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Effectiveness and safety of alternate chemotherapy regimens in Diffuse Large B Cell Lymphoma
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Dentro dos linfomas não Hodgkin, o Linfoma Difuso de Grandes Células B é o mais frequente a nível mundial, com uma taxa de sobrevivência a cinco anos, quando tratado, de cerca de 50-60%. Contudo, e apesar de diversas melhorias nos outcomes, esta taxa decresce significativamente quando armas terapêuticas de primeira linha se revelam ineficazes. Cerca de 40% dos doentes têm resistência ao tratamento ou recidiva da doença, maioritariamente nos primeiros dois anos após terapêutica de primeira linha. Um estudo retrospetivo de uma população de 88 doentes seguida no Hospital de Santa Maria com diagnóstico histopatológico entre 2016 e 2018 foi realizado com o objetivo de analisar a eficácia e segurança de linhas terapêuticas alternativas, articuladas ou não com transplante autólogo de células estaminais, para angariar orientações clínicas mais robustas para o seguimento destes casos. Fatores como a idade, comorbilidades ou estadio avançado da doença restringiram o acesso de muitos pacientes a estratégias de transplante, pelo que poucas conclusões se puderam tirar a seu respeito. O caráter retrospetivo do estudo, a compliance dos pacientes e a colheita adequada de dados dos diários clínicos foram outros fatores limitantes neste sentido.
Amongst non-Hodgkin lymphomas, Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype, with a survival rate of about 50-60% when properly treated. However, despite overall improvements in outcomes, this rate will decrease significantly when first-lines of therapy are ineffective. Relapsed/refractory disease occurs in approximately 40% of patients and mostly in the first two years following first-line therapy. The role of this study is to describe and understand how a population of 88 patients diagnosed between 2016 and 2018 and treated by medical assistants at Hospital de Santa Maria, Lisbon (CHLN), responded to different chemotherapy regimens, alongside elected cases of autologous stem cell transplantation (ASCT), in an attempt to design better management and therapeutic guidelines directed at patients who have not responded to conventional treatment. Unfortunately, because refractory disease and age/comorbidities are undermining factors in the eligibility of patients for ASCT, this approach had limited breach and impact in the outcomes of the study. Its retrospective nature also limited more foreground conclusions, contingent upon the correct registry and collection of hospital data and patient compliance.
Amongst non-Hodgkin lymphomas, Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype, with a survival rate of about 50-60% when properly treated. However, despite overall improvements in outcomes, this rate will decrease significantly when first-lines of therapy are ineffective. Relapsed/refractory disease occurs in approximately 40% of patients and mostly in the first two years following first-line therapy. The role of this study is to describe and understand how a population of 88 patients diagnosed between 2016 and 2018 and treated by medical assistants at Hospital de Santa Maria, Lisbon (CHLN), responded to different chemotherapy regimens, alongside elected cases of autologous stem cell transplantation (ASCT), in an attempt to design better management and therapeutic guidelines directed at patients who have not responded to conventional treatment. Unfortunately, because refractory disease and age/comorbidities are undermining factors in the eligibility of patients for ASCT, this approach had limited breach and impact in the outcomes of the study. Its retrospective nature also limited more foreground conclusions, contingent upon the correct registry and collection of hospital data and patient compliance.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Linfoma difuso de grandes células B Resistência ao tratamento Quimioterapia Hematologia