I-R-EPOCH, ebizwa nangokuthi i-EPOCH-R, iyinhlangano ye- chemotherapy ehlanganiswa esetshenziselwa ukwelapha izilima ezithile, ikakhulukazi izinhlobo ezithile ze- aggressive non-Hodgkin lymphoma .
Umuthi wezidakamizwa unamalungu alandelayo:
- R = Rituximab
- E = Etoposide phosphate
- P = i-Prednisone
- O = Vincristine sulfate (Oncovin)
- C = i-Cyclophosphamide
- H = Doxorubicin hydrochloride (Hydroxydaunorubicin)
R-EPOCH vs. R-CHOP
Uma usujwayelene kakade ne- R-CHOP ngesibizo , umshini ovame ukusetshenziselwa i-non-Hodgkin lymphoma, khona-ke ungacabanga ngo-R-EPOCH njengenguqulo "ehlutshiwe" ye-R-CHOP enezinto ezimbalwa ezibalulekile.
I-R-EPOCH ihluke ku-R-CHOP hhayi nje kokungezwa kwe-etoposide, kodwa futhi nokulethwa okuhleliwe kwamakhemikhali e-chemotherapy kanye namanani abo emzimbeni.
Ku-R-EPOCH, i- chemotherapies ifakwa ezindaweni eziguquguqukayo isikhathi eside-izinsuku ezine. Lokhu kuqhathaniswa ne-R-CHOP yendabuko, lapho umjikelezo ngamunye, i-CHOP ihanjiswa khona kanye, kulelo okuthiwa i-bolus-type administration.
Iyini i-DA-R-EPOCH?
I-DA-R-EPOCH, ebizwa nangokuthi i-DA-EPOCH-R, ichaza uhlobo lohlobo lwe-etoposide, i-prednisone, i-vincristine, i-cyclophosphamide, i-doxorubicin (ne-rituximab). Kulesi simo esihlukile, imithi ye-chemotherapies ishintshwe ukuze izame ukwandisa ukusebenza.
Uhlelo lwe-DA-EPOCH lwakhiwa kwi-National Cancer Institute (NCI) ngokusekelwe ekucatshangweni ukuthi ukukhethwa kwezidakamizwa, isimiso sezidakamizwa, kanye nokutholakala kwezidakamizwa zamangqamuzana omdlavuza kungakhipha imiphumela engcono kunomthetho we-CHOP kuziguli ezine-aggressive non-Hodgkin i-lymphoma.
Kwasungulwa isimiso sokunyuswa kwamahora angu-96 okuqhubekayo, lapho i-DA-EPOCH iphathwa njalo ngezinsuku ezingu-21.
Ukulungiswa kwe-dose ku doxorubicin, etoposide, ne-cyclophosphamide kwenziwa ngokususelwa ekubaleni okuphansi (inani eliphelele le-neutrophil nedir) kumjikelezo odlule.
Ucwaningo nge-R-EPOCH ye-DLBCL Subsets
Ama-lymphomas ngokuvamile ahlukaniswe ngezigaba ezimbili eziyinhloko: i- Hodgkin lymphoma (HL) ne-non-Hodgkin lymphoma (NHL). Ukusakaza i-B-cell lymphoma enkulu (i-DLBCL) yi-B-cell ejwayelekile kakhulu ye-NHL, emele amacala angu-30 kuya kwangu-35 futhi ethinta iziguli zonyaka wonke.
I-World Health Organization (WHO) ihlukanisa iDLBCL ngezigaba ezine ezinkulu. Isigaba esikhulu kunazo zonke-i-DLBCL engacacisiwe ngenye indlela-ingahle ihlukaniswe ibe yi-subtypes emithathu esekelwe kuseli lomsuka, kufaka phakathi isikhungo se-B-cell-like (GCB), i-B-cell (ABC) esebenzayo, kanye ne-B-cell lymphoma (PMBL).
Ngamanye amazwi, uma ubheka izinga lamangqamuzana, i-DLBCL iyinhlangano ehlukahlukene yama-lymphomas nezinhlobo ezahlukene ze-DLBCL ingahle ibe ne-prognoses ehlukile yokwelapha . Ngaphezu kwalokho, uhlobo oluthile oluthile lwe-lymphoma olubi lubizwa ngokuthi "i-double hit" lymphoma. I-DHL inezinkinga ezithile eziphathelene nezakhi zofuzo ezingathinta imiphumela. Ukusetshenziswa kwalo lonke ulwazi mayelana ne-DLBCL kungakwazi ukuguqula ukwelashwa, kodwa njengamanje okwamanje kuyindawo engalungile nesihloko socwaningo oluqhubekayo.
