Decreased absolute lymphocyte/monocyte ratio (LMR) in peripheral blood has been reported as an unfavorable prognostic marker in Hodgkin lymphoma. We aimed to investigate whether combining LMR and interim PET/CT scan result (PET2) confers stronger prognostic value than PET2 alone. 121 HL patients were investigated. LMR was calculated from a blood sample taken at the time of diagnosis. PET2 was carried out after the second chemotherapy cycle. Survival was calculated using the Kaplan-Meier method and significance was determined by log-rank test. Effect of variants on survival results was examined using univariate and multivariate analyses. Best LMR cut-off value was determined by receiver operating characteristic (ROC) curve. Best LMR cut-off value was 2.11 in the case of our patients (LMR > 2.11: favorable, LMR ≤ 2.11: unfavorable). Overall and progression-free survivals (OS/PFS) were significantly worse both in lower LMR (≤ 2.11) (OS: P = 0.041, PFS: P = 0.044) and PET2 positive groups (OS: P < 0.001, PFS: P < 0.001). In PET2 positive patient group (n = 32) the low LMR result meant a significantly worse OS (0.030) and PFS (0.001). Both LMR and PET2 proved to be independent prognostic factors on multivariate analysis, and strengthened each other's effect.
Introduction. Hodgkin lymphoma shows a well-known geographic pattern. Incidence also varies significantly by age, sex, ethnicity and socioeconomic status. These clinical pathological features of the disease are changing. Patients and methods. 715 Hodgkin lymphoma patients' clinicopathological and treatment data were assessed in a maximum of ten-year periods. The patients were treated at the University of Debrecen, Department of Hematology from 1980 until the end of 2014. Results. The first period (1980-89) contained 193, the second (1990-99) 199, the third (2000-09) 236 and the fourth (2010-14) 87 Hodgkin lymphoma patients. The mean age of the patients were 39, 34.5, 38 and 36.8 years respectively. The male/female ratio was 1.29, 1.23, 1.03 and 0.97 in order. A unimodal age group pattern can be seen in the first and second periods with an incidence peak between 20 and 29 years of age. Bimodal age group pattern was observed in the third and fourth periods with the first incidence peak between 20 and 29 years of age and the second between 50 and 59 years. The incidence of classical mixed cellularity (cMC) histological subtype is decreasing (38%, 49%, 48% and 26%; p < 0.01) while classical nodular sclerosis (cNS) shows an increasing tendency (21%, 28%, 30% and 50%; p < 0.01). The first peak is predominantly caused by the cNS subtype in the third and fourth period, and the second peak caused by cMC subtype in the third and cNS in the fourth period. The number of advanced stage patients (59%) is beyond the early stage patients (41%) in the last observed period. The 5-year overall survival is increasing (64.2%, 84.6%, 87% and 92%). Discussion. The changing patterns can be explained by the altered nature of the disease, changes in immunological features, environmental factors, socioeconomic status and development of diagnostic and therapy methods.
Autologous stem cell transplantation (ASCT) is the standard treatment of primary refractory or relapsed Hodgkin-lymphoma, which can provide a cure rate of about 50%. The aim of our study was to analyze the data of 126 HL patients undergoing AHSCT in Hungary between 01/01/2016 and 31/12/2020. We assessed the progression-free and overall survival, the prognostic role of PET/CT performed before transplantation and effect of brentuximab vedotin (BV) treatment on survival outcomes. The median follow-up time from AHSCT was 39 (1–76) months. The 5-year OS comparing PET- and PET + patients was 90% v. 74% (p = 0.039), and 5-year PFS was 74% v. 40% (p = 0.001). There was no difference in either OS or PFS compared to those who did not receive BV before AHSCT. We compared BV treatments based on their indication (BV only after AHSCT as maintenance therapy, BV before and after AHSCT as maintenance treatment, BV only before AHSCT, no BV treatment). There was statistically significant difference in the 5-year PFS based on the inication of BV therapy. Recovery rates of our R/R HL patient population, who underwent AHSCT, improved significantly. Our positive results can be attributed to the PET/CT directed, response-adapted treatment approach, and the widespread use of BV.
Az akut, életet veszélyeztető gasztroenterológiai kórképek közül a súlyos akut pancreatitis és az akut májelégtelenség magas mortalitású kórképek, kezelésük napjainkban is kihívást jelent. Mindkét kórkép esetén jelentős sejtkárosodás jön létre, ezen felül a gyakran társuló infekció is túlzott immunválaszt, "citokinvihart" eredményezhet, amelynek kontrollálására a gyógyszeres próbálkozások nem jelentettek kellő hatékonyságú megoldást, ezért az extracorporalis technikák kerültek előtérbe. A citokin-adszorberek közül a CytoSorb alkalmazásával van jelenleg világszerte a legtöbb tapasztalat, amely kombinálható egyéb extracorporalis szervpótló kezelésekkel is. Két esetünk kapcsán szeretnénk bemutatni a jelenlegi terápiás lehetőségeinket, illetve tapasztalatainkat. KULCSSZAVAK: SIRS, citokinek, akut májkárosodás, akut pancreatitis, immunmoduláció The use of extracorporal immunomodulatory treatments in acute gastroenterological disorders Among acute, life-threatening gastroenterological disorders, severe acute pancreatitis and acute liver failure are high-mortality diseases, and their treatment remains a challenge today. In both cases, significant cell damage occurs and, in addition, frequently associated infections may result in an excessive immune response, a "cytokine storm". Since attempts to control this condition using medication therapy have not been successful enough, extracorporal techniques are more often preferred. Of cytokine absorbers, CytoSorb is the most widely used agent globally, which can also be combined with other extracorporeal organ replacement treatments. This paper presents our current therapeutic options and experiences based on two cases.
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