12.5.2.30 DHS rekommandationer for KMT 2011.pdf - e-Dok

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Kemoterapi, autolog- og allogen transplantation Manglende opnåelse af 1. CR er et dårligt prognostisk tegn, og få patienter responderer på 2. linie kemoterapi . Afgørende for behandlingsudfaldet i relapsfasen er kemosensitiviteten. Således fandtes i ovennævnte EBMTmateriale (Sweetenham 1996) en overlevelse på 37 % ved kemosensitivt relaps og 7 % ved refraktær sygdom ved autotransplantation. Resultaterne ved allogen transplantation var ikke bedre (Peniket 2003). Ved opnået 2. CR på kemoterapi er der behov for hurtig konsolidering. Den manglende evidens for GVLeffekt medfører derfor at hos patienter uden knoglemarvsinfiltration og uden søskendedonor foretrækkes autotransplantation frem for søgning af fremmed donor, hvilket ofte indebærer betydelig forsinkelse i behandlingsstrategien. Minitransplantation er der på grund af det progressive sygdomsforløb og den manglende GVLeffekt ingen indikation for. Rekommandationer for transplantation ved Burkitt lymfom/-leukæmi. Primær behandling Den primære behandling er kortvarig, men intensiv multiagens kemoterapi, omfattende aggressiv CNS-profylakse. Der er ikke indikation for autolog- eller allogen transplantation i 1.CR Efter relaps Ved kemosensitivt relaps er der indikation for auto- eller allogen transplantation afhængig af alder eller donorforhold. Behovet for hurtig konsolidering vil ofte indebære at autotransplantation vil blive foretrukket. Refraktær sygdom Resultaterne af alle former for behandling er dårlige og autolog- eller allogen transplantation er eksperimentel. Der ingen indikation for minitransplantation. Referencer: Review Blum K A, Lozanski C, Byrd J C (2004).Adult Burkitt leukaemia and lymphoma. Blood, 104, 3009- 3020. Kemoterapi Reiter A, Schrappe M, Parwaresch R et al (1995) Non-Hodgkins lymphomas of childhood and adolescence: results of treatment stratified for biologic subtypes and stage: a report of the Berlin-Frankfurt-Munster Group. J Clin Oncol ,13, 359-372. 64
Hoelzer D, Ludwig W-D, , Thiel E et al (1996) Improved outcome in adult B-cell acute lymphoblastic leukaemia. Blood, 87, 495-508. Magrath I, Adde M, Shad A et al (1996). Adults and children with small non-cleaved lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol ,14,925-935. Thomas D, Cortes J, O’ Brien S, et al ( 1999 ). Hyper-CVAD program in Burkitts type adult acute lymphoblastic leukaemia. J Clin Oncol, 17, 2461-2470. Thomas DA, Faderl S, O’Brien et al (2006). Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukaemia. Cancer, 106, 1569-1580 Autolog transplantation Sweetenham J, Pearce R, Taghipour G, Blaise D, et al (1996). Adult Burkitt’s and Burkitt-like non-Hodgkin’s lymphoma: outcome for patients treated with high-dose therapy and autologous stem-cell transplantation in first remission or at relapse: results from the European Group for Blood and Marrow Transplantation. J Clin Oncol, 14,2465-2472. Nademanee A, Molina A, O'Donnell MR et al (1997). Results of high-dose therapy and autologous bonemarrow/stem-cell transplantation during remission in poor-rsik intermediate and high-grade lymphoma: International Index high and high-intermediate group. Blood, 90,3844-3852. Smeland S, Blystad AK, Kvaloy SO, Ikonomou IM et al (2004). Treatment of Burkitt’s/Burkitt-like lymphoma in adolescents and adults: a 20-year experience from the Norwegian Radium Hospital with the use of three successive regimens. Ann Oncol, 15, 1072-1078. Allogen transplantation Peniket AJ, Ruiz de Elvira MC, Taghipour G, Cordonnier C et al (2003). An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relaps rate but a higher procedure-related mortality rate than autologous transplantation. Bone Marrow Transplant., 31, 667- 678. 65
