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Povzetek: High-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements are known for their aggressive clinical course and so are the ones with MYC and BCL2 protein overexpression. The optimal therapy for these lymphomas remains to be elucidated. A retrospective analysis of all diffuse large B-cell lymphomas and high-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements diagnosed between 2017 and 2021 at the Institute of Oncology Ljubljana, Slovenia, has been performed. Only patients with double-expressor lymphoma (DEL), double-hit lymphoma (DHL), or triple-hit lymphoma (THL) were included. Demographic and clinical parameters were assessed, as well as progression-free survival (PFS) and overall survival (OS). In total, 161 cases out of 309 (161/309; 52,1%) were classified as DEL. Sixteen patients had DHL, MYC/BCL2 rearrangement was observed in eleven patients, and MYC/BCL6 rearrangement was observed in five patients. Five patients were diagnosed with THL. Out of 154 patients (according to inclusion/exclusion criteria) included in further evaluation, one-hundred and thirty-five patients had double-expressor lymphoma (DEL), sixteen patients had DHL, and three patients had THL. In total, 169 patients were treated with R-CHOP, 10 with R-CHOP and intermediate-dose methotrexate, 19 with R-DA-EPOCH, and 16 with other regimens. The median follow-up was 22 months. The 5-year OS for the whole DEL group was 57.1% (95% CI 45.9–68.3%) and the 5-year PFS was 76.5% (95% CI 72.6–80.4%). The log-rank test disclosed no differences in survival between treatment groups (p = 0.712) while the high-risk international prognostic index (IPI) carried a significantly higher risk of death (HR 7.68, 95% CI 2.32–25.49, p = 0.001). The 5-year OS for DHL patients was 32.4% (95% CI 16.6–48.2%) while all three TH patients were deceased or lost to follow-up. Our analyses of real-life data disclose that the R-CHOP protocol with CNS prophylaxis is a successful and curative treatment for a substantial proportion of DEL patients.
Ključne besede: lymphoma, double-expressor lymphoma, oncology
Objavljeno v DiRROS: 18.04.2024; Ogledov: 41; Prenosov: 11
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Povzetek: Velikocelični B limfomi z BCL2 in BCL6 preureditvijo so imenovani "double-hit" oziroma "triplehit" limfomi, z imunohistokemično ekspresijo pa dvojni ekspresorji (DE) in vsi imajo slabšo prognozo od klasičnih velikoceličnih limfomov B. Opravljena je bila študija vseh bolnikov z visoko malignimi B limfomi in difuznim velikoceličnim limfomom B, zdravljenih na Onkološkem inštitutu Ljubljana med leti 2017 in 2021. Večina izmed 154 vključenih bolnikov je bila zdravljenih z R-CHOP terapijo (rituksimab, ciklofosfamid, doksorubicin, vinkristin in prednizon), mediani čas spremljanja bolnikov je bil 22 mesecev. 110 bolnikov (71,4 %) ni imelo ponovitve bolezni v opazovanem obdobju. V primerjavi štirih uporabljenih terapevtskih protokolov v skupini DE nismo našli razlik v preživetju (p < 0,712). Preživetje bolnikov z "double-hit" in "triple-hit" limfomi je bilo, pričakovano, slabo. Naši podatki kažejo, da je velik del bolnikov z DE, zdravljen z R-CHOP in standardno CŽS profilakso, tudi uspešno ozdravljen. Za potrditev naših izsledkov so potrebne večje randomizirane raziskave.
Ključne besede: limfomi, kemoterapija, onkološko zdravljenje
Objavljeno v DiRROS: 16.06.2023; Ogledov: 351; Prenosov: 135
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Povzetek: The present retrospective study was undertaken to investigate the association of relative dose intensity (RDI) with the outcome of patients with advanced stage Hodgkin lymphoma (HL) receiving ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP regimens (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). A total of 114 patients with HL treated between 2004 and 2013 were enrolled for evaluation. The association of variables with overall survival (OS) and progression-free survival (PFS) was analysed using univariate and multivariate Cox proportional hazards models. The median age of patients was 39 years, and the majority were male and had stage IV disease. A total of 54 patients received ABVD and 60 received BEACOPP chemotherapy with 24 and four deaths, respectively. Patients in the BEACOPP group were significantly younger with lower Charlson comorbidity index (CCI) and better performance status in comparison with the ABVD group, making the comparison of groups not possible. In the ABVD group, RDI was not significantly associated with OS (P=0.590) or PFS (P=0.354) in a multivariate model where age was controlled. The low number of events prevented this analysis in the BEACOPP group. The age of patients was strongly associated with both OS and PFS; all statistically significant predictors for OS and PFS from univariate analyses (chemotherapy regimen, CCI, RDI, performance status) lost their effect in multivariate analyses where age was controlled. Based on these observations, it was concluded that RDI was not associated with OS or PFS after age is controlled, neither in all patients combined nor in the ABVD group.
Ključne besede: Hodgkin lymphoma, chemotherapy, outcome, primary treatment
Objavljeno v DiRROS: 23.09.2022; Ogledov: 521; Prenosov: 159
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Ključne besede: maligni limfomi, smernice, novotvorbe
Objavljeno v DiRROS: 14.03.2022; Ogledov: 786; Prenosov: 433
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Ključne besede: farmacija, nefrologija, protitrombotično zdravljenje
Objavljeno v DiRROS: 06.04.2021; Ogledov: 1456; Prenosov: 309
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