Ngesinye isikhathi, kube nethemba lokuthi imiphumela yokulungiswa kwe-R-EPOCH enomthamo ingaba ngaphezu kuka-R-CHOP ngeziguli ezine-DLBCL. Ngenkathi lokhu kungase kube yiqiniso kuma-subsets akhethiwe, kubonakala sengathi akuyona into ngokuvamile, okungenani ngokusekelwe ebufakazini obukhona.
Ukutadisha kwabangu-524 abaqhathaniswa kuqhathanisa ukusebenza kohlelo lwe-R-CHOP ne-DA-R-EPOCH ekwelapheni iziguli ze-DLBCL, ikakhulukazi ku-GCB naku-ABC subtypes. Ababambiqhaza babelwe ukuthola uR- CHOP noma i-DA-EPOCH-R, futhi ekulandeleni okuphakathi kweminyaka emihlanu, imiphumela yokuphila yayifana phakathi kwamaqembu. I-DA-EPOCH ikhombise uketshezi oludakayo, kodwa kulindeleke ukuthi isetshenziswe ngokwezinga eliphezulu.
Noma kunjalo, abacwaningi basheshe basho ukuthi ukuhlaziywa okwengeziwe kuyadingeka ukunquma umphumela wemigomo ehlukahlukene kuma-subset ethize weziguli ezine-DLBCL.
I-DLBCL Enokuveza okuphezulu kwe-Ki-67
I-Ki-67 ingumaki osetshenziselwa ukwelapha ezihlukahlukene njengenkomba yokukhula-okungukuthi, umaka wokukhula kweseli mayelana nokuhlukaniswa kweseli. Izicubu ezinokukhula okuphezulu kulindeleke ukuba ziboniswe ngokuphezulu kwe-Ki-67.
Inqubo ye-EPOCH yasungulwa ngokuyingxenye ngokusekelwe ekutheni ukwandiswa kwezidakamizwa ezithengiswayo kungenza kube ngcono ukusebenza kwe-antitumor kunokulawulwa kwe-bolus, njenge-CHOP.
Esifundweni esandulele, kwakunqunywe ukuthi iziguli ze-DLBCL ezinezinkulumo eziphezulu ze-Ki-67 zithole izinzuzo zokusinda ezilinganiselwe ezivela ku-R-CHOP ukwelashwa. Ngakho-ke, ucwaningo olwenziwa nguHuang nosebenza nabo luhlose ukuphenya ukuthi ngabe i-R-EPOCH iphakeme kune-R-CHOP kuziguli ezingaphenduliwe ze-DLBCL ezinezinkulumo eziphezulu ze-Ki-67.
U-Huang nozakwethu babesebenzisa i-R-EPOCH njengombhalo wokuqala wolayini kuziguli ze-DLBCL ezinamazwi aphezulu ka-Ki-67 futhi ziqhathanise ukusebenza kahle kwe-R-EPOCH no-R-CHOP ukwelashwa kule nhlangano ngokusebenzisa ukulawula kokubili. Imiphumela yabo iphakamisa ukuthi iziguli eziphathwe nge-R-EPOCH zibonisa ukuthi zisinda kangcono kunezo ezilawulwa yi-R-CHOP, futhi zibiza ukuthi ziqhubeke nezifundo zokuqinisekisa ukuthi zifunyenwe nokuthi zikwazi yini ukutholakala nezidakamizwa ezibikezelayo ukuze zisetshenziswe ngokuhlanganyela no-R-EPOCH therapy .
I-Double Hit Lymphoma
Ukushaya kabili i-lymphomas, noma i-DHLs, i-akhawunti ngamacala angu-5 kuya kwangu-10 amacala e-DLBCL, futhi iningi lingabonakaliswa njengohlobo lwama-germinal kanye nokuveza izakhi zofuzo BCL-2 (BCL-2 + / MYC +). I-subset encane ye-DHLs iveza i-BCL-6 (BCL-6 + / MYC +) noma iveza i-BCL-2 ne-BCL-6 futhi ibizwa ngokuthi i-lymphomas (BCL-2 + / BCL-6 + / MYC +).
