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Primární mediastinální velko-buněčný B-lymfom

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Primary mediastinal large B-cell lymphoma

Primary mediastinal large B-cell lymphoma is an aggressive tumour characterized by a rapid increase of tumour mass in the anterior mediastinum that occurs in younger patients. Currently, in the age of immunochemotherapy, 5-year overall survival of patients is 80–90%. However, relapse occurs early, usually within one year from the end of therapy and the prognosis of these patients is unsatisfactory. Positron emission tomography combined with computed tomography using 18F-fluorodeoxyglucose is currently widely used not only at the time of diagnosis but also for monitoring response to treatment. The FDG PET/CT has a strong prognostic significance at the time of diagnosis, during treatment and after its termination. Maximum treatment efficacy and reduction of the long-term toxicity risk are key when selecting therapeutic modalities. Standard, anthracycline-based immunochemotherapy (R-CHOP, DA-EPOCH-R), autologous stem cell transplantation or consolidation radiotherapy for residual tumour mass are the current standard of the therapy. New modalities (PD1 inhibitors, brentuximab vedotin or CAR T cell therapy) are available, but require results from ongoing clinical trials to assess their effectivity.

Keywords:

radiotherapy – primary mediastinal large B-cell lymphoma – immunochemotherapy – positronemission tomography

Autoři: V. Hanáčková 1;  F. Folber 2;  L. Henzlová 3;  P. Flodr 4;  V. Procházka 1
Působiště autorů: Hemato-onkologická klinika LF UP a FN Olomouc 1;  Interní hematologická a onkologická klinika LF MU a FN Brno 2;  Klinika nukleární medicíny LF UP a FN Olomouc 3;  Ústav klinické a molekulární patologie, LF UP a FN Olomouc 4
Vyšlo v časopise: Transfuze Hematol. dnes,30, 2024, No. Ahead of Print, p. 1-11.
Kategorie: Souhrnné/edukační práce
doi: https://doi.org/10.48095/cctahd2024prolekare.cz17

Souhrn

Primární mediastinální velkobuněčný B-lymfom je agresivní nádorové onemocnění charakterizované rychlým nárůstem nádorové masy v předním mediastinu, vyskytující se u pacientů mladšího věku. V době imunochemoterapie je 5leté přežívání pacientů 80–90 %, přesto část pacientů časně relabuje do jednoho roku od ukončení terapie a prognóza těchto pacientů je neuspokojivá. Pro diagnostiku, stážování i monitoraci odpovědi na léčbu je v současné době široce využívána pozitronová emisní tomografie kombinovaná s výpočetní tomografií s využitím 18F-fluorodeoxyglukózy. Vyšetření má silný prognostický význam v době diagnózy, v průběhu léčby i po ukončení. Pro volbu terapie je zásadní zvážení snahy o maximální efektivitu a zároveň redukci rizika dlouhodobé toxicity. V terapii je v současné době používána standardní, na antracyklinech založená, imunochemoterapie (R-CHOP, DA-EPOCH-R), konsolidační radioterapie na reziduální nádorovou masu, případně vysocedávkovaná imunochemoterapie doprovázená autologní transplantací periferních kmenových buněk. K dispozici jsou pro terapii také nové léčebné modality (PD1 inhibitory, brentuximab vedotin či CAR-T buněčná terapie), k ověření jejichž efektivity přispívají probíhající klinické studie.

Klíčová slova:

radioterapie – pozitronová emisní tomografie – primární mediastinální velkobuněčný B-lymfom – imunochemoterapie

Stránka z 
Zdroje
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  29. PODÍL AUTORŮ NA PŘÍPRAVĚ RUKOPISU

    VH – příprava rukopisu

    FF – příprava kazuistiky a revize textu

    LH, PF – příprava obrazových podkladů a revize textu

    VP – léčba pacientů, revize textu, závěrečná kontrola rukopisu

    PODĚKOVÁNÍ

    Podpořeno granty: MZ ČR – RVO (FNOl, 00098892), IGA_LF_2024_001 a AZV NU21-03-00411.

    ČESTNÉ PROHLÁŠENÍ

    Autoři práce prohlašují, že v souvislosti s tématem, vznikem a publikací tohoto článku nejsou ve střetu zájmů a vznik ani publikace článku nebyly podpořeny žádnou farmaceutickou firmou.

    Do redakce doručeno dne: 3. 5. 2024.
    Přijato po recenzi dne: 4. 7. 2024.

    MUDr. Veronika Hanáčková
    Hemato-onkologická klinika LF UP a FN Olomouc
    Zdravotníků 248/7
    779 00 Olomouc
    e-mail:     veronika.hanackova@fnol.cz

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