57 research outputs found
Clinical experiences in Hodgkin lymphoma in particular with regard to pulmonary complications
A Hodgkin lymphoma (HL) a nyirokrendszer daganatos megbetegedĂ©se, mely tipikus klinikai Ă©s morfolĂłgiai jellemzĆkkel bĂr. A Hodgkin/ Reed-Sternberg (HRS) sejtek B-sejtes eredete ma mĂĄr nyilvĂĄnvalĂł, a HL egyĂ©rtelmƱ oka azonban tovĂĄbbra sem tisztĂĄzott. A HRS sejtek patogenezisĂ©ben Ă©s tĂșlĂ©lĂ©sĂ©ben az aberrĂĄns jelĂĄtviteli Ăștvonalak Ă©s a kĂŒlönbözĆ mutĂĄciĂłk mellett a megfelelĆ mikrokörnyezetnek is jelentĆs szerepe van.
A HL a hematolĂłgia sikertörtĂ©netei közĂ© tartozik, a kezdetben halĂĄlos betegsĂ©gben szenvedĆk mostanra több mint 80%-a tartĂłsan tĂșlĂ©l. Azon relabĂĄlĂł/ refrakter betegek kezelĂ©se azonban â akik az autolĂłg transzplantĂĄciĂł utĂĄn esnek vissza â komoly kihĂvĂĄst jelent. SzĂĄmukra ma mĂĄr a monometil auristatin E-vel (MMAE) konjugĂĄlt anti-CD30 antitest brentuximab vedotin, PD-1 gĂĄtlĂł szerek hasznĂĄlata, valamint a haploidentikus allogĂ©n transzplantĂĄciĂł jelenthet tĂșlĂ©lĂ©si esĂ©lyt.
A jelenleg Ă©s a közelmĂșltban elsĆ vonalban hasznĂĄlt bleomycin tartalmĂș polikemoterĂĄpiĂĄk Ă©s a mellkast Ă©rintĆ IFRT potenciĂĄlisan tĂŒdĆkĂĄrosĂtĂł hatĂĄsĂș lehet. VizsgĂĄlatunkban a hosszĂș tĂĄvĂș tĂŒdĆkĂĄrosodĂĄst 21 Ă©s 45% köztinek talĂĄltuk vizsgĂĄlĂłmĂłdszertĆl fĂŒggĆen Ă©s összefĂŒggĂ©st talĂĄltunk a dohĂĄnyzĂĄssal, a betegek Ă©letkorĂĄval, Ă©s a kumulatĂv bleomycin dĂłzissal, mĂg a mellkast Ă©rintĆ irradiĂĄciĂł additĂv tĂŒdĆkĂĄrosĂtĂł hatĂĄsa nem volt igazolhatĂł.
A bleomycint inaktivĂĄlĂł enzim, a bleomycin hydrolĂĄz (BLMH) gĂ©njĂ©nek polimorfizmusa egy lehetsĂ©ges tĂ©nyezĆ lehet, amely befolyĂĄsolhatja a bleomycint kapĂł betegek hosszĂștĂĄvĂș tĂŒdĆfunkciĂłjĂĄt. Jelen vizsgĂĄlatunkban a BLMH gĂ©n A1450G SNP polimorfizmusa szignifikĂĄns kĂŒlönbsĂ©geket mutatott korĂĄbban ABVD-vel kezelt HL-s betegek hosszĂș tĂĄvĂș pulmonĂĄlis funkciĂłs vizsgĂĄlatainak felmĂ©rĂ©sekor.
A kuratĂv eredmĂ©nyesĂ©g fenntartĂĄsa mellett javasoljuk bleomycin tartalmĂș kemoterĂĄpiĂĄk ciklusszĂĄmĂĄnak csökkentĂ©sĂ©t, illetve felmerĂŒl többszörös pulmonĂĄlis rizikĂłfaktorok fennĂĄllĂĄsa esetĂ©n a bleomycin helyettesĂtĂ©se cĂ©lzott terĂĄpiĂĄs lehetĆsĂ©gekkel.