Iziguli ezine-DHLs zivame ukuba nezici ezimbi zokubikezela, amaphuzu aphezulu e-IPI, nokubandakanyeka komnkantso wamathambo noma isimiso sezinzwa esiyinhloko. Uhlobo oluhle lwe-DHLs alukwazi; Kodwa-ke, iziguli ezitholwe yi-R-CHOP-like regimens zihlushwa kabi, zine-median jikelele yokuphila ezinyangeni ezingaphansi kwengu-12.
Ekubuyekezeni okubukeziwe, ukusinda okuqhubekayo okuqhubekayo okuqhubekayo kuthuthukiswe ngemigomo ejulile, kuhlanganise ne-DA-EPOCH-R, kuqhathaniswa no-R-CHOP. Umthetho we-DA-EPOCH-R waba nemiphumela ephakeme kakhulu yokuxoxwa okuphelele kunezinye izilawuli ezinzulu.
I-Primary Mediastinal Lymphoma (PMBL)
I-PMBL ingenye i-subtype ye-DLBCL emele amaphesenti ayishumi amacala e-DLBCL. Kuyinto yokwelashwa futhi ehlobene ne-biologically ne-nodular sclerosing i-Hodgkin lymphoma, evela nakumama-b we-thymic.
I-PMBL inonya futhi ikhula ibe yinqwaba ye-mediastinal . Iningi leziguli zinezakhi zofuzo ezakhiweni ze-BCL-6. I-immunochemotherapy ejwayelekile ayiphumeli, kanti iziguli eziningi zidinga imisebe ye-mediastinal, engabangela imiphumela embi kakhulu. Leli lymphoma engavamile kakhulu engenalo idatha eminingi yokutadisha emtholampilo; Kodwa-ke, idatha ebheka emuva ezimweni ezedlule (izifundo ezibuyiselwayo) zikhomba ukuthi imishanguzo enamandla kakhulu yamakhemikhali ebonakala sengathi iyasebenza kakhulu kune-R-CHOP.
Ekuhlaziyweni okubukeziwe, isilinganiso sokuhluleka se-R-CHOP sasingamaphesenti angama-21, okusikisela isidingo sokwelapha ezinye izindlela.
I-DA-EPOCH-R isebenzisa amasu okukhipha lapho izidakamizwa ze-etoposide, doxorubicin, ne-cyclophosphamide zilungiswa ukuze zisebenzise kakhulu. Imiphumela yecala elilodwa lezandla nge-DA-EPOCH-R, elaphethwe abacwaningi be-NCI, elalandela iziguli ezingu-51 isikhathi esingaphezu kweminyaka engu-14, lanyatheliswa kuyi -New England Journal of Medicine , ngo-Ephreli 11, 2013. .
Iziguli ezingamashumi ayisishiyagalolunye nesinye ezine-B-cell lymphoma engasetshenziswanga engalashwa zifakwe kulolu cwaningo. Zonke iziguli ezimbili zithola ukuxoxwa okuphelele nge-DA-EPOCH-R ukwelapha, futhi akekho weziguli ezinokukhululwa okuphelele okuye kwakhiwa i-lymphoma ephindaphindiwe. Iziguli ezimbili ezingazange zithole ukukhishwa okuphelele zithole imisebe futhi azizange zibuye zibuyele nezidumbu zazo. Kwakungekho bufakazi bezinye izifo ezathuthuka kamuva noma imiphumela emibi ye-cardiac.
Ukuhlaziywa kwama-multi-institution kwabantu abadala abane-PMBL kuqhathanisa ukusinda okujwayelekile kwiziguli eziphathwe nalezi zinhlobo (iziguli ezingu-132 ezikhonjiswe ezikhungweni ezine ezihlinzekayo; 56 R-CHOP no-76 DA-R-EPOCH). Ngenkathi izinga eliphelele lokuxoxisana liphakeme nge-DA-R-EPOCH (amaphesenti angama-84 namaphesenti angu-70), lezi ziguli zazivame ukuzwa utshwala obuhlobene nokwelapha. Eminyakeni emibili, iziguli ezingama-R-CHOP ezingu-89 kanye namaphesenti angu-91 e-DA-R-EPOCH iziguli zaziphila.
R-EPOCH ye-Burkitt Lymphoma ezigulini ezine-HIV / nge-HIV
I-Burkitt i-lymphoma ivame kakhulu e-equatorial Afrika kunamazwe aseNtshonalanga. I-Burkitt yisifo esivela njalo esigulini se-AIDS esicindezelwe ngumzimba. Amazinga okuguqulwa kwe-Burkitt lymphoma emazweni aseNtshonalanga afinyelela kuma-90 amaphesenti ezinganeni, kanti kuphela amaphesenti angu-30 kuya kuma-50 ezingane ase-Afrika aphulukiswa ngenxa yokungakwazi ukuphatha ukwelashwa okusezingeni dose ngokuphepha.
