Non-Hodgkin lenfoma hastalarında tedaviye yanıtsızlık ile ilişkili faktörler: Tek merkezden 10 yıllık deneyim

Amaç: Kemo(radyo)terapi alan non-Hodgkin lenfoma (NHL) hastalarında tedaviye yanıtla ilişkili faktörleri araştırmak ve ikincil olarak mortaliteyi etkileyen parametreleri belirlemek. Yöntemler: Bu çalışma Ocak 2013-Aralık 2022 tarihleri arasında retrospektif tek merkezli olarak gerçekleştirilmiştir. Bölümümüzde tedavi gören yeni NHL tanısı almış toplam 245 hasta çalışmaya dahil edilmiştir. Klinikodemografik özellikler, NHL özellikleri, tedavi ve takip verileri hastane veri tabanından ve kayıtlarındna elde edilmiştir. Hastalar tedaviye yanıt verenler (RT) ve yanıt vermeyenler (NRT) ile ölenler (DP) ve hayatta kalanlar (SP) olarak gruplandırılmıştır. Tedaviye yanıt ve mortalite ile ilişkili faktörler, tek değişkenli ve çok değişkenli analizlerle belirlenmiştir. Bulgular: RT (56,2 ± 14,5) ve NRT (59,5 ± 13,7) gruplarında yaş benzerdi; ancak erkek cinsiyet RT grubunda anlamlı olarak daha sıktı (%58.1'e karşı %35.71; p = 0.042). Çoklu lojistik regresyon, kadın cinsiyet, düşük performans durumu, kırılganlık, yüksek lenfosit düzeyi, ekstranodal tutulum, mantle hücreli lenfoma, tedavi sırasında trombositopeni ve tedavi sırasında kardiyak komplikasyonların tedaviye yanıtsızlıkla bağımsız olarak ilişkili olduğunu ortaya koydu. Mortaliteye dayalı gruplara göre, DP grubu SP grubuna kıyasla anlamlı düzeyde daha gençti (50,8 ± 11,7'ye karşı 57,1 ± 14,6; p = 0,048), cinsiyet dağılımı benzerdi (erkekler DP'nin %54,7'sini ve SP’nin %63,6'sını oluşturuyordu). Çoklu regresyon, ekstranodal tutulum, tedavi sırasında tromboz ve sekonder malignitenin mortalite ile bağımsız olarak ilişkili olduğunu gösterdi. Sonuç: NHL'de tedavi kararı verilirken ve takip süresince bu özelliklerin göz önünde bulundurulması sağkalımı artırabilir ve mortaliteyi azaltabilir.

Anahtar Kelimeler:

Non-Hodgkin lenfoma, tedaviye yanıt, mortalite, ekstranodal tutulum

Factors associated with unresponsiveness to treatment in patients with non-Hodgkin lymphoma: 10 years of experience from a single center

Aim: To investigate factors associated with response to treatment in non-Hodgkin lymphoma (NHL) patients receiving chemo(radio)therapy, and secondarily, to identify parameters influencing mortality. Methods: This was a retrospective single center study carried out between January 2013 and December 2022. A total of 245 patients newly diagnosed with NHL who were treated in our department were included. Clinicodemographic features, NHL characteristics, treatments and follow-up data were retrieved from the hospital database and charts. Patients were grouped as responders (RT) and non-responders (NRT) to treatment, as well as deceased (DP) and survivors (SP). Factors associated with response to treatment and mortality were determined by univariate and multivariable analysis. Results: Age was similar in the RT (56.2 ± 14.5) and NRT (59.5 ± 13.7) groups; however, male sex was significantly more frequent in the RT group (58.1% vs. 35.71%; p = 0.042). Multiple logistic regression revealed that female sex, low performance status, frailty, high lymphocyte level, extranodal involvement, mantle cell lymphoma, thrombocytopenia during treatment, and cardiac complications during treatment were independently associated with no response to treatment. With respect to groups based on mortality, the DP group was significantly younger compared to the SP group (50.8 ± 11.7 vs. 57.1 ± 14.6; p = 0.048), while sex distribution was similar (males comprised 54.7% of the DP and 63.6% of SP group). Multiple regression showed that extranodal involvement, thrombosis during treatment, and secondary malignancy were independently associated with mortality. Conclusion: Considering these characteristics when making treatment decisions and throughout the follow-up period may improve survival and reduce mortality in NHL.

Keywords:

Non-Hodgkin lymphoma, response to treatment, mortality, extranodal involvement,

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