиотерапии. Однако этот гормон эпифиза до сих пор рутинно не используется в клинической онкологии и его активность следует изучать в дальнейшем в рамках рандомизированных клинических исследований. AbstractNowadays great successes have been reached in chemotherapy treatment of cancer. New medications let increase time to progression, overall survival and to improve a quality of life. Recently, antitumor activity of melatonin is actively investigated. Many in vitro/in vivo studies are devoted to this topic. In these trials was shown ability of melatonin to inhibit tumor growth and to potentiate the cytotoxic effects of chemotherapy. This review describes the use of melatonin in the treatment of patients with solid tumors. Melatonin has been used in both monotherapy and in combination with chemotherapy and immunotherapy. According to these studies, the use of melatonin increases the objective response and overall survival of patients and reduce the incidence of side effects of chemotherapy. However, this epiphyseal hormone does not routinely used in clinical oncology and will be must to investigate it in more clinical trials. УРОВНИ МЕЛАТОНИНА У БОЛЬНЫХ ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИС начала 40-х гг. 20-го века проводились исследования, в ходе которых выявлено, что у онкологических больных наблюдаются морфологические изменения эпифиза. Это проявляется как гипертрофией [26], так и атрофией шиш-ковидной железы [27], появлением множества кист [28,29], кальцификацией эпифиза у пациенток с раком молоч-
This article presented a review of the literature on the features of nutritional support for oncohematological patients who have undergone allogeneic (alloHSCT)/autologous hematopoietic stem cell transplantation (autoHSCT). Bone marrow transplantation associated with a high risk of developing nutritional deficiencies. Nutritional support (NP) is indicated for patients undergoing alloHSCT and autoHSCT in order to reduce the incidence of infectious complications and reduce the risk of developing severe forms of acute and chronic GVHD. Currently, there are recommendations for conducting NP in alloHSCT, while there are no recommendations for patients with autoHSCT. An important task in planning NP is the calculation of the daily energy requirement. Bone marrow transplantation accompanied by a prolonged negative nitrogen balance. The protein requirement for alloHSCT is significantly higher than for patients with chemotherapy alone – 1.5–2 g/kg per day. An effective method of controlling the needs of hematological patients during the analysis of HSCT and alloHSCT is the calculation of the nitrogen balance and the daily protein norm. In this article was analyzed the role of macronutrients and immunonutrients in the recovery of patients during alloHSCT. It has been shown that low levels of vitamin D and vitamin A increase the risk of development and the severity of the transplant versus host reaction. The addition of omega-3 fatty acids helps maintain an optimal proportion of calorie intake from lipids, as well as maintain the necessary level of triglycerides in the blood. The article presents data on reducing the risk of developing acute GVHD with systemic addition of omega-3 fatty acids. For a final assessment of the effect of the neutropenic diet on the development of infectious complications in oncohematological patients, randomized prospective multicenter studies with the development of a unified approach in choosing a diet for HSCT are needed.
This article provides an overview of current nutritional support recommendations for autologous hematopoietic stem cell transplantation recipients, and the impact of nutritional status on infectious complications frequency.
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