R-EPOCH, inonziwo EPOCH-R, inosanganiswa chemotherapy regimen inoshandiswa kurapa zvimwe zvirwere, zvikurukuru mamwe marudzi ehasha asiri Hodgkin lymphoma .
Mushonga wezvinodhaka unosanganisira avo vanotevera:
- R = Rituximab
- E = Etoposide phosphate
- P = Prednisone
- O = Vincristine sulfate (Oncovin)
- C = Cyclophosphamide
- H = Doxorubicin hydrochloride (Hydroxydaunorubicin)
R-EPOCH vs. R-CHOP
Kana iwe uchitoziva nezita re -R-CHOP , regimen inowanzoshandiswa kwete yeHodgkin lymphoma, iwe unogona kufunga nezveR-EPOCH se "chinyorwa" shanduro yeR-CHOP ine zvishoma zvakasiyana zvakasiyana.
R-EPOCH yakasiyana neR-CHOP kwete chete pakuwedzerwa kwe etoposide, asi zvakare mune zvakarongwa zvekupa chemotherapy agents uye maitiro avo kumutumbi.
Muna R-EPOCH, chemotherapies inoshandiswa pane zvakasiyana-siyana kwenguva yakareba-mazuva mana. Izvi zvakasiyana nechekare R-CHOP, iyo iyo imwe neimwe inotenderera, CHOP inopihwa zvose kamwechete, mune zvinonzi bhuus-type hutungamiri.
Chii chinonzi DA-R-EPOCH?
DA-R-EPOCH, iyo inonziwo DA-EPOCH-R, inotsanangura regimen ne etoposide yakagadziriswa nedzivo, prednisone, vincristine, cyclophosphamide, doxorubicin (uye rituximab). Mune izvi zvakasiyana-siyana zvehurumende, maitiro e chemotherapies anorongedzwa kuedza kuwedzera kubudirira.
Sangano reDA-EPOCH rakagadzirwa paNational Cancer Institute (NCI) zvichibva pakufungidzira kuti kushandiswa kwekushandisa zvinodhaka, purogiramu yemishonga, uye kushandiswa kwezvinodhaka zvemasero emukenza kunobereka zvibereko zviri nani kudarika CHOP regimen kune varwere vane utsinye husina Hodgkin lymphoma.
Maawa makumi matatu nemazana matanhatu ekuenderera mberi kwepukisi yakagadzirwa, iyo DA-EPOCH inoshandiswa mazuva ose makumi maviri nemaviri.
Dose kugadziriswa kwe doxorubicin, etoposide, uye cyclophosphamide zvinoshandiswa zvichienderana nenhamba yakaderera (absolute neutrophil count nadir) mumutambo wekare.
Tsvakurudzo paR-EPOCH yeDLBCL Subsets
Lymphomas inowanzobatanidzwa mumapoka maviri makuru: Hodgkin lymphoma (HL) uye isiri Hodgkin lymphoma (NHL). Kupararira kukuru B-cell lymphoma (DLBCL) ndiyo yakajairika zvikuru B-cell NHL, inomiririra 30 kusvika ku 35 muzana yematambudziko uye inobata varwere vezera rose.
World Health Organization (WHO) inoratidzira DLBCL muzvikamu zvina zvikuru. Chikamu chikuru-DLBCL chisati chajekeswa-chinogona kugoverwa kuva matatu subtypes kubva pane sero yezvakabva, kusanganisira midzi B-cell-like (GCB), yakagadziridzwa B-cell (ABC), uye nharaunda yepakati pepakati B-cell lymphoma (PMBL).
Mune mamwe mazwi, patinotarisa pamakoromendi, DLBCL ibato rakasiyana-siyana remakiromasi uye marudzi akasiyana eDLBCL angave akasiyana akashandisa kurapa . Mukuwedzera, rudzi rwakarongeka rwemhirizhonga lymphoma inonzi "kaviri hit" lymphoma. DHL ine ruzivo rwakasiyana-siyana runogona kukanganisa migumisiro. Kushandiswa kwemashoko ose aya pamusoro peDLBCL kunogona kugadzirisa kurapwa, asi ikozvino iko kwakangoita nzvimbo isina kugadzikana uye musoro wekutsvakurudza kwakapfuurira.
