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EN
Human cytomegalovirus (HCMV) infection remains the leading cause of serious contagious complications after allogeneic hematopoietic stem cell transplantation. These infections in HCMV-seropositive recipients can be due to reactivation or reinfection. Different HCMV strains were identified by determining the genotypes isolated from repeatedly tested patients. The UL55 sequences encoding viral glycoprotein B (gB) have been chosen as the target gene. The region, in which the gB precursor protein is cleaved into two fragments by a cellular endoprotease, is characterized by genetic variability, and based on that HCMV is classified into four major genotypes: gB1, gB2, gB3 and gB4. Multiplex real-time PCR assay enabled both, HCMV gB genotyping, as well as simultaneous quantitative assessment of the detected genotypes. This study was carried out in 30 transplant recipients, from whom 105 isolates of HCMV DNA were genotyped. In 40% of recipients, a mixed infection with two or three genotypes was detected. Genotype gB1 dominated in general, and characteristically for mixed infections, the genotype gB3 or gB4 was always present. Although there were no significant differences in the load for each genotype, in case of multiple infections, the number of copies of gB1 genotype was significantly higher when compared to a single gB1 infection. In patients with mixed genotypes, chronic HCMV infections and graft versus host disease were observed more often, as well as antiviral treatment was less effective. It was assumed that these adverse effects can be related to the presence of gB3 and gB4 genotypes.
EN
Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in Western European countries. This disease occurs mainly in adult population at an age of over 50 years, more commonly in men. Many years of research have shown that CLL is a disease with a very diverse clinical course and variable sensitivity to treatment. Therefore, in each case of newly diagnosed CLL, the clinical stage, prognostic factors and individualized therapeutic goals should be precisely defined before the treatment initiation. Recent 50 years have been a period of significant development in the treatment of proliferative diseases of the hematopoietic and lymphatic systems. Along with dynamic development of molecular biology techniques, several new specific prognostic markers have been investigated and introduced, allowing better stratification of patients and more accurate direction of the therapy. A lot of effort has gone into searching for the next prognostic factors which allow to determine better probable life span and to implement the successful treatment. Furthermore, many preclinical and clinical studies continually extend the list of effective anticancer drugs, including these for CLL treatment. Increasingly, in addition to standard cytostatics, drugs with more selective mechanisms of action are being tested in monotherapy and new combinations. Considering the historical aspects, only a few anticancer drugs were available 50 years ago. In addition, they mainly presented the one mechanism of action directed at nucleic acids. Today, the list of effective drugs is significantly longer. In addition to typical cytostatics, it also contains drugs with selective mechanisms of action, affecting the cell life processes, their subcellular structures, signaling from outside and inside the cell, surface antigens, as well as drugs that act on the microenvironment of cancer cells and their vascularization. The aim of this paper was to show the historical background in the therapy of leukemia and summarize the current knowledge in CLL biology and treatments. The manuscript is focused on the clinical course of the disease, the main risk factors and mainly, on the available treatment strategies.
PL
Przewlekła białaczka limfocytowa (PBL) jest najczęściej występującą postacią białaczki w krajach Europy Zachodniej. Jest to choroba dotycząca przede wszystkim osób powyżej 50 roku życia, częściej mężczyzn niż kobiet. Wieloletnie badania wykazały, że PBL jest chorobą o bardzo zróżnicowanym przebiegu klinicznym i zmiennej wrażliwości na zastosowane leczenie. W związku z powyższym, w każdym przypadku nowo zdiagnozowanej PBL, przed rozpoczęciem leczenia, należy precyzyjnie określić stadium zaawansowania klinicznego, czynniki prognostyczne oraz cele terapeutyczne zindywidualizowane dla danego pacjenta. Ostatnie 50 lat to okres istotnego postępu w leczeniu chorób rozrostowych układu krwiotwórczego i chłonnego. Wraz z dynamicznym rozwojem technik biologii molekularnej pojawiły się nowe, specyficzne czynniki prognostyczne, umożliwiające lepszą stratyfikację chorych oraz dokładniejsze określenie dalszego kierunku terapii. W dalszym ciągu prowadzone są prace nad kolejnymi czynnikami umożliwiającymi określenie długości przeżycia pacjenta oraz szans powodzenia terapii. Jednocześnie prowadzone badania przedkliniczne i kliniczne wydłużają listę bardziej skutecznych leków przeciwnowotworowych, znajdujących swoje zastosowanie również w PBL. Coraz częściej obok standardowych cytostatyków pojawiają się leki o bardziej swoistym mechanizmie działania, zarówno w monoterapii, jak i w nowych połączeniach. Celem pracy było przedstawienie rysu historycznego w zakresie terapii białaczek i przegląd dotychczasowej wiedzy na temat charakterystyki i terapii PBL. W artykule zwrócono szczególną uwagę na przebieg choroby, czynniki ryzyka oraz stosowane obecnie strategie leczenia.
EN
Diffuse large B-cell lymphomas are the most common group among all lymphomas. Despite the effectiveness of the I line therapy in 10–40% of patients, the possibility of relapse should be taken into account. The anthracycline antibiotics