12.5.2.30 DHS rekommandationer for KMT 2011.pdf - e-Dok
12.5.2.30 DHS rekommandationer for KMT 2011.pdf - e-Dok
12.5.2.30 DHS rekommandationer for KMT 2011.pdf - e-Dok
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De vigtigste parametre som <strong>for</strong>udsiger dårlig effekt af RIC-HCT er tilstedeværelse af<br />
comorbiditet og/eller bulky sygdom med lymfeknuder over 5 cm på<br />
transplantationstidspunktet. Det er der<strong>for</strong> afgørende at patienten er i bedst mulig remission på<br />
transplantationstidspunktet. (Sorror et al, JCO 2008). Hvis der bruges alemtuzumab børe<br />
denne behandling stoppe senest 2 måneder før transplantation, <strong>for</strong> at mindske risikoen <strong>for</strong> at<br />
tilbageværende alemtuzumab i organismen interfererer med transplantations processen.<br />
Trans<strong>for</strong>mation fra CLL til en anden histologi (Richter’s trans<strong>for</strong>mation), specielt diffust<br />
storcellet lymfom, er <strong>for</strong>bundet med meget dårlig prognose (Tsimberidou et al, cancer 2005). I<br />
et retrospektivt studie var overlevelsen signikant bedre <strong>for</strong> patienter som modtog RIC-HCT,<br />
sammenlignet med patienter som fik høj-dosis kemoterapi med stamcellestøtte eller alene fik<br />
kemoterapi (Tsimberidou et al, JCO 2006).<br />
Litteratur:<br />
Delgado J, Milligan DW and Dreger P: Allogeneic hematopoietic transplantation <strong>for</strong> chronic lymphocytic<br />
leukemia: Ready <strong>for</strong> prime time? Blood 1009; 114, 2581-2588.<br />
Dreger P, Corradini P, Kimby E et al. Indications <strong>for</strong> allogeneic stem cell transplantation in chronic lymphocytic<br />
leukemia: the EBMT transplant consensus. Leukemia 2007; 21, 12-17.<br />
Hallek M, Cheson BD, Catovsky D et al. Guidelines <strong>for</strong> the diagnosis and treatment of chronic lymphocytic<br />
leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National<br />
Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111, 5446-5456.<br />
Kornblit B, Masmas T, Madsen HO et al. Hematopoietic cel transplantation with non-myeloablative conditioning<br />
in Denmark: disease-free outcome, complications and hospitalization requirements of the first 100 transplants.<br />
Bone Marrow Transplantation 2008; 41, 851-859.<br />
Schetelig J, von Biezen A, Brand R et al: Allogeneic Hematopietic Stem-Cell Transplantation <strong>for</strong> Chronic<br />
Lymphocytic Leukemia with 17p Deletion: A Retrospective European Group <strong>for</strong> Blood and Bone Marrow<br />
Transplantation Analysis. J Clin Oncol 2008; 26, 5094-5100.<br />
Sorror ML, Storer BE, Sandmaier BM et al. Five-year follow-up of Patients With Advanced Chronic Lymphocytic<br />
Leukemia Treated With Allogeneic Hematopoietic Cell Transplantation After Nonmyeloablative Conditioning. J<br />
Clinical Oncol. 2008; 26, 4912-4920.<br />
Tsimberidou AM, O’Brien S, Khouri I et al. Clinical outcomes and prognostic factors in patients with Richter’s<br />
syndrome treated with chemotherapy or chemoimmuno therapy with or without stem-cell transplantation. J Clin<br />
Onc 2006, 24, 2343-2351.<br />
Tsimberidou AM and Keating MJ. Richter’s syndrome: Biology, incidence and therapeutic strategies. Cancer<br />
2005; 103, 216-228.<br />
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