Relaps akutní myeloidní leukemie (AML) nebo AML primárně rezistentní na léčbu je prognosticky velmi nepříznivým onemocněním. V období VIII/2001 – III/2009 bylo v ČR s touto diagnózou léčeno 20 pacientů ve věku 0–18 let v mezinárodní studii Relapsed AML 2001/01. Protokol se skládal ze dvou bloků chemoterapie založené na vysokodávkovaném cytosin-arabinosidu v kombinaci s fludarabinem, v prvním bloku byli pacienti randomizováni pro podání lipozomálního daunorubicinu (DaunoXome). Pokud po prvním bloku bylo v kostní dřeni > 20 % blastů nebo po druhém bloku nebylo dosaženo kompletní remise, byli pacienti jako non-respondeři vyřazeni ze studie. Alternativou pro ně byla léčba ve studii Relapsed AML 2001/02 monoterapií gemtuzumab ozogamicinem (Mylotarg; GO). Po dosažení 2. remise byly děti indikovány k alogenní transplantaci kmenových buněk krvetvorby (HSCT). Dva pacienti byli léčeni pro primárně rezistentní onemocnění, 18 dětí pro první relaps AML. V 61 % byl relaps časný do 12 měsíců od diagnózy. Šest dětí neodpovědělo na léčbu, dvě zemřely časnou smrtí, dvanáct (60 %) pacientů dosáhlo 2. remise a 11 z nich podstoupilo alogenní HSCT. Celkem žije s mediánem sledování 5,8 roku 6 (30 %) dětí, všechny po alogenní transplantaci (2 děti po 2. HSCT). Pravděpodobnost 5letého přežití do selhání (EFS) je pro celou skupinu 18 ± 9 %, pravděpodobnost celkového přežití (OS) 34 ± 11 %. Léčba ve studii Relapsed AML 2001 zlepšila prognózu dětí s relapsem AML v České republice ve srovnání s předchozím obdobím 1993–2001 (n = 22 dětí, OS 14 %). period 1993-2001 (n=22 children, OS 14%).

Relapse of acute myeloid leukaemia (AML) or AML initially resistant to treatment is extremely prognostically unfavourable. Between VIII/2001 and III/2009 in the Czech Republic, twenty patients aged 0-18 years with this diagnosis were treated as part of the international Relapsed AML 2001/01study. The protocol consisted of two blocks of chemotherapy based on a high-dose cytosine-arabinoside in combination with fludarabine. In the first block, patients were randomized to receive liposomal daunorubicin (DaunoXome). If there was > 20% blasts in the bone marrow after the first block or if a complete remission was not achieved after the second block, patients were considered non-responders and were excluded from the study. They were however eligible for the therapeutic study Relapsed AML 2001/02 with gemtuzumab ozogamicin (Mylotarg; GO) in monotherapy. After achieving a 2nd remission, children were indicated to undergo hematopoietic stem cell transplantation (HSCT). Two patients were treated for an initially resistant disease, 18 children for the 1st relapse of AML. In 61%, the relapse occurred early, less than 12 months from diagnosis. Six children did not respond to treatment, two died of an early death, twelve (60%) patients achieved a 2nd remission and 11 of these underwent allogeneic HSCT. In total, 6 (30%) of the children are alive with a median follow up of 5.8 years, all having undergone allogeneic transplantation (2 children after the 2nd HSCT). For the whole group, the event free survival probability (EFS) at 5 years is 18 ± 9%, the overall survival (OS) probability is 34 ± 11%. Treatment in the Relapsed AML 2001 study improved the prognosis of children with relapsed AML in the Czech Republic compared to the previous period 1993-2001 (n=22 children, OS 14%).