Pane imwe nguva, pane tariro iyo inoguma nekuita maitiro akachinjwa R-EPOCH angave akakwirira kupfuura R-CHOP kazhinji kune varwere vane DLBCL. Kunyange zvazvo ichi chichiri kuve chechokwadi mumassetse echasarudzwa, zvinoratidzika kuti hazvisi izvo zvinowanzoitika, zvichida zvichibva pane uchapupu huripo.
Chidzidzo chevadzidzi vanosvika 524 vakaenzanisa kushanda kwemasangano eR-CHOP uye DA-R-EPOCH mukurapa varwere veDLBCL, kunyanya muGCB neAbC subtypes. Vaparidzi vakagoverwa kuti vagamuchire R- CHOP kana DA-EPOCH-R, uye pamushure mekutevedzana kwemakore anoda kusvika mashanu, migumisiro yekupona yakanga yakafanana pakati pemapoka. DA-EPOCH yakaratidza kuwedzera kwehutu, asi izvi zvaitarisirwa zvichienderana nehuwandu hwemazi.
Kunyange zvakadaro, vatsvakurudzi vakakurumidza kutaura kuti zvimwe zvinongororwa zvinotarisirwa kuti zviongorore zvinokonzerwa nemitemo yakasiyana-siyana pane zvikamu zvakasiyana zvevarwere vane DLBCL.
DLBCL neHigh Ki-67 Chirevo
Ki-67 chiratidzo chekare chakashandiswa mumakondomu akasiyana-siyana sechirwere chekuwedzera-izvo, chiratidzo chekuwedzera kwema cell pamusoro pekuparadzaniswa kwemajeri. Tumha nehuwandu hwekuwedzera huri kutarisirwa kuva nekutaura kwakanyanya kweKi-67.
Ipo ye EPOCH yakagadziridzwa muchidimbu ichienderana nekufunga kuti kuwedzerwa kwemishonga inokonzerwa nekushandisa zvinodhaka kunogona kubvumira kushandiswa kwehutano hwakanaka kudarika urus regimen, yakadai seCOP.
Mune imwe yedzidzo yapfuura, yakagadzirirwa kuti varwere veDLBCL vane kutaura kwakakwirira kweKi-67 vakagamuchira kuponeswa kusingabatsiri kubva kuR-CHOP therapy. Nokudaro, chidzidzo chaHuang nevakashanda navo chinangwa chekuongorora kana R-EPOCH iri nani kupfuura R-CHOP mune varwere vasina kudzidza vanonzi DLBCL vane kutaura kukuru kweKi-67.
Huang nevamwe vaishanda R-EPOCH semutambo wekutanga mutambo muvarwere veDLBCL vane kutaura kwakakwirira kweKi-67 uye vakaenzanisa kuporesa kwehutano hweR-EPOCH uye R-CHOP rushonga muchikamu ichi tichishandisa maitiro maviri-akafanana. Migumisiro yavo yakaratidza kuti varwere vanobatwa neR-EPOCH regimen vakaratidza kuponesa zviri nani kudarika avo vaitungamira r-CHOP regimen, uye vakadana kuti vawedzere zvidzidzo zvinotarisa kuti vimbise zvitsva uye kuti vaone kuti zvinogona kuitika kuti vashandise zvigadziriswe zvekushandiswa pamwe chete neR-EPOCH therapy .
Double Hit Lymphoma
Double hit lymphomas, kana DHLs, nhoroondo yechishanu kusvika kune 10 muzana yezviitiko zveDLBCL, uye vazhinji vanogona kufananidzirwa senhengo yemagariro ehurumende uye kuratidza maitiro e BCL-2 (BCL-2 + / MYC +). Chinyorwa chiduku cheDHLs chinotsanangura BCL-6 (BCL-6 + / MYC +) kana kuratidza zvose BCL-2 uye BCL-6 uye inonzi katatu-hit lymphomas (BCL-2 + / BCL-6 + / MYC +).
