Research Article
BibTex RIS Cite
Year 2019, Volume: 10 Issue: 3, 224 - 229, 20.09.2019
https://doi.org/10.22312/sdusbed.497315

Abstract

References

  • 1 ) Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014; 64(1): 9-29.
  • 2 ) Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, et al. A five drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. 1995; 85(8): 2025-2037.
  • 3 ) Stock W, Johnson JL, Stone RM, Kolitz JE, Powell BL, Wetzler M, et al. Dose intensification of daunorubicin and cytarabine during treatment of adult acute lymphoblastic leukemia: results of Cancer and Leukemia Group B Study 19802 [published correction appears in Cancer. 2014; 120(14) 2222]. Cancer. 2013; 119(1): 90-98.
  • 4 ) Kantarjian HM, O'Brien S, Smith TL, Cortes J, Giles FJ, Beran M, et al. Results of treatment with hyper-CVAD, a dose intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000; 18(3): 547-561.
  • 5 ) Larson RA, Dodge RK, Linker CA, Stone RM, Powell BL, Lee EJ, et al. A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood. 1998; 92: 1556–64.
  • 6 ) Delannoy A, Sebban C, Cony-Makhoul P, Cazin B, Cordonnier C, Bouabdallah R, et al. Age-adapted induction treatment of acute lymphoblastic leukemia in the elderly and assessment of maintenance with interferon combined with chemotherapy. A multicentricprospective study in forty patients. French Group for Treatment of Adult Acute Lymphoblastic Leukemia. Leukemia. 1997; 11: 1429– 34.
  • 7 ) Goekbuget N, Beck J, Brueggemann M, Burmeister T, Buss EC, Frickhofen N et al. Moderate intensive chemotherapy including CNS prophylaxis with liposomal cytarabine is feasible and effective in older patients with Ph-negative acute lymphoblastic leukemia (ALL): results of a prospective trial from the German Multicenter Study Group for Adult ALL (GMALL). Blood. 2012; 120.
  • 8 ) O’Brien S, Thomas DA, Ravandi F, Faderl S, Pierce S, Kantarjian H. Results of the hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone regimen in elderly patients with acute lymphocytic leukemia. Cancer. 2008; 113: 2097–2101.
  • 9 ) Rowe JM. Optimal management of adults with ALL. Br J Haematol. 2009; 144: 468–83.
  • 10 ) Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009; 27: 2758–65.
  • 11 ) Moorman AV, Chilton L,Wilkinson J, Ensor HM, Bown N, Proctor SJ. A population-based cytogenetic study of adults with acute lymphoblastic leukemia. Blood. 2010; 115: 206–14.
  • 12 ) Gökbuget N, Hartog M, Dengler J, Helm G, Irmer S, Lipp T, et al. First analysis of prognostic factors in elderly Ph/BCR-ABL negative ALL including comorbidity scores: different factors predict mortality and relapse. ONKOLOGIE. 2008; 31S4: 29.
  • 13 ) Gökbuget N. How I treat older patients with ALL. Blood. 2013; 122: 1366–75.
  • 14 ) Altekruse SF, Kosary CL, Krapcho M, et al. Seer Cancer Statistics Review 1975-2007. National Cancer Institute, Bethesda, MD, http://seer.cancer.gov/csr/1975_2010/. 2007.
  • 15 ) Gokbuget N. Treatment of older patients with acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program. 2016; 2016 (1): 573–9.
  • 16 ) Kozlowski P, Lennmyr E, Ahlberg L, Bernell P, Hulegardh E, Karbach H, et al. Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden. Eur J Haematol. 2017; 99 (2): 141–9.
  • 17 ) Thomas X, Olteanu N, Charrin C, Lheritier V, Magaud JP, Fiere D. Acute lymphoblastic leukemia in the elderly: the Edouard Herriot Hospital experience. Am J Hematol. 2001; 67 (2): 73–83.
  • 18) Juliusson G, Karlsson K, Hallböök H. Populationbased analyses in adult acute lymphoblastic leukemia. Blood. 2010; 116 (6): 1011, author reply 1012.
  • 19) Toft N, Schmiegelow K, Klausen TW, Birgens H. Adult acute lymphoblastic leukaemia in Denmark. A national population-based retrospective study on acute lymphoblastic leukaemia in Denmark 1998-2008. Br J Haematol. 2012; 157 (1): 97-104.
  • 20 ) Taylor PR, Reid MM, Proctor SJ. Acute lymphoblastic leukaemia in the elderly. Leuk Lymphoma. 1994; 13(5-6): 373-380.
  • 21) Delannoy A, Ferrant A, Bosly A, Chatelain C, Doyen C, Martiat P, et al. Acute lymphoblastic leukemia in the elderly. Eur J Haematol. 1990;45(2):90-93.
  • 22 ) Nagura E, Minami S, Nagata K, Morishita Y, Takeyama H, Sao H, et al. [Analysis of elderly patients, aged 60 years old or over, with acute lymphoblastic leukemia]. Nippon Ronen Igakkai Zasshi. 1999; 36 (1): 52-58.
  • 23 ) Onciu M, Lai R, Kantarjian H, Ball G, Smith T, Buesco-Ramos C. Acute lymphoblastic leukemia (ALL) in the elderly - the significance of the philadelphia chromosome [abstract]. Blood. 2000; 96(11). Abstract 4558.
  • 24 ) Mandelli F, Annino L, Ferrari A; for the GG. ALL in elderly: The GIMEMA trials [abstract]. Ann Hematol. 1995; 70 (S2): 41a.
  • 25 ) Todeschini G, Tecchio C, Meneghini V, et al. Acute lymphoblastic leukemia (ALL) in elderly patients receiving intensive treatment. Experience in 26 consecutive patients [abstract]. Blood. 1996; 88 (Suppl 1). Abstract 170.

