Recommendations for the Use of Granulocyte Colony Stimulating Factors (G-CSFs) in Systemic Treatment of Cancer

Dejavniki rasti granulocitne vrste (G-CSF) so z rekombinantno DNK-tehnologijo pridobljeni naravni glikoproteini, ki spodbudijo dozorevanje belih krvničk. S preventivno uporabo G-CSF lahko preprečimo febrilno nevtropenijo (FN), ki je resen, življenje ogrožajoč neželeni učinek zdravljenja s citostatiki. Priporočamo jih, kadar je verjetnost febrilne nevtropenije 20-odstotna ali večja ali pa je tveganje za FN večje zaradi starosti in spremljajoče bolezni. G-CSF naj se ne uporabljajo rutinsko, če je febrilna nevtropenija že nastala. Njihovo mesto je še pri mobilizaciji krvotvornih perifernih matičnih celic, pri spodbudi rasti nevtrofilcev po alogeni ali avtologni presaditvi kostnega mozga in pri mielodisplastičnem sindromu (MDS).Granulocyte colony stimulating factors (G-CSFs) are natural glycoproteins produced by recombinant DNA technology, which stimulate the production of white blood cells. The use of G-CSFs could prevent febrile neutropenia (FN) which is a relatively frequent event in cancer patients treated with chemotherapy and is a potentially life-threatening situation. Primary G-CSF support is recommended in the patients with the overall FN risk ≥ 20% and in those who are at high risk for FN associated with age, medical history and disease characteristics. G-CSFs should not be routinely used in afebrile or febrile neutropenic patients. G-CSFs have a number of other indications, such as mobilization of peripheral blood stem cells, acceleration of neutrophil count recovery after allogeneic or autologous transplantation and in MDS

Sindrom zgornje vene kave

Superior vena cava syndrome (SVCS) results from the compression of the superior vena cava (SVC) by a surrounding tumor, invasion of the vein by tumor masses or thrombosis. The most common cause of SVCS is malignant disease. More recently, the incidence of SVCS due to catheter related thrombosis has increased. Althouh the symptoms of the VCS occlusion can be very dramatic, it is usually not a life-threatening condition. The most common symptoms are dyspnea, facial and upper body edema, cough and cyanosis. Treatment depends on the aetiology of the obstructive process and should not be undertaken until a diagnoses is obtained. It may include radiotherapy, chemotherapy, thrombolytic therapy or interventional radiologic techniques. The prognosis of patients correlates with the prognosis of the underlying disease and response to treatment.Sindrom zgornje vene kave (SZVK) nastane zaradi zapore pretoka krvi skozi zgornjo veno kavo (ZVK), ki jo povzroči pritisk od zunaj, vraščanje tumorske mase v žilno steno ali tromboza. Večinoma je vzrok za nastanek SZVK maligna bolezen, vse pomembnejši vzrok pa postaja tromboza ZVK zaradi uporabe venskih katetrov. Čeprav so simptomi zapore ZVK lahko zelo hudi, navadno ne gre za življenje ogrožujoče stanje. Glavni simptomi so težko dihanje, otekanje v obraz in zgornji del telesa, suh kašelj in cianoza. Zdravljenje je vzročno in ni upravičeno pred postavitvijo histološke diagnoze. Uporabljamo obsevanje, kemoterapijo, trombolitično zdravljenje in interventne radiološke posege. Prognoza bolnikov je odvisna od vzroka nastanka SZVK in njihovega odgovora na zdravljenje

Anemija pri bolnikih z rakom

Anemia is defined as a significant reduction of the red cell mass and a corresponding decrease of the oxigen-carrying capacity of the blood. The etiology of anemia can be due to decreased red blood cell (RBC) production, increased RBC destruction and blood loss. Anemia is prevalent in 30-90 % of cancer patients with a number of factors that may contribute to its developement, most often overexpression of inflammatory cytokines accompanying malignant disease and mielosuppressive cancer treatment. Anemia in cancer patients should be identified by standard diagnostic procedures. Decision about treatment of cancer related anemia depends on the patient's symptoms, degree of anemia and the rate at which it has evolved, patient's comorbidities and the goal of cancer treatment in a certain patient. Management of anemia in cancer patients includes the transfusion of packed red blood cells and / or the administration of recombinant erythropoetin.Anemija ali slabokrvnost je bolezensko stanje, pri katerem je zmanjšana celotna masa eritrocitov v krvnem obtoku, zaradi česar se zmanjša tudi sposobnost krvi za prenos kisika. Glavni vzroki anemije so zmanjšana tvorba eritrocitov, povečana razgradnja eritrocitov in krvavitev. Anemija, ki se pojavlja pri 30 do 90 % bolnikov z rakom je navadno posledica kombinacije več vzrokov, najpogosteje vpliva citokinov, ki se sproščajo ob maligni bolezni in mielosupresivnega učinka specifičnega onkološkega zdravljenja. Anemijo tudi pri bolnikih z rakom opredelimo po standardnih diagnostičnih postopkih, zdravljenje pa je odvisno od bolnikovih simptomov, stopnje anemije, hitrosti njenega nastanka, spremljajočih bolezni in ciljev zdravljenja bolnika z rakom. Najpogosteje uporabljamo transfuzijo koncentriranih eritrocitov in rekombinantne eritropoetine (EPA)

Chronic myelogenous leukemia

Kronična mieloična levkemija (KML) je redka mieloproliferativna bolezen z incidenco okrog 1–2/100.000 prebivalcev na leto. Je klonska bolezen pluripotentne matične celice, usmerjene v granulopoezo. Večino bolnikov odkrijemo v kroničnem obdobju, za katero je značilna levkocitoza v krvni sliki, s prevladovanjem zrelih nevtrofilnih granulocitov, znaki pospešene presnove, kot so utrujenost, hujšanje in potenje, ter splenomegalija. Kronično obdobje prek pospešenega obdobja preide v blastno krizo s sliko akutne levkemije. Za postavitev diagnoze je nujna najdba kromosoma Philadelphia, ki nastane kot posledica kromosomske translokacije t(922), gena BCR-ABL ali njegovega produkta tirozinske kinaze BCR- -ABL v celicah periferne krvi ali kostnega mozga. Velik napredek pri zdravljenju KML je bilo odkritje zaviralcev tirozinske kinaze BCR-ABL, s katerimi dosežemo dolgotrajen nadzor bolezni, in sicer z imatinibom kot prvo izbiro zdravljenja kroničnega obdobja KML. Drugi možni izbiri zdravljenja sta alogenična presaditev krvotvornih matičnih celic in paliativno zdravljenje s kemoterapevtiki.Chronic myelogenous leukemia (CML) is a rare myeloproliferative disease with an incidence of approximately 1-2/100,000 population per year. It is a clonal disease of a pluripotent stem cell committed to granulopoiesis. Most patients are diagnosed in the chronic phase when the blood count typically shows leukocytosis with predominance of mature neutrophil granulocytes and there are evident signs of increased metabolism, such as fatigue, weight loss and perspiration, and splenomegaly. Through the accelerated phase, the chronic phase progresses to a blast crisis resembling acute leukemia. The diagnosis is based on the discovery of the Philadelphia chromosome arising as a consequence of chromosomal translocation t(922), BCRABL gene or its product, BCR-ABL tyrosine kinase, in the peripheral blood or bone marrow cells. Significant progress in the treatment of CML was accomplished by the discovery of the BCR-ABL tyrosine kinase inhibitors, which provide long-term disease control, namely with imatinib as the first choice of treatment in the chronic phase of CML. The other two possible treatments are the allogeneic transplantation of haematopoietic stem cells and palliative treatment with chemotherapeutics

Anemia in Cancer Patients

Anemija ali slabokrvnost je bolezensko stanje, pri katerem je zmanjšana celotna masa eritrocitov v krvnem obtoku, zaradi česar se zmanjša tudi sposobnost krvi za prenos kisika. Glavni vzroki anemije so zmanjšana tvorba eritrocitov, povečana razgradnja eritrocitov in krvavitev. Anemija, ki se pojavlja pri 30 do 90 % bolnikov z rakom je navadno posledica kombinacije več vzrokov, najpogosteje vpliva citokinov, ki se sproščajo ob maligni bolezni in mielosupresivnega učinka specifičnega onkološkega zdravljenja. Anemijo tudi pri bolnikih z rakom opredelimo po standardnih diagnostičnih postopkih, zdravljenje pa je odvisno od bolnikovih simptomov, stopnje anemije, hitrosti njenega nastanka, spremljajočih bolezni in ciljev zdravljenja bolnika z rakom. Najpogosteje uporabljamo transfuzijo koncentriranih eritrocitov in rekombinantne eritropoetine (EPA).Anemia is defined as a significant reduction of the red cell mass and a corresponding decrease of the oxigen-carrying capacity of the blood. The etiology of anemia can be due to decreased red blood cell (RBC) production, increased RBC destruction and blood loss. Anemia is prevalent in 30-90 % of cancer patients with a number of factors that may contribute to its developement, most often overexpression of inflammatory cytokines accompanying malignant disease and mielosuppressive cancer treatment. Anemia in cancer patients should be identified by standard diagnostic procedures. Decision about treatment of cancer related anemia depends on the patient\u27s symptoms, degree of anemia and the rate at which it has evolved, patient\u27s comorbidities and the goal of cancer treatment in a certain patient. Management of anemia in cancer patients includes the transfusion of packed red blood cells and / or the administration of recombinant erythropoetin

