3 research outputs found
Clinical studies in adult lymphomas with special emphasis on late effects of treatments
Abstract
Lymphomas are a heterogeneous group of malignancies of the lymphoid cells with almost a hundred different subtypes. In recent decades, there has been a major improvement in treatment results, and nowadays, only one-third of patients die due to lymphoma. As treatment results have improved, more attention has been paid to the adverse effects of treatment, which may be serious or even lead to death. The aim of this study was to describe treatment methods with a smaller risk of late adverse effects without impairing the treatment results.
Follicular lymphoma (FL) is the second most common type of lymphoma in adults. Its prognosis is good, but relapses are common, and treatment must often be repeated, which causes a carcinogenic burden to the patient. Secondary malignancies are a significant late-onset adverse effect of lymphoma treatments. Currently, there are several treatment options available for FL. However, the risks of secondary malignancies associated with different treatment methods are not totally clear. In the present study, a higher risk for secondary haematological malignancies was observed after multiple lines of treatment. For secondary solid tumours, on the other hand, the greater risk was associated with the use of bendamustine.
Diffuse large B-cell lymphoma is the most common lymphoma subtype. Patients are elderly and therefore more vulnerable to treatment-related adverse effects. Moreover, cardiac comorbidities are common in elderly patients, which may limit the use of certain treatment options. In this study, treatment results with standard therapy R-CHOP were retrospectively compared to those obtained with R-CEOP and R-CIOP, which are known to be less cardiotoxic. Treatment with R-CEOP was comparable to standard therapy, whereas results with R-CIOP were inferior.
Nodular lymphocyte predominant Hodgkin lymphoma is a rare lymphoma subtype. These patients are traditionally treated with the same methods as those with classical Hodgkin lymphoma, although the diseases are very different biologically. Treatments used in Hodgkinâs disease are remarkably toxic. We examined the use of an R-bendamustine regimen among this group of patients.
The results of the present study indicate that the late adverse effects of lymphoma treatments should be considered when selecting the most optimal treatment for lymphoma patients.TiivistelmÀ
Lymfoomat ovat heterogeeninen joukko imukudoksen syöpiÀ ja lÀhes sata erilaista alatyyppiÀ on tunnistettu. Lymfoomien hoitotuloksissa on tapahtunut merkittÀvÀÀ edistystÀ viime vuosikymmenien aikana ja tÀllÀ hetkellÀ vain noin kolmannes potilaista menehtyy tautiin. Hoitotulosten parantuessa on alettu kiinnittÀÀ enemmÀn huomiota myös hoitojen aiheuttamiin haittoihin, jotka saattavat olla huomattavan hankalia ja johtaa jopa potilaan menehtymiseen. Tutkimuksen tarkoituksena oli kuvata hoitomuotoja, joilla hoidon haittojen riski olisi pienempi ilman, ettÀ lymfooman hoitotulokset heikkenevÀt.
Follikulaarinen lymfooma on aikuisten toiseksi yleisin lymfoomatyyppi. Taudin ennuste on hyvÀ, mutta uusiutuminen on yleistÀ ja tÀllöin hoitoja joudutaan toistamaan, mikÀ aiheuttaa potilaille merkittÀvÀn karsinogeenisen altistuksen. Mahdollisia hoitomuotoja on useita eikÀ eri hoitomuotojen aiheuttamaa sekundaarisen syövÀn riskiÀ vielÀ tarkasti tunneta. TÀssÀ tutkimuksessa selvisi, ettÀ sekundaaristen hematologisten syöpien riski kasvoi hoitolinjojen lukumÀÀrÀn kasvaessa. Bendamustiinin kÀyttö oli yhteydessÀ suurempaan kiinteiden kasvainten riskiin.
Diffuusi suurisoluinen B-solulymfooma on yleisin lymfooman alatyyppi. Potilaat ovat iÀkkÀitÀ, mikÀ lisÀÀ riskiÀ saada hoitojen haittavaikutuksia. LisÀksi iÀkkÀillÀ potilailla sydÀnsairaudet ovat yleisempiÀ, mikÀ voi rajoittaa sydÀntoksisten hoitovaihtoehtojen kÀyttöÀ. TÀssÀ tutkimuksessa verrattiin sydÀnturvallisempien R-CEOP ja R-CIOP sytostaattiyhdistelmien tehoa R-CHOP standardihoitoon. R-CEOP.lla saadut hoitotulokset olivat verrattavissa standardihoitoon, mutta R-CIOP.lla saadut hoitotulokset olivat heikompia.