Yaşlı Akut Lenfositik Lösemi Hastalarının Tedavisinde Standart Tedavi mi? Düşük Yoğunluklu Tedavi mi?

Year 2019, Volume: 10 Issue: 3, 224 - 229, 20.09.2019
https://doi.org/10.22312/sdusbed.497315

Abstract



Amaç:
Akut lenfositik lösemi tüm yaş gruplarında görülebilen, çocukluk yaşlarında
tedavi başarısı yüksek iken ileri yaş grubunda tedavi başarısının düşük, sağ
kalımın az olduğu bir hastalıktır. Yaşlı hasta grubunda eşlik eden hastalıklar,
bu hastalıklar nedeni ile kullanılan ilaçlar ve kemoterapide kullanılacak
ilaçların ilaç-ilaç etkileşimleri nedeni ile tedavi yüz güldürücü değildir. Bu
retrospektif incelemenin amacı bu yaş grubundaki ALL hastalarında standart
tedavi ile düşük yoğunluklu tedavinin sonuçlarını kıyaslamaktır.



Materyal Metod:
Kliniğimizde tedavi ve takip edilen  50
yaş üzeri olan 18 ALL hastasının dosyası incelenmiştir Hastaların eşlik eden
hastalıkları, tanı sırasındaki semptomları, uygulanan tedavi protokolleri,  tedaviye aldıkları yanıtlar, tedavi
sürecindeki enfeksiyon odakları ve sayıları, 
son kontrol zamanları ve hayatta olup olmadıklarına ait veriler analiz
edilmiştir. Her iki tedavi kolu arasında sağ kalım analizi yapılmıştır.



