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Mantle Hücreli Lenfoma Hastalarımızın Klinik ve Laboratuvar Özellikleri: Kesitsel Bir Çalışma

Yıl 2021, Cilt: 43 Sayı: 1, 56 - 61, 20.01.2021
https://doi.org/10.20515/otd.759341

Öz

Mantle hücreli lenfoma (MHL), Hodgkin dışı lenfoma vakalarının %10’dan daha azını oluşturur. Başlıca bağımsız risk faktörleri; MHL Uluslararası Prognostik İndeksi (MIPI) ve Ki-67 tümör proliferasyonu indeksidir. Bu çalışmanın amacı; bölümümüzde takip ve tedavisi yapılan MHL hastalarının geriye dönük olarak değerlendirilmesidir. Çalışmaya tıbbi kayıtlarına ulaşılabilen toplam 27 MHL hastası dahil edildi. Bu veriler incelenerek hastaların, MIPI skoru, kemik iliği tutulumu, ekstranodal tutulum, tedavi protokolleri, tedaviye yanıtı, nüks durumu ve nakil öyküsü kaydedildi. Bulgular: Hastalar ortalama 64,4 (1-246) ay süreyle takip edilmişti. Hastaların 5’ine (%18) otolog, 2’sine (%8) allogeneik hematopoietik kök hücre nakli yapılmıştı. Birinci basamak tedavi sonrası 17 (%63) hastada tam yanıt, 3 (%11) hastada kısmi yanıt elde edilirken 7 (%26) hastada progresyon saptandı. Birinci basamak tedavi sonrası medyan progresyonsuz sağkalım 29 (3-120) ay olarak hesaplandı. MIPI skorlamasına göre düşük riskli hasta grubunun medyan sağkalımı, yüksek riskli hasta grubuna göre daha uzun (194 ay vs 126 ay, p=0.04), orta riskli hasta grubunun progresyonsuz sağkalımı yüksek riskli hasta grubuna göre daha uzun (41 ay vs 3 ay, p=0.025) bulundu. Sonuç olarak, çalışmamızda hastaların medyan tanı yaşı, çoğunun evre III-IV olması, MIPI skoru yüksek hastalarda progresyonsuz sağkalımın kısa olması literatürle uyumlu bulgular olarak saptandı. Merkezimizde en çok tercih edilen birinci basamak tedavi R-hyper-CVAD/MTX-AraC olup literatüre kıyasla medyan progresyonsuz sağ kalım süresi daha kısa bulundu. MHL’de giderek artan hedefe yönelik tedavi kullanımı dikkate alındığında, bu tür tedavilerle eskiden beri mevcut olan tedavilerin kıyaslanması açısından sonuçlarımızın önemli olduğu kanaatindeyiz.

