ABVD PROTOKOL NIJE ADEKVATAN ZA SVE PACIJENTE SA UZNAPREDOVALIM KLASIČNIM HOČKINOVIM LIMFOMOM: PETOGODIŠNJE ISKUSTVO JEDNOG CENTRA IZ SVAKODNEVNE KLINIČKE PRAKSE
Sažetak
Uvod/Cilj: Uznapredovali klasični Hočkinov limfom (UkHL) predstavlja terapijski izazov zbog značajnog procenta neuspeha prve terapijske linije. Cilj rada je da se opiše lečenje bolesnika sa UkHL-om u svakodnevnoj kliničkoj praksi ABVD protokolom.
Metode: U ovoj retrospektivnoj studiji su ispitivani kliničko-laboratorijski parametri, lečenje i ishod bolesnika kod kojih je UkHL dijagnostikovan u periodu od 2016. do kraja 2020. godine.
Rezultati: Kohortu je činilo 49 bolesnika sa UkHL-om čija je medijana praćenja bila 47 meseci (opseg: 1 – 79). Najvažnije kliničko-laboratorijske karakteristike su sumirane u Tabeli 1.
Svi bolesnici su inicijalno lečeni ABVD protokolom. Ukupni odgovor je iznosio 72,3% (kompletni odgovor = 61,7%; parcijalni odgovor = 10,6%), dok je ostalih 27,7% pacijenata ispoljilo refraktornost. Još 10,6% bolesnika je relapsiralo naknadno. Od ispitivanih parametara (Tabela 1) samo je povišena sedimentacija eritrocita (SE ≥ 50 mm u prvom satu) uticala na kraće preživljavanje bez progresije (PBP), (medijana PBP = 19 meseci naspram nedostignuta, kod bolesnika sa SE < 50mm u prvom satu; p = 0,039), dok je prisustvo velike tumorske mase (engl. bulky tumor mass/bulky disease) bilo povezano sa kraćim ukupnim preživljavanjem (UP), (p = 0,044). Takođe, primarno refraktorni bolesnici su imali značajno kraće UP (medijana UP = 54 meseca naspram nedostignuta, kod bolesnika sa postignutom remisijom; p = 0,004). Medijana PBP-a i UP-a nije dostignuta; četvorogodišnje PBP i UP iznosili su 61%, odnosno 89%. Pacijenti koji su lečeni autolognom transplantacijom (AT) u relapsiranoj/refraktornoj (R/R) bolesti imali su duže PBP (p = 0,02), ali ne i UP. Brentuksimab vedotin (BV) je uspešno primenjen kod četiri od 14 bolesnika, od čega troje u konsolidaciji nakon autologne transplantacije.
Zaključak: Značajan broj bolesnika sa UkHL-om ne može da bude izlečen ABVD protokolom, već je neophodno za njih obezbediti intenzivnije lečenje ili inovativne terapije.
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