I-R-EPOCH, ekwabizwa ngokuba yi-EPOCH-R, iyinkqubo ye- chemotherapy edibeneyo esetyenziselwa ukuphatha izibizo ezithile, ngokukodwa iintlobo ezithile zobudlova obungenalo i-Hodgkin lymphoma .
I-regimen yeziyobisi iqulethwe ngamagosa alandelayo:
- R = Rituximab
- E = Etoposide phosphate
- P = iPrednisone
- O = iVincristine sulfate (Oncovin)
- C = Cyclophosphamide
- H = Doxorubicin hydrochloride (Hydroxydaunorubicin)
R-EPOCH kunye no-R-CHOP
Ukuba usuvele uqhelene nesigama R-CHOP , i-regimen esetyenziswa ngokuqhelekileyo kwi-non-Hodgkin lymphoma, ngoko unokucinga nge-R-EPOCH njengenguqu "ecutshulwa" ye-R-CHOP eneempawu ezimbalwa ezibalulekileyo.
I-R-EPOCH ihluke kwi-R-CHOP kungekhona kuphela kwongezwa kwe-epoposide, kodwa nakwi-e-schematic delivery of the chemotherapy agents kunye namayeza abo emzimbeni.
Kwi-R-EPOCH, i- chemotherapies ifakwe kwiindawo eziguquguqukayo kwixesha elide-iintsuku ezine. Oku kuhambelani ne-R-CHOP yendabuko, apho umjikelezo ngamnye, i-CHOP inikelwa ngokukhawuleza, kwindawo ebizwa ngokuba yi-bolus-type administration.
Yintoni i-DA-R-EPOCH?
I-DA-R-EPOCH, ebizwa ngokuba yi-DA-EPOCH-R, ichaza i-regimen nge-etoposide eguqulelwe idosi, prednisone, vincristine, cyclophosphamide, doxorubicin (kunye ne-rituximab). Kule ndlela ehlukileyo ye-regimen, amanani e-chemotherapies ahlengahlengiswa ukuze azame ukwandisa ukusebenza.
I-DA-EPOCH irejimeni yenziwe kwiNational Cancer Institute (NCI) ngokusekelwe kwingcamango yokuba ukulungiswa kokukhethwa kwezidakamizwa, ishedyuli yeziyobisi kunye nokuchithwa kweziyobisi kumaseli omhlaza kuza kuvelisa iziphumo ezingcono kune-CHOP regimen kwizigulane ezingenalo i-Hodgkin lymphoma.
I-rejista ye-infusion eqhubekayo yeeyure ezingama-96 yaphuhliswa, apho i-DA-EPOCH ilawulwa rhoqo iintsuku ezingama-21.
Ukulungiswa kweelayi kwi doxorubicin, etoposide, kunye ne-cyclophosphamide zenziwe ngokusekelwe kwinqanaba elincinane (i-neutrophil count count nadir) kumjikelezo wangaphambili.
Uphando nge-R-EPOCH kwi-DLBCL Subsets
I-Lymphomas ngokuqhelekileyo iqokelelwe kwiindidi ezibini eziphambili: iHodgkin lymphoma (HL) kunye non-Hodgkin lymphoma (NHL). Ukusabalalisa i-B-cell lymphoma enkulu (iDLBCL) iyona nto iqhelekileyo ye-B-cell NHL, emele ama-30 ukuya kuma-35 ekhulwini amatyala kwaye inokuchaphazela izigulane zonyaka.
Umbutho wezeMpilo wehlabathi (i-WHO) ubeka iDLBCL kwiindidi ezine ezinkulu. I-category enkulu kunazo zonke-i-DLBCL engacacisiwe ngenye indlela-inokuphinda ihlulwe ibe ngamacandelo amathathu esekelwe kwiseli yemvelaphi, kubandakanywa isikhungo se-B-cell (GCB), i-B-cell (ABC), kunye ne-B-cell lymphoma (PMBL).
Ngamanye amagama, xa ukhangela i-molecular level, i-DLBCL yiqela elihlukeneyo le-lymphomas kunye neentlobo ezahlukeneyo ze-DLBCL zinokuthi zineendlela ezahlukeneyo zonyango . Ukongezelela, uhlobo oluthile lwe-lymphoma enobudlova lubizwa ngokuthi "i-double hit" lymphoma. I-DHL inezinto ezingafaniyo zofuzo ezingachaphazela iziphumo. Ukusetyenziswa kwazo zonke iinkcukacha malunga ne-DLBCL kunakho ukuguqula unyango, kodwa ngoku okwangoku kukho indawo engaxhaswanga kunye nesihloko sophando oluqhubekayo.
