Bendamustine is a uniquely structuredalkylating agent that lacks cross-resistance with other alkylators. This agent has a high degreeof activity against a variety of tumor cell lines.Based on clinical data from randomized phase III trials, bendamustine, with or without rituximab, hasbeen shown to be an appropriate option for first-line treatment or treatment of relapsed/refractory patients with indolent non-Hodgkin’s lymphoma or elderly patients with mantle cell lymphoma. Bendamustine treatment is associated with abetter therapeutic index and offers an improved overall quality of life compared to R-CHOP or R-CVP. It is now often used as achemotherapy backbone for combination with novel drugs including ibrutinib or idelalisib. This article provides a comprehensivesummaryof the clinical data along with practical adviceonhowto optimallymanagepatients with bendamustine therapy, includingdose recommendations, antiemetic prophylaxis, prevention of infusion and skin reactions, as well as prophylaxis of opportunisticinfections. This information might be helpful for clinicians using bendamustine in their daily practice.
Relevance. Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are the most common variants of indolent non-Hodgkin lymphoma (iNHL). Despite the adequate choice of the first-line therapy, 10 15% of affected patients with iNHL develop refractory disease, and in most of the cases the relapse of the disease among the others patients is detected, and each subsequent remission is shorter than the previous. According to the data of the National LymphoCare Study Group, the relapses that can occur during the first 2 years (POD24) after the beginning of the first-line therapy with R-CHOP in patients with FL, as well as with MZL, have a negative impact on the prognosis: 5-year overall survival in these patients decreases from 90 to 50%. The arsenal of therapy options is actively expanding along with a deep understanding of the biological basis of the disease development. At present, the most topical problem remains the choice of the best approach for each patient the personalization of the therapy. The review includes the data from clinical trials concerning FL and MZL treatment presented at the Congress of the American Society of Hematology in 2020. There are a large number of studies concerning new anticancer drugs in the world, such as monoclonal antibodies to different targets on the surface of B-cells, macrophages, bispecific antibodies, antibody conjugates, immunomodulators, BCR signaling pathway inhibitors (Bruton tyrosine kinase, PI3K inhibitors), immune checkpoint inhibitors and many others. Conclusion. The development of weighting approach for the choice of therapy will give a chance to patients with FL and MZL to stay alive up to the next era of new effective anticancer drugs. Future strategies, according to the current studies, show the trend away from the cytotoxic chemotherapy in iNHL therapy.
Actuality. The inability of a persons immune system to withstand foreign antigenic aggression is called immunodeficiency. More than 1/2 of all cases of secondary immunodeficiency (SID) in the world are occupied by hemoblastosis and, in a greater degree, the therapy, accompanied by the immunosuppression. Due to the expansion of the arsenal of new targeted drugs for the treatment of oncohematological diseases affecting different parts of the immune system, to increasingly frequent use of autologous and especially allogeneic hematopoietic cell transplantation, the prevalence and the frequency of SID are inexorably increasing. Timely diagnosis of SID should be the starting point of the management of oncohematological patients to reduce the incidence of infectious complications and, as a result, case fatality rate. Monitoring is based on assessing risk factors and identifying the category of patients requiring active preventive measures before they develop severe infection. Elimination of the main cause of SID development is the preferred option for the prevention of the infectious complications. However, in case of multiple myeloma, chronic lymphocytic leukemia and other oncohematological diseases, this option is often impossible. Therefore, active accompanying therapy is necessary for this category of patients, in particular immunoglobulin (Ig) replacement therapy. Main clinical communities are currently in the process of updating their guidelines and recommendations on using Ig replacement therapy in patients with hemoblastosis accompanied severe recurrent infections; after ineffective antibiotic treatment; with a proven inadequate specific antibody response; IgG4 g/l. Numerous cohort, observational and randomized trials showed the significant reduction in the number of infectious complications in oncohematological patients on using long-term (not less than 1012 months) intravenous Ig replacement therapy. The lack of attention of oncologists and hematologists to the early diagnosis and prevention of these conditions leads to the increase in the number of infectious complications with all the consequences such as worsen treatment results and increase mortality among oncohematological patients. Conclusion. There is a real need to raise awareness among physicians and patients, to use screening and better management of the group of patients with increased risk of SID, and preventive use of intravenous Ig to reduce the incidence of infectious complications and active accompanying therapy aimed at reducing infection-related mortality.
The aim is to evaluate the efficacy of the first-line rituximab-containing therapy of B-cell lymphoproliferative diseases in Russian clinical practice between 2014 and 2017. Materials and methods. In the post-authorisation multicenter study EQUILIBRIUM were included 1 thousand patients aged from 21 to 91 with B-cell non-Hodgkins lymphoma or chronic lymphatic leukemia who had received at least 4 cycles of rituximab-containing therapy using the drug Acellbia. This article was devoted to the group of indolent non-Hodgkins lymphomas and included 253 patients: follicular lymphoma 51% of cases, marginal zone lymphoma 44% of patients, extremely rare were registered lymphoplasmacytic lymphoma and Waldenstrom macroglobulinemia in 3% and in 2% of cases, respectively. The median age in patients with indolent non-Hodgkins lymphomas was 62 years (2191 years). The vast majority of patients were diagnosed with stage IIIIV 190 (75%) of patients. More than 1/2 (53.4%) of patients in routine practice received R-CHOP therapy as a first-line. BR regimen was applied in 15.4% of cases, 14.2% of patients were treated with R-CVP/R-COP. We indicated rare use of rituximab as monotherapy in induction mode only 4.4% of patients. And 2.4% of patients were treated with fludarabine-containing therapy. Results. The final assessment of the effect was carried out after 68 cycles of treatment and as a result the overall effect was more than 90%: the frequency of complete remission was 61%, partial responses 32.9%. The progression admitted only in 17 (6.7%) patients among 253 observed. With a median of 15 months, the median of overall survival and event-free survival was not achieved. Conclusion. The use of the available and appropriate treatment according to the domestic clinical guidelines with the inclusion of the Russian biosimilar anti-CD20 monoclonal antibody Acellbia, demonstrates high direct efficacy and satisfactory long-term treatment results comparable to the retrospective analysis of the previous clinical studies of the original drug rituximab.
Primary cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of T-cell lymphoproliferative diseases that involve mainly the skin and are characterized by features of their diagnosis, clinical course and therapeutic approach. They include mainly fungal mycosis and CD30 + lymphoproliferative skin diseases (primary cutaneous anaplastic large cell lymphoma and lymphomatoid papulosis) which account for >50% of CTCL and primary cutaneous peripheral T-cell lymphoma, unspecified/ /not otherwise specified (PTL NOS) which occurs extremely rare. Activation antigen CD30 is a cell membrane glycoprotein that belongs to tumor necrosis factor (TNF) superfamily. Tumor cells in primary skin CD30-positive skin lymphomas express CD30 in more than 75%; in other nosological units it also can be detected but to a lesser extent. Most patients with cutaneous CD30 + lymphoproliferative diseases have an indolent the disease course of the disease with a favorable prognosis. Refractory course occurs in approximately 30% patients, and in 8% of cases lymphoma results in deaths. Recently monoclonal antibodies have been included in clinical practice for the treatment of T-cell lymphomas, one of which is brentuximab vedotin, a CD30 monoclonal antibody conjugated to monomethyl auristatin E. This article provides the clinical case of a patient with a refractory form of PTL NOS.
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