RESUMEN
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are essentially different manifestations of the same disease that are similarly managed. A number of molecular and cytogenetic variables with prognostic implications have been identified. Undetectable minimal residual disease at the end of treatment with chemoimmunotherapy or venetoclax-based combination regimens is an independent predictor of improved survival among patients with previously untreated or relapsed/refractory CLL/SLL. The selection of treatment is based on the disease stage, presence or absence of del(17p) or TP53 mutation, immunoglobulin heavy chain variable region mutation status, patient age, performance status, comorbid conditions, and the agent's toxicity profile. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with CLL/SLL.
Asunto(s)
Leucemia Linfocítica Crónica de Células B , Humanos , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/genética , Pronóstico , InmunoterapiaRESUMEN
The treatment landscape of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has significantly evolved in recent years. Targeted therapy with Bruton's tyrosine kinase (BTK) inhibitors and BCL-2 inhibitors has emerged as an effective chemotherapy-free option for patients with previously untreated or relapsed/refractory CLL/SLL. Undetectable minimal residual disease after the end of treatment is emerging as an important predictor of progression-free and overall survival for patients treated with fixed-duration BCL-2 inhibitor-based treatment. These NCCN Guidelines Insights discuss the updates to the NCCN Guidelines for CLL/SLL specific to the use of chemotherapy-free treatment options for patients with treatment-naïve and relapsed/refractory disease.
Asunto(s)
Antineoplásicos , Leucemia Linfocítica Crónica de Células B , Linfoma de Células B , Antineoplásicos/uso terapéutico , Humanos , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Neoplasia Residual , Proteínas Proto-Oncogénicas c-bcl-2/uso terapéuticoRESUMEN
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are characterized by a progressive accumulation of leukemic cells in the peripheral blood, bone marrow, and lymphoid tissues. Treatment of CLL/SLL has evolved significantly in recent years because of the improved understanding of the disease biology and the development of novel targeted therapies. In patients with indications for initiating treatment, the selection of treatment should be based on the disease stage, patient's age and overall fitness (performance status and comorbid conditions), and cytogenetic abnormalities. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with CLL/SLL.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/normas , Trasplante de Células Madre Hematopoyéticas/normas , Leucemia Linfocítica Crónica de Células B/terapia , Oncología Médica/normas , Recurrencia Local de Neoplasia/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Médula Ósea/patología , Supervivencia sin Enfermedad , Resistencia a Antineoplásicos/genética , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Inmunofenotipificación , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/genética , Leucemia Linfocítica Crónica de Células B/mortalidad , Ganglios Linfáticos/citología , Ganglios Linfáticos/patología , Linfocitos/patología , Oncología Médica/métodos , Mutación , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Organizaciones sin Fines de Lucro/normas , Pronóstico , Inducción de Remisión/métodos , Trasplante Homólogo/normas , Estados Unidos/epidemiologíaRESUMEN
Chronic lymphocytic leukemia (CLL) is generally characterized by an indolent disease course. Histologic transformation (also known as Richter's transformation) to more aggressive lymphomas, such as diffuse large B-cell lymphoma or Hodgkin lymphoma, occurs in approximately 2% to 10% of patients and is associated with a poor prognosis. These NCCN Guidelines Insights discuss the recommendations for the diagnosis and management of patients with histologic transformation.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Oncología Médica/normas , Sociedades Médicas/normas , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Ensayos Clínicos como Asunto , Humanos , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/etiología , Leucemia Linfocítica Crónica de Células B/mortalidad , Oncología Médica/métodos , Supervivencia sin Progresión , Estados UnidosRESUMEN
Plasmapheresis is an efficient method of removing light chains from the circulation. Several studies have shown that it improves renal function in patients with multiple myeloma and renal impairment due to cast nephropathy. The degree of renal failure has been shown to be an important predictor of morbidity and mortality in myeloma. The use of plasmapheresis remains controversial, since it does not affect plasma cells and thus further production of light chains. In addition, existing evidence does not demonstrate a clear benefit from plasmapheresis in these patients. However, data, including some of the new targeted therapies for myeloma, are lacking. Herein, we present our institution's experience in the use of plasmapheresis in patients with myeloma and renal failure, and review the existing literature.
Asunto(s)
Enfermedades Renales/terapia , Mieloma Múltiple/terapia , Intercambio Plasmático , Plasmaféresis , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades Renales/etiología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicacionesRESUMEN
Organ transplant recipients are at an increased risk for subsequent malignancies including hematologic malignancies. The development of acute myeloid leukemia (AML) after solid organ transplantation is a rare but well-documented event. It is thought to be a consequence of immune dysregulation secondary to the use of immunosuppressive agents. Herein, we present the management of a liver transplantation recipient who presented with AML and comprehensively review the relevant literature. A 59-year-old male patient presented with fever and cough eight years after an orthotopic liver transplantation for cirrhosis and hepatocellular carcinoma. He received methylprednisolone and mycofenolate mofetil (MMF) followed by tacrolimus and rapamycin as immunosuppression. Upon admission to our hospital, his peripheral blood demonstrated 34% blasts and pancytopenia. A bone marrow biopsy confirmed the diagnosis of myelodysplastic syndrome (MDS) in transformation to AML. He was treated with induction chemotherapy and his sirolimus was continued but he expired four weeks after from refractory disease. No specific guidelines exist for the treatment of AML in solid organ transplant recipients. Treatment should be individualized and concurrent use of chemotherapeutic and immunosuppressive agents should be carefully balanced.
Asunto(s)
Médula Ósea/patología , Inmunosupresores/efectos adversos , Leucemia Mieloide Aguda/etiología , Leucemia Mieloide Aguda/patología , Trasplante de Hígado , Enfermedad Aguda , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Resultado Fatal , Humanos , Inmunosupresores/uso terapéutico , Quimioterapia de Inducción , Leucemia Mieloide Aguda/tratamiento farmacológico , Cirrosis Hepática/patología , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Herein, we describe a case of a female patient in whom B cell chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) were diagnosed simultaneously. She presented with anemia, thrombocytopenia and splenomegaly. Flow cytometry demonstrated two immunophenotypically distinct CD5-positive monoclonal B cell populations. Peripheral blood fluorescence in situ hybridization (FISH) was positive for IGH/CCND1, consistent with t(11;14) translocation. She received 6 cycles of bendamustine 70 mg/m(2)/day for 2 days and rituximab on the first day every 4 weeks along with granulocyte-colony stimulating factor. She had an excellent response, and repeat computed tomography after her third cycle of chemotherapy revealed no organomegaly or lymphadenopathy. Her peripheral blood lymphocytosis also resolved. Bone marrow examination revealed no detectable flow-cytometric evidence of MCL or CLL. Repeat cytogenetic and FISH analysis were also normal. The patient remains in complete remission 20 months after her initial diagnosis and is receiving maintenance rituximab 375 mg/m(2) weekly for 4 weeks every 6 months for 2 years.