• Klíčová slova
• studie RELAPSED AML 2001,
• MeSH
• akutní myeloidní leukemie farmakoterapie   chirurgie   MeSH
• analýza přežití MeSH
• cytarabin farmakologie   terapeutické užití   MeSH
• daunomycin farmakologie   terapeutické užití   MeSH
• dítě MeSH
• klinická studie jako téma MeSH
• kojenec MeSH
• kombinovaná farmakoterapie MeSH
• koordinovaný terapeutický postup * MeSH
• lidé MeSH
• mladiství MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• recidiva MeSH
• transplantace kostní dřeně MeSH
• vidarabin analogy a deriváty   farmakologie   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

Primární CNS lymfom (PCNSL) je vzácnou formou B-non-hodgkinského lymfomu s výskytem v řádu jednotek procent nově diagnostikovaných lymfomů i nádorů CNS. Onemocnění je klinicky agresivní, s mediánem přežití bez zahájení léčby 3-7 měsíců, v případě efektivní a relativně intenzivní chemoimunoterapie lze ale vyléčit polovinu pacientů. Naopak relabující PCNSL představuje velký problém s velmi špatnou prognózou s mediánem přežití v řádu několika měsíců prakticky bez ohledu na podanou léčbu. Zde prezentujeme kazuistiku pacienta se dvěma časnými relapsy PCNSL, u kterého byla úspěšně použita v konsolidační léčbě anti-PD-LI monoklonální protilátka nivolumab.

Primary CNS lymphoma (PCNSL) is a rare form of B-cell non-Hodgkin lymphoma accounting for a small percentage of newly diagnosed lymphomas and CNS tumors. The disease is clinically aggressive, with a median survival of 3-7 months without treatment; however, with effective and relatively intensive chemoimmunotherapy, about half of the patients can be cured. On the other hand, relapsed PCNSL represents a significant problem with a very poor prognosis, with a median survival of a few months, practically regardless of the treatment administered. Here we present a case report of a patient with two early relapses of PCNSL, successfully treated with the anti-PD-LI monoclonal antibody nivolumab in consolidation therapy.

• MeSH
• inhibitory kontrolních bodů terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfom * farmakoterapie   MeSH
• magnetická rezonanční tomografie metody   MeSH
• nádory mozku * farmakoterapie   MeSH
• nivolumab * farmakologie   terapeutické užití   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Standardem léčby u mladších pacientů s relabovaným nebo refrakterním Hodgkinovým lymfomem po 1. linii léčby je nadále vysokodávkovaná chemoterapie s autologní transplantací kmenových buněk. Z prognostických faktorů v relapsu je nejvýznamnější klinické stadium IV, krátká doba do relapsu po 1. linii léčby, špatný stav tělesné kondice, velká nádorová masa a nedosažení alespoň parciální remise po záchranné chemoterapii. Dosud není definován standard záchranné chemoterapie před autologní transplantací. Nejčastěji používané režimy jsou DHAP (dexametazon, cytarabin, cisplatina) a ICE (ifosfamid, karboplatina, etoposid). Standardním přípravným režimem před autologní transplantací je BEAM (BCNU – karmustin, etoposid, cytarabin, melfalan). U vysoce rizikových pacientů se zkouší podání tandemové autologní transplantace. V konsolidaci po autologní transplantaci u pacientů s vysokým rizikem relapsu je doporučeno podání brentuximab vedotinu. V relapsu po autologní transplantaci je standardem podání brentuximab vedotinu a je vhodné zvážit následnou alogenní transplantaci kmenových buněk u mladých pacientů. Brentuximab vedotin v kombinaci s bendamustinem, nivolumab a pembrolizumab a jejich kombinace s dalšími léky se nadále zkoumají v rámci studií u pacientů s relabovaným nebo refrakterním Hodgkinovým lymfomem.

High-dose chemotherapy with autologous stem cell transplantation remains the current standard of treatment for young patients with Hodgkin lymphoma in first relapse or in those who are refractory to first-line treatment. The most important prognostic factors in relapses are clinical stage IV, poor performance status, bulky mass, and less than partial remission after salvage chemotherapy. Standard salvage chemotherapy in relapse before autologous transplantation has not been defined; however, DHAP and ICE are most frequently used in this setting. A standard conditioning regimen before autologous transplantation is BEAM. Tandem autologous transplantation has been investigated in high-risk patients. Brentuximab vedotin is recommended as a consolidation treatment in patients with a high risk of relapse after autologous transplantation. Brentuximab vedotin is the standard of treatment for relapse after autologous transplantation, and subsequent allogeneic stem cell transplantation should be considered in young patients. Bretuximab vedotin in combination with bendamustine, nivolumab, and pembrolizumab, and combinations thereof with other drugs, were investigated in clinical trials in relapsed or refractory patients with Hodgkin lymphoma.

