Infuzijski protokol DA-R-EPOCH za liječenje B-velikostaničnog limfoma u starijih bolesnika

master's thesis

• Title (english): Infusional DA-R-EPOCH regimen in elderly patients with B-large cell lymphomas
• Author: Neno Živković
• Mentor: Igor Aurer (mentor)
• Committee member: Nadira Duraković (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Igor Aurer (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

UVOD: B-velikostanični limfom (B-LCL) je najčešći tip agresivnog ne-Hodgkinovog limfoma. Prognoza starijih pacijenata s visokorizičnim B-LCLom je nezadovoljavajuća. Mladi pacijenti mogu imati koristi od agresivnijih protokola poput R-ABCVP i R-CHOEP14, ali oni su previše toksični za starije pacijente. ----- CILJ: Cilj ove studije je procijeniti ukupno preživljenje (OS) i preživljenje u remisiji (PFS) u pacijenata liječenih DA-R-EPOCHom i usporediti ih s povijesnim kontrolama liječenim R-CHOPom i R-CEOPom. ----- ISPITANICI I METODE: Podatci su prikupljeni retrospektivno iz bolničke arhive. Uključni kriteriji su bili novo dijagnosticirani B-LCL, dob >60, dobi prilagođen Međunarodni prognostički indeks (aaIPI) ≥ 2. 31 pacijent je zadovoljio uključne kriterije, 14 muškaraca, 17 žena. Medijan dobi je 67 godina (60-76). 14 pacijenata je imalo GC, 16 ne-GC B-LCL, 1 nije bilo moguće klasificirati. 15 pacijenata je imalo veliku tumorsku masu, 3 stadij III, 28 stadij IV. 22 pacijenta je imalo ECOG Performance Status (PS) 0-2 i 9 3-4. ----- REZULTATI: 22 pacijenta (71%) su odgovorila na terapiju, kompletnu remisiju je postiglo 17 (55%). Četiri nisu odgovorila na terapiju, a 5 je umrlo od nuspojava tijekom liječenja. Nakon medijana praćenja preživljelih od 22 mjeseca, dvogodišnji PFS i OS su 58%. PS je jedini statistički značajan prognostički faktor; PFS pacijenata sa PS 0-2 nakon 2 godine bio je 70% u usporedbi sa 33% u onih sa PS 3-4 (p=0.004). Nuspojave su bile značajne, u 11 pacijenata (35%) doza lijekova je podizana, a u 11 (35%) snižena. Teška anemija je zabilježena u 10 (32%), trombocitopenija u 9 (29%), neutropenija u 23 (74%), infekcije u 28 (90%), kardiovaskularne nuspojave u 10 (32%). PFS grupe ECOG PS 0-2 (70%) je bolji u odnosu na povijesne skupine čiji PFS je 53%, ali rezultat nije dosegao statističku značajnost (p=0.20). ----- ZAKLJUČAK: DA-R-EPOCH je toksičan protokol s visokom incidencijom teških nuspojava. Ovaj protokol bi trebalo izbjegavati u pacijenata lošeg općeg stanja. U bolesnika dobrog općeg stanja rezultira boljim PFS, no potrebno je analizirati ishode većeg broja bolesnika.

Abstract (english)

INTRODUCTION: B-large cell lymphoma (B-LCL) is the most common type of aggressive non-Hodgkin lymphoma. Outcomes of elderly patients with high-risk B-LCL treated with R-CHOP are unsatisfactory. Younger patients can benefit from aggressive regimens like R-ABCVP and R-CHOEP14, but they are too toxic for the elderly. ----- AIM: The aim of this study is to examine overall survival (OS) and progression free survival (PFS) in patients treated with DA-R-EPOCH and compare them to historical controls treated with R-CHOP and R-CEOP. ----- PATIENTS AND METHODS: Data were collected retrospectively from hospital archive. Inclusion criteria were: newly diagnosed B-LCL, age >60, age adjusted International Prognostic Index (aaIPI) >=2. 31 patients fulfilled entry criteria, 14 men, 17 women. Median age was 67 (60-76). 14 had GC, 16 non-GC B-LCL, 1 could not be classified. 15 patients had bulky disease, 3 stage III and 28 stage IV. 22 patients had ECOG performance status (PS) 0-2 and 9 3-4. ----- RESULTS: 22 patients (71%) responded to treatment, 17 (55%) achieved complete remission. Four patients did not respond to treatment and 5 died of toxicity. After a median follow-up of survivors of 22 months, PFS and OS at 2 years were 58%. PS was the only statistically significant prognostic factor; PFS of patients with PS 0-2 at 2 years was 70% in comparison to 33% in those with PS 3-4 (p=0.004). Side effects were significant, in 11 (35%) patients was the drug dose increased, and in 11 (35%) decreased. Severe anemia occurred in 10 (32%), thrombocytopenia in 9 (29%), neutropenia in 23 (74%), infections in 28 (90%), cardiovascular events in 10 (32%). PFS of the ECOG PS 0-2 group (70%) compares favorably to historical controls whose PFS was 53%, but the difference failed to reach statistical significance (p=0.20). ----- CONCLUSION: DA-R-EPOCH is a toxic protocol with high incidence of severe side effects. This regimen should be avoided in unfit elderly patients. In fit patients it results in numerical better PFS but outcomes of a larger number of patients need to be analyzed.

• Keywords: B-LCL; stariji pacijenti; DA-R-EPOCH
• Keywords (english): B-LCL; elderly; DA-R-EPOCH
• Language: croatian
• URN:NBN: urn:nbn:hr:105:822280
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Repository: Dr Med - University of Zagreb School of Medicine Digital Repository
• Created on: 2022-06-07 08:56:07