Ngesinye isikhathi, kwakukho ithemba lokuba iziphumo ze-dose eguqulelwe i-R-EPOCH ziza kuba ziphezulu kune-R-CHOP ngokubanzi kwizigulane ezine-DLBCL. Nangona le nto ingaba yinyaniso kwiissetyenzisi ezikhethiweyo, kubonakala kungenjalo imeko, ubuncinane ngokusekelwe kubungqina obukhoyo.
Uhlolisiso lwabathathi-nxaxheba abangama-524 luthelekisa nokusebenza kolawulo lwe-R-CHOP kunye ne-DA-R-EPOCH iirimimenti ekuphatheni izigulane ze-DLBCL, ngokukodwa kwi-GCB kunye ne-ABC subtypes. Abathathi-nxaxheba babelwe ukuba bafumane i-R- CHOP okanye i-DA-EPOCH-R, kunye nokulandelelana okuphakathi kweminyaka emihlanu, iziphumo zokusinda zifana phakathi kwamaqela. I-DA-EPOCH ibonise ukwanda kwetyhefu, kodwa kulindeleke ukuba isekelwe kwizinga eliphezulu leqondo.
Sekunjalo, abaphandi bakhawuleza ukubonisa ukuba kuphinde kuhlaziywe ngakumbi ukuhlalutya imiphumo eyahlukileyo kwiingqutyana ezithile zezigulane ezine-DLBCL.
I-DLBCL Ngomxholo ophezulu we-Ki-67
I-Ki-67 ngummakishi osetyenziswe kwiindidi ezinomdlavuza njengesalathiso sokwanda-oko kukuthi, umakishi wokukhula kweseli malunga nokuhlukana kweseli. Ukuxhamla ngokukhuphuka okuphezulu kulindeleke ukuba kubonakaliswe ngokuphezulu kwi-Ki-67.
I-regomen ye-EPOCH yaphuhliswa inxalenye esekelwe kwingcamango yokuba ukwandiswa kwezidakamizwa kungabonakalisa ukwenziwa ngcono kwe-regusen ye-bolus, njenge-CHOP.
Kwisifundo esedlulileyo, kwacaciswa ukuba izigulane ze-DLBCL ezinezibonakalisi eziphezulu ze-Ki-67 zafumana iinzuzo zokusinda ezixhomekeke kwi-R-CHOP unyango. Ngenxa yoko, isifundo sikaHuang kunye nabalingane bajolise ekuphandeni ukuba i-R-EPOCH iphezulu kune-R-CHOP kwizigulane ezingapheliyo ze-DLBCL ezinezibonakalisi eziphezulu ze-Ki-67.
I-Huang kunye noogxa basebenzisana no-R-EPOCH njengemigangatho yokuqala yomgca kwizigulane ze-DLBCL ezinezandi eziphezulu ze-Ki-67 kwaye zithelekisa ukuphumelela kwonyango lwe-R-EPOCH kunye ne-R-CHOP kule nxalenye ngokusebenzisa ukulawula okufanayo. Iziphumo zabo zicebise ukuba izigulane ziphathwe nge-R-EPOCH irejimen ibonisa ukuqhubeka nokuphila kunokuba kulawulwe i-R-CHOP, kwaye bacela ukuqhubela phambili izifundo ukuze baqinisekise ukufunyaniswa kunye nokuchonga izixhobo zokuhlaziya izixhobo zokusetyenziswa ngokubambisana no-R-EPOCH unyango .
Double Hit Lymphoma
Ukubetha kabini i-lymphomas, okanye i-DHLs, i-akhawunti yimiba ye-DLBCL ibe ngamahlanu ukuya kwe-10, kwaye uninzi lunokuthi lufakwe njengolu hlobo lwezityalo kunye nokubonisa izakhi ze-BCL-2 (BCL-2 + / MYC +). I-subset encinci ye-DHLs ibonisa iBBCL-6 (BCL-6 + / MYC +) okanye ivakalise zombini i-BCL-2 ne-BCL-6 kwaye ibizwa ngokuba yi-lymphomas (BCL-2 + / BCL-6 + / MYC +).
