Terapija održavanja rituksimabom u kroničnoj limfocitnoj leukemiji

master's thesis

• Title (english): Rituximab maintenance therapy in chronic lymphocytic leukemia
• Author: Petar Babić
• Mentor: Igor Aurer (mentor)
• Committee member: Josip Batinić (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: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

UVOD: Kronična limfocitna leukemija (KLL) kronični je limfoproliferativni poremećaj obilježen progresivnim nakupljanjem monoklonskih limfocita u krvi, koštanoj srži, limfnim čvorovima i slezeni. Dugi niz godina kemoimunoterapija bila je zlatni standard liječenja ove bolesti. Nekoliko velikih randomiziranih kliničkih studija dokazalo je uspješnost liječenja folikularnih limfoma terapijom održavanja rituksimabom. Takva studije nisu provedene za liječenje KLL-a, ali postoje istraživanja manjeg stupnja pouzdanosti koje su ukazale na korist od takvog pristupa. Na temelju toga su hematolozi s KBC Zagreb počeli provoditi terapiju održavanja kod bolesnika s KLL-om koji su povoljno odgovorili na kemoimunoterapiju. -----
METODE: Ovo je retrospektivna studija kojom su analizirani ishodi liječenja pacijenata kojima je u razdoblju između 2015. i 2020. godine provedena terapija održavanja rituksimabom. Podaci su prikupljani iz BIS-a ili iz arhiva KBC-a Zagreb, a uključivali su opće podatke o pacijentima, bolesti te prijašnjem i sadašnjem liječenju. -----
REZULTATI: Analizirani su podaci za 89 pacijenata. Medijan praćenja cijele skupine iznosio je 40,1 mj. U trenutku analize podataka udio pacijenata s progresijom bolesti iznosio je 58%, a preživjelih 74%. Medijan sveukupnog preživljenja (OS) za cijelu skupinu nije dosegnut, a medijan preživljenja bez događaja (EFS) iznosio je 42,3 mj. Na prognozu su utjecali izbor uvodne kemoimunoterapije, odgovor na uvodnu terapiju i citogenetski profil. Najbolji rezultati postižu se uvodnom terapijom koja se sastoji od fludarabina, ciklofosfamida i rituksimaba (FCR) uz koju medijan EFS iznosio je 57,7 mj., a medijan OS nije dosegnut. Nuspojave su bile prihvatljive učestalosti i toksičnosti. U bolesnika liječenih u kasnijim linijama liječenja, linija s terapijom održavanja je rezultirala za 34% dužim EFS. -----
ZAKLJUČAK: Naše istraživanje ukazuje da je terapija održavanja korisna. Rezultati liječenja u skladu su s ishodima postignutim u drugim studijama.

Abstract (english)

BACKGROUND: Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disease characterised by a progressive rise in lymphocytes of monoclonal origin in peripheral blood, bone marrow, lymph nodes and spleen. For years, chemoimmunotherapy has been gold standard treatment for treatment of this disease. Several large randomised clinical studies have proven the efficiency of maintenance therapy with Rituximab in treatment of follicular lymphomas. Such studies have not been carried out for treatment of CLL, but there have been a couple of research projects with lesser degrees of reliability that indicate benefits of the approach. In accordance with these findings, haematologists from Clinical Hospital Centre Zagreb have started carrying out maintenance therapy on patients with CLL that have had a good response on chemoimmunotherapy. -----
METHODS: This is a retrospective study that analyses outcomes of treatment for patients that have received maintenance therapy with Rituximab between 2015 and 2020. Data has been collected from hospital's informatics system or from the hospital archives. It included patient information, past treatment history, current disease staging and current treatment. -----
RESULTS: Analysis has been performed for 89 patients. Median follow up for the entire group was 40.1 months. At the moment of analysis, disease-free survival and overall survival rates were 58% and 74%. Median event-free survival (EFS) was 42,3 months, while median overall survival (OS) was not reached. Outcomes were affected by induction chemoimmunotherapy, response to induction therapy and cytogenetic profile of the disease. Fludarabine, cyclophosphamide and rituximab (FCR) chemoimmunotherapy have achieved the best results. Median EFS was 57,7 months while median survival was not reached. Side effects were well tolerated. Maintenance therapy resulted with 34% longer EFS for patients treated with later lines of treatment. -----
CONCLUSION: Our research suggests that there are benefits of maintenance therapy. Outcomes are similar to those achieved in other studies.

• Keywords: kronična limfocitna leukemija; terapija održavanja; rituksimab; ishodi
• Keywords (english): chronic lymphocytic leukaemia; maintenance therapy; Rituximab; outcome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:269895
• 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
• Created on: 2023-01-02 10:48:48