Hodgkin lymphoma is the malignant disease of the lymphatic system, which holds typical clinical and morphological features. Although the B-cell origin of Hodgkin/ Reed-Sternberg (HRS) cells is now obvious, but the explicit reason of HL is still unknown. Aberrantly activated signaling pathways, several mutations and an appropriate microenvironment have major role in the pathogenesis and survival of HRS cells.
HL represents one of the major success stories of hematology. The disease, which was fatal at the beginning, has nowadays 80% of survival rate nowadays. However, treatment of those relapsing/ refractory patients, who fail ASCT is challenging. For them anti-CD30 antibody conjugated with monomethyl auristatin E (MMAE) (brentuximab vedotin), PD-1 inhibitors and haploidentic allogenic transplantation can be the chance to survive.
Currently and recently used bleomycin containing polychemotherapy and IFRT involving the chest may cause potential pulmonary toxicity. We found long-term pulmonary toxicity to be 21-45% according to test method, and we found correlation with smoking, age, cumulative bleomycin dose, while additive worsening effect of chest irradiation couldnât be verified.
Bleomycin hydrolase (BLMH), the enzyme inactivating bleomycin may be a possible factor that can affect long-term pulmonary function of patients receiving bleomycin. In the current study BLMH gene SNP A1450G polymorphism led to significant differences in the long term follow-up pulmonary test results of ABVD-treated HL patients.
Decrease of bleomycin containing chemotherapy cycles is recommended while maintaining favourable survival rates. Bleomycin may be substituted by targeted therapeutic agents in case of multiple pulmonary risk factors.N
Pulmonalis eltérések Hodgkin-lymphomåban
Absztrakt
A Hodgkin-lymphoma kezelése a hematológia sikertörténetei közé tartozik. A
korszerƱ kombinĂĄlt kemo- Ă©s radioterĂĄpiĂĄnak köszönhetĆen a betegek jelentĆs
rĂ©sze tĂșlĂ©l, Ăgy elĆtĂ©rbe kerĂŒlnek a kezelĂ©sek mellĂ©khatĂĄsai, amelyek a betegek
kĂ©sĆbbi Ă©letminĆsĂ©gĂ©t Ă©s Ă©lettartamĂĄt befolyĂĄsolhatjĂĄk. A szerzĆk a
Hodgkin-lymphoma tĂŒdĆben elĆfordulĂł megjelenĂ©si formĂĄit Ă©s a kezelĂ©s
következtĂ©ben kialakulĂł pulmonalis eltĂ©rĂ©seket, szövĆdmĂ©nyeket elemzik â sajĂĄt
eseteik pĂ©ldĂĄjĂĄn. A Hodgkin-lymphoma tĂŒdĆĂ©rintettsĂ©ge gyakrabban mĂĄsodlagos,
primer pulmonalis Ă©rintettsĂ©g igen ritkĂĄn fordul elĆ. A szerzĆk sajĂĄt betegeik
vizsgĂĄlata sorĂĄn tĂŒdĆĂ©rintettsĂ©get összesen az esetek 8â12%-ĂĄban Ă©szleltek. A
kezelĂ©s rövid Ă©s hosszĂș tĂĄvĂș pulmonalis mellĂ©khatĂĄsait egyrĂ©szt az
immunszuppressziĂłval összefĂŒggĂ©sben lĂ©vĆ infekciĂłk, mĂĄsrĂ©szt a jelenleg elsĆ
vonalbeli standard kezelĂ©s rĂ©szĂ©t kĂ©pezĆ bleomycin, illetve a mellkasi
irradiĂĄciĂł okozta pneumonitis Ă©s fibrosis jelentik. A Hodgkin-lymphoma
pulmonalis megjelenése egyrészt diagnosztikai és differenciåldiagnosztikai
nehĂ©zsĂ©geket jelenthet, stĂĄdiumot Ă©s ennek következtĂ©ben kezelĂ©st mĂłdosĂthat,
mĂĄsrĂ©szt a kialakulĂł mellĂ©khatĂĄsok a kĂ©sĆbbi Ă©lettartamot Ă©s Ă©letminĆsĂ©get
jelentĆsen meghatĂĄrozzĂĄk, Ăgy felismerĂ©sĂŒk döntĆ fontossĂĄgĂș. Orv. Hetil., 2016,
157(5), 163â173
Európai tapasztalatok a tårsadalmi-gazdasågi modellezésben
