engleski

Are moloclonal antibodies necessary int the treatment children's b-non Hodgkin lymphoma?

Introduction: B-non-Hodgkin’s lymphomas (B-NHL) are a group of highly aggressive malignant lymphoproliferative diseases that require rapid diagnosis and prompt therapy initiation. The aims of the study were to confirm excellent results recorded in the BFMNHL trial in Croatia and to identify appropriate measures to prevent the lifethreateningevents frequently accompanying the early phase of treatment. Patients andMethods: During the 1990–2012 period, 41 children with B-NHL (23 male and 18 female) aged 2–16 (mean age 9.7) years were treated according to the NHL-BFM protocol. Therapy consisted of 5-day pretreatment (standard chemotherapy dosage) combined with two to six cycles of high-dose chemotherapy ; in addition, 14 patients received monoclonal antibodies (MabteraW) in 2006–2012. Patients were divided into three risk groups. Results: Complete remission was achieved in all 41 (100%) patients ; disease relapse and lethal outcome were recorded in four (9.75%) patients, that is, three patients on chemotherapy alone and one patient also administered monoclonal antibodies (meningeal relapse 2months of treatment completion) ; in 37 (90.2%) patients, the first complete remission has been persisting to the present. Grade III and IV toxicity was mostly observed after the first and second cycles of chemotherapy. The level of toxicity associated with the first cycle of chemotherapy was considerably lower in patients administered monoclonal antibodies, but in nine with moderate hypogammaglobulinemia. In one patient, secondary tumour disease (AML) developed 4 years of treatment discontinuation. Conclusion: Although referring to a relatively small number of patients, therapeutic results were very good and consistent with those reported from other European centres. However, many questions remain to be answered. For instance, should monoclonal antibodies be administered in all patients with B-NHL, or in the high risk group only, or during the first chemotherapy cycle only, or in patients with disease relapse only, or as maintenance therapy in patients with B-ALL/NHL?

B-non-Hodgkin lymphoma; children; monoclonal antibodies

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