Kronik lenfositik lösemi hastalarının genel klinik değerlendirilmesi

Amaç: Çalışmamızda 2000-2011 yılları arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Hematoloj Bilim Dalı tarafından takip edilen 114 hastanın demografik verileri, tedavi endikasyonları, tedavi yanıtları ve total sağ kalım analizlerinin yapılması amaçlandı. Yöntemler: Kronik lenfoblastik lösemi tanısıyla takip edilen 114 hastanın verileri geriye dönük olarak değerlendirildi. Bulgular: Hastaların 60’ı erkek (%52,6), 54’ü kadındı (%47,4). Ortanca yaş 64 olarak saptandı. 61 hasta tedavisiz izlenirken 53 hasta tedavi aldı. Tanıdan ilk tedaviye kadar geçen süre ortalama 15,57 ay idi. İlk sıra kemoterapide en sık klorambusil kullanıldı (%62). Hastaların ilk sıra kemoterapi sonrası yapılan değerlendirmelerinde 40 hastada kısmi yanıt, 5 tam yanıt, 7 stabil hastalık ve 1 hastada progresyon izlendi ve progresyonsuz sağ kalım ortalaması 18 ay olarak bulundu. 25 hasta ikinci sıra kemoterapi aldı. İkinci sıra kemoterapinin progresyonsuz sağ kalım ortalaması 6,23 ay olarak hesaplandı. 6 hastaya üçüncü sıra kemoterapi verildi ve üçüncü sıra kemoterapinin progresyonsuz sağ kalım ortalaması 5,5 ay idi. Çalışma sonunda 114 hastanın ortalama toplam sağ kalım süreleri 92,8 ay olarak hesaplandı. Rai ve Binet evresi yüksek olan hastalarda tedavisiz sağ kalım ve progresyonsuz sağ kalım sürelerinin kısaldığı görüldü (p

General clinical evaluation of the chronic lymphocytic leukemia patients

Objectıve: Demographic features, treatment endications, responds to treatment of 114 chronic lymphocytic leukemia patients observed in years of 2000-2011 on hematology department of Dokuz Eylül University Medical Faculty have been analyzed in our study. Methods: Features of 114 CLL patients were evaluated retrospectively. Results: In 60 patients were male (%52.6), 54 patients were female(%47.4). The median age was 64. While 61 patients were being observed without treatment, 53 patients were under medical treatment. The therapy free survival was 15.57 months. Chlorambucil was the most prefered drug on the first line therapy (%62). In the evaluation first line chemotherapy; partial remission for 40, complete remission for 5, stable disease for 7, progression for 1 patient was observed.Progression free survival was 18 months. 25 patients have second line therapy. The progression free survival of the second line therapy was 6.23 months. The third line therapy was given to 6 patients, the progression free survival of the third line therapy was 5,5 months. At the end of the study overall survival was 92.8 months. For the patients whose Rai and Binet stage is high, therapy free survival and progression free survival 1 time is shorter (p<0.05). During the study deaths of the 14 patients were related to the CLL and 9 patients related to another reasons. Conclusıon: Demographic features of patients are similar to other studies. Causes of shorter survival time in therapy group may be related to lack of using modern prognostic markers in our center, lack of using monoclonal antibodies on the first line therapy and poor patient adaptation to treatment