Syfte: Att undersöka intensivvÄrdssjuksköterskors upplevelser av att smÀrtlindra respiratorvÄrdade patienter dÀr bÄde verbal och icke verbal kommunikation Àr en utmaning. Bakgrund: IntensivvÄrdssjuksköterskor möter dagligen respiratorbehandlade patienter som vÄrdas pÄ grund av svÄra sjukdomstillstÄnd. Denna patientgrupp upplever mÄttlig till svÄr smÀrta och intensivvÄrdssjuksköterskan stÀlls inför utmaningen att ge en adekvat smÀrtlindring. NÀr dessa patienter inte kan kommunicera verbalt mÄste bedömningen av patientens behov ske utifrÄn tolkningar av kroppssprÄk, ansiktsuttryck och fysiologiska reaktioner. Design: En kvalitativ intervjustudie med induktiv ansats. Metod: Sex intensivvÄrdssjuksköterskor frÄn tvÄ intensivvÄrdsavdelningar vid samma sjukhus i norra Sverige intervjuades hösten 2014 med stöd av en semistrukturerad intervjuguide. Intervjuerna analyserades med kvalitativ innehÄllsanalys dÀr tre kategorier och elva subkategorier framkom. Resultat: Analysen resulterade i tre kategorier: att hitta en hÄllbar medicinsk och omvÄrdnadsmÀssig smÀrtbehandling, att skapa en ömsesidig kommunikation Àr en utmaning, samarbete och utbildning skapar förutsÀttningar för en patientsÀker vÄrd. Konklusion: För att optimera smÀrtlindring till respiratorvÄrdade patienter krÀvs bÄde omvÄrdnadsÄtgÀrder samt farmakologisk behandling. Det finns en rÀdsla att underbehandla smÀrta vilket kan skapa kÀnslor av otillrÀcklighet och frustration. Den icke verbala kommunikationen Àr inte alltid tillrÀcklig och dÄ krÀvs en kreativitet hos intensivvÄrdssjuksköterskorna för att tolka patienternas smÀrta. Vilka utmaningar intensivvÄrdssjuksköterskorna Àn stÀlls inför har de alltid patienternas bÀsta i Ätanke.
Changing Patterns in the Clinical Pathological Features of Hodgkin Lymphoma: A Report from Debrecen, Hungary
Introduction. Hodgkin lymphoma shows a well-known geographic pattern, but temporal changes have been found recently as well.
Patients and Methods. 439 Hodgkin lymphoma patients' clinicopathological and treatment data were processed in calendar periods of approximately ten years. The patients were treated at our department from 1980 until the end of 2008.
Results. The first period (1980â89) contained 177 patients, the second (1990â99) 147, and the third (2000â08) 115 Hodgkin lymphoma patients. The mean age of the patients was 40.1, 35.9, and 36.8 years in order. The male/female ratio: 1.42, 1.45, 1.05 in order. Contrary-wise a unimodal age group pattern could have been seen with an incidence peak between 30 and 39 in the past decades. The incidence of classical mixed cellularity histological subtype is decreasing (43.7%, 58.23%, 42.6%, P = 0.0098 (it is only significant in the second period)); classical nodular sclerosis shows an increasing tendency (25%, 27.32%, 34.78%, P = 0.1734). The first incidence peak is predominantly created by classical nodular sclerosis, meanwhile the second peak by classical mixed cellularity. The number of early-stage patients (59.12%) is beyond the advanced stage (40%) in the last decade. Meanwhile, the number of second-stage patients was increasing (25.8%, 26.35%, 49.56%ââP < 0.0001) and of patients in third stage was decreasing (53.4 %, 50.67%, 20%ââP < 0.0001). The 5- and 10-year overall survival data were progressing: 59.7 %, 77.4 %, and 90.5 % and 44.1 %, 70.6 % and 90.5 % (expected survival) in the last decade.
