R-EPOCH, yomwe imatchedwanso EPOCH-R, ndi mankhwala omwe amagwiritsidwa ntchito pofuna kuthana ndi malungo ena, makamaka mitundu yambiri ya nkhanza yopanda mphamvu ya Hodgkin lymphoma .
Mankhwalawa ndi awa:
- R = Chiwerengero
- E = Etoposide phosphate
- P = Prednone
- O = Vincristine sulfate (Oncovin)
- C = Cyclophosphamide
- H = Doxorubicin hydrochloride (Hydroxydaunorubicin)
R-EPOCH vs. R-CHOP
Ngati mumadziŵa kale dzina la R-CHOP , regimen yomwe nthawi zambiri imagwiritsidwa ntchito m'malo mwa Hodgkin lymphoma, ndiye kuti mungaganize za R-EPOCH monga "chophwanyika" cha R-CHOP ndi zosiyana zosiyana.
R-EPOCH imasiyanasiyana ndi R-CHOP osati kokha kuwonjezera pa etoposide, komanso pa kukonzekera kwa mankhwala a chemotherapy ndi mlingo wawo kwa thupi.
Mu R-EPOCH, mankhwala a chemotherapies amamasulidwa pakamwa mosiyanasiyana kwa nthawi yaitali-masiku anai. Izi ndi zosiyana ndi chikhalidwe cha R-CHOP, chomwe chimachitika panthawi iliyonse, CHOP imaperekedwa mwakamodzi, mu bungwe lomwe limatchedwa bungus.
Kodi DA-R-EPOCH N'chiyani?
DA-R-EPOCH, yomwe imatchedwanso DA-EPOCH-R, imalongosola kachitidwe ka etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (ndi rituximab). M'malo osiyanasiyana a regimen, mlingo wa chemotherapies amasinthidwa kuti ayese kuwonjezera mphamvu.
Dipatimenti ya DA-EPOCH inakhazikitsidwa ku National Cancer Institute (NCI) pogwiritsa ntchito lingaliro lakuti kukonzekera kwa mankhwala osokoneza bongo, ndondomeko ya mankhwala, ndi kusokoneza mankhwala kwa maselo a khansa kungabweretse zotsatira zabwino kuposa chiwerengero cha CHOP kwa odwala omwe si a Hodgkin lymphoma.
Pulogalamu ya maola 96 yowonjezereka yakhazikika, yomwe DA-EPOCH imaperekedwa masiku onse 21.
Kusintha kwa dose ku doxorubicin, etoposide, ndi cyclophosphamide kumapangidwa kuchokera pa chiwerengero chochepa kwambiri (absolute neutrophil count nadir) m'mbuyomo.
Kafukufuku pa R-EPOCH kwa DLBCL Subsets
Mafupa amadzimadzi amakhala m'magulu awiri: Hodgkin lymphoma (HL) ndi omwe si a Hodgkin lymphoma (NHL). Kuphwanya lalikulu B-cell lymphoma (DLBCL) ndilo B-cell NHL yambiri, yomwe imaimira 30 mpaka 35 peresenti ya milandu ndipo imakhudza odwala a mibadwo yonse.
Bungwe la World Health Organization (WHO) limaika DLBCL m'magulu akuluakulu anayi. Gulu lalikulu kwambiri-DLBCL losatchulidwa mwachindunji-likhoza kugawidwa kwambiri mu magawo atatu omwe amachokera ku selo yoyambira, kuphatikizapo majeremusi a B-cell-like (GCB), a B-cell (ABC) omwe amavomerezedwa, ndi a primary-mediastinal B-cell lymphoma (PMBL).
Mwa kuyankhula kwina, poyang'ana pa msinkhu wa maselo, DLBCL ndi gulu losiyanasiyana la maimphine ndi mitundu yosiyanasiyana ya DLBCL akhoza kukhala osiyana ndi mankhwala . Kuphatikizanso apo, mtundu wina woopsa wa lymphoma umatchedwa "kuphwanyidwa" kaŵirikaŵiri kakomboma. DHL ili ndi zovuta zenizeni zomwe zingakhudze zotsatira. Kugwiritsira ntchito zonsezi za DLBCL kungasinthe mankhwala, koma panopa ndi malo osokonezeka komanso phunziro la kafukufuku wopitirira.
