Ferenc Magyari

Quality of life and fatigue in Hodgkin's lymphoma patients.

Aims and background Quality of life and survival of patients with malignant diseases are improving thanks to the development in diagnostics and therapy. Methods We determined the quality of life and frequency and severity of fatigue with an EORTC QLQ-C30 questionnaire in 168 Hodgkins lymphoma patients (85 women, 83 men). We scored all functional and symptom scales in cured patients (who were in complete remission for at least 10 years; mean period of survival after the treatment(s) was 16.61 years) and in those who suffered from late complications. Results The global health status score (QL2) was significantly lower in patients who had late complications (mean QL2, 45.53) than in patients with no complications (mean QL2, 67.57, P <0.001) and in cured patients (mean QL2, 52.5) than in those who were not disease free 10 years after the treatment or who were treated actively (mean QL2, 67.48, P <0.001). We found that fatigue level (FA) was significantly higher in patients who had been treated more than 20 years before (FA score, 53.37) than in those who were undergoing treatment (FA score, 29.35, P = 0.03). A significantly higher FA score (FA, 48.72) was observed in patients who suffered from late complications of the treatment than in those who had no complications (FA, 31.88; P = 0.001). More co-morbidity can cause higher fatigue scores than observed in these groups of Hodgkins lymphoma patients. Conclusions Fatigue is more frequent than we think, and it has a strong effect on quality of life, so its early recognition and treatment is important and needs multidisciplinary cooperation.

Successful administration of rituximab–bendamustine regimen in the relapse of Hodgkin lymphoma after autologous hemopoietic stem cell transplantation

Objectives. Treatment options for relapsing Hodgkin lymphoma (HL) are controversial after autologous hemopoietic stem cell transplantation (HSCT). Nevertheless, allogeneic HSCT may be curative if it is performed in complete remission. Case report. In 2007, a 22‐year‐old female patient was diagnosed with nodular sclerosis subtype of classical HL. Her clinical stage was IIAX with unfavorable prognosis. Eight courses of doxorubicin, bleomycin, vinblastine and dacarbazine chemotherapy and involved field irradiation were applied, but after 3 months of complete remission, disseminated relapse was recognised by 18FDG‐PET/CT. After two cycles of salvage dexamethasone, cisplatinum, and cytosine arabinoside therapy, further progression was noticed, so the treatment was modified to ifosfamide, gemcitabine, vinorelbine, and prednisone (IGEV) regimen. After two cycles of IGEV regimen, she achieved a complete metabolic remission, which was confirmed by a 18FDG‐PET/CT scan again. She was referred for autologous‐HSCT, and a successful stem cell collection was performed in August 2008. However, a rapid progression was detected again, so total body irradiation was applied before the conditioning therapy with R‐mini‐BEAM regimen. The 18FDG‐PET/CT scan performed 100 days after the autologous‐HSCT was still positive. In December 2009, multiple nodal and extranodal progression was detected, so ifosfamide, carboplatine, etoposide, mesna protection rescue treatment was started, but it was ineffective. Based on sporadic data of the literature, rituximab–bendamustine therapy was started in March 2010. After four cycles, she achieved complete metabolic remission, which was verified by 18FDG‐PET/CT. The patient has been referred for an allogeneic HSCT with reduced intensity conditioning. Conclusions. Based on our experience, bendamustine–rituximab salvage therapy can be a suitable option for the treatment of post‐transplant progression or relapse of HL. Copyright

Immunological changes in diffuse large B-cell lymphomas after Rituximab-CHOP treatment: Own data and review of the literature

INTRODUCTION Rituximab treatment may induce a long-term B-cell depletion, which can be accompanied with an increased infection risk. AIMS To examine the changes of the white blood cell, CD19+ B-cell and CD4+ T-cell counts and the levels of immunoglobulin G, A, M after rituximab containing chemotherapy and to explore the infectious complications in our patients and review of the literature. PATIENTS AND METHODS Thirty-five diffuse large B-cell lymphoma patients were examined, who were treated with rituximab-cyclophosphamide-vincristine-doxoribicine-prednisolone (R-CHOP). The B- and T-cell populations were analyzed with flow-cytometry while the immunoglobulin levels were measured by nephelometry. RESULTS CD19+ B-lymphocytes were undetectable after the treatment and their count only increased from the post-therapeutic 12th month. Infection did not occur in this group of patients. CONCLUSIONS Rituximab induced B-cell depletion was appreciable also in this group of patients, while serious or unexpected infection did not occur. Increased infectious risk primarily can be observed after long-term, maintenance rituximab treatment.