• Klíčová slova
• tandemová transplantace, pembrolizumab,
• MeSH
• analýza přežití MeSH
• autologní transplantace MeSH
• brentuximab vedotin MeSH
• Hodgkinova nemoc * farmakoterapie   terapie   MeSH
• homologní transplantace MeSH
• humanizované monoklonální protilátky terapeutické užití   MeSH
• imunokonjugáty terapeutické užití   MeSH
• kombinovaná terapie MeSH
• konsolidační chemoterapie metody   MeSH
• lidé MeSH
• monoklonální protilátky terapeutické užití   MeSH
• nivolumab MeSH
• premedikace metody   MeSH
• příprava pacienta k transplantaci MeSH
• protinádorové látky škodlivé účinky   terapeutické užití   MeSH
• protokoly protinádorové kombinované chemoterapie škodlivé účinky   terapeutické užití   MeSH
• recidiva MeSH
• transplantace kmenových buněk MeSH
• záchranná terapie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

BACKGROUND: Elotuzumab, an immunostimulatory monoclonal antibody targeting signaling lymphocytic activation molecule F7 (SLAMF7), showed activity in combination with lenalidomide and dexamethasone in a phase 1b-2 study in patients with relapsed or refractory multiple myeloma. METHODS: In this phase 3 study, we randomly assigned patients to receive either elotuzumab plus lenalidomide and dexamethasone (elotuzumab group) or lenalidomide and dexamethasone alone (control group). Coprimary end points were progression-free survival and the overall response rate. Final results for the coprimary end points are reported on the basis of a planned interim analysis of progression-free survival. RESULTS: Overall, 321 patients were assigned to the elotuzumab group and 325 to the control group. After a median follow-up of 24.5 months, the rate of progression-free survival at 1 year in the elotuzumab group was 68%, as compared with 57% in the control group; at 2 years, the rates were 41% and 27%, respectively. Median progression-free survival in the elotuzumab group was 19.4 months, versus 14.9 months in the control group (hazard ratio for progression or death in the elotuzumab group, 0.70; 95% confidence interval, 0.57 to 0.85; P<0.001). The overall response rate in the elotuzumab group was 79%, versus 66% in the control group (P<0.001). Common grade 3 or 4 adverse events in the two groups were lymphocytopenia, neutropenia, fatigue, and pneumonia. Infusion reactions occurred in 33 patients (10%) in the elotuzumab group and were grade 1 or 2 in 29 patients. CONCLUSIONS: Patients with relapsed or refractory multiple myeloma who received a combination of elotuzumab, lenalidomide, and dexamethasone had a significant relative reduction of 30% in the risk of disease progression or death. (Funded by Bristol-Myers Squibb and AbbVie Biotherapeutics; ELOQUENT-2 ClinicalTrials.gov number, NCT01239797.).

• MeSH
• dexamethason terapeutické užití   MeSH
• dospělí MeSH
• humanizované monoklonální protilátky škodlivé účinky   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mnohočetný myelom farmakoterapie   mortalita   MeSH
• přežití bez známek nemoci MeSH
• protokoly protinádorové kombinované chemoterapie škodlivé účinky   terapeutické užití   MeSH
• receptory imunologické antagonisté a inhibitory   MeSH
• recidiva MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• thalidomid analogy a deriváty   terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Clubfoot deformity (pes equinovarus) is one of the most common birth defects, and its etiology is still unknown. Initial clubfoot treatment is based on the Ponseti method throughout most of the world. Despite the effectiveness of this therapy, clubfoot may relapse. Recent studies confirm the theory of active fibrotic remodeling processes in the extracellular matrix of the affected tissue. The aim of this study was to clarify whether relapses in clubfoot therapy are associated with altered angiogenesis and to suggest possible regulatory pathways of this pathologic process. METHODS: We compared microvessel density, arteriole density, and concentration of angioproliferative-related proteins found between tissues in the contracted, that is, the medial side (M-side), and noncontracted, that is, the lateral side (L-side) of the relapsed clubfeet. Tissue samples from 10 patients were analyzed. Histopathologic analysis consisted of immunohistochemistry and image analysis. Real-time polymerase chain reaction was used to study mRNA expression. RESULTS: An increase in microvessel and arteriole density was noted in contracted, relapsed clubfoot tissue. This was accompanied by a significant increase in the levels of the vascular endothelial growth factor, vascular endothelial growth factor receptor 2, β catenin and active β catenin. Vascular endothelial growth factor, vascular endothelial growth factor receptor 2, and CD31 overexpression was also seen with mRNA analysis. CONCLUSIONS: Increased microvessel and arteriole density in the contracted side of the relapsed clubfoot was noted. These processes are mediated by specific proangiogenic proteins that are overexpressed in the contracted tissue. These findings contribute to the etiology and the development of relapses in the treatment of clubfoot. LEVEL OF EVIDENCE: Level II-analytical and prospective.

