İmmünsüpresyon Zemininde Gelişen Lenfoproliferatif Hastalik Özellikleri Ve Sağkalimi Etkileyen Parametreler

Year 2024, , 671 - 679, 31.10.2024

Sabin Goktas Aydın , Meliha Nalçacı , İpek Yönal Hindilerden , Sevgi Kalayoğlu Beşışık , Mustafa Nuri Yenerel , Ahmet Aydin

https://doi.org/10.54005/geneltip.1493721

Abstract

Amaç: Lenfoid hücre maligniteleri, en yavaş seyirliden en agresife kadar değişen, diferansiasyonun farklı seyrindeki immun sistem hücrelerinden ortaya çıkan malignitelerdir. İmmün yetersizlik zemininde gelişen lenfoma ise, primer lenfomaya kıyasla daha nadir gözlenen, prognozu ve tedaviye yanıtı kötü, mortalitesi yüksek bir hastalıktır. Biz bu çalışmada immün yetersizlik zemininde gelişen lenfoma hastalarının klinik ve laboratuvar özelliklerini değerlendirmeyi, bu hastalarda sağkalım oranlarını, tedavi yanıtlarını ve mortalite-sağkalım üzerine etkili olabilecek faktörleri değerlendirmeyi amaçladık.
Yöntem: Çalışmaya, Ocak 2013 ile Ocak 2023 tarihleri arasında başvuran, 15 immün yetersizlik zemininde gelişen lenfoma hastası ve aynı tarihte başvuran 49 primer yeni tanı lenfoma hastası dahil edildi. İmmünsüpresyon nedenleri, immünsüpresyon tedavileri ve süreleri, lenfoma evre ve tedavileri, tedaviye verilen yanıtları, mortalite oranları, sağkalım süreleri, laboratuvar değerleri poliklinik dosyaları ve yatış epikrizleri kullanılarak değerlendirildi.
Bulgular: Tedavi sonrası remisyon/kısmi remisyon gelişimi immünsüpresyon zemininde lenfoma gelişen olgularda anlamlı olarak daha düşüktü (p=0,025 OR 5,6 (1,4-22 %95CI)). Primer lenfomalı hastalarda international prognostic index (IPI) değeri anlamlı olarak daha düşük bulunmakla birlikte; her iki grup birlikte değerlendirildiğinde, IPI skoru yükseldikçe tedaviye verilen yanıt kötüydü (p<0,001). B2 mikroglobulin düzeyleri eksitus olan hastalarda daha yüksek olarak bulundu (3,4±1,8mg/l vs 5,2±1,8 mg/l p<0,01). İmmünsüpresyon zemininde gelişen lenfoma hastalarından, eksitus gözlenenlerde Epstein-Barr Virus (EBV) DNA pozitiflik oranı anlamlı olarak daha yüksekti . Takip süresi sonunda, primer lenfoma olan hastaların 5’inde (%10,2) mortalite gözlenirken, immünsüpresyon zemininde gelişen lenfomalı hastaların 7’sinde (%46,7) mortalite gözlendi (p<0,01 OR7,7). Her iki grup birlikte değerlendirildiğinde, progresyonsuz ortalama sağkalım süresi 30,8±1,8 ay bulundu. İmmünsüpresyon zemininde gelişen lenfoma hastalarında, ortalama progresyonsuz sağkalım süresi 22,4±4,2 ay (14,1-90,6 %95CI) iken; primer lenfoma olanlarda ortalama progresyonsuz sağkalım süresi 32,2±1,5 ay (29,1-35,3 %95CI) olarak saptandı ve gruplar arasında anlamlı fark bulundu (p=0,004).
Sonuç: İmmünsüpresyon zemininde gelişen lenfoproliferatif hastalıkların, primer lenfomaya kıyasla prognozu kötü, sağkalımı kısa, mortalitesi yüksek bir hastalık olduğu çalışmamızda da gösterilmiştir. Ayrıca bu hastalarda sağkalım ve prognozu belirlemede IPI değeri, B2 mikroglobulin değeri ve EBV serolojisi önemlidir.

Keywords

Uzun kodlamayan RNA, lncRNA, Laringeal kanser, miRNA, UCA1, miR138, CDK6

Immunosuppression-Based Lymphoproliferative Disease Features and Parameters Affecting Survival

Abstract

Aim: Lymphoid cell malignancies originate from the immune cells at various stages of differentiation, ranging from the slowest progressing ones to the most aggressive types. The immune deficiency-associated lymphomas are less frequently seen with worse prognoses, poor treatment responses, and high mortality rates than the primary lymphomas. In this study, we aim to evaluate the clinical and laboratory findings and to determine the survival rates, treatment responses, and the factors that may influence the mortality and survival rates in patients with immunodeficiency-associated lymphomas.
Methods: The study included 15 patients with immunodeficiency-associated lymphomas and 49 patients with newly diagnosed primary lymphomas between January 2013 and January 2023. Patient characteristics, treatments, and mortality rates were retrospectively analyzed using data charts.
Results: The remission and partial remission rates after the treatment were significantly lower in the patients with immunodeficiency-associated lymphomas [p=0.025; OR=5.6 (1.4-22, 95%CI)]. The IPI values of the primary lymphoma patients were significantly lower. Upon evaluating all patients in both groups collectively, a discernible trend indicated a deterioration in treatment responses correlating with escalating International Prognostic Index (IPI) values (p < 0.001). The levels of β-2 microglobulin were higher in the deceased patients (3.4±1.8mg/l vs 5.2±1.8mg/l; p<0.01). The EBV DNA positivity rates were significantly higher in the deceased patients in the patient group with immunodeficiency-based lymphomas (p<0.05). Mortalities were observed in 5 (10.2%) patients with primary lymphomas and in 7 (46.7%) patients with immunodeficiency-associated lymphomas at the end of the follow-up period (p<0.01; OR=7.7). The mean progression-free survival rate was 30.8±1.8. The mean progression-free survival rate of the patients with immunodeficiency-associated lymphomas was 22.4±4.2 months (14.1-90.6 95%CI), whereas, in the primary lymphoma patients, it was 32.2±1.5 months (29.1-35.3 95%CI), leading to a significant difference between the two groups (p=0.004).
Conclusion: Our study demonstrated that immunodeficiency-associated lymphoma has a poorer prognosis, shorter survival rates, and higher mortality. In addition, IPI values, levels of β-2 microglobulin, and the outcomes of EBV serology tests are essential factors in determining this group of patients' prognoses and survival rates.

Keywords

Non-Hodgkin lymphoma, immunosuppression-related lymphoma survival, prognosis

Ethical Statement

E-10840098-202.3.02-3213 numarası ile onaylanmıştır.

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