Kronik Lenfositik Lösemi Hastalarının Genel Klinik Değerlendirilmesi,

Yıl 2012, Cilt: 26 Sayı: 1, 9 - 19, 01.04.2012

V. Demir S. Kahraman A. Katgı Ö. Pişkin G. H. Özsan F. Demirkan B. Ündar M. A. Özcan

Öz

Anahtar Kelimeler

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Kronik Lenfositik Lösemi Hastalarının Genel Klinik Değerlendirilmesi,

Öz

Amaç: Çalışmamızda 2000-2011 yılları arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Hematoloj Bilim Dalı tarafından takip edilen 114 hastanın demografik verileri, tedavi endikasyonları, tedavi yanıtları ve total sağ kalım analizlerinin yapılması amaçlandı. Yöntemler: Kronik lenfoblastik lösemi tanısıyla takip edilen 114 hastanın verileri geriye dönük olarak değerlendirildi. Bulgular: Hastaların 60’ı erkek (%52,6), 54’ü kadındı (%47,4). Ortanca yaş 64 olarak saptandı. 61 hasta tedavisiz izlenirken 53 hasta tedavi aldı. Tanıdan ilk tedaviye kadar geçen süre ortalama 15,57 ay idi. İlk sıra kemoterapide en sık klorambusil kullanıldı (%62). Hastaların ilk sıra kemoterapi sonrası yapılan değerlendirmelerinde 40 hastada kısmi yanıt, 5 tam yanıt, 7 stabil hastalık ve 1 hastada progresyon izlendi ve progresyonsuz sağ kalım ortalaması 18 ay olarak bulundu. 25 hasta ikinci sıra kemoterapi aldı. İkinci sıra kemoterapinin progresyonsuz sağ kalım ortalaması 6,23 ay olarak hesaplandı. 6 hastaya üçüncü sıra kemoterapi verildi ve üçüncü sıra kemoterapinin progresyonsuz sağ kalım ortalaması 5,5 ay idi. Çalışma sonunda 114 hastanın ortalama toplam sağ kalım süreleri 92,8 ay olarak hesaplandı. Rai ve Binet evresi yüksek olan hastalarda tedavisiz sağ kalım ve progresyonsuz sağ kalım sürelerinin kısaldığı görüldü (p

Anahtar Kelimeler

Kronik lenfositik lösemi, prognoz, sağ kalım

Kaynakça

• Cheson, BD, Bennett JM, Grever M, et al. National Cancer Institute-sponsored Working Group guidelines for chronic lymphocytic leukemia: revised guidelines for diagnosis and treatment. Blood 1996; 87: 4990-4997.
• Rozman C, and Montserrat E. Chronic lymphocytic leukemia. N Engl J Med 1995; 333: 1052-1057.
• Hallek M, Cheson BD, Catovsky D, et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111: 5446-5456.
• Chiorazzi N, Rai KR, and Ferrarini M. Chronic lymphocytic leukemia. N Engl J Med 2005; 352: 804-815.
• Yee KW, and O'Brien SM. Chronic lymphocytic leukemia: diagnosis and treatment. Mayo Clin Proc 2006; 81: 1105-1129.
• Montserrat E. New prognostic markers in CLL. Hematology Am Soc Hematol Educ Program 2006; 279284.
• Thomas R, Ribeiro I, Shepherd P, et al. Spontaneous clinical regression in chronic lymphocytic leukaemia. Br J Haematol 2002; 116: 341-345.
• Mauro FR, Foa R, Giannarelli D, et al. Clinical characteristics and outcome of young chronic lymphocytic leukemia patients: a single institution study of 204 cases. Blood 1999; 94: 448-454.
• Catovsky D, Fooks J, Richards S. Prognostic factors in chronic lymphocytic leukaemia: the importance of age, sex and response to treatment in survival. A report from the MRC CLL 1 trial. MRC Working Party on Leukaemia in Adults. Br J Haematol 1989; 72: 141-149.
• Lee JS, Dixon DO, Kantarjian HM, Keating MJ, Talpaz M. Prognosis of chronic lymphocytic leukemia: a multivariate regression analysis of 325 untreated patients. Blood 1987; 69: 929-936.
• Montserrat E, Sanchez-Bisono J, Viñolas N, Rozman C. Lymphocyte doubling time in chronic lymphocytic leukaemia: analysis of its prognostic significance. Br J Haematol 1986;62: 567-575.
• Oscier DG, Gardiner AC, Kalıp SJ, et al. Multivariate analysis of prognostic factors in CLL: clinical stage, IGVH gene mutational status, and loss or mutation of the p53 gene are independent prognostic factors. Blood 2002;100: 1177-1184.
• Damle RN, Wasil T, Fais F, et al. Ig V gene mutation status and CD38 expression as novel prognostic indicators in chronic lymphocytic leukemia. Blood 1999;94: 1840-1847.
• Kröber A, Seiler T, Benner A, et al. V(H) mutation status, CD38 expression level, genomic aberrations, and survival in chronic lymphocytic leukemia. Blood 2002;100: 1410-1416.
• Poeta GD, Maurillo L, Venditti A, et al. Clinical significance of CD38 expression in chronic lymphocytic leukemia. Blood 2001; 98: 2633-2639.
• Orchard JA, Ibbotson RE, Davis Z, et al. ZAP-70 expression and prognosis in chronic lymphocytic leukaemia. Lancet 2004; 363: 105-111.
• Pangalis GA, Boussiotis VA, Kittas C. B-chronic lymphocytic leukemia. Disease progression in 150 untreated stage A and B patients as predicted by bone marrow pattern. Nouv Rev Fr Hematol 1988; 30: 373-375.
• Diehl LF, Karnell LH, Menck HR. The American College of Surgeons Commission on Cancer and the American Cancer Society. The National Cancer Data Base report on age, gender, treatment, and outcomes of patients with chronic lymphocytic leukemia. Cancer 1999; 86: 2684-2692.
• Cartwright RA, Gurney KA, Moorman AV. Sex ratios and the risks of haematological malignancies. Br J Haematol 2002; 118: 1071-1077.
• Dores GM, Anderson WF, Curtis RE, et al. Chronic lymphocytic leukaemia and small lymphocytic lymphoma: overview of the descriptive epidemiology. Br J Haematol 2007; 139: 809-819.
• Rai KR, Sawitsky B, Cronkite EP, Chanana AD, Levy RN and Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood 1975; 46: 219-234.
• Binet JL, Auquier A, Dighiero G, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 1981; 48: 198-206.
• Oscier DG, Matutes E, Copplestone A, et al. Atypical lymphocyte morphology: an adverse prognostic factor for disease progression in stage A CLL independent of trisomy 12. Br J Haematol 1997; 98: 934-939.
• Moreno C, Hodgson K, Ferrer G, et al. Autoimmune cytopenia in chronic lymphocytic leukemia: prevalence, clinical associations, and prognostic significance. Blood 116: 4771-4776.
• Visco C, Ruggeri M, Evangelista LM, et al. Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia. Blood 2008; 111: 1110-1116.
• Robak T. Second malignancies and Richter's syndrome in patients with chronic lymphocytic leukemia. Hematology 2004; 9: 387-400.
• Kyasa MJ, Hazlet L, Rudolph SP, et al. Veterans with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) have a markedly increased rate of second malignancy, which is the most common cause of death. Leuk Lymphoma 2004; 45: 507-513.
• Travis LB, Curtis RE, Hankey BF, Fraumeni JF, Jr. Second cancers in patients with chronic lymphocytic leukemia. J Natl Cancer Inst 1992; 84: 1422-1427.
• James DF, and Kipps TJ. Rituximab in chronic lymphocytic leukemia. Adv Ther 2011; 28: 534-554.
• Kennedy B, Rawstron A, Carter C, al. Campath-1H and fludarabine in combination are highly active in refractory chronic lymphocytic leukemia. Blood 2002; 99: 2245-2247.
• Wierda WG. Current and investigational therapies for patients with CLL. Hematology Am Soc Hematol Educ Program 2006; 285-294.
• Sawitsky A, Rai KR, Glidewell O, Silver RT, et al. Comparison of daily versus intermittent chlorambucil and prednisone therapy in the treatment of patients with chronic lymphocytic leukemia. Blood 1977;50:1049-1059.
• Montserrat E, and Rozman C. Chronic lymphocytic leukaemia treatment. Blood Rev 1993; 7: 164-175.
• Knospe WH, Loeb VJr, and Huguley CMJr. Proceedings: Bi-weekly chlorambucil treatment of chronic lymphocytic leukemia. Cancer 1974; 33: 555-562.
• Robak T, Bloński JZ, Kasznicki M, et al. Cladribine with prednisone versus chlorambucil with prednisone as firstline therapy in chronic lymphocytic leukemia: report of a prospective, randomized, multicenter trial. Blood 2000; 96:2723-2729.
• Knauf WU, Lissichkov T, Aldaoud A, et al. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 2009; 27: 4378-4384.
• Eichhorst BF, Busch R, Stilgenbauer S, et al. First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia. Blood 2009; 114: 3382-3391.
• Robak T, Jamroziak K, Gora-Tybor J, et al. Comparison of cladribine plus cyclophosphamide with fludarabine plus cyclophosphamide as first-line therapy for chronic lymphocytic leukemia: a phase III randomized study by the Polish Adult Leukemia Group (PALG-CLL3 Study). J Clin Oncol 2010 28: 1863-1869.