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Abstract: 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.
Keywords: lymphoma, double-expressor lymphoma, oncology
Published in DiRROS: 18.04.2024; Views: 35; Downloads: 9
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Abstract: 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.
Keywords: limfomi, kemoterapija, onkološko zdravljenje
Published in DiRROS: 16.06.2023; Views: 351; Downloads: 135
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Keywords: palliative care, primary site of cancer, early referral
Published in DiRROS: 21.09.2022; Views: 400; Downloads: 235
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