Targeted therapy - state-of-the-art treatment option for advanced non-hodgkin lymphomas

Abstract

Introduction: Non-Hodgkin lymphomas (NHL) are the most common hematologic malignancies within the structure of morbidity by malignant tumors, exhibiting in generalized stages a recurrent evolution and unfavorable prognosis, with negative socio-economic effects. Predominantly late diagnosis, increased rates of morbidity and disability perceive NHL as an actual issue of public health and hematologic oncology. Methods: We performed a clinical-analytical, descriptive study. The study involved 80 patients with different stages and histological types of NHL, who were treated and followed up the Institute of Oncology between 2016 – 2020. The age range was 18-70 years (median age - 63 years old). There were 48 (60.0%) males and 32 (40.0%) females. The diagnosis was proved by histopathological, cytological and immunohistochemical examinations of the biopsied lymph nodes and bone marrow. The type of NHL was identified according to the Revised 2017 WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Two investigational groups were formed according to the treatment options. Chemotherapy was administered in 40 (50.0%) patients, and chemotherapy combined with monoclonal antibodies (Rituximab) - in another 40 (50.0%). The following chemotherapy regimens were used alone or in combination with Rituximab: CHOP, R-CHOP, CHOEP, CEOP, R-COP, Bleo-COP, CVChlP, R-CVChlP, BR. Results: NHL was diagnosed more commonly in the age categories of 50-70 years (80.0%). Indolent B-cell NHL occurred in 32 (40.0%) cases, and aggressive diffuze B-cell NHL – in 48 (60.0%). The patients with aggressive histological types prevailed in both investigational groups (57.5% and 62.5%). Stage III disease was revealed in 17 (21.25%) cases, and stage IV - in 63 (78.75%). The complete and partial response rates were 55.0% and 40.0% under the conventional chemotherapy combined with Rituximab, and respectively 12.5% and 60.0% after the conventional chemotherapy alone. Complete response was registered more frequently in females (58.8%) than in males (52.1%). The rate of complete responses turned out to be higher in indolent NHL (66.6%), as compared with those aggressive (48,0%). One- and 3-year relapse-free survival rates after R-CHOP regimen constituted 63.0% and 47.0% correspondingly, and proved to be superior to the same indicator after all other chemotherapy regimens alone or in combination with Rituximab. Conclusions: Both investigational groups of NHL were characterized by the prevalence of the aggressive histological types, stage IV disease, male gender and workable age categories greater than or equal to 50 years old. The short- and long-term results of the conventional chemotherapy combined with Rituximab proved to be superior to those of chemotherapy alone regardless of the histological type and stage of NHL. The relapse-free survival rate was higher after R-CHOP regimen as compared with all other chemotherapy regimens alone or in combination with Rituximab.