oncolog-hematolog
ro
hematologie
Complicaţiile neutropenice
Impactul asupra răspunsului terapeutic şi supravieţuirii
bolnavilor cu limfom difuz cu celule mari B
G. Oltean, Smaranda Demian,
I. Macarie, Marcela Cândea
Clinica Medicală 1,
Compartimentul de Hematologie,
Universitatea de Medicină şi Farmacie
Târgu-Mureş
Abstract
Purpose: to evaluate the impact of neutrope- and 32.87% PR); 6.84% had progressive disease.
nic complications (NC) on therapeutic response Eight patients with neutropenic complications
and survival of patients with diffuse large B cell died due to severe infections. 29 (19.6%) patients
lymphoma (DLBCL) treated by cytostatic che- received in addtition G-CSF. NC lead to reduced
motherapy. Patients and methods: A total of dose intensity in 26 patients (17.8%). The CR rates
146 patients with advanced (stage II-IV) DLBCL, were 42.22% in patients with NC versus 68.31%
from a single institution, were analysed in terms in patients without NC (p < 0.005). The overall
of incidence of neutropenic complications, im- response rates were 91.11% in cases with NC ver-
pact on chemotherapy dose intensity, need of sus 94.05% in patients without NC (p = NS). A 3-
myeloid growth factor, therapeutic response and years survival rates were 57.77% in patients with
survival. Patients (median age 52 years, range NC versus 83.16% in patients without NC (p =
22-78 years) received CHOP (cyclophosphamide, 0.0017). A 5-years survival rates were 40% in pa-
farmorubicin, vincristine, prednisone) chemo- tients with NC versus 66.33% in patients without
therapy, every 3 weeks, for 4-8 cycles. In cases with NC (p = 0.0037). Conclusions: NC are relatively
severe or febrile neutropenia G-CSF (granulocyte frequent in patients with DLBCL undergoing che-
colony stimulating factor) 5 microg/Kg, for 4-5 motherapy. They lead to reduce dose intensity of
days, was administered. Results: Severe or fe- chemotherapy or addition of a myeloid growth
brile neutropenia occured in 32 (21,9%) patients factor. The presence of NC is a negative prognos-
in cycle 1. During the initial 4 cycles of chemo- tic factor for the treatment response rate and for
therapy 45 (31,82%) patients experienced at least survival of patients with DLBCL.
two neutropenic events. After 4 cycles of treat- Keywords: diffuse large B-cell lymphoma, neu-
ment, the response rate was 93,14% (60.27% CR tropenic complications, survival
Rezumat
Scopul lucrării: Evaluarea impactului complicaţiilor neutropenice peutic (60,27% RC şi 32,87% RP); 6,84% au prezentat progresia bolii.
(CN) asupra răspunsului terapeutic şi asupra supravieţuirii bolnavilor Opt bolnavi cu CN au decedat din cauza infecţiilor severe. 29 (19,6%)
cu limfom difuz cu celule mari B (DLBCL) supuşi chimioterapiei cito­ bolnavi au primit şi G­CSF. CN au dus la reducerea dozei de citostatice
statice. Material şi metode: Studiul a fost efectuat retrospectiv pe 141 la 26 de bolnavi (17,8%). Ratele de RC au fost de 42,22% la bolnavii
de bolnavi cu DLBCL în stadii avansate de boală (II­IV); au fost anali­ cu CN faţă de 68,31% la cei fără CN (p <0,005). Ratele de răspuns
zate incidenţa CN, impactul acestora asupra intensităţii dozei terapeu­ terapeutic global nu au înregistrat diferenţe semnificative (91,11% vs
tice, necesarul de factori hematopoietici de creştere, răspunsul tera­ 94,05%). Supravieţuirea la 3 ani a fost de 57,77% la bolnavii cu CN
peutic şi supravieţuirea. Pacienţii (vârsta medie 52 de ani, limite 22­78 faţă de 83,16% la cei fără CN (p = 0,0017), iar supravieţuirea la 5 ani
de ani) au primit chimioterapie tip CHOP (ciclofosfamidă, farmorubi­ de 40%, respectiv 66,33% (p = 0,0037). Concluzii: CN sunt relativ
cin, vincristin, prednison) la fiecare 3 săptămâni, 4­8 cicluri. În cazurile frecvente la bolnavii cu DLBCL supuşi chimioterapiei citostatice. Ele
cu neutropenie severă sau febrilă s­a administrat G­CSF (granulocyte impun reducerea dozelor de citostatice sau administrarea de factori de
colony stimulating factor) 5 microg/kg, timp de 4­5 zile. Rezultate: creştere granulocitară. Prezenţa CN reprezintă un factor de prognostic
Neutropenia severă sau febrilă a apărut la 32 (21,9%) de bolnavi după negativ pentru rata răspunsului terapeutic şi pentru supravieţuirea
ciclul 1. În timpul primelor 4 cicluri de chimioterapie, 45 (31,82%) de bolnavilor cu DLBCL.
bolnavi au prezentat cel puţin două episoade neutropenice. După 4 Cuvinte-cheie: limfom cu celule mari B, complicaţii neutropenice,
cicluri de tratament, 93,14% dintre bolnavi au obţinut răspuns tera­ supravieţuire
pag. 42
Nr. 6/martie 2009
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68