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Rekommandationer for knoglemarvstra
Page 3 and 4:
Vævstyper og terminologi Ved valg
Page 5 and 6:
3.valg: 9/10 allel forligelig ubesl
Page 7 and 8:
Petersdorf EW et al: Major-histocom
Page 9 and 10:
Sygdomsspecifikke overvejelser & kr
Page 11 and 12:
Non myeloablativ stamcelletransplan
Page 13 and 14: Akutte Leukæmier ALL hos voksne AL
Page 15 and 16: En metaanalyse af 7 studier, hvor a
Page 17 and 18: Højrisikofaktorer • Fænotype: N
Page 19 and 20: Kemoterapi Hoelzer, D.F (1993). The
Page 21 and 22: unrelated transplant in first compl
Page 23 and 24: ALL hos børn 5% blaster i knoglema
Page 25 and 26: i det nordamerikanske register, af
Page 27 and 28: Risikogrupper for AML i 1. CR Lavri
Page 29 and 30: Autolog KMT Litteraturen på områd
Page 31 and 32: Gale, R.P., Horowitz, M.M., Weiner,
Page 33 and 34: myelogenous leukemia in first compl
Page 35 and 36: AML hos børn
Page 37 and 38: Eapen M, Rubinstein P, Zhang MJ, Ca
Page 39 and 40: Point Parameter 0 0.5 1 1.5 2 Blast
Page 41 and 42: *) Specielt i denne gruppe gælder
Page 43 and 44: Kantarjian H, O'Brien S, Cortes J,
Page 45 and 46: Scott BL, Sandmaier BM, Storer B, M
Page 47 and 48: tiltagende. Patienter med RC og hø
Page 49 and 50: Donor leukocyte infusion after hema
Page 51 and 52: � Konstitutionelle symptomer, for
Page 53 and 54: Responskriterier ved CML Responstyp
Page 55 and 56: patienter, som statistisk set vil h
Page 57 and 58: Mauro,M.J. (2006) Defining and mana
Page 59 and 60: LYMFOMER Lymfoblastært lymfom Lymf
Page 61 and 62: Der er ingen data, der indicerer at
Page 63: BURKITT'S LYMFOM Senest revideret:
Page 67 and 68: Der er ikke indikation for autolog
Page 69 and 70: sequential chemotherapy in poor-ris
Page 71 and 72: af immunosuppressiv beh. og DLI og
Page 73 and 74: following high-dose sequential chem
Page 75 and 76: Marginal Zone Lymfom Senest revider
Page 77 and 78: Rezvani AR, Storer B, Maris M et al
Page 79 and 80: eskriver også sammenhæng mellem i
Page 81 and 82: HCT ved refraktær sygdom (Verdonck
Page 83 and 84: transplantation for lymphoprolifera
Page 85 and 86: Perifere T-Celle Lymfomer Senest re
Page 87 and 88: Referencer: Evens AM, Gartenhaus RB
Page 89 and 90: Hodgkin Lymfom (HL) Senest revidere
Page 91 and 92: Patienter med progressiv sygdom ell
Page 93 and 94: Transplant, 12,172-183. Anderlini,P
Page 95 and 96: Allogen KMT 1. HLA-identisk søsken
Page 97 and 98: Referencer Definition Bacigalupo A,
Page 99 and 100: Paroxysmal Nocturn Haemoglobinuri,
Page 101 and 102: Autolog transplantation Myelomatose
Page 103 and 104: Cavo M, Tosi P, Zagmani E, Cellini
Page 105 and 106: Myelofibrose Idiopatisk myelofibros
Page 107 and 108: Introduktion Retransplantation af b
Page 109 and 110: Den samlede konklusion kunne være,
Page 111 and 112: Thalassæmier Senest revideret nove
Page 113 and 114: thalassæmifri overlevelse på 66%
Page 115 and 116:
Kronisk granulomatøs sygdom Senest
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