• MeSH
• arterioly * MeSH
• beta-katenin metabolismus   MeSH
• lidé MeSH
• patologická angiogeneze * MeSH
• pes equinovarus etiologie   metabolismus   terapie   MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• receptor 2 pro vaskulární endoteliální růstový faktor metabolismus   MeSH
• recidiva MeSH
• sádrové obvazy MeSH
• vaskulární endoteliální růstový faktor A metabolismus   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: We sought to investigate clinical outcomes of relapsed medulloblastoma and to compare molecular features between patient-matched diagnostic and relapsed tumors. METHODS: Children and infants enrolled on either SJMB03 (NCT00085202) or SJYC07 (NCT00602667) trials who experienced medulloblastoma relapse were analyzed for clinical outcomes, including anatomic and temporal patterns of relapse and postrelapse survival. A largely independent, paired molecular cohort was analyzed by DNA methylation array and next-generation sequencing. RESULTS: A total of 72 of 329 (22%) SJMB03 and 52 of 79 (66%) SJYC07 patients experienced relapse with significant representation of Group 3 and wingless tumors. Although most patients exhibited some distal disease (79%), 38% of patients with sonic hedgehog tumors experienced isolated local relapse. Time to relapse and postrelapse survival varied by molecular subgroup with longer latencies for patients with Group 4 tumors. Postrelapse radiation therapy among previously nonirradiated SJYC07 patients was associated with long-term survival. Reirradiation was only temporizing for SJMB03 patients. Among 127 patients with patient-matched tumor pairs, 9 (7%) experienced subsequent nonmedulloblastoma CNS malignancies. Subgroup (96%) and subtype (80%) stabilities were largely maintained among the remainder. Rare subgroup divergence was observed from Group 4 to Group 3 tumors, which is coincident with genetic alterations involving MYC, MYCN, and FBXW7. Subgroup-specific patterns of alteration were identified for driver genes and chromosome arms. CONCLUSION: Clinical behavior of relapsed medulloblastoma must be contextualized in terms of up-front therapies and molecular classifications. Group 4 tumors exhibit slower biological progression. Utility of radiation at relapse is dependent on patient age and prior treatments. Degree and patterns of molecular conservation at relapse vary by subgroup. Relapse tissue enables verification of molecular targets and identification of occult secondary malignancies.

• MeSH
• časové faktory MeSH
• dítě MeSH
• epigenom MeSH
• epigenomika MeSH
• klinické zkoušky jako téma MeSH
• kojenec MeSH
• lidé MeSH
• lokální recidiva nádoru * MeSH
• meduloblastom genetika   mortalita   sekundární   terapie   MeSH
• metylace DNA * MeSH
• nádorové biomarkery genetika   MeSH
• nádory mozečku genetika   mortalita   patologie   terapie   MeSH
• opakovaná terapie MeSH
• předškolní dítě MeSH
• progrese nemoci MeSH
• výsledek terapie MeSH
• vysoce účinné nukleotidové sekvenování MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

