Chronická lymfocytární leukemie je nejčastější leukemií dospělých v České republice.1 V posledních letech dochází k významnému posunu v její léčbě od chemoimunoterapie k novým cíleným lékům a tím i k nemalému prodloužení a zkvalitnění života nemocných. V popisovaném případu se věnuji zavedení léčby acalabrutinibem u předléčené pacientky s chronickou lymfocytární leukemií.
Chronic lymphocytic leukemia is the most common leukemia in adult population of Czech Republic. In a last few years there have been a significant shift in its treatment from chemoimmunotherapy to novel targeted agents achieving a prolonged life with better quality. In a discussed case report I present an administration of acalabrutinib to a pretreated patient with chronic lymphocytic leukemia.
The treatment of relapsed/refractory chronic lymphocytic leukemia (CLL) remains a challenging clinical issue. An important treatment option is the use of high-dose corticosteroids. The purpose of this clinical trial was to determine the efficacy and toxicity of an ofatumumab-dexamethasone (O-Dex) combination in relapsed or refractory CLL. The trial was an open-label, multicenter, nonrandomized, Phase II study. The O-Dex regimen consisted of intravenous ofatumumab (Cycle 1: 300 mg on day 1, 2,000 mg on days 8, 15, and 22; Cycles 2-6: 1,000 mg on days 1, 8, 15, and 22) and oral dexamethasone (40 mg on days 1-4 and 15-18; Cycles 1-6). The O-Dex regimen was given until best response, or a maximum of six cycles. Thirty-three patients (pts) were recruited. Twenty-four (73%) pts completed at least three cycles of therapy. The remaining nine pts were prematurely discontinued owing to Grade 3/4 infections (seven pts), disease progression (one pt), or uncontrollable diabetes mellitus (one pt). Overall response rates/complete remissions (ORR/CR) were achieved in 22/5 pts (67/15%). The median progression-free survival (PFS) was 10 months. In pts with p53 defects (n = 8), ORR/CR were achieved in 5/2 pts (63/25%) with a median PFS of 10.5 months. The median overall survival (OS) was 34 months. The Grades 3-5 infectious toxicity in 33% of pts represented the most frequent side effect during the treatment period. In conclusion, the O-Dex regimen shows a relatively high ORR and CR with promising findings for PFS and OS. The study was registered at www.clinicaltrials.gov (NCT01310101).
- MeSH
- analýza přežití MeSH
- chronická lymfatická leukemie farmakoterapie genetika mortalita patologie MeSH
- dexamethason terapeutické užití MeSH
- kombinovaná farmakoterapie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- monoklonální protilátky terapeutické užití MeSH
- mutace MeSH
- nádorový supresorový protein p53 genetika MeSH
- protinádorové látky terapeutické užití MeSH
- recidiva MeSH
- rozvrh dávkování léků MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: Merkel cell polyomavirus (MCPyV), a ubiquitous DNA tumor virus, has been found to be associated with Merkel cell carcinoma and chronic lymphocytic leukemia (CLL). Previous studies have reported conflicting results on the frequency and potential pathogenetic role of MCPyV in CLL. The aim of this study was to evaluate MCPyV's association with CLL and its prognostic significance. PATIENTS AND METHODS: Between 2006 and 2013, DNA samples obtained from CLL patients (n = 119) before treatment were tested for MCPyV using quantitative real-time polymerase chain reaction analysis and verified by gel electrophoresis. Only samples testing positive by both methods were considered valid. RESULTS: We found that 13 (11%) of 119 CLL cases were positive for MCPyV. Between the groups of MCPyV-positive and -negative patients, there was no significant difference in the sex, age, cytogenetics, presence of p53 defect, or immunoglobulin heavy chain (IGHV) mutational status. In the subset of MCPyV-negative patients, advanced Rai stage (III to IV) was found more frequently, and therapy was initiated more often. There was no difference in overall response rate, median progression-free survival, and overall survival between both groups. We did not observe any new positivity after treatment in initially MCPyV-negative patients. CONCLUSION: This study provides the first analysis of the prognostic role of MCPyV in CLL. MCPyV occurrence seems to be a relatively rare event during the course of CLL. MCPyV is also unlikely to influence the outcome of CLL patients.
- MeSH
- chronická lymfatická leukemie diagnóza virologie MeSH
- elektroforéza v polyakrylamidovém gelu MeSH
- infekce onkogenními viry diagnóza virologie MeSH
- kvantitativní polymerázová řetězová reakce MeSH
- lidé středního věku MeSH
- lidé MeSH
- Merkelův polyomavirus patogenita MeSH
- mutace MeSH
- polyomavirové infekce diagnóza virologie MeSH
- prevalence MeSH
- prognóza MeSH
- těžké řetězce imunoglobulinů genetika MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