___

  • 1. Cheson, BD, Bennett JM, Grever M, et al. National Cancer Institute-sponsored Working Group guidelines for chronic lymphocytic leukemia: revised guidelines for diagnosis and treatment. Blood 1996; 87: 4990-4997.
  • 2. Rozman C, and Montserrat E. Chronic lymphocytic leukemia. N Engl J Med 1995; 333: 1052-1057.
  • 3. Hallek M, Cheson BD, Catovsky D, et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111: 5446-5456.
  • 4. Chiorazzi N, Rai KR, and Ferrarini M. Chronic lymphocytic leukemia. N Engl J Med 2005; 352: 804-815.
  • 5. Yee KW, and O'Brien SM. Chronic lymphocytic leukemia: diagnosis and treatment. Mayo Clin Proc 2006; 81: 1105-1129.
  • 6. Montserrat E. New prognostic markers in CLL. Hematology Am Soc Hematol Educ Program 2006; 279- 284.
  • 7. Thomas R, Ribeiro I, Shepherd P, et al. Spontaneous clinical regression in chronic lymphocytic leukaemia. Br J Haematol 2002; 116: 341-345.
  • 8. Mauro FR, Foa R, Giannarelli D, et al. Clinical characteristics and outcome of young chronic lymphocytic leukemia patients: a single institution study of 204 cases. Blood 1999; 94: 448-454.
  • 9. Catovsky D, Fooks J, Richards S. Prognostic factors in chronic lymphocytic leukaemia: the importance of age, sex and response to treatment in survival. A report from the MRC CLL 1 trial. MRC Working Party on Leukaemia in Adults. Br J Haematol 1989; 72: 141-149.
  • 10. Lee JS, Dixon DO, Kantarjian HM, Keating MJ, Talpaz M. Prognosis of chronic lymphocytic leukemia: a multivariate regression analysis of 325 untreated patients. Blood 1987; 69: 929-936.
  • 11. Montserrat E, Sanchez-Bisono J, Viñolas N, Rozman C. Lymphocyte doubling time in chronic lymphocytic leukaemia: analysis of its prognostic significance. Br J Haematol 1986;62: 567-575.
  • 12. Oscier DG, Gardiner AC, Kalıp SJ, et al. Multivariate analysis of prognostic factors in CLL: clinical stage, IGVH gene mutational status, and loss or mutation of the p53 gene are independent prognostic factors. Blood 2002;100: 1177-1184.
  • 13. Damle RN, Wasil T, Fais F, et al. Ig V gene mutation status and CD38 expression as novel prognostic indicators in chronic lymphocytic leukemia. Blood 1999;94: 1840-1847.
  • 14. Kröber A, Seiler T, Benner A, et al. V(H) mutation status, CD38 expression level, genomic aberrations, and survival in chronic lymphocytic leukemia. Blood 2002;100: 1410-1416.
  • 15. Poeta GD, Maurillo L, Venditti A, et al. Clinical significance of CD38 expression in chronic lymphocytic leukemia. Blood 2001; 98: 2633-2639.
  • 16. Orchard JA, Ibbotson RE, Davis Z, et al. ZAP-70 expression and prognosis in chronic lymphocytic leukaemia. Lancet 2004; 363: 105-111.
  • 17. Pangalis GA, Boussiotis VA, Kittas C. B-chronic lymphocytic leukemia. Disease progression in 150 untreated stage A and B patients as predicted by bone marrow pattern. Nouv Rev Fr Hematol 1988; 30: 373- 375.
  • 18. Diehl LF, Karnell LH, Menck HR. The American College of Surgeons Commission on Cancer and the American Cancer Society. The National Cancer Data Base report on age, gender, treatment, and outcomes of patients with chronic lymphocytic leukemia. Cancer 1999; 86: 2684- 2692.
  • 19. Cartwright RA, Gurney KA, Moorman AV. Sex ratios and the risks of haematological malignancies. Br J Haematol 2002; 118: 1071-1077.
  • 20. Dores GM, Anderson WF, Curtis RE, et al. Chronic lymphocytic leukaemia and small lymphocytic lymphoma: overview of the descriptive epidemiology. Br J Haematol 2007; 139: 809-819.
  • 21. Rai KR, Sawitsky B, Cronkite EP, Chanana AD, Levy RN and Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood 1975; 46: 219-234.
  • 22. Binet JL, Auquier A, Dighiero G, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 1981; 48: 198-206.
  • 23. Oscier DG, Matutes E, Copplestone A, et al. Atypical lymphocyte morphology: an adverse prognostic factor for disease progression in stage A CLL independent of trisomy 12. Br J Haematol 1997; 98: 934-939.
  • 24. Moreno C, Hodgson K, Ferrer G, et al. Autoimmune cytopenia in chronic lymphocytic leukemia: prevalence, clinical associations, and prognostic significance. Blood 116: 4771-4776.
  • 25. Visco C, Ruggeri M, Evangelista LM, et al. Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia. Blood 2008; 111: 1110- 1116.
  • 26. Robak T. Second malignancies and Richter's syndrome in patients with chronic lymphocytic leukemia. Hematology 2004; 9: 387-400.
  • 27. Kyasa MJ, Hazlet L, Rudolph SP, et al. Veterans with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) have a markedly increased rate of second malignancy, which is the most common cause of death. Leuk Lymphoma 2004; 45: 507-513.
  • 28. Travis LB, Curtis RE, Hankey BF, Fraumeni JF, Jr. Second cancers in patients with chronic lymphocytic leukemia. J Natl Cancer Inst 1992; 84: 1422-1427.
  • 29. James DF, and Kipps TJ. Rituximab in chronic lymphocytic leukemia. Adv Ther 2011; 28: 534-554.
  • 30. Kennedy B, Rawstron A, Carter C, al. Campath-1H and fludarabine in combination are highly active in refractory chronic lymphocytic leukemia. Blood 2002; 99: 2245-2247.
  • 31. Wierda WG. Current and investigational therapies for patients with CLL. Hematology Am Soc Hematol Educ Program 2006; 285-294.
  • 32. Sawitsky A, Rai KR, Glidewell O, Silver RT, et al. Comparison of daily versus intermittent chlorambucil and prednisone therapy in the treatment of patients with chronic lymphocytic leukemia. Blood 1977;50:1049-1059.
  • 33. Montserrat E, and Rozman C. Chronic lymphocytic leukaemia treatment. Blood Rev 1993; 7: 164-175.
  • 34. Knospe WH, Loeb VJr, and Huguley CMJr. Proceedings: Bi-weekly chlorambucil treatment of chronic lymphocytic leukemia. Cancer 1974; 33: 555-562.
  • 35. Robak T, Bloński JZ, Kasznicki M, et al. Cladribine with prednisone versus chlorambucil with prednisone as firstline therapy in chronic lymphocytic leukemia: report of a prospective, randomized, multicenter trial. Blood 2000; 96:2723-2729.
  • 36. Knauf WU, Lissichkov T, Aldaoud A, et al. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 2009; 27: 4378-4384.
  • 37. Eichhorst BF, Busch R, Stilgenbauer S, et al. First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia. Blood 2009; 114: 3382-3391.
  • 38. Robak T, Jamroziak K, Gora-Tybor J, et al. Comparison of cladribine plus cyclophosphamide with fludarabine plus cyclophosphamide as first-line therapy for chronic lymphocytic leukemia: a phase III randomized study by the Polish Adult Leukemia Group (PALG-CLL3 Study). J Clin Oncol 2010 28: 1863-1869.
Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi-Cover
  • ISSN: 1300-6622
  • Yayın Aralığı: Yıllık
  • Başlangıç: 2015
  • Yayıncı: -
Sayıdaki Diğer Makaleler