A korai/praefibroticus primer myelofibrosis kivizsgálása és kezelése egy eset kapcsán

Absztrakt: Mersekelt thrombocytosis szamos korkephez tarsulhat (verzes, gyulladas, vashiany, autoimmun betegsegek stb.), de tartos, 450 G/l folotti verlemezkeszam eseten a beteg hematologiai kivizsgalasa javasolt, ha a thrombocytosist egyeb, gyakoribb ok nem magyarazza. Egy 47 eves nő anamneziseben hypertonia, asthma bronchiale, endometriosis szerepel. Kivizsgalasa 2015 marciusaban fogyas, etvagytalansag miatt indult. Laboratoriumi vizsgalatai kozul kiemelhető az emelkedett thrombocytaszam (617 G/l), vashianya nem volt. 2015. aprilis 7-en jelentkezett bal bordaiv alatti akut fajdalom miatt, amelynek hattereben egyszerű kepalkoto vizsgalatok elterest nem mutattak. A hasi CT-vizsgalat az aorta abdominalis szakaszan 4,5 cm-es thrombust irt le, amely beterjedt a bal arteria renalisba, es elzarta azt. Az APTI-hez (aktivalt parcialis thromboplastinidő) igazitott folyamatos natrium-heparin kezelest inditottunk. A kesőbb megerkezett JAK2V617F-mutacio-analizis pozitiv lett, majd a csontvelővizsgalat korai/praefibr...

Így kezeljük az autológ őssejt-transzplantáció után kiújult Hodgkin-lymphomát

Absztrakt: Az elsődleges kezeles utan a Hodgkin-lymphomas betegek 10–30%-a relabal vagy refrakter. Jelenleg elsőkent autolog haemopoeticus őssejt-transzplantacio javasolt ezekben az esetekben, bar ezt kovetően csak a betegek fele gyogyul meg, a median teljes tuleles is mindossze 2–2,5 ev. Szamos prognosztikai tenyező hatarozza meg az autolog haemopoeticus őssejt-transzplantacio sikeresseget, amelyek figyelembevetelevel, szukseg eseten konszolidacios kezeles alkalmazasaval az eredmenyek javithatok. Az autolog őssejt-transzplantacio utan relabalo betegeknek meg kedvezőtlenebb a tulelese, es ennek a betegcsoportnak a kezelese jelenti a legnagyobb kihivast a Hodgkin-lymphoma terapiaja soran. Szerencsere az utobbi evekben szamos uj kezelesi mod valt elerhetőve, igy a brentuximab vedotin es az immuncheckpoint-gatlok, amelyektől a tulelesi es gyogyulasi eredmenyek javulasat remeljuk. Az allogen transzplantacio eredmenyei is javulhatnak a haploidentikus transzplantacio alkalmazasaval. Osszefoglalonkban ezeket az ...

Alternative salvage regimens for relapsed/refractory classical Hodgkin's lymphoma

Objective and importance: Hodgkins lymphoma (HL) is a well-curable disease. The treatment usually includes combined multiagent conventional chemotherapy and radiotherapy. One-fifth of the patients need repeated treatments because of relapse or primary progressive disease. Those HL patients, who cannot be cured at least with salvage therapy (including autologous haemopoietic stem cell transplantation (auto-HSCT)), have really unfavourable prognosis. Intervention: For this heavily pretreated subset of HL patients, novel but less toxic treatment strategies should be considered. Brentuximab-vedotin (BV) is a novel targeted treatment option, which was administered after the failure of two different regimens in patients, who were ineligible for auto-HSCT or after the failure of auto-HSCT. Moreover, there are favourable data with chemotherapeutical regimens supplemented with rituximab not only in relapsed but also in newly diagnosed classical HL patients. Bendamustine, an almost forgotten 50-year-old drug, lives its renaissance in the twenty-first century, which can be administered in refractory HL as well. Combination of the ‘new’ and ‘old’ drugs might be also helpful. Conclusion: Our data suggest that rituximab plus bendamustine (supplemented with or without BV) could be a suitable alternative bridging salvage therapy for heavily pretreated HL patients.