Title MALIGNI LIMFOMI Title (english) MALIGNANT LIMFOMA Author Marija Blažić Mentor Josip Konja (mentor)Committee member Nina Barišić (predsjednik povjerenstva)Committee member Marija Jelušić (član povjerenstva)Committee member Josip Konja (član povjerenstva)Granter University of Zagreb Defense date and country 2015-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Maligne bolesti su jedan od vodećih uzroka smrti djece u Europi i Americi. Tijekom posljednjih deset godina došlo je do znatnog napretka u dijagnostici i liječenju, osobito u liječenju leukemije i limfoma djece. Iza akutnih leukemija i tumora mozga, treće mjesto na ljestvici najčešćih malignih oboljenja u djetinjstvu i adolescenciji zauzeli su limfomi, s godišnjom incidencijom 15 na milijun djece do 14-te godine. Od svih limfoma, zrele B non Hodgkin limfome (B-NHL) čine do 60% novodijagnosticiranih bolesnika. Dvije opsežne kategorije limfoma, Hodginov limfom (HL) i non-Hodgkin limfom (NHL), imaju sasvim različite kliničke značajke i terapijski pristup. Usprkos brojnim otkrićima genetskih, imunoloških i molekularnobioloških ispitivanja u pogledu nastanka limfne stanice, uzročne čimbenike nastanka limfoma još uvijek treba utvrditi. Zahvaljujući velikim multicentričnim studijama i uvođenju novih tretmana liječenja koji su prilagođeni stupnju bolesti (nove kombinacije citostatika, zračenja, monoklonskih antititijela i presađivanja koštane srži), a s ciljem optimalnog rizika, postižu se sve zapaženiji rezultati u postizanju dugoročne remisije i izlječenje. Dok se u liječenju 'klasičnog' Hodgkinovog limfoma isključivo primjenjuje polikemoterpija prema određenom protokolu liječenja, u kasnijem stadiju i uz manje doze zračenja, u NHL-u se primjenjuje kirurški zahvat, radioterapija, kemoterapija i imunoterapija (monoklonska antitijela). Dijagnoza pojedinih entiteta B-NHL a samim time i najoptimalnija strategija liječenja leže na kvalitetnoj mofrološkoj, imunofenotipskoj, genetičkoj i citogenetičkoj analizi. U odrasloj populaciji značajan preokret u liječenju B-NHL postiglo se rituksimabom, kimeričnim monoklonskim protutijelom koji u kombinaciji s CHOP poboljšala stopu preživljavanja do 20%. Djelotvornost rituksimaba u pedijatrijskoj populaciji još uvijek nije dovoljno istražena. Rituksimab u kombinaciji s B-NHL-BFM-95 protokolom se inače dobro podnosi i pokazao se učinkovit u djece i adolescenata s B-NHL-a. Još uvijek je sporno da li je u NHL djece potrebna terapija održavanja postignute remisije i da li bi to bila terapija s monoklonskim antitijelima.
Abstract (english) Malignant diseases are one of the leading causes of death of children in Europe and America. Over the past decade, there has been a significant progress in diagnosis and treatment, especially in the treatment of leukemia and lymphoma of children. After acute leukemia and brain tumors, lymphomas are in the third place among the most common malignancies in childhood and adolescence, with an annual incidence of 15 per million children under 14 years. Of all lymphoma, mature B non Hodgkin lymphoma (B-NHL) make up 60% of newly diagnosed patients. Two broad categories of lymphoma, Hodgkin’s lymphoma (HL) and non-Hodgkin's lymphoma (NHL), have very different clinical features and therapeutic approach. Despite the numerous discoveries of genetic, immunological and molecular tests in terms of the occurrence of lymph cells, causal factors of the development of lymphoma is still to be determined. Thanks to large multicenter studies and the introduction of new treatment therapies that are adapted to the level of disease (new combinations of cytostatics, radiation, monoclonal antibodyes and bone marrow transplantation), with the aim of optimal risk, acknowledged results in achieving long-term remission and cure were achieved. While the treatment of 'classical' Hodgkin lymphoma exclusively polychemotherapy applied to a specific treatment protocol, at a later stage and with less radiation dose, the NHL applied surgery, radiotherapy, chemotherapy and immunotherapy (monoclonal antibodies). The diagnosis of individual entities B-NHL and thus optimal treatment strategies lie on the quality of morphologic, immunophenotypic, genetic and cytogenetic analysis. In the adult population, a significant reversal in the treatment of B-NHL achieved the Rituximab chimeric monoclonal antibody in combination with CHOP improved the survival rate to 20%. The efficacy of rituximab in the pediatric population has not yet been sufficiently explored. Rituximab in combination with B-NHL-BFM-95 protocol is usually well tolerated and proved to be effective in children and adolescents with B-NHL. It is still debatable whether the NHL children need maintenance therapy achieved remission and whether it would be a therapy with a monoclonal antibody.
Keywords
limfom
monoklonska antitijela
liječenje
remisija
Keywords (english)
lymfoma
monoclonal antibodies
treatment
remision
Language croatian URN:NBN urn:nbn:hr:105:684963 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2016-12-07 11:37:52