Varwere neDHLs vanowanzova nehupenzi hwekufananidzira, hukuru hwePI, uye kubatanidzwa kwepfupa remafu kana hutachiona hwemutambo. Izvo zvakanakisisa regimen yeDHLs hazvizivikanwe; zvisinei, varwere vakagamuchira R-CHOP-soro regimens vane hutachiona husina kunaka, pamwe nekupona kwemazuva ese kwemaawa mashoma kusvika pasi gumi nemaviri.
Muchiitiko chekuongororazve, kufambira mberi kwekusununguka-kusina kusununguka kwakavandudzwa nemitemo yakawanda, kusanganisira DA-EPOCH-R, kuenzaniswa neR-CHOP. Dare re DA-EPOCH-R rakaguma nemazinga akakwirira zvikuru ekuregererwa kwakakwana kudarika mamwe masimba makuru.
Primary Mediastinal Lymphoma (PMBL)
PMBL imwe imwe subtype yeDLBCL iyo inomirira 10 muzana yematambudziko eDLBCL. Iro kliniki uye biologically yakabatana ne nodular sclerosing Hodgkin lymphoma, iyo inobvawo kubva kumaromu e-thymic B.
PMBL inotyisa uye inokura mumusasa wepakati . Vakawanda varwere vanochinja-chinja muBelL-6 gene. Iko immunochemotherapy haisi inoshanda, uye varwere vakawanda vanoda rayhu yehutachiona, iyo inogona kutungamirira kumigumisiro yakaipisisa yakaguma. Ichi ndicho chisingambowanzorevi lymphoma isina kunyanya kuwanda kwechirwere chekudzidza; zvisinei, deta iri kutarisa kumashure ematambudziko (retrospective studies) inoratidza kuti mamwe maitiro emakemikari akawanda anoratidza seanobudirira kupfuura R-CHOP.
Muchiitiko chekuongorora, kusakwanira kwechikwata cheR-CHOP chaive 21 muzana, zvichiratidza kudiwa kwemishonga dzimwe nzira.
DA-EPOCH-R inoshandisa maitiro ekuderedza umo kushandiswa kwezvinodhaka etoposide, doxorubicin, uye cyclophosphamide zvinogadziriswa kuti zvibudirire zvikuru. Migumisiro yechiratidzo chimwe chete neDA-EPOCH-R, yakagadzirwa nevatsvakurudzi veCNI, iyo yakatevera varwere 51 kwemakore anopfuura 14, yakabudiswa muApril 11, 2013, yeEngland Journal of Medicine .
Makumi makumi mashanu-mumwe varwere vasina kunyatsotarisana nepamusoro-kati B-cell lymphoma vakaiswa mubhuku rino. Vose asi varwere vaviri vakawana kuregererwa kwakakwana neAra-EPOCH-R therapy, uye hapana mumwe wevarwere vane kukanganiswa kwakakwana akashandura kakarenda lymphoma. Vachiri vaviri avo vasina kukwanisa kuregererwa kwakakwana vakagamuchira miviri uye havana zvakare kuti mvere dzavo dzidzoke zvakare. Pakanga pasina humwe humwe hutano hunozove huripo kana hutachiona hwehutano huipi.
Kuongorora kwakasiyana-siyana kwevanhu vakuru ne PMBL kwakafananidza kuponeswa kwevakawanda kune varwere vanobatwa nehurumende idzi (132 varwere vanozivikanwa kubva kune 11 vanopa nzvimbo, 56 R-CHOP uye 76 DA-R-EPOCH). Kunyange zvazvo zvikwereti zvakakwana zvekuregererwa zvaive zvakakwirira neDA-R-EPOCH (84 muzana vs. 70 muzana), varwere ava vainyanya kuve nezvinodhaka zvine chokuita nemishonga. Mumakore maviri, 89 muzana yevarwere veR-CHOP uye 91 muzana yevarwere veDA-R-EPOCH vakanga vari vapenyu.
R-EPOCH yeBurkitt Lymphoma muVarwere Ne / Vasina HIV
Burkitt lymphoma inowanzowedzera kuEricatorial Africa kupfuura munyika dzekuMadokero. Burkitt chirwere chinowanzoitika muzvirwere zvekudzivirira zvirwere zveAIDS. Mishonga yemitengo yeBurkitt lymphoma munyika dzekuMadokero inosvika 90 kubva muzana muvana, asi 30 kubva muzana kusvika 50 kubva muzana yevana muAfrica vanorapwa nekuda kwekusakwanisa kuchengetedza zvakanyanya kurapa kwemazinga.