BACKGROUND: In addition to treatment response, cytogenetic and molecular aberrations are the most important prognostic factors in children with de novo acute myeloid leukemia (AML). However, little is known about cytogenetics at the time of relapse. METHODS: This international study analyzed the prognostic value of cytogenetic profiles and karyotypic changes in pediatric relapsed AML in relation to the probability of event-free (pEFS) and overall survival (pOS). For this purpose, cytogenetic reports from all patients registered on the Relapsed AML 2001/01 Study were reviewed and classified. RESULTS: Cytogenetic information at relapse was available for 403 (71%) of 569 registered patients. Frequently detected aberrations at relapse were t(8;21)(q22;q22) (n = 60) and inv(16)(p13.1q22)/t(16;16)(p13.1;q22) (n = 24), both associated with relatively good outcome (4-year pOS 59% and 71%, respectively). Monosomy 7/7q-, t(9;11)(p22;q23), t(10;11)(p12;q23), and complex karyotypes were associated with poor outcomes (4-year pOS 17%, 19%, 22%, and 22%, respectively). Of 261 (65%) patients for whom cytogenetic data were reliable at both diagnosis and relapse, pEFS was inferior for patients with karyotypic instability (n = 128, 49%), but pOS was similar. Unstable karyotypes with both gain and loss of aberrations were associated with inferior outcome. Early treatment response, time to relapse, and cytogenetic profile at time of relapse were the most important prognostic factors, both outweighing karytoypic instability per se. CONCLUSION: The cytogenetic subgroup at relapse is an independent risk factor for (event-free) survival. Cytogenetic assessment at the time of relapse is of high importance and may contribute to improved risk-adapted treatment for children with relapsed AML.

• MeSH
• akutní myeloidní leukemie * genetika   MeSH
• chromozomální aberace * MeSH
• dítě MeSH
• kohortové studie MeSH
• lidé MeSH
• prognóza MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: In a multinational, phase 3, head-to-head trial, ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, was compared with zanubrutinib, a BTK inhibitor with greater specificity, as treatment for relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). In prespecified interim analyses, zanubrutinib was superior to ibrutinib with respect to overall response (the primary end point). Data from the final analysis of progression-free survival are now available. METHODS: We randomly assigned, in a 1:1 ratio, patients with relapsed or refractory CLL or SLL who had received at least one previous course of therapy to receive zanubrutinib or ibrutinib until the occurrence of disease progression or unacceptable toxic effects. In this final analysis, progression-free survival (a key secondary end point) was assessed with the use of a hierarchical testing strategy to determine whether zanubrutinib was noninferior to ibrutinib. If noninferiority was established, the superiority of zanubrutinib was assessed and claimed if the two-sided P value was less than 0.05. RESULTS: At a median follow-up of 29.6 months, zanubrutinib was found to be superior to ibrutinib with respect to progression-free survival among 652 patients (hazard ratio for disease progression or death, 0.65; 95% confidence interval, [CI], 0.49 to 0.86; P = 0.002), as assessed by the investigators; the results were similar to those as assessed by an independent-review committee. At 24 months, the investigator-assessed rates of progression-free survival were 78.4% in the zanubrutinib group and 65.9% in the ibrutinib group. Among patients with a 17p deletion, a TP53 mutation, or both, those who received zanubrutinib had longer progression-free survival than those who received ibrutinib (hazard ratio for disease progression or death, 0.53; 95% CI, 0.31 to 0.88); progression-free survival across other major subgroups consistently favored zanubrutinib. The percentage of patients with an overall response was higher in the zanubrutinib group than in the ibrutinib group. The safety profile of zanubrutinib was better than that of ibrutinib, with fewer adverse events leading to treatment discontinuation and fewer cardiac events, including fewer cardiac events leading to treatment discontinuation or death. CONCLUSIONS: In patients with relapsed or refractory CLL or SLL, progression-free survival was significantly longer among patients who received zanubrutinib than among those who received ibrutinib, and zanubrutinib was associated with fewer cardiac adverse events. (Funded by BeiGene; ALPINE ClinicalTrials.gov number, NCT03734016.).