Kaynakça

  • REFERENCES 1) Swerdlow, SH, Campo E, Harris NL, et al. (2008), Swerdlow, S. H. (2008). WHO classification of tumours of haematopoietic and lymphoid tissues. WHO classification of tumours, 22008, 439. 2) Jiang W, Kahn SM, Zhou P, et al. Overexpression of cyclin D1 in rat fibroblasts causes abnormalities in growth control, cell cycle progression and gene expression. Oncogene 1993; 8:3447–3457. 3) Raty R, Franssila K, Joensuu H, et al. Ki-67 expression level, histological subtype, and the International Prognostic Index as outcome predictors in mantle cell lymphoma. Eur J Haematol 2002; 69:11-20. 4) Gouill LS, Thieblemont C, Oberic L, et al. Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma. N. Engl. J. Med 2017; 377:1250–1260. 5) Eskelund CW, Kolstad A, Jerkeman M, et al. 15-year follow-up of the second nordic mantle cell lymphoma trial (MCL2): prolonged remissions without survival plateau. Br. J. Haematol 2016; 175:410–418. 6) Alinari L, Christian B, Baiocchi RA. Novel targeted therapies for mantle cell lymphoma. Oncotarget 2012; 3:203–211. 7) Dreyling M, Geisler C, Hermine O, et al. Newly diagnosed and relapsed mantle cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25:83-92. 8) Okay M, Meletli O, Kelkitli E, et al. Mantle cell lymphoma: a Turkish Multi-Center Study. JBUON 2019; 24:2084-2089. 9) Smith A, Howell D, Patmore R, et al. Incidence of haematological malignancy by sub-type: report from the Haematological Malignancy Research Network. Br J Cancer 2011; 105:1684-1692. 10) Pileri SA, Falini B. Mantle cell lymphoma. Haematologica 2009; 94:1488-1492 11) Cortelazzo S, Ponzoni M, Ferreri AJ, et al. Mantle cell lymphoma. Crit Rev Oncol Hematol 2012; 82:78-101. 12) Herrmann A, Hoster E, Zwingers T, et al. Improvement of overall survival in advanced stage mantle cell lymphoma. J Clin Oncol 2009; 27:511-518. 13) He J, Chen X, Wei G, et al. Simplified MIPI-B prognostic stratification method can predict the outcome well-retrospective analysis of clinical characteristics and management of newly-diagnosed mantle cell lymphoma patients from China. Medicine 2019; 98:1. 14) Tiemann M, Schrader C, Klapper W, et al. Histopathology, cell proliferation indices and clinical outcome in 304 patients with mantle cell lymphoma (MCL): a clinicopathological study from the European MCL Network. Br J Haematol 2005; 131:29-38.
  • 15) Geisler CH, Kolstad A, Laurell A, Andersen NS, Pedersen LB, Jerkeman M, Eriksson M, Nordström M, Kimby E, Boesen AM, Kuittinen O, Lauritzsen GF, Nilsson-Ehle H, Ralfkiaer E, Akerman M, Ehinger M, Sundström C, Langholm R, Delabie J, Karjalainen-Lindsberg ML, Brown P, Elonen E. Long-term progression-free survival of mantle cell lymphoma after intensive front-line immunochemotherapy with in vivo-purged stem cell rescue: a nonrandomized phase 2 multicenter study by the Nordic Lymphoma Group. Blood 2008; 112:2687-2693. 16) Merli F, Luminari S, Ilariucci F, Petrini M, Visco C, Ambrosetti A, Stelitano C, Caracciolo F, Di Renzo N , Angrilli F, Carella AM, Capodanno I, Barbolini E, Galimberti S, Federico M. Rituximab plus HyperCVAD alternating with high dose cytarabine and methotrexate for the initial treatment of patients with mantle cell lymphoma, a multicentre trial from Gruppo Italiano Studio Linfomi. Br J Haematol 2012; 156:346-353. 17) Kumar A, Sha F, Toure A, Dogan A, Ni A , Batlevi CL, Palomba ML, Portlock C, Straus DJ , Noy A, Horwitz SM, Moskowitz A, Hamlin P, Moskowitz CH, Matasar MJ, Zelenetz AD, Youneset. Patterns of survival in patients with recurrent mantle cell lymphoma in the modern era: progressive shortening in response duration and survival after each relapse. Blood Cancer Journal 2019; 9:1-10. 18) Lamm W, Kaufmann H, Raderer M, Hoffmann M, Chott A, Zielinski C, Drach J. Bortezomib combined with rituximab and dexamethasone is an active regimen for patients with relapsed and chemotherapy-refractory mantle cell lymphoma. Haematologica 2011; 96:1008-1014.

Clinical and Laboratory Characteristics of Our Mantle Cell Lymphoma Patients: A Cross Sectional Study

Yıl 2021, Cilt: 43 Sayı: 1, 56 - 61, 20.01.2021
https://doi.org/10.20515/otd.759341

Öz

Mantle cell lymphoma (MCL) comprises less than 10% of non-Hodgkin's lymphoma cases. Major independent risk factors are identified as the MCL International Prognostic Index (MIPI) and Ki-67 proliferation index of tumor. The aim of this study is retrospectively evaluate MCL patients treated and followed-up in our department. Materials and Methods: This study included 27 MCL patients medical records of whom could be reached. The data was reviewed to figure out MIPI score, bone marrow involvement, extranodal involvement, treatment protocols, treatment response, relapse status, and transplant history. Patients were followed-up for a mean duration of 64.4 (1-246) months. Subsequent to the first-line treatment, complete response was achieved in 17 (63%) and partial response was achieved in 3 (11%) patients, whereas 7 (26%) patients experienced disease progression. Median PFS following first-line treatment was 29 (3-120) months. Based on the classification by MIPI scoring, low-risk patients had significantly longer median survival than that of high-risk patients (194 months vs 126 months, p=0.04), and the patients at moderate-risk had significantly longer PFS compared to high-risk patients (41month vs 3 months, p=0.025). Median age, stage III-IV, and short duration of PFS in patients with high MIPI score were our findings in parallel with available literature. R-hyper-CVAD/MTX-AraC was mostly preferred first-line treatment at our center with a shorter median PFS compared to literature. Given the expanding use of target-driven therapies for MCL, we believe our results are noteworthy in comparing such therapies with pre-existing therapies.

