Вестник Витебского государственного медицинского университета (Dec 2022)

Short-term results of personalized chemoimmunotherapy use in patients with ABC-subtype of diffuse B-cell non-Hodgkin’s lymphoma

  • N.E. Konoplya ,
  • P.D. Dziameshka

DOI
https://doi.org/10.22263/2312-4156.2022.6.71
Journal volume & issue
Vol. 21, no. 6
pp. 71 – 77

Abstract

Read online

Objectives. To develop a personalized method of immunochemotherapy in patients with ABC-subtype of diffuse B-cell lymphoma (DBCL) based on the assessment of metabolic response after two courses of R-CHOP and alternation of the first- and second-line chemotherapy regimens and to evaluate its short-term results. Material and methods. A prospective, non-randomized study included 69 patients with ABC-subtype of DBCL treated from 2020 to 2022. At the first stage, all patients received two courses according to R-CHOP+interleukin-2 (IL-2) scheme, followed by positron emission tomography (FDG-PET/CT). In the presence of a complete metabolic response (CMR), another 2-4 courses of R-CHOP + IL-2 were performed with subsequent dynamic monitoring. In the absence of CMR, 2 courses of R-DA-EPOCH+IL-2 were given followed by FDG-PET/CT. If CMR was achieved, 2 more courses of R-DA-EPOCH+IL-2 followed by dynamic monitoring were performed. In the absence of CMR, 2 courses of R-DHAP+IL-2 followed by FDG-PET/CT were performed. When CMR was achieved, 2 more courses of R-DHAP+IL-2 were given, followed by dynamic monitoring. In the absence of CMR, two alternating courses of immunochemotherapy according to R-ICE+IL-2, R-GEMOX+IL-2 schemes were conducted with FDG-PET/CT, followed by dynamic monitoring and choosing individual tactics of treatment by the multidisciplinary council. Results. After 2 courses of R-CHOP+IL-2, CMR was achieved in 45 (65.2%) patients, 24 (34.8%) patients showed no CMR. Of these patients, 10 (41.7%) had CMR after two courses of R-DA-EPOCH+IL-2. Of the 14 persons who did not respond to therapy, 8 more cases had CMR after 2 courses of R-DHAP+IL-2. The other 6 patients underwent two courses of alternating R-ICE+IL-2 and R-GEMOX+IL-2, CMR was detected in 2 patients, in 4 patients full response to therapy could not be achieved. Thus, after provided treatment according to the developed approach, the rate of CMR made up 94.2%. Conclusions. The developed treatment algorithm of patients with ABC-subtype of DBCL is an effective approach to personalized therapy and is characterized by satisfactory short-term results.

Keywords