Panthawi ina, panali chiyembekezo chimene chidzasinthidwa ndi mlingo wa R-EPOCH kukhala wamkulu kuposa R-CHOP makamaka kwa odwala omwe ali ndi DLBCL. Ngakhale kuti izi zikhoza kukhala zenizeni m'magulu osankhidwa, zikuoneka kuti sizinali choncho, malinga ndi umboni womwe alipo.
Kafukufuku wa ophunzira okwana 524 anayerekezera mphamvu ya R-CHOP ndi DA-R-EPOCH mabungwe pochiza odwala DLBCL, makamaka mu GCB ndi ABC subtypes. Ophunzirawo anapatsidwa ntchito kuti alandire R- CHOP kapena DA-EPOCH-R, ndipo pakapita zaka pafupifupi zisanu, zotsatira zowonjezera zinali zofanana pakati pa magulu. DA-EPOCH inasonyeza kuwonjezeka kwa poizoni, koma izi zinkayembekezeredwa chifukwa cha mlingo wapamwamba kwambiri.
Komabe, ofufuza adafulumira kunena kuti kufufuza kwina kuli kofunikira kuti mudziwe zotsatira za madongosolo osiyanasiyana pa odwala omwe ali ndi DLBCL.
DLBCL Ndi Ndemanga Yapamwamba Ki-67
Ki-67 ndi chizindikiro chomwe chagwiritsidwa ntchito m'magazi osiyanasiyana ngati ndondomeko ya kuchulukitsa-yomwe ndi chizindikiro cha kukula kwa maselo pokhudzana ndi magawano. Ziphuphu ndi kuwonjezeka kwakukulu zikuyembekezeredwa kukhala ndi maonekedwe a Ki-67.
Pulogalamu ya EPOCH inakhazikitsidwa pang'onopang'ono poganiza kuti kuwonjezereka kwa mankhwala osokoneza bongo kungapangitse bwino kupititsa patsogolo mankhwala oposa antusumor regimen, monga CHOP.
Mu phunziro lapitalo, zinatsimikiziridwa kuti odwala a DLBCL okhala ndi mawu apamwamba a Ki-67 adalandira kupulumuka kochepa kwa R-CHOP mankhwala. Choncho, phunziro la Huang ndi anzake ogwira ntchito likufuna kufufuza ngati R-EPOCH iliposa R-CHOP mwa odwala omwe sanatengedwe ndi DLBCL omwe ali ndi chiganizo chokwanira cha Ki-67.
Huang ndi anzake amagwira ntchito R-EPOCH monga mzere woyamba pa odwala DLBCL omwe ali ndi mawu apamwamba a Ki-67 ndipo anayerekezera njira yothandizira ya R-EPOCH ndi R-CHOP kuchipatala pogwiritsa ntchito njira zofanana. Zotsatira zawo zimasonyeza kuti odwala amathandizidwa ndi R-EPOCH yomwe imapulumuka kwambiri kuposa awo omwe ankayang'anira R-CHOP, ndipo adayitanitsa kufufuza kuti apitirize kufufuza kuti adziwe zomwe zapeza ndikupeza zida zogwiritsira ntchito zogwiritsa ntchito ndi R-EPOCH mankhwala .
Double Hit Lymphoma
Ambiri amadzipiritsa mitsempha, kapena DHLs, amawerengera 5 mpaka 10 peresenti ya milandu ya DLBCL, ndipo ambiri akhoza kufotokozedwa ngati mbeu ya germinal ndi kufotokoza ma jeremusi BCL-2 (BCL-2 + / MYC +). DHLs ndogo ya DHLs imafotokoza BCL-6 (BCL-6 + / MYC +) kapena imafotokoza zonse BCL-2 ndi BCL-6 ndipo imatchedwa ma lymphomas (BCL-2 + / BCL-6 + / MYC +).
