Ocena postępowania diagnostycznego i terapeutycznego w ...

5/ Basing on immunological tests performed in 17 patients with NBS before the lymphoma
diagnosis, more severe humoral immune deficiencies were observed in patients developing B-
cell lymphomas. During the follow-up of 8 (47%) out of 17 patients, an increasing
concentration of serum IgM was found, which normalized shortly before the diagnosis of
lymphoma. Simultaneously 67% of patients developed monoclonal gammopathy.
6 / There was a significant difference in dosage of cytostatic agents in patients with NBS in
group I and II (before and after the year 2000), the median dose in LMB89/LMB2001
protocols was 55% and 88% respectively, and in the BFM 90/EURO-LB02 protocols 64% and
92%.
7 / In B-NHLs the time between the treatment initiation till achieving a remission did not differ
in both groups, but the final results were better in group II (survival 4/5) than in group I
(survival 1/5).
8 / In TLBL there were differences in the time of achieving remission between groups I and II
(CR on day 33 in 40% and 75% of patients, respectively). There were also differences in the
process of treatment. The entire intensive phase (Protocol I, M and II) was realized only by 2/5
of patients in group I, and all 4/4 patients in group II. There are no subjects alive in group I and
there are 2/4 patients still alive in group II.
9 /The results of the treatment of lymphoma in patients with NBS were significantly better in
patients treated after the year 2000, with usage of cytostatic doses greater than 80%: 5-year
overall survival (OS) in group II was 45% vs. 10% in group I (p=0.0210).
10 / Complications associated with the cytostatic treatment occurred in all patients with NBS;
myelosuppression occurred significantly earlier in patients with NBS than in the RG group
(p=0.0059 and p=0.0077 in the B-and T-NHL, respectively).
11 / The results of the treatment of lymphoma in patients with NBS (including group I and II),
were worse than in immunocompetent patients. Among the patients with NBS 5-year OS was
25%, while in the RG 82%. Median survival time was 3.8 years in the NBS group and 10.3
years in RG.
On the basis of long-term clinical observations and the results of non-Hodgkin lymphoma
treatment in patients with NBS, as well as taking into account the specificity of the disease,
some new enhanced diagnostic and therapeutic recommendations were developed.
The study was partially supported by the Polish Ministry of Science and Higher Education
(grant no N N407 100938).
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