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Oulun yliopiston väitöskirjat




DLBCL, PRIMARY AND SECONDARY CENTRAL NERVOUS SYSTEM INVOLVEMENT, TREATMENT AND PROPHYLAXIS, ACTA UNIVERSITATIS OULUENSIS D Medica 1436


ISBN-10:978-952-62-1714-7 
Kieli:englanti 
Kustantaja:Oulun yliopisto 
Oppiaine:Lääketiede 
Painos:Osajulkaisuväitöskirjan yhteenveto-osa 
Painosvuosi:2017 
Sijainti:Print Tietotalo 
Sivumäärä:110 
Tekijät:KUITUNEN HANNE 

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Diffuse large B-cell lymphoma (DLBCL) is the most common type of Non-Hodgkin´s Lymphoma (NHL). The standard treatment for DLBCL is R-CHOP chemoimmunotherapy (rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone). About one -third of patients have refractory disease or the lymphoma relapses. Prognosis after relapse of refractory disease is poor. Fitter and younger patients are recommended new intensive salvage chemotherapy followed by autologous stem cell transplantation. Central nervous system (CNS) relapse is the most feared complication with dismal prognosis in DLBCL. High dose methotrexate intravenously administered concurrently with R-CHOP treatment has shown to be most promising to prevent CNS relapses. Primary CNS lymphoma (PCNSL) is a rare aggressive lymphoma limited to the CNS and eyes. PCNSL is a chemo-and radiosensitive disease, but long-term response is rare since the blood brain barrier (BBB) limits access of many drugs to the CNS. BBB disruption (BBBD) is a treatment modality where the BBB is opened by hypertonic mannitol infusion. Administration of chemotherapeutics will achieve over ten-fold concentrations in the CNS and eradicate microscopic disease involvement. This study retrospectively analyses patients who treated as first line with Bonn/Bonn-like treatment (study I), with BBBD treatment followed by high-dose treatment/autologous stem cell transplantation (HDT/ASCT) in first- or second-line (study II) or those treated with primary RCHOP or its derivatives with or without concurrent CNS-targeted treatment (study III). HD-MTX-based multichemotherapy is an effective induction treatment in CNS lymphoma, but long-lasting responses are rare. BBBD-treatment is well-tolerated and a promising method to attain high drug concentrations in the CNS to eradicate microscopic disease involvement in firstand second-line. CNS-prophylaxis with HD-MTX prevents CNS events in high risk DLBCL. PCNSL is agressive disease despite excellent primary response with HD-MTX based multichemotherapy. BBBD-treatment is a promising method to eradicate microscopic disease in the CNS and achieve a long-term response and cure rate. Fatal CNS relapses can be avoided using CNS-targeted treatment.


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