• MeSH
• chronická lymfatická leukemie * farmakoterapie   MeSH
• lidé MeSH
• nemoci srdce * chemicky indukované   MeSH
• progrese nemoci MeSH
• protinádorové látky * škodlivé účinky   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The prognostic significance of early response to treatment has not been reported in relapsed pediatric acute myeloid leukemia. In order to identify an early and easily applicable prognostic factor allowing subsequent treatment modifications, we assessed leukemic blast counts in the bone marrow by morphology on days 15 and 28 after first reinduction in 338 patients of the international Relapsed-AML2001/01 trial. Both day 15 and day 28 status was classified as good (≤20% leukemic blasts) in 77% of patients. The correlation between day 15 and 28 blast percentages was significant, but not strong (Spearman correlation coefficient = 0.49, P<0.001). Survival probability decreased in a stepwise fashion along with rising blast counts at day 28. Patients with bone marrow blast counts at this time-point of ≤5%, 6-10%, 11-20% and >20% had 4-year probabilities of survival of 52%±3% versus 36%±10% versus 21%±9% versus 14%±4%, respectively, P<0.0001; this trend was not seen for day 15 results. Multivariate analysis showed that early treatment response at day 28 had the strongest prognostic significance, superseding even time to relapse (< or ≥12 months). In conclusion, an early response to treatment, measured on day 28, is a strong and independent prognostic factor potentially useful for treatment stratification in pediatric relapsed acute myeloid leukemia. This study was registered with ISRCTN code: 94206677.

• MeSH
• akutní myeloidní leukemie diagnóza   farmakoterapie   mortalita   patologie   MeSH
• analýza přežití MeSH
• buňky kostní dřeně účinky léků   patologie   MeSH
• daunomycin terapeutické užití   MeSH
• dítě MeSH
• indukce remise MeSH
• lidé MeSH
• mladiství MeSH
• monitorování léčiv MeSH
• předškolní dítě MeSH
• prognóza MeSH
• protinádorová antibiotika terapeutické užití   MeSH
• protokoly protinádorové kombinované chemoterapie MeSH
• recidiva MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

High doses of corticosteroids in combination with rituximab remain an alternative in the treatment in relapsed or refractory chronic lymphocytic leukaemia (CLL) in the current era of targeted therapies. This study retrospectively evaluates the efficacy of an RCD (rituximab, cyclophosphamide and dexamethasone) regimen in the treatment of 51 patients with relapsed CLL (median age, 72 years). Unfavourable prognostic features, such as Rai stage III/IV, unmutated IGHV, del11q, TP53 mutation/deletion, complex karyotype and bulky lymphadenopathy, were frequent. The overall response or complete remission was of 57% and 7%, respectively, and the median progression-free survival (PFS) was of 12.3 months, median time to next treatment 23.1 months and median overall survival 39.2 months. Significant independent predictors of shorter PFS were TP53 deletion/mutation, advanced Rai stage and ≥2 previous lines of treatment. The incidence of neutropenia grade ≥ 3 was of 13%. Serious (CTCAE grade 3-5) infections were found in 20% of patients. Steroid-induced diabetes or diabetes decompensation occurred in 20% patients. Treatment-related adverse events resulted in RCD dose reduction in 35% of patients. In comparison with a historical R-Dex patient group, the treatment response and/or toxicity in our group was largely similar. However, the substantial differences in the baseline clinical characteristics of the groups may affect this comparison. In conclusion, the RCD regimen is an active, time-limited therapeutic strategy for elderly patients with relapsed CLL. Further, the results of our analysis indicate that the addition of cyclophosphamide to the R-Dex regimen maintains a similar efficacy, even after 50% reduction in the dexamethasone dose.

• MeSH
• chronická lymfatická leukemie farmakoterapie   genetika   patologie   MeSH
• cyklofosfamid aplikace a dávkování   MeSH
• dexamethason aplikace a dávkování   MeSH
• diabetes mellitus chemicky indukované   epidemiologie   MeSH
• doba přežití bez progrese choroby MeSH
• indukce remise MeSH
• infekce epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru farmakoterapie   genetika   patologie   MeSH
• míra přežití MeSH
• nádorový supresorový protein p53 genetika   MeSH
• neutropenie chemicky indukované   epidemiologie   MeSH
• protokoly protinádorové kombinované chemoterapie terapeutické užití   MeSH
• retrospektivní studie MeSH
• rituximab aplikace a dávkování   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• vysazování léků MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH