Lymfoomien luokitus tarkentuu

Lymfoomien alatyyppien yleisyystiedot ovat nyt saatavilla Suomen syöpärekisterin verkkosivuilla. Lymfoomat yleistyvät, mutta kuolleisuus non-Hodgkin-lymfoomiin on laskussa. Lymfoomat jaetaan nykyään B- ja T-solulymfoomiin, kun aiemmin jako tehtiin vain Hodgkinin ja non-Hodgkin-lymfoomiin. Laadukas ja kattava rekisteritieto on tärkeää harvinaissairauksien hoidon kehittämisen pohjaksi.Peer reviewe

Transformation and outcome of nodular lymphocyte predominant Hodgkin lymphoma : a Finnish Nationwide population-based study

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy associated with excellent survival. However, some patients experience histological transformation into aggressive large B-cell lymphoma. Population-based data on transformation in patients with NLPHL is limited. We conducted a nationwide population-based study to estimate the risk of transformation and relative survival in patients diagnosed with NLPHL in Finland between 1995 and 2018. We identified a total of 453 patients (median age, 48 years; 76% males) with the incident NLPHL from the Finnish Cancer Registry. The cumulative incidence of transformation was 6.3% (95% CI, 4.2-9.6) at 10 years. After adjusting for sex, age and year of diagnosis, transformation was associated with a substantially increased risk of death (HR 8.55, 95% CI 4.49-16.3). Ten-year relative survival was 94% (95% CI, 89%-100%). The patients diagnosed at a later calendar year had lower excess risk of death (HR, 0.38 per 10-year increase; 95% CI, 0.15-0.98). We conclude that while the 10-year relative survival for the patients with NLPHL was excellent in this large population-based cohort for the entire study period, transformation resulted in a substantially increased mortality compared with the patients without transformation. Our results also suggest a reduction in excess mortality over time.Peer reviewe

Diffuusin suurisoluisen B-solulymfooman nykyhoito

Diffuusi suurisoluinen B-solulymfooma on yleisin imukudossyöpä. Se on kliinisesti ja biologisesti monimuotoinen tauti, jonka alatyyppien ominaisuuksia pystytään toistaiseksi huomioimaan hoitosuunnitelmissa vain rajoitetusti. Hoidon runko koostuu CD20-vasta-aineen ja solunsalpaajien yhdistelmästä. Nykyhoitojen avulla paranee 75 % alle 65-vuotiaista potilaista ja 46 % yli 65-vuotiaista. Ennustetta huonontavia riskitekijöitä ovat vanhuus, laaja levinneisyys, huono yleistila, levinneisyys imusolmukealueiden ulkopuolella ja seerumin suurentunut laktaattidehydrogenaasipitoisuus. Lymfoomat, joissa esiintyy Bcl2-, Myc- ja Bcl6-geenien uudelleenjärjestymiä ja p53-geenin muutoksia ovat poikkeuksellisen aggressiivisia ja huonoennusteisia. Haasteita ovat iäkkäiden potilaiden, suuren biologisen riskin ja uusiutuneen taudin hoidot.</p

Diffuusin suurisoluisen B-solulymfooman nykyhoito

Teema : Hematologiset syövät. English summaryPeer reviewe

Somatostatin Receptors and Chemokine Receptor CXCR4 in Lymphomas: A Histopathological Review of Six Lymphoma Subtypes

