Barbara Jezeršek Novaković (Author), Ana Benigar (Author)

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

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Language: Slovenian
Year of publishing:
Typology: 1.01 - Original Scientific Article
Organization: OI - Institute of Oncology
UDC: 616-006
COBISS: 618363 Link will open in a new window
ISSN: 1408-1741
Parent publication: Onkologija
Views: 2257
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Secondary language: English
Secondary title: Rituximab for Non-Hodgkin's Lymphoma
Secondary 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.
Secondary keywords: Lymphoma, non-Hodgkin;Drug therapy;Mortality;Slovenia;Registries;Survival analysis;Antibodies, monoclonal;
URN: URN:NBN:SI
Pages: str. 17-25
Volume: ǂLetn. ǂ12
Issue: ǂšt. ǂ1
Chronology: jun. 2008
ID: 10956240