Nodulaarinen lymfosyyttivaltainen Hodgkinin lymfooma on harvinainen Hodgkinin lymfooma. NÀitÀ potilaita on perinteisesti hoidettu samoilla hoitomuodoilla kun muita Hodgkinin lymfoomia, vaikka taudit ovat biologialtaan hyvin erilaisia. Hodgkinin lymfooman hoidossa kÀytettÀvÀt hoidot ovat huomattavan toksisia. Tutkimuksessamme selvitimme R-Bendamustiinin kÀyttökelpoisuutta tÀllÀ potilasryhmÀllÀ.
Tutkimustulokseemme osoittivat, ettÀ lymfoomahoitojen aiheuttamat haitat tulee huomioida hoitovalinnoissa ja hoitojen haittavaikutuksia tulee aktiivisesti pyrkiÀ vÀhentÀmÀÀn. Eri hoitomuotojen aiheuttamista myöhÀishaittavaikutuksista on tÀrkeÀÀ olla tietoinen jo hoitopÀÀtöksiÀ tehtÀessÀ
Treatment of diffuse large Bâcell lymphoma in elderly patients:replacing doxorubicin with either epirubicin or etoposide (VPâ16)
Abstract
Diffuse large Bâcell lymphoma (DLBCL) is the most common type of lymphoma. The standard therapy for DLBCL is RâCHOP. The current 5âyear overall survival is 60% to 70% using standard frontline therapy. However, the use of doxorubicin and its cardiotoxicity is a major clinical problem and preexisting cardiac disease may prevent the use of doxorubicin. Age greater than 65 years is a significant risk factor for anthracyclineâinduced cardiotoxicity, and therefore, the use of RâCHOP is often withheld from elderly patients. The feasibility of replacing doxorubicin with either epirubicin or etoposide in patients who have risk factors for heart complications is analyzed here. Clinical data of 223 DLBCL patients were retrospectively collected from hospital records. Fiftyâfive patients were treated with RâCHOP, 105 with RâCIOP (epirubicin instead of doxorubicin), 17 with RâCEOP (etoposide instead of doxorubicin), and 31 with RâCHOEP. Matchedâpair analysis was carried out between 30 patients treated with RâCEOP and RâCHOP. For all patients, the 2âyear progressionâfree survival (PFS) was 73.6%. In patients treated with RâCHOP, the 2âyear PFS was 84.2%, with RâCIOP 64.4%, with RâCEOP 87.7%, and with RâCHOEP 83.2%. In matchedâpair analysis, the 2âyear PFS was 92.3% with RâCHOP and 86.2% with RâCEOP. The 2âyear disease specific survival was 100% with RâCHOP and 86.2% with RâCEOP. In conclusion, RâCEOP offers reasonable PFS and disease specific survival in the treatment of DLBCL and good disease control can be achieved in elderly patients. Elderly patients with impaired cardiac function could benefit from the use of RâCEOP instead of RâCHOP. The results with RâCIOP were unsatisfactory, and we do not recommend using this protocol in elderly patients with cardiac disease
Risk of secondary haematological malignancies in patients with follicular lymphoma:an analysis of 1028 patients treated in the rituximab era
Summary
Follicular lymphoma (FL) is the most common indolent lymphoma. Currently there are many comparable treatment options available for FL. When selecting the most optimal therapy it is important to consider possible late effects of the treatment as well as survival. Secondary haematological malignancy (SHM) is a severe late effect of treatments, but the incidence of SHMs is still largely unknown. The goal of the present study was to determine the incidence of SHMs and how therapeutic decisions interfere with this risk. The study included 1028 FL patients with a median followâup time of 5·6 years. The 5âyear risk of SHM was 1·1% and the risk was associated with multiple lines of treatment (P = 0·016). The 5âyear risk of SHM was 0·5% after the firstâline treatment and 1·6% after the secondâline. The standardized incidence ratio (SIR) was 6·2 (95% confidence interval 3·4â10·5) for SHM overall. This retrospective study found that the risk of SHM was low after firstâline treatment in FL patients from the rituximab era. However, the risk of SHM increases with multiple lines of treatment. Therapeutic approaches should aim to achieve as long a remission as possible with firstâline treatment, thereby postponing the added risk of SHM