            Bulgular: Elli
yaş üzeri hastalarda ensık eşlik eden hastalıklar hipertansiyon, diyabetes
mellitus, koroner arter hastalığı  ve
kronik obstrüktif akciğer hastalığıdır. Hastalar en sık ateş ve enfeksiyon
semptomları ile başvurmaktadırlar. Remisyon indüksiyon tedavisi başarı oranı
%44,4’dür. Standart tedaviler ve düşük yoğunluklu tedaviler arasında enfeksiyon
atağı açısından fark bulunmamıştır. Standart tedavi grubundaki enfeksiyonlar
daha çok parenteral tedavi ve yatış gerektiri iken düşük dozlu tedavi
grubundaki enfeksiyon atakları oral tedaviler ile yönetilebilmiştir. Her iki
grupta hem remisyon indüksiyon hem de idame tedavi açısından sağ kalım
analizinde anlamlı bir fark tespit edilmemiştir.



            Sonuç: Prognozun
hasta ve hastalık nedenli faktörler nedeni ile kötü olduğu yaşlı ALL
hastalarında, hasta performansını ve tolerabilitesini daha az etkileyen
CHOP/CVP protokollerinden oluşan düşük yoğunluklu tedaviler hastane yatışlarını
azaltmak ve hastanın yaşam kalitesini bozmamak iin uygun olabilir. Bu verilerin
sonraki yaklaşımımzda yol gösterici olacağı düşüncesindeyiz.

