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Title:Zdravljenje Nehodgkinovih limfomov z rituksimabom
Authors:ID Jezeršek Novaković, Barbara (Author)
ID Benigar, Ana (Author)
Files:.pdf PDF - Presentation file, download (712,12 KB)
MD5: 194ADF3E077AFE5610901ADACB5D4EA4
PID: 20.500.12556/dirros/20266145-867d-4ccc-a122-5605fc9d7464
 
Language:Slovenian
Typology:1.01 - Original Scientific Article
Organization:Logo OI - Institute of Oncology
Abstract:Uvedba rituksimaba v zdravljenje bolnikov z Nehodgkinovimi limfomi je spremenila dolgoročno prognozo bolnikov s CD20-pozitivnimi B-celičnimi limfomi, predvsem folikularnimi in difuznimi velikoceličnimi B-limfomi. Smernice NCCN priporočajo uporabo rituksimaba tudi pri zdravljenju bolnikov z drugimi vrstami limfomov, kot so marginalnocelični limfomi, limfomi plaščnih celic ter drobnocelični limfocitni limfomi/kronična limfatična levkemija. Dodatek rituksimaba h kemoterapiji izboljša odgovor na zdravljenje, podaljša trajanje remisij in celokupno preživetje tako pri bolnikih s folikularnimi ali drugimi indolentnimi CD20-pozitivnimi limfomi kot pri bolnikih z difuznimi velikoceličnimi B-limfomi. Vzdrževalno zdravljenje z rituksimabom pri indolentnih limfomih še podaljša trajanje remisij, nekatere raziskave so pokazale tudi daljše celokupno preživetje. Vzdrževalno zdravljenje pri agresivnih limfomih verjetno ne prinese dodatnega izboljšanja, če so bolniki že med indukcijskim zdravljenjem dobivali rituksimab. Na Onkološkem inštitutu rituksimab uporabljamo že od leta 1998. Od 2004 do 2006 smo z njim samostojno ali v kombinaciji s kemoterapijo zdravili 340 bolnikov. Med temi je bilo 46,8 % bolnikov z difuznimi velikoceličnimi B-limfomi in 19,4 % s folikularnimi limfomi. Kombinacijo R-CHOP je prejemalo 67,4 % bolnikov, ostali pa so prejemali druge kombinacije. Celotni odgovor na zdravljenje pri vseh bolnikih ne glede na histološki podtip limfoma je bil 78,8-odstoten (62,4 % popolnih odgovorov, 2,6 % nepotrjenih popolnih odgovorov, 13,8 % delnih odgovorov), najboljši celotni odgovor pa smo dosegli pri folikularnem agresivnem limfomu (91,7 %). Pri 75 % vseh bolnikov ne glede na histološki podtip je odgovor trajal več kot 12 mesecev, mediano trajanje odgovora še ni bilo doseženo. Najdaljše preživetje brez ponovitve bolezni smo ugotovili pri bolnikih z difuznim velikoceličnim B-limfomom. Po 26 mesecih od začetka zdravljenja je bilo celokupno preživetje bolnikov ne glede na podtip limfoma 75-odstotno, mediano celokupno preživetje še ni bilo doseženo. Celokupno preživetje je bilo najboljše pri bolnikih s folikularnim indolentnim limfomom. Rezultati zdravljenja bolnikov z Nehodgkinovimi limfomi z rituksimabom na Onkološkem inštitutu so v celoti primerljivi z rezultati večjih randomiziranih raziskav. Rituksimab zaradi ugodnega vpliva na dolgoročno prognozo bolnikov s CD20-pozitivnimi limfomi predstavlja standard v obravnavi teh bolnikov
Publication status:Published
Publication version:Version of Record
Year of publishing:2008
Number of pages:str. 17-25
Numbering:Letn. 12, št. 1
PID:20.500.12556/DiRROS-8684 New window
UDC:616-006
ISSN on article:1408-1741
URN:URN:NBN:SI:doc-4PO1MUGZ
COBISS.SI-ID:618363 New window
Copyright:by Authors
Publication date in DiRROS:31.08.2018
Views:2950
Downloads:686
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Record is a part of a journal

Title:Onkologija. strokovni časopis za zdravnike
Shortened title:Onkologija
Publisher:Onkološki inštitut
ISSN:1408-1741
COBISS.SI-ID:65324032 New window

Licences

License:CC BY 4.0, Creative Commons Attribution 4.0 International
Link:http://creativecommons.org/licenses/by/4.0/
Description:This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
Licensing start date:31.08.2018

Secondary language

Language:English
Title:Rituximab for Non-Hodgkin's Lymphoma
Abstract:The introduction of rituximab into the treatment of patients with Non-Hodgkin's lymphomas has changed the long term prognosis of patients with CD20 positive B-cell lymphomas, especially follicular and diffuse large B-cell lymphomas. The NCCN guidelines recommend the application of rituximab also for the treatment of patients with other types of lymphomas, such as marginal cell lymphomas, mantle cell lymphomas and chronic lymphocytic leukemia. The addition of rituximab to chemotherapy improves the overall response rate, prolongs the response duration and the overall survival both in the patients with follicular and other indolent CD20 positive lymphomas and diffuse large B-cell lymphomas. Maintenance treatment with rituximab in the patients with indolent lymphomas further prolongs the remission and some of the studies have also shown the survival benefit. However, the maintenance therapy in aggressive lymphomas most probably gives no further improvement in the patients who received rituximab already in the induction treatment. Rituximab has been used at the Institute of Oncology Ljubljana since 1998. In the period from 2004 to 2006, we have treated 340 patients with rituximab either as a single agent (minority of patients) or in combination with chemotherapy. Our treatment group included 46.8% of patients with diffuse large B-cell lymphomas and 19.4% with follicular lymphomas; 67.4% of patients were treated with R-CHOP combination, while the others received different rituximabchemotherapy combinations. The overall response rate regardless of the histological type of lymphoma was 78.8% (62.4% complete responses, 2.6% unconfirmed complete responses, 13.8% partial responses) and the highest response rate was achieved in the patients with aggressive follicular lymphomas (91.7%). In 75% of patients, regardless of the histological type of lymphoma, the response lasted more than 12 months, the median response duration has not been reached yet. The longest disease-free survival was observed in the patients with diffuse large B-cell lymphomas. The overall survival rate of all patients, regardless of the type of lymphoma, was 75% 26 months after the beginning of treatment and the median overall survival has not been reached yet. The longest overall survival was observed in the patients with indolent follicular lymphomas. The treatment results with rituximab obtained at the Institute of Oncology Ljubljana are comparable to the results of larger randomized trials. According to the beneficial influence of rituximab on the long term prognosis of patients with CD20 positive lymphomas, it became the standard of treatment in these patients.


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