Icala laqhutshwa nguWilson kanye nozakwethu eNational Cancer Institute (NCI) futhi wavela eNew England Journal of Medicine. Icala labandakanya ukuhlukahluka okubili kwe-EPOCH-R, okubandakanya ukuchayeka isikhathi eside ezindaweni eziphansi zezidakamizwa esikhundleni sokungena ngokubhebhetheka kwezidakamizwa eziphakeme.
Iziguli ezingamashumi amathathu ezine-Burkitt lymphoma ezingakaze zathathwa zifakiwe kulolu cwaningo. Iziguli zathola enye yezinhlobo ezimbili ze-EPOCH-R, kuye ngesimo sabo se-HIV. Iziguli ezingu-19 ezingenayo i-HIV zithole i-DA-EPOCH-R, kanti iziguli ezine-HIV zathola i-SC-EPOCH-RR, okuyiyona ndlela efushane ye-EPOCH-R equkethe amanani amabili we-rituximab umjikelezo wokwelashwa ngamunye futhi unamandla okwelashwa okuphansi kune-DA-EPOCH-R.
Ukulungiswa kwamazinga omthamo kwenziwa ukuzama ukunikeza inani elihle lemithi esekelwe ekubekezeleni komuntu we-chemotherapy. Izinyathelo eziqakathekile ezibonakalayo ekuvivinyweni kwakungumkhuhlane kanye ne-neutropenia (izibalo ezingaphansi kwegazi eliphansi); akukho ukufa okuhlobene nokwelashwa okwenzekile. Ngezikhathi ezilandelanayo ezilandelanayo ezinyangeni ezingu-86 no-73, inani lokusinda lalingamaphesenti angu-100 namaphesenti angama-90, ngokulandelana, ne-DA-EPOCH-R ne-SC-EPOCH-RR.
Ngokusekelwe kulezi ziphumo, izilingo ukuqinisekisa ukuthi ukusebenza kwe-EPOCH-R ukwelashwa kweziguli ezikhulile kanye nezingane ezitholwa yiBurkitt lymphoma ziqalisiwe.
Izwi elivela
Uhlelo lwe-dose-adjusted-EPOCH lwakhiwa ku-National Cancer Institute, ngokusekelwe ekucabangeni ukuthi ukwandisa ukukhethwa kwezidakamizwa, ukulethwa kanye nokuchayeka okubangelwa amangqamuzana omdlavuza kungakhipha imiphumela engcono kunomthetho we-CHOP kuziguli ezine-aggressive non-Hodgkin lymphoma.
Ngenkathi kunethemba lokuqala lokuthi i-R-EPOCH izofeza imiphumela engcono kakhulu kune-R-CHOP ngokuvamile kwiziguli ezine-DLBCL, ukugxila manje kungenzeka ukuthi lo mgomo ungathuthukisa imiphumela yezinhlu ezihlukahlukene zokukhetha zeziguli ezine-DLBCL nezinye izidakamizwa. Uma ungena kulezi zingxenyekazi, xoxani ngalolu daba nodokotela wakho.
> Imithombo:
> Curry MA, Liewer S. Ukwenza ukwelashwa okunolwazi olwenziwe ngokuhlukunyezwa okungenalo i-Hodgkin lymphoma: umgomo we-R-CHOP ngokumelene ne-EPOCH-R. J Hematol Oncol Pharm . 2016; 6 (4): 145-152.
> Dunleavy K, Pittaluga S, Shovlin M, et al. Ukwelapha okunamandla kakhulu ku-Burkitt lymphoma omdala. N Engl J Med. 2013; 369 (20): 1915-25.
> Wilson HW et al. Ucwaningo lwe-Phase III olwenziwa ngokungahleliwe ngo-R-CHOP oluhambisana ne-DA-EPOCH-R nokuhlaziywa kwamangqamuzana e-Diffuse Large B-Cell Lymphoma engaphenduliwe: CALGB / Alliance 50303. 2016 Disemba 4; I-Oral Abstract # 469: Umhlangano Wonyaka Wonyaka ka-ASH 58 nokuboniswa, eSan Diego, CA.