Conclusions. Changes can be explained by the altered nature of Hodgkin lymphoma, the changes in socioeconomic status and the development of diagnostic and therapy methods
Hypoxia related carbonic anhydrase IX expression is associated with unfavourable response to first-line therapy in classical Hodgkin's lymphoma
L
Ăj lehetĆsĂ©gek a refrakter Ă©s relabĂĄlt Hodgkin-lymphomĂĄs betegek kezelĂ©sĂ©ben
Absztrakt
BevezetĂ©s: A Hodgkin-lymphoma 80â90%-ban gyĂłgyĂthatĂł, azonban a
betegek körĂŒlbelĂŒl 30%-a relabĂĄl, Ă©s csak ezeknek a betegeknek a felĂ©ben Ă©rhetĆ
el gyĂłgyulĂĄs autolĂłg Ćssejt-transzplantĂĄciĂł alkalmazĂĄsĂĄval.
CélkitƱzés: 1980. januår 1. és 2014. december 31. között
kezelt Ă©s gondozott Hodgkin-lymphomĂĄs betegek tĂșlĂ©lĂ©si adatainak, a relapsusok
gyakorisĂĄgĂĄnak elemzĂ©se, az Ășj terĂĄpiĂĄs lehetĆsĂ©gek bemutatĂĄsa.
MĂłdszer: A betegek adatainak retrospektĂv elemzĂ©se.
EredmĂ©nyek: Ăsszesen 715 beteget kezeltek (382 fĂ©rfi Ă©s 333
nĆ, ĂĄtlagĂ©letkoruk a betegsĂ©g diagnosztizĂĄlĂĄsakor 38 Ă©v). A relabĂĄlĂł betegek
arĂĄnya a legutolsĂł idĆszakban 24,87%-rĂłl 8,04%-ra csökkent. Az elvĂ©gzett autolĂłg
haemopoeticus transzplantĂĄciĂłk szĂĄma a relabĂĄlĂł/refrakter betegek között nĆtt,
2000-tĆl kezdve 75%-ot Ă©rt el. A teljes tĂșlĂ©lĂ©s szignifikĂĄnsan javult; az 5 Ă©ves
teljes tĂșlĂ©lĂ©s 1980â1989 között 64,4%, 1990â1999 között 82,4%, 2000â2009 között
88,4%, 2010â2014 között 87,1% volt. A relapsusmentes tĂșlĂ©lĂ©s nem mutatott
szignifikåns våltozåst. Következtetések: A kezelési eredmények
javultak. A relabĂĄlĂł Ă©s refrakter betegeknek az utĂłbbi Ă©vek Ășj kezelĂ©si
lehetĆsĂ©gei nyĂșjthatnak mĂ©g több esĂ©lyt a gyĂłgyulĂĄsra. Orv. Hetil., 2015,
156(45), 1824â1833
Rapidly Progressing Refractory Hodgkin Lymphoma: A Case Report and a Possible Explanation
Introduction. Hodgkin lymphoma is a highly curable lymphoid malignancy; however treatment of a significant number of patients remains challenging. Case Report. The authors present an unusually rapidly progressing case of refractory advanced stage classical nodular sclerosis subtype Hodgkin lymphoma with unfavorable prognosis. A 66-year-old male patient was refractory for first-line doxorubicin, bleomycin, vinblastin, dacarbazine (ABVD) treatment with persistent disease; therefore physicians changed treatment for dexamethasone, cytarabine, and cisplatin (DHAP) and later ifosfamide, gemcitabine, and vinorelbine (IGEV) regimen. Unfortunately the patient developed acute kidney and respiratory failure and died after 6 months of treatment. Current and retrospective histological examination of the patientâs lymph node biopsy, skin lesion, and autopsy revealed the same aberrantly expressing CD4 positive nodular sclerosis subtype Hodgkin lymphoma. Conclusion. Aberrant expression of T-cell antigens on the Hodgkin and Reed/Sternberg cells could be associated with inferior outcome. T-cell associated antigens should be investigated more often in patients not responding sufficiently to treatment and hence treatment should be intensified or targeted therapy (brentuximab vedotin) should be considered
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