DOI: https://doi.org/10.22263/2312-4156.2022.6.71
V.A. Kalenik, N.E. Konoplya, P.D. Dziameshka
Short-term results of personalized chemoimmunotherapy use in patients with ABC-subtype of diffuse B-cell non-Hodgkin’s lymphoma
N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
Vestnik VGMU. 2022;21(6):71-77.
Abstract.
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: diffuse B-cell lymphoma, ABC-subtype, R-CHOP, personalized therapy.
Sources of research financing: The research was performed within the frames of the task 03.15 “To elaborate and implement a method of personalized treatment of patients, suffering from diffuse B-cell lymphoma on the basis of determining molecular genetic subtype of the tumor” of the State Research Program (GPNI) “New methods of providing medical aid” of the subprogram “Oncological diseases”.
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Information about authors:
V.A. Kalenik – Candidate of Medical Sciences, leading research officer of the photodynamic therapy and hyperthermia laboratory with chemotherapy group, N.N. Alexandrov National Cancer Centre of Belarus, https://orcid.org/0000-0001-8629-2830
N.E. Konoplya – Doctor of Medical Sciences, professor, principal research officer of the photodynamic therapy and hyperthermia laboratory with chemotherapy group, N.N. Alexandrov National Cancer Centre of Belarus, https://orcid.org/0000-0003-0592-7182
P.D. Dziameshka – Doctor of Medical Sciences, associate professor, principal research officer of the radiation therapy laboratory, N.N. Alexandrov National Cancer Centre of Belarus, https://orcid.org/0000-0002-1324-3656
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