References

  • 1 ) Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014; 64(1): 9-29.
  • 2 ) Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, et al. A five drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. 1995; 85(8): 2025-2037.
  • 3 ) Stock W, Johnson JL, Stone RM, Kolitz JE, Powell BL, Wetzler M, et al. Dose intensification of daunorubicin and cytarabine during treatment of adult acute lymphoblastic leukemia: results of Cancer and Leukemia Group B Study 19802 [published correction appears in Cancer. 2014; 120(14) 2222]. Cancer. 2013; 119(1): 90-98.
  • 4 ) Kantarjian HM, O'Brien S, Smith TL, Cortes J, Giles FJ, Beran M, et al. Results of treatment with hyper-CVAD, a dose intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000; 18(3): 547-561.
  • 5 ) Larson RA, Dodge RK, Linker CA, Stone RM, Powell BL, Lee EJ, et al. A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood. 1998; 92: 1556–64.
  • 6 ) Delannoy A, Sebban C, Cony-Makhoul P, Cazin B, Cordonnier C, Bouabdallah R, et al. Age-adapted induction treatment of acute lymphoblastic leukemia in the elderly and assessment of maintenance with interferon combined with chemotherapy. A multicentricprospective study in forty patients. French Group for Treatment of Adult Acute Lymphoblastic Leukemia. Leukemia. 1997; 11: 1429– 34.
  • 7 ) Goekbuget N, Beck J, Brueggemann M, Burmeister T, Buss EC, Frickhofen N et al. Moderate intensive chemotherapy including CNS prophylaxis with liposomal cytarabine is feasible and effective in older patients with Ph-negative acute lymphoblastic leukemia (ALL): results of a prospective trial from the German Multicenter Study Group for Adult ALL (GMALL). Blood. 2012; 120.
  • 8 ) O’Brien S, Thomas DA, Ravandi F, Faderl S, Pierce S, Kantarjian H. Results of the hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone regimen in elderly patients with acute lymphocytic leukemia. Cancer. 2008; 113: 2097–2101.
  • 9 ) Rowe JM. Optimal management of adults with ALL. Br J Haematol. 2009; 144: 468–83.
  • 10 ) Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009; 27: 2758–65.
  • 11 ) Moorman AV, Chilton L,Wilkinson J, Ensor HM, Bown N, Proctor SJ. A population-based cytogenetic study of adults with acute lymphoblastic leukemia. Blood. 2010; 115: 206–14.
  • 12 ) Gökbuget N, Hartog M, Dengler J, Helm G, Irmer S, Lipp T, et al. First analysis of prognostic factors in elderly Ph/BCR-ABL negative ALL including comorbidity scores: different factors predict mortality and relapse. ONKOLOGIE. 2008; 31S4: 29.
  • 13 ) Gökbuget N. How I treat older patients with ALL. Blood. 2013; 122: 1366–75.
  • 14 ) Altekruse SF, Kosary CL, Krapcho M, et al. Seer Cancer Statistics Review 1975-2007. National Cancer Institute, Bethesda, MD, http://seer.cancer.gov/csr/1975_2010/. 2007.
  • 15 ) Gokbuget N. Treatment of older patients with acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program. 2016; 2016 (1): 573–9.
  • 16 ) Kozlowski P, Lennmyr E, Ahlberg L, Bernell P, Hulegardh E, Karbach H, et al. Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden. Eur J Haematol. 2017; 99 (2): 141–9.
  • 17 ) Thomas X, Olteanu N, Charrin C, Lheritier V, Magaud JP, Fiere D. Acute lymphoblastic leukemia in the elderly: the Edouard Herriot Hospital experience. Am J Hematol. 2001; 67 (2): 73–83.
  • 18) Juliusson G, Karlsson K, Hallböök H. Populationbased analyses in adult acute lymphoblastic leukemia. Blood. 2010; 116 (6): 1011, author reply 1012.
  • 19) Toft N, Schmiegelow K, Klausen TW, Birgens H. Adult acute lymphoblastic leukaemia in Denmark. A national population-based retrospective study on acute lymphoblastic leukaemia in Denmark 1998-2008. Br J Haematol. 2012; 157 (1): 97-104.
  • 20 ) Taylor PR, Reid MM, Proctor SJ. Acute lymphoblastic leukaemia in the elderly. Leuk Lymphoma. 1994; 13(5-6): 373-380.
  • 21) Delannoy A, Ferrant A, Bosly A, Chatelain C, Doyen C, Martiat P, et al. Acute lymphoblastic leukemia in the elderly. Eur J Haematol. 1990;45(2):90-93.
  • 22 ) Nagura E, Minami S, Nagata K, Morishita Y, Takeyama H, Sao H, et al. [Analysis of elderly patients, aged 60 years old or over, with acute lymphoblastic leukemia]. Nippon Ronen Igakkai Zasshi. 1999; 36 (1): 52-58.
  • 23 ) Onciu M, Lai R, Kantarjian H, Ball G, Smith T, Buesco-Ramos C. Acute lymphoblastic leukemia (ALL) in the elderly - the significance of the philadelphia chromosome [abstract]. Blood. 2000; 96(11). Abstract 4558.
  • 24 ) Mandelli F, Annino L, Ferrari A; for the GG. ALL in elderly: The GIMEMA trials [abstract]. Ann Hematol. 1995; 70 (S2): 41a.
  • 25 ) Todeschini G, Tecchio C, Meneghini V, et al. Acute lymphoblastic leukemia (ALL) in elderly patients receiving intensive treatment. Experience in 26 consecutive patients [abstract]. Blood. 1996; 88 (Suppl 1). Abstract 170.
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Article
Authors

Pınar Tarkun 0000-0003-0851-3583

Özgür Mehtap This is me 0000-0002-5603-1178

Meral Uluköylü Mengüç This is me 0000-0002-4303-9488

Sinan Mersin This is me 0000-0001-7588-6000

Serkan Ünal This is me 0000-0002-8513-8476

Ayfer Gedük This is me 0000-0001-9556-8915

Elif Birtaş Ateşoğlu This is me 0000-0002-2596-4493

Abdullah Hacıhanefioğlu This is me 0000-0001-5164-6301

Publication Date September 20, 2019
Submission Date December 18, 2018
Published in Issue Year 2019 Volume: 10 Issue: 3

Cite

Vancouver Tarkun P, Mehtap Ö, Uluköylü Mengüç M, Mersin S, Ünal S, Gedük A, Birtaş Ateşoğlu E, Hacıhanefioğlu A. Yaşlı Akut Lenfositik Lösemi Hastalarının Tedavisinde Standart Tedavi mi? Düşük Yoğunluklu Tedavi mi?. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2019;10(3):224-9.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.