Chiitiko chaitungamirirwa naWilson uye vaishanda navo kuNational Cancer Institute (NCI) uye vakaonekwa muNew England Journal of Medicine. Mhosva yacho yaisanganisira zvidimbu zviviri zve EPOCH-R, zvinosanganisira nguva yakareba yekudzivirirwa kwezvinhu zvakaderera zvezvinodhaka panzvimbo pekutsvaira zvakanyanya kune zvakanyanya kuwedzera kwemishonga.
Vatatu vane chirwere chisina kutorwa Burkitt lymphoma vakaiswa mukutongwa. Varwere vakagamuchira chimwe chezvinhu zviviri zve EPOCH-R, zvichienderana nehutachiona hweHIV. Vane makumi mapfumbamwe vasina HIV vane chirwere chakagadziriswa (DA) -EPOCH-R, asi varwere vane HIV vane 11 vakagamuchira SC-EPOCH-RR, iyo yakasiyana-siyana yechikoro (SC) ye EPOCH-R inosanganisira maitiro maviri e rituximab purogiramu yekurapa uye ane chirwere chinotapukira chakanyanya kudarika DA-EPOCH-R.
Kugadziriswa kwemazinga emiti kunenge kwaitwa kuedza kupa huwandu hwakawanda hwezvinodhaka zvichienderana nekutsungirira kwomunhu chemotherapy. Izvozvo zvakanyanya kutyisa zvakaratidzwa mukutongwa kwaiva fever uye neutropenia (yakadzika masero eropa rekare); hapana rufu rwakabatwa nehutachiona hwakaitika. Nenguva dzenguva dzekutsvaga nguva yemwedzi 86 nemwedzi 73, hupenyu hwese hwehupenyu hwaive zana nezana uye 90 muzana, pamwe chete, ne DA-EPOCH-R uye SC-EPOCH-RR.
Kubva pamigumisiro iyi, miedzo yekusimbisa kubudirira kwerapi ye EPOCH-R muvanhu vakuru uye vana veBurkitt lymphoma varwere vakatanga.
Shoko Rinobva
Chirongwa ichi-chakagadziriswa-EPOCH chakagadzirwa paNational Cancer Institute, zvichibva pakufungidzira kuti kugadzirisa kusarudzwa kwezvinodhaka, kuburitsa uye kusvibiswa kunoitwa nemasero ekenza kunobereka zvibereko zviri nani kupfuura CHOP regimen kune varwere vane utsinye kwete Hodgkin lymphoma.
Kunyange zvazvo paiva netariro yekutanga kuti R-EPOCH yaizobudirira pane zvakakosha kupfuura R-CHOP kazhinji kune varwere vane DLBCL, chinonyanya kukosha ndechokuti mukana wekuti regimen inogona kuvandudza migumisiro yezvikamu zvakasiyana-siyana zvekuda kwevarwere vane DLBCL nedzimwe zvirwere. Kana iwe ukawira mune zvinyorwa izvi, kurukurai sarudzo nachiremba wenyu.
> Sources:
> Curry MA, Liewer S. Kuita sarudzo yakagadziriswa kusarudzwa kwechisimba chisina Hodgkin lymphoma: R-CHOP regimen maererano ne EPOCH-R. J Hematol Oncol Pharm . 2016; 6 (4): 145-152.
> Dunleavy K, Pittaluga S, Shovlin M, et al. Kuderedza-kupisa kwehutano mune munhu mukuru Burkitt lymphoma. N Engl J Med. 2013; 369 (20): 1915-25.
> Wilson HW et al. Chikamu III chekudzidza zvakanyorwa R-CHOP maererano neDA-EPOCH-R uye kuongorora kwemasero ehurwere risina kutenderwa Kupararira Guru B-Cell Lymphoma: CALGB / Alliance 50303. 2016 December 4; Chirevo Chemufananidzo # 469: ASH 58th Annual Meeting uye Kuratidzwa, San Diego, CA.