Izigulane ezine-DHLs zihlala zineempembelelo ezingekho kakuhle, amanqaku aphezulu e-IPI, kunye nokubandakanyeka komnxeba wethambo okanye inkqubo ye-nervous central. I-regimen efanelekileyo ye-DHLs ayiyazi; Nangona kunjalo, izigulane ezithe zafumana iR-CHOP-like regimens zineempembelelo ezimbi, kunye nokuphila okuphakathi kweenyanga ezili-12.
Kuhlalutyo lokuphindaphindiweyo, ukuqhubeka kokuqhubekeka kokuqhubekayo okuqhubekayo kuphuculwe kunye nemigangatho eninzi, kuquka iDA-EPOCH-R, xa kuthelekiswa ne-R-CHOP. I-DA-EPOCH-R ibangelwa kwiirhafu eziphezulu kakhulu zokuxolelwa ngokupheleleyo kunezinye iirimi ezinzulu.
I-Primary Mediastinal Lymphoma (PMBL)
I-PMBL yenye enye i-subtype ye-DLBCL emele ama-10 ekhulwini lamatyala e-DLBCL. Kuyiklinikhi kunye ne-biologically ehambelana ne-nodular sclerosing i-Hodgkin lymphoma, ephuma kwi-thymic B-cell.
I-PMBL inobundlobongela kwaye iqhubela kwi- mass mediinal . Uninzi lwezigulane ziye zatshintshwa kwi-gene-BCL-6. I-immunochemotherapy ephezulu ayiyisebenzisayo, kwaye ezininzi izigulana zifuna imitha ye-mediastinal, engakhokelela kwimiphumo emibi emva kwexesha. Le lymphoma engaqhelekanga yinto engekho nkcazelo yeenkliniki yokufunda; Nangona kunjalo, i-data ekhangele phambili kumatyala adlulileyo (uphando oluthileyo) lubonisa ukuba ii-regimens ezinzulu kakhulu zibonakala zisebenza ngakumbi kune-R-CHOP.
Kuhlalutyo olulandelayo, izinga lokungaphumeleli kwi-R-CHOP lilingama-21 ekhulwini, ebonisa ukuba kuyimfuneko yokwelashwa kwezinye iindlela.
I-DA-EPOCH-R isebenzisa amaqhinga okungena kwamanzi apho amayeza etoposide, doxorubicin, kunye ne-cyclophosphamide ahlengahlengiswa ukuze kube lula kakhulu. Iziphumo zesilingo esisodwa seengalo kunye ne-DA-EPOCH-R, eqhutywe ngabaphandi be-NCI, elandela izigulane ezingama-51 kwithuba eliyiminyaka eyi-14, zapapashwa ngo-Apreli 11, 2013, kwincwadi ye -New England Journal of Medicine. .
Izigulane ezingamashumi amahlanu-nye ezineziphumo ze-B-cell lymphoma eziphambili ezingaphelelwanga zifakwe kulolu cwaningo. Zonke izigulane ezimbini ziphumelele ukuxolelwa ngokupheleleyo nge-DA-EPOCH-R unyango, kwaye akukho namnye wezigulane ezixoxwayo ngokupheleleyo eziye zavelisa i-lymphoma ephindaphindiweyo. Ezi zigulane ezimbini ezingazange ziphumelele ukuxolelwa ngokupheleleyo zifumene imirhumo kwaye azizange zibuye ziphinde zihlambe. Kwakungabikho ubungqina bezinye izifo eziphuhlisa kamva okanye iziphumo ezinobungozi benhliziyo.
Uhlalutyo lwamanyathelo amaninzi lwabantu abadala abane-PMBL lifanisa ukusinda jikelele kwizigulane eziphathwe ngale mijimeni (132 izigulane ezichazwe kumaziko anikezelayo angama-56; 56 R-CHOP kunye no-76 DA-R-EPOCH). Nangona ixabiso lokugqithisa elipheleleyo liphezulu kunye ne-DA-R-EPOCH (amaphesenti angama-84 kunye nama-70 ekhulwini), ezi zigulane zenzeka ukuba zifumane unyango olunxulumene neyeza. Kwiminyaka emibili, iipesenti ezingama-89 zezigulane ze-R-CHOP kunye neepesenti ezingama-91 zezigulane ze-DA-R-EPOCH zaziphila.
