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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="other" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Pediatric Hematology/Oncology and Immunopathology</journal-id><journal-title-group><journal-title xml:lang="en">Pediatric Hematology/Oncology and Immunopathology</journal-title><trans-title-group xml:lang="ru"><trans-title>Вопросы гематологии/онкологии и иммунопатологии в педиатрии</trans-title></trans-title-group></journal-title-group><issn publication-format="print">1726-1708</issn><issn publication-format="electronic">2414-9314</issn><publisher><publisher-name xml:lang="en">Fund Doctors, Innovations, Science for Children</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">668</article-id><article-id pub-id-type="doi">10.24287/1726-1708-2023-22-1-122-125</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>CLINICAL OBSERVATIONS</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ</subject></subj-group><subj-group subj-group-type="article-type"><subject></subject></subj-group></article-categories><title-group><article-title xml:lang="en">Resistance to BRAF inhibitors in a patient with <italic>BRAF</italic> V600E-positive Langerhans cell histiocytosis</article-title><trans-title-group xml:lang="ru"><trans-title>Резистентность к терапии BRAF-ингибиторами у пациента с <italic>BRAF</italic> V600E-позитивным гистиоцитозом из клеток Лангерганса</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0717-2019</contrib-id><name-alternatives><name xml:lang="en"><surname>Lyudovskikh</surname><given-names>E. I.</given-names></name><name xml:lang="ru"><surname>Людовских</surname><given-names>Э. И.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p><bold>Evelina I. Lyudovskikh</bold>, a pediatric oncologist at the Department of Hematopoietic Stem Cell Transplantation №2</p><p>1 Samory Mashela St., Moscow 117997, Russia </p></bio><bio xml:lang="ru"><p><bold>Людовских Эвелина Игоревна</bold>, врач-детский онколог отделения трансплантации гемопоэтических стволовых клеток №2</p><p>117997, Москва, ул. Саморы Машела, 1 </p></bio><email>evcola@yandex.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8610-0624</contrib-id><name-alternatives><name xml:lang="en"><surname>Evseev</surname><given-names>D. A.</given-names></name><name xml:lang="ru"><surname>Евсеев</surname><given-names>Д. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p> Москва </p></bio><email>dmitryevseev1991@gmail.com</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9968-9332</contrib-id><name-alternatives><name xml:lang="en"><surname>Osipova</surname><given-names>D. S.</given-names></name><name xml:lang="ru"><surname>Осипова</surname><given-names>Д. С.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p>Москва</p></bio><email>d_ossipova@mail.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7634-2053</contrib-id><name-alternatives><name xml:lang="en"><surname>Raykina</surname><given-names>E. V.</given-names></name><name xml:lang="ru"><surname>Райкина</surname><given-names>Е. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p> Москва </p></bio><email>elena.raykina@fccho-moscow.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0813-5626</contrib-id><name-alternatives><name xml:lang="en"><surname>Kalinina</surname><given-names>I. I.</given-names></name><name xml:lang="ru"><surname>Калинина</surname><given-names>И. И.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p> Москва </p></bio><email>Irina.Kalinina@fccho-moscow.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7130-8596</contrib-id><name-alternatives><name xml:lang="en"><surname>Baidildina</surname><given-names>D. D.</given-names></name><name xml:lang="ru"><surname>Байдильдина</surname><given-names>Д. Д.</given-names></name></name-alternatives><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p> Москва </p></bio><email>Dina.Baydildina@fccho-moscow.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0016-6698</contrib-id><name-alternatives><name xml:lang="en"><surname>Maschan</surname><given-names>A. A.</given-names></name><name xml:lang="ru"><surname>Масчан</surname><given-names>А. А.</given-names></name></name-alternatives><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p> Москва </p></bio><email>Aleksey.Maschan@fccho-moscow.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1735-0093</contrib-id><name-alternatives><name xml:lang="en"><surname>Maschan</surname><given-names>M. A.</given-names></name><name xml:lang="ru"><surname>Масчан</surname><given-names>М. А.</given-names></name></name-alternatives><bio xml:lang="en"><p> Moscow </p></bio><bio xml:lang="ru"><p> Москва </p></bio><email>Michael.Maschan@fccho-moscow.ru</email><xref ref-type="aff" rid="aff1"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation</institution></aff><aff><institution xml:lang="ru">ФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава России</institution></aff></aff-alternatives><pub-date date-type="pub" iso-8601-date="2023-03-01" publication-format="electronic"><day>01</day><month>03</month><year>2023</year></pub-date><volume>22</volume><issue>1</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><fpage>122</fpage><lpage>125</lpage><history><date date-type="received" iso-8601-date="2022-11-21"><day>21</day><month>11</month><year>2022</year></date><date date-type="accepted" iso-8601-date="2022-12-05"><day>05</day><month>12</month><year>2022</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2023, «D. Rogachev NMRCPHOI»</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2023, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="en">«D. Rogachev NMRCPHOI»</copyright-holder><copyright-holder xml:lang="ru">ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0</ali:license_ref></license></permissions><self-uri xlink:href="https://hemoncim.com/jour/article/view/668">https://hemoncim.com/jour/article/view/668</self-uri><abstract xml:lang="en"><p>Here we report a clinical case of a patient with <italic>BRAF</italic>-positive Langerhans cell histiocytosis treated with combination therapy including trametinib. As the patient was undergoing long-term therapy with a BRAF inhibitor, his underlying disease reactivated. Hence it was suggested that the child might have become resistant to the treatment as a result of a subclonal mutation. It was concluded that this event undermined the efficacy of long-term therapy with BRAF inhibitors and highlighted the need for further study of possible molecular genetic mechanisms involved in the pathogenesis of Langerhans cell histiocytosis, as well as the need for the development of new treatment approaches. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.</p></abstract><trans-abstract xml:lang="ru"><p>В статье представлен клинический случай применения траметиниба в составе комбинированной терапии <italic>BRAF</italic>-позитивного гистиоцитоза из клеток Лангерганса. На фоне длительной терапии BRAF-ингибитором у пациента произошла реактивация основного заболевания. На основании этого было выдвинуто предположение о формировании резистентности к терапии путем возникновения субклональной мутации. Был сделан вывод, что данное событие ставит под вопрос эффективность длительной терапии BRAF-ингибиторами и подчеркивает необходимость дальнейшего изучения возможных молекулярногенетических механизмов патогенеза гистиоцитоза из клеток Лангерганса, а также разработки новых подходов к терапии. Родители пациента дали согласие на использование информации, в том числе фотографий ребенка, в научных исследованиях и публикациях.</p></trans-abstract><kwd-group xml:lang="en"><kwd>Langerhans cell histiocytosis</kwd><kwd>BRAF V600E</kwd><kwd>BRAF inhibitors</kwd><kwd>MEK inhibitors</kwd><kwd>children</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>гистиоцитоз из клеток Лангерганса</kwd><kwd>BRAF V600E</kwd><kwd>BRAF-ингибиторы</kwd><kwd>MEKингибиторы</kwd><kwd>дети</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Исследование проведено при поддержке гранта Российского научного фонда, проект №22-15-00450.</funding-statement></funding-group></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Румянцев А.Г., Масчан А.А. Федеральные клинические рекомендации по диагностике и лечению гистиоцитоза из клеток Лангерганса. М.; 2014.</mixed-citation></ref><ref id="B2"><label>2.</label><mixed-citation>Lipscomb M.F., Masten B.J. 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