Kearns-Sayre sendromlu bir hastada anestezi yöntemi

Abdulkadir YEKTAŞ, Sıtkı Nadir ŞİNİKOĞLU, Melehat EROL, Mevlüt ÇÖMLEKÇİ, Kerem ERKALP

Favizm Sonucu Gelişen Akut Böbrek Yetmezliği: Olgu Sunumu Ve Literatür Derlemesi,

Tülay AKMAN, CANER ÇAVDAR, Mehmet Ali ÖZCAN, Özden PİŞKİN

Bir Üniversite Hastanesi Bildirimi Zorunlu Bulaşıcı Hastalık Bildirimlerinin Değerlendirilmesi (2005-2008),

İ. E. İBRHİM, R. UÇKU

Kearns-Sayre Sendromlu Bir Hastada Anestezi Yöntemi,

A.yektaş, S. N. ŞİNİKOĞLU, M. EROL, M.çömlekçi, K. ERKALP

Bir üniversite hastanesi bildirimi zorunlu bulaşıcı hastalık bildirimlerinin değerlendirilmesi (2005-2008)

İBRHİM İbrheem ERYAN, Reyhan UÇKU

Obez Ve Dislipidemik Türk Çocuklarında Apolipoprotein E Gen Polimorfizmi Ve Plazma Lipid Seviyelerinin Karşılaştırılması,

E. YILMAZ, E. BORA, T. CANKAYA, A. ÜGENALP, O. G. BOZKAYA, M. ÇOKER, D. ERÇAL, -

Akılcı İlaç Kullanımı: Yaygınlaştırılması ve Tıp Eğitiminin Rolü,

B. AYDIN, A. GELAL

obez ve dislipidemik Türk çocuklarında apolipoprotein e gen polimorfizmi ve plazma lipid seviyelerinin karşılaştırılması

Ebru YILMAZ, Elçin BORA, Tufan ÇANKAYA, Ayfer ÜLGENALP, Giray Özlem BOZKAYA, Mahmut ÇOKER, Derya ERÇAL

Kronik Lenfositik Lösemi Hastalarının Genel Klinik Değerlendirilmesi,

V. DEMİR, S. KAHRAMAN, A. KATGI, Ö. PİŞKİN, G. H. ÖZSAN, F. DEMİRKAN, B. ÜNDAR, M. A. ÖZCAN

Yoğun bakım ünitelerindeki hastaların alt solunum yolu örneklerinden izole edilen non-fermantatif gram-negatif bakterilerin antimikrobiyal duyarlılıkları ve alt solunum yolu enfeksiyonu ile ilişkili risk faktörleri

Gonca KÜME, Mustafa DEMİRCİ