I-R-EPOCH ye-Burkitt Lymphoma kwizigulane ezine-HIV / ezingenayo i-HIV
I-Burkitt lymphoma ixhaphake kakhulu kwi-equatorial Afrika kunamazwe aseNtshona. I-Burkitt isifo esenzeka rhoqo kwizigulane zikaGawulayo ezikhuselekileyo. Amanqanaba okuphilisa i-Burkitt lymphoma kumazwe aseNtshona afikelela kuma-90 ekhulwini kubantwana, kanti kuphela iipesenti ezingama-30 ukuya kuma-50 ekhulwini kubantwana base-Afrika baphiliswa ngenxa yokungakwazi ukulawula unyango oluphezulu lwezonyango.
Uvavanyo lwaluqhutywa nguWilson kunye noogxa kwi-National Cancer Institute (NCI) kwaye babonakala kwiNew England Journal of Medicine. Ulingo lwalubandakanya ukutshintsha okubini kwe-EPOCH-R, okubandakanya ukutyhila ixesha elide kwiindawo ezincinci zamachiza endaweni yokugqithisa ngokukhawuleza kwiindawo eziphezulu zamachiza.
Izigulane ezingama-30 ezazingaphathwa kakubi i-Burkitt lymphoma zafakwa kwilingo. Izigulane zanikwa enye yeendidi ezimbini ze-EPOCH-R, kuxhomekeka kwiimeko zabo ze-HIV. Izigulane ezingama-19 ezingenayo igciwane lesandulela ngculazi zitholwe ngokulungelelaniswa kwedoloji (DA) -EPOCH-R, kanti izigulane ezi-11 ezifumana i-HIV zifumana i-SC-EPOCH-RR, efana ne-short-course (SC) ye-EPOCH-R equka amabini ama-rituximab umjikelezo wonyango kwaye unesifo esiphantsi kwe-DA-EPOCH-R.
Ulungiso lwamanqanaba e dosi lwenziwe ukuzama ukubonelela ngokuthe ngqo inani lezonyango ezisusela ekunyamezelweni komntu we-chemotherapy. Izidakamizwa eziphambili ezibonwe kwilingo kwakuyi-fever kunye ne-neutropenia (ubuncinane bee-cell white counts); akukho kufa okuhlobene nonyango kwenzeka. Ngamaxesha alandelelanayo okulandelelana kwezigidi eziyi-86 neye-73, inani lokusinda lilonke lalingama-100 ekhulwini kunye ne-90 ekhulwini, ngokulandelana, kunye ne-DA-EPOCH-R kunye ne-SC-EPOCH-RR.
Ngokusekelwe kwezi ziphumo, izilingo zokuqinisekisa ukuphumelela kwonyango lwe-EPOCH-R kumagulane akhulileyo kunye neengxaki zezilwanyana zaseBurkitt lymphoma zaqaliswa.
ILizwi
I-regomen ye-dose-adjusted-EPOCH yaqulunqwa kwiNational Cancer Institute, esekelwe kwingcamango yokuba ukwandisa ukukhethwa kwezidakamizwa, ukuhanjiswa kunye nokutyhila okubangelwa ngumhlaza wecala kuza kuvelisa iziphumo ezingcono kune-CHOP regimen kwizigulane ezinezigulane ezingenalo i-Hodgkin lymphoma.
Nangona kwakukho ithemba lokuqala lokuba i-R-EPOCH iya kufikelela kwiziphumo ezingcono kuneR-CHOP ngokubanzi kwizigulane ezine-DLBCL, ngoku kugxininiswa ukuba le regimen ingaphucula iziphumo zeefomathi ezikhethiweyo zezigulane ezine-DLBCL kunye nezinye izigulane. Ukuba uya kula ma-subset, xubusha ukhetho kunye nogqirha wakho.
> Imithombo:
> I-Curry MA, i-Liewer S. Ukwenza ukhetho olunolwazi olwenziwe ngolwaphulo olungenalo i-Hodgkin lymphoma: i-R-CHOP i-regimen versus EPOCH-R. J Hematol Oncol Pharm . 2016; 6 (4): 145-152.
> Dunleavy K, Pittaluga S, Shovlin M, et al. Ukunyanga okunyanzelekileyo kwi-Burkitt lymphoma. N Engl J Med. 2013; 369 (20): 1915-25.
> Wilson HW et al. Uvavanyo lweSigaba III ngokulandelelwaniswa kwe-R-CHOP ngokumalunga ne-DA-EPOCH-R kunye nohlalutyo lwama-molecular of Diffuse Large B-Cell Lymphoma: CALGB / Alliance 50303. 2016 Disemba 4; I-Oral Abstract # 469: I-ASH 58 yeNtlanganiso Yonyaka kunye nokuboniswa, iSan Diego, CA.