Odwala omwe ali ndi DHLs nthawi zambiri amakhala ndi malingaliro osauka, mapulogalamu apamwamba a IPI, komanso kuphatikizidwa kwa mafupa kapena dongosolo la mitsempha. Dipatimenti yoyenera ya DHLs siidziwika; Komabe, odwala omwe analandira ma R-CHOP-ali ndi vuto loperewera, amakhala ndi moyo wapakati pa miyezi yosachepera 12.
Pofufuza mwachidwi, kupulumuka kwapanda phindu kwapakati pazomwekukuyenda bwino ndi machitidwe olemera kwambiri, kuphatikizapo DA-EPOCH-R, poyerekeza ndi R-CHOP. Dipatimenti ya DA-EPOCH-R inachititsa kuti chiwerengero chachikulu cha chikhululukiro chokwanira chikhale chokwanira kuposa ma regimen ena olemera.
Primary Mediastinal Lymphoma (PMBL)
PMBL ndi gawo lina la DLBCL lomwe limaimira 10 peresenti ya milandu ya DLBCL. Ndizochitika kuchipatala komanso zamoyo zomwe zimagwirizana ndi nodular sclerosing Hodgkin lymphoma, yomwe imachokeranso ku maselo a thymic B.
PMBL ndi wamwano ndipo imakula mpaka pakatikati . Odwala ambiri ali ndi kusintha kwa jini la BCL-6. Mankhwala a immunochemotherapy si othandiza, ndipo odwala ambiri amafuna ma radiation a pakati, omwe angabweretse mavuto aakulu. Ichi ndi chosowa kwambiri cha lymphoma, osati ndi deta yambiri yophunzira zachipatala; Komabe, deta yomwe ikuyang'ana mmbuyomu m'mbuyo mwake (kafukufuku wamakono) imasonyeza kuti madokotala ambiri amadziwika kuti ndi othandiza kuposa R-CHOP.
Pofufuza mwachidule, mlingo wolephera wa R-CHOP unali 21 peresenti, ponena kuti pakufunika njira zina zothandizira.
DA-EPOCH-R amagwiritsira ntchito njira zowonongeka zomwe mankhwala osokoneza bongo etoposide, doxorubicin, ndi cyclophosphamide amasinthidwa kuti athetse mphamvu. Zotsatira za mayesero amodzi ndi DA-EPOCH-R, ochita kafukufuku a NCI, omwe adatsatira odwala 51 kwa zaka 14, anafalitsidwa mu magazini ya New England Journal of Medicine pa April 11, 2013. .
Odwala makumi asanu ndi limodzi ndi mmodzi omwe ali ndi ma B-cell lymphoma omwe sagwiritsidwe ntchito mopanda chithandizo anaphatikizidwa mu phunziro ili. Odwala onse oposa awiri adalandira chikhululukiro chonse ndi mankhwala a DA-EPOCH-R, ndipo palibe amene ali ndi chikhululukiro chokwanira chakhala ndi lymphoma yowonongeka. Odwala awiri omwe sanakwanitse kukalandira mpweya wabwino amalandira ma radiation ndipo sanakhalenso ndi zotupa. Panalibenso umboni wa matenda ena omwe amayamba mtsogolo kapena zotsatira zoopsa za mtima.
Kusanthula kwa anthu akuluakulu omwe ali ndi PMBL kunayesa kupulumuka kwa odwala omwe ali ndi matendawa (odwala 132 omwe amadziwika ku malo 11 othandizira, 56 R-CHOP ndi 76 DA-R-EPOCH). Ngakhale kuti ndalama zothandizira kwathunthu zinali zazikulu ndi DA-R-EPOCH (84 peresenti ndi 70 peresenti), odwalawa anali odwala kwambiri. Pazaka ziŵiri, 89 peresenti ya odwala R-CHOP ndi 91 peresenti ya odwala DA-R-EPOCH anali amoyo.