Background Somatostatin receptors (SSTR) and chemokine receptor CXCR4 are expressed in lymphomas, while the abundance is known to be heterogeneous in different subtypes of lymphomas. Targeting tumor cells expressing these receptors might add to therapeutic opportunities while radiolabeled ligands for both imaging and therapy have been developed. The aim of this study was to establish SSTR subtype 2, 3 and 5 and also CXCR4 status immunohistochemically in six different lymphoma subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), mucosa-associated marginal B-cell lymphoma (MALT), Hodgkin lymphoma (HL) and peripheral T-cell lymphoma (PTCL). Material and Methods This study included a total of 103 lymphoma patients (24 DLBCL, 22 FL, 18 HL, 9 MALT, 20 MCL and 10 PTCL) diagnosed in the Southwest hospital district of Finland during 2010-2019. SSTR 2, 3 and 5 and CXCR4 expression was analyzed immunohistochemically (IHC) in lymphoma samples obtained from local archival Biobank tissue repository. Immunopositivity of each receptor was scored on a four-point scale accounting for staining intensity and proportion of positively stained tumor cells. Results Of different SSTR subtypes SSTR2 immunopositivity was most common and seen predominantly at the cell membrane of the malignant cells in 46-56% of DLBCL, HL and FL. CXCR4 co-expression was frequently present in these cases. SSTR3 and SSTR5 IHC were negative in DLBCL and FL but in HL SSTR expression was more heterogenous and SSTR3 and SSTR5 positivity was found in cytoplasm in 35% and 25% of cases. 2/4 blastoid MCL variants and one pleomorphic MCL variant had positive CXCR4 IHC whilst all other MCL cases (85%) were negative for all receptors. 30% (n=3) of the PTCL patients had positive SSTR5 IHC and CXCR4. MALT lymphomas were negative for all receptors. Conclusion SSTR2 and CXCR4 are found in DLBCL, FL and HL and co-expression of these receptors is common. Although in general expression of SSTRs and CXCR4 is heterogenous and very low in some subtypes such as MCL and MALT there are also patients with abundant expression. The latter are candidates for trials studying SSTR2 and/or CXCR4 based treatments in the future.</p

Palliatiivisen hoidon ja saattohoidon säädösmuutosten kustannusvaikutusten arviointi : Laskentatyöryhmän raportti

STM:n asettama Elämän loppuvaiheen hoito -työryhmä on julkaissut kaksi selvitysraporttia (2019a, 2019b), joissa on esitetty suositukset elämän loppuvaiheen hoidon järjestämisestä Suomessa. Tässä raportissa esitetään laskelmia suositusten pohjalta esitettyjen toimintamallien ja lainsäädännön muutosehdotusten kustannusvaikutuksista. Taloudellisten vaikutusten arviointi kohdistetaan uusille tai laajeneville tehtäville. Kustannusten alueittainen jakautuminen riippuu siitä, ovatko tarkastelun kohteena erityisvastuu- vai hyvinvointialueet. Valtaosa odotetuista uusista menoista (n. 40 Me) koostuisi henkilöstön palkkauksesta (n. 33 Me). Sairaanhoitajien osuus olisi 370–418 henkilötyövuotta, lääkäreiden 46–53 ja psykologien 55 henkilötyövuotta. Perustettavien professuurien kustannuksiksi arvioitiin 0,5 Me. Ruotsin mallin mukainen saattohoitovapaata koskeva erityismääräraha tuottaisi noin 6-7 Me kustannukset. Tilamuutosten ja koulutuksen aiheuttamia kustannuksia ei arvioitu raportissa. Kustannussäästöjä on mahdollista saavuttaa omaksumalla valtakunnallisesti käytössä olevia alueiden parhaita käytäntöjä iäkkäiden palveluissa. Säästöt kumuloituvat ja hillitsevät merkittävästi kustannuskehitystä lähivuosikymmenien tulevaisuuden skenaariossa. Kustannusten hallinnassa oleellista on suositusten mukainen osaamistason nosto. Säästö tulee viiveellä ja edellyttää raportissa esitettyjä investointeja

A predictive model of overall survival in patients with metastatic castration-resistant prostate cancer

Metastatic castration resistant prostate cancer (mCRPC) is one of the most common cancers with a poor prognosis. To improve prognostic models of mCRPC, the Dialogue for Reverse Engineering Assessments and Methods (DREAM) Consortium organized a crowdsourced competition known as the Prostate Cancer DREAM Challenge. In the competition, data from four phase III clinical trials were utilized. A total of 1600 patients’ clinical information across three of the trials was used to generate prognostic models, whereas one of the datasets (313 patients) was held out for blinded validation. As a performance baseline, a model presented in a recent study (so called Halabi model) was used to assess improvements of the new models. This paper presents the model developed by the team TYTDreamChallenge to predict survival risk scores for mCRPC patients at 12, 18, 24 and 30-months after trial enrollment based on clinical features of each patient, as well as an improvement of the model developed after the challenge. The TYTDreamChallenge model performed similarly as the gold-standard Halabi model, whereas the post-challenge model showed markedly improved performance. Accordingly, a main observation in this challenge was that the definition of the clinical features used plays a major role and replacing our original larger set of features with a small subset for training increased the performance in terms of integrated area under the ROC curve from 0.748 to 0.779.</p