RESUMO
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.
Assuntos
Leucemia Linfocítica Crônica de Células B , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Linfocítica Crônica de Células B/genética , Prognóstico , ImunoterapiaRESUMO
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.
Assuntos
Antineoplásicos , Leucemia Linfocítica Crônica de Células B , Linfoma de Células B , Antineoplásicos/uso terapêutico , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Neoplasia Residual , Proteínas Proto-Oncogênicas c-bcl-2/uso terapêuticoRESUMO
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.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/normas , Transplante de Células-Tronco Hematopoéticas/normas , Leucemia Linfocítica Crônica de Células B/terapia , Oncologia/normas , Recidiva Local de Neoplasia/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Medula Óssea/patologia , Intervalo Livre de Doença , Resistencia a Medicamentos Antineoplásicos/genética , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imunofenotipagem , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/genética , Leucemia Linfocítica Crônica de Células B/mortalidade , Linfonodos/citologia , Linfonodos/patologia , Linfócitos/patologia , Oncologia/métodos , Mutação , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Organizações sem Fins Lucrativos/normas , Prognóstico , Indução de Remissão/métodos , Transplante Homólogo/normas , Estados Unidos/epidemiologiaRESUMO
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.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Oncologia/normas , Sociedades Médicas/normas , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Ensaios Clínicos como Assunto , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/etiologia , Leucemia Linfocítica Crônica de Células B/mortalidade , Oncologia/métodos , Intervalo Livre de Progressão , Estados UnidosRESUMO
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.
Assuntos
Nefropatias/terapia , Mieloma Múltiplo/terapia , Troca Plasmática , Plasmaferese , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicaçõesRESUMO
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.
Assuntos
Medula Óssea/patologia , Imunossupressores/efeitos adversos , Leucemia Mieloide Aguda/etiologia , Leucemia Mieloide Aguda/patologia , Transplante de Fígado , Doença Aguda , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Evolução Fatal , Humanos , Imunossupressores/uso terapêutico , Quimioterapia de Indução , Leucemia Mieloide Aguda/tratamento farmacológico , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
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.