R-EPOCH kwa Burkitt Lymphoma kwa Odwala Ndi / Osakhala ndi HIV
Burkitt lymphoma imafala kwambiri ku equatorial Africa kuposa m'mayiko a kumadzulo. Burkitt ndi matenda omwe amapezeka kawirikawiri m'magulu odwala matenda a Edzi omwe amatetezedwa ndi mthupi. Mankhwala a Burkitt lymphoma m'mayiko a Kumadzulo amapitirira 90 peresenti kwa ana, pamene 30 peresenti mpaka 50 peresenti ya ana ku Africa amachiritsidwa chifukwa cholephera kupereka mankhwala apamwamba kwambiri mosamala.
Chiyeso chinachitidwa ndi Wilson ndi anzake ku National Cancer Institute (NCI) ndipo adawonekera ku New England Journal of Medicine. Mlanduwu unaphatikizapo mitundu iŵiri ya EPOCH-R, yomwe imakhudza nthawi yayitali ndi mankhwala osokoneza bongo m'malo mochepetsera mankhwala osokoneza bongo.
Odwala makumi atatu omwe anali ndi Burkitt lymphoma asanayambe kutengedwera anaphatikizidwa mu mayesero. Odwala adalandira chimodzi mwa mitundu iwiri ya EPOCH-R, malingana ndi momwe aliri ndi kachirombo ka HIV. Odwala khumi ndi anayi omwe alibe kachilombo ka HIV adalandira ma ARV (DA) -EPOCH-R, pamene odwala 11 omwe ali ndi kachilombo ka HIV adalandira SC-EPOCH-RR, yosiyana ndi EPOCH-R yomwe imaphatikizapo mitundu iwiri ya rituximab pafupipafupi komanso mankhwala ochepetsetsa kuposa DA-EPOCH-R.
Kusintha kwa mlingo wa mlingo kumachitika pofuna kuyesa kuchulukitsa kuchuluka kwa mankhwala chifukwa cha kulolerana kwa chemotherapy. Mavuto aakulu omwe amapezeka poyesedwa anali fever ndi neutropenia (ochepa maselo oyera a magazi); palibe imfa zokhudzana ndi chithandizo. Ndili ndi nthawi yotsatira ya miyezi 86 ndi miyezi 73, chiwerengero chonse cha moyo chinali 100% ndipo 90 peresenti, ndi DA-EPOCH-R ndi SC-EPOCH-RR.
Malingana ndi zotsatirazi, mayesero otsimikizira kuti ntchito ya EPOCH-R imathandizira pa odwala akuluakulu komanso odwala a Burkitt lymphoma.
Mawu Ochokera
Ndondomeko ya EPOCH inasinthidwa ku National Cancer Institute, pogwiritsa ntchito lingaliro lakuti kukonza mankhwala osokoneza bongo, kubereka ndi kufotokozedwa kwa maselo a khansa kungabweretse zotsatira zabwino kuposa chiwerengero cha CHOP kwa odwala omwe ali ndi nthenda yotchedwa non-Hodgkin lymphoma.
Pamene panali chiyembekezo choyamba kuti R-EPOCH idzapeza zotsatira zabwino kuposa R-CHOP makamaka kwa odwala omwe ali ndi DLBCL, zomwe zilipo tsopano ndizotheka kuti regimen ikhoza kukwaniritsa zotsatira zosiyanasiyana za odwala omwe ali ndi DLBCL ndi zina zoipa. Ngati mulowa muzigawozi, kambiranani ndi dokotalayo.
> Zotsatira:
> Curry MA, Liewer S. Kupanga chisankho chodziwika bwino cha mankhwala oopsa omwe si a Hodgkin lymphoma: R-CHOP regimen ndi EPOCH-R. J Hematol Oncol Pharm . 2016; 6 (4): 145-152.
Dunleavy K, Pittaluga S, Shovlin M, et al. Mankhwala otsika kwambiri mu wamkulu wa Burkitt lymphoma. N Engl J Med. 2013; 369 (20): 1915-25.
> Wilson HW et al. Maphunziro a Phase III mwachindunji a R-CHOP motsutsana ndi DA-EPOCH-R ndi kusanthula maselo a B-Cell Lymphoma omwe sagwidwa ndi matenda aakulu: CALGB / Alliance 50303. 2016 December 4; Mwamwayi Abwino # # 469: Msonkhano wa pachaka wa ASH 58 ndi Kuwonetsera, San Diego, CA.