Hypercalcemia

Hiperkalcemija je relativno pogosta elektrolitna motnja pri bolnikih z maligno boleznijo, običajno je prisotna pri napredovalem stadiju in nosi slabšo prognozo. Hiperkalcemija je lahko blaga, srednja ali huda, bolniki so ob tem lahko povsem asimptomatski ali pa imajo močno izražene simptome (bolečine v trebuhu – renalna/biliarna kolika, pankreatitis, bruhanje, zaprtje, bolečine v kosteh, motnje osebnosti in zavesti) ter so tudi ogroženi za nenadni srčni zastoj. Hiperkalcemija pri maligni bolezni nastane zaradi t.i. humoralnega mehanizma, ki katerem maligne celice izločajo parathormonu podoben protein, kostnih zasevkov, pospešenega nastajanja aktivne oblike vitamina D (kalcitriol) ali ektopičnega nastajanja parathormona. Pri zdravljenju hudo simptomatske hiperkalcemije lahko uporabimo kalcitonin, ključni pa so obilna parenteralna hidracija, forsirana diureza s furosemidom, antiresorptivna zdravila (v urgentnih situacijah zolendronska kislina, glede na vzrok kasneje lahko denosumab) ter seveda specifično onkološko zdravljenje

Kronična mieloična levkemija

Chronic myelogenous leukemia (CML) is a rare myeloproliferative disease with an incidence of approximately 1-2/100,000 population per year. It is a clonal disease of a pluripotent stem cell committed to granulopoiesis. Most patients are diagnosed in the chronic phase when the blood count typically shows leukocytosis with predominance of mature neutrophil granulocytes and there are evident signs of increased metabolism, such as fatigue, weight loss and perspiration, and splenomegaly. Through the accelerated phase, the chronic phase progresses to a blast crisis resembling acute leukemia. The diagnosis is based on the discovery of the Philadelphia chromosome arising as a consequence of chromosomal translocation t(9;22), BCRABL gene or its product, BCR-ABL tyrosine kinase, in the peripheral blood or bone marrow cells. Significant progress in the treatment of CML was accomplished by the discovery of the BCR-ABL tyrosine kinase inhibitors, which provide long-term disease control, namely with imatinib as the first choice of treatment in the chronic phase of CML. The other two possible treatments are the allogeneic transplantation of haematopoietic stem cells and palliative treatment with chemotherapeutics.Kronična mieloična levkemija (KML) je redka mieloproliferativna bolezen z incidenco okrog 1–2/100.000 prebivalcev na leto. Je klonska bolezen pluripotentne matične celice, usmerjene v granulopoezo. Večino bolnikov odkrijemo v kroničnem obdobju, za katero je značilna levkocitoza v krvni sliki, s prevladovanjem zrelih nevtrofilnih granulocitov, znaki pospešene presnove, kot so utrujenost, hujšanje in potenje, ter splenomegalija. Kronično obdobje prek pospešenega obdobja preide v blastno krizo s sliko akutne levkemije. Za postavitev diagnoze je nujna najdba kromosoma Philadelphia, ki nastane kot posledica kromosomske translokacije t(9;22), gena BCR-ABL ali njegovega produkta tirozinske kinaze BCR- -ABL v celicah periferne krvi ali kostnega mozga. Velik napredek pri zdravljenju KML je bilo odkritje zaviralcev tirozinske kinaze BCR-ABL, s katerimi dosežemo dolgotrajen nadzor bolezni, in sicer z imatinibom kot prvo izbiro zdravljenja kroničnega obdobja KML. Drugi možni izbiri zdravljenja sta alogenična presaditev krvotvornih matičnih celic in paliativno zdravljenje s kemoterapevtiki

Superior Vena Cava Syndrome

Sindrom zgornje vene kave (SZVK) nastane zaradi zapore pretoka krvi skozi zgornjo veno kavo (ZVK), ki jo povzroči pritisk od zunaj, vraščanje tumorske mase v žilno steno ali tromboza. Večinoma je vzrok za nastanek SZVK maligna bolezen, vse pomembnejši vzrok pa postaja tromboza ZVK zaradi uporabe venskih katetrov. Čeprav so simptomi zapore ZVK lahko zelo hudi, navadno ne gre za življenje ogrožujoče stanje. Glavni simptomi so težko dihanje, otekanje v obraz in zgornji del telesa, suh kašelj in cianoza. Zdravljenje je vzročno in ni upravičeno pred postavitvijo histološke diagnoze. Uporabljamo obsevanje, kemoterapijo, trombolitično zdravljenje in interventne radiološke posege. Prognoza bolnikov je odvisna od vzroka nastanka SZVK in njihovega odgovora na zdravljenje.Superior vena cava syndrome (SVCS) results from the compression of the superior vena cava (SVC) by a surrounding tumor, invasion of the vein by tumor masses or thrombosis. The most common cause of SVCS is malignant disease. More recently, the incidence of SVCS due to catheter related thrombosis has increased. Althouh the symptoms of the VCS occlusion can be very dramatic, it is usually not a life-threatening condition. The most common symptoms are dyspnea, facial and upper body edema, cough and cyanosis. Treatment depends on the aetiology of the obstructive process and should not be undertaken until a diagnoses is obtained. It may include radiotherapy, chemotherapy, thrombolytic therapy or interventional radiologic techniques. The prognosis of patients correlates with the prognosis of the underlying disease and response to treatment