Kaynakça

  • REFERENCES 1) Swerdlow, SH, Campo E, Harris NL, et al. (2008), Swerdlow, S. H. (2008). WHO classification of tumours of haematopoietic and lymphoid tissues. WHO classification of tumours, 22008, 439. 2) Jiang W, Kahn SM, Zhou P, et al. Overexpression of cyclin D1 in rat fibroblasts causes abnormalities in growth control, cell cycle progression and gene expression. Oncogene 1993; 8:3447–3457. 3) Raty R, Franssila K, Joensuu H, et al. Ki-67 expression level, histological subtype, and the International Prognostic Index as outcome predictors in mantle cell lymphoma. Eur J Haematol 2002; 69:11-20. 4) Gouill LS, Thieblemont C, Oberic L, et al. Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma. N. Engl. J. Med 2017; 377:1250–1260. 5) Eskelund CW, Kolstad A, Jerkeman M, et al. 15-year follow-up of the second nordic mantle cell lymphoma trial (MCL2): prolonged remissions without survival plateau. Br. J. Haematol 2016; 175:410–418. 6) Alinari L, Christian B, Baiocchi RA. Novel targeted therapies for mantle cell lymphoma. Oncotarget 2012; 3:203–211. 7) Dreyling M, Geisler C, Hermine O, et al. Newly diagnosed and relapsed mantle cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25:83-92. 8) Okay M, Meletli O, Kelkitli E, et al. Mantle cell lymphoma: a Turkish Multi-Center Study. JBUON 2019; 24:2084-2089. 9) Smith A, Howell D, Patmore R, et al. Incidence of haematological malignancy by sub-type: report from the Haematological Malignancy Research Network. Br J Cancer 2011; 105:1684-1692. 10) Pileri SA, Falini B. Mantle cell lymphoma. Haematologica 2009; 94:1488-1492 11) Cortelazzo S, Ponzoni M, Ferreri AJ, et al. Mantle cell lymphoma. Crit Rev Oncol Hematol 2012; 82:78-101. 12) Herrmann A, Hoster E, Zwingers T, et al. Improvement of overall survival in advanced stage mantle cell lymphoma. J Clin Oncol 2009; 27:511-518. 13) He J, Chen X, Wei G, et al. Simplified MIPI-B prognostic stratification method can predict the outcome well-retrospective analysis of clinical characteristics and management of newly-diagnosed mantle cell lymphoma patients from China. Medicine 2019; 98:1. 14) Tiemann M, Schrader C, Klapper W, et al. Histopathology, cell proliferation indices and clinical outcome in 304 patients with mantle cell lymphoma (MCL): a clinicopathological study from the European MCL Network. Br J Haematol 2005; 131:29-38.
  • 15) Geisler CH, Kolstad A, Laurell A, Andersen NS, Pedersen LB, Jerkeman M, Eriksson M, Nordström M, Kimby E, Boesen AM, Kuittinen O, Lauritzsen GF, Nilsson-Ehle H, Ralfkiaer E, Akerman M, Ehinger M, Sundström C, Langholm R, Delabie J, Karjalainen-Lindsberg ML, Brown P, Elonen E. Long-term progression-free survival of mantle cell lymphoma after intensive front-line immunochemotherapy with in vivo-purged stem cell rescue: a nonrandomized phase 2 multicenter study by the Nordic Lymphoma Group. Blood 2008; 112:2687-2693. 16) Merli F, Luminari S, Ilariucci F, Petrini M, Visco C, Ambrosetti A, Stelitano C, Caracciolo F, Di Renzo N , Angrilli F, Carella AM, Capodanno I, Barbolini E, Galimberti S, Federico M. Rituximab plus HyperCVAD alternating with high dose cytarabine and methotrexate for the initial treatment of patients with mantle cell lymphoma, a multicentre trial from Gruppo Italiano Studio Linfomi. Br J Haematol 2012; 156:346-353. 17) Kumar A, Sha F, Toure A, Dogan A, Ni A , Batlevi CL, Palomba ML, Portlock C, Straus DJ , Noy A, Horwitz SM, Moskowitz A, Hamlin P, Moskowitz CH, Matasar MJ, Zelenetz AD, Youneset. Patterns of survival in patients with recurrent mantle cell lymphoma in the modern era: progressive shortening in response duration and survival after each relapse. Blood Cancer Journal 2019; 9:1-10. 18) Lamm W, Kaufmann H, Raderer M, Hoffmann M, Chott A, Zielinski C, Drach J. Bortezomib combined with rituximab and dexamethasone is an active regimen for patients with relapsed and chemotherapy-refractory mantle cell lymphoma. Haematologica 2011; 96:1008-1014.
Toplam 2 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Nur Oguz Davutoglu 0000-0003-3898-3527

Eren Gunduz 0000-0001-7455-2949

Hava Üsküdar Teke 0000-0002-4434-4580

Neslihan Andıc 0000-0003-0510-4733

Yayımlanma Tarihi 20 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 43 Sayı: 1

Kaynak Göster

Vancouver Oguz Davutoglu N, Gunduz E, Üsküdar Teke H, Andıc N. Clinical and Laboratory Characteristics of Our Mantle Cell Lymphoma Patients: A Cross Sectional Study. Osmangazi Tıp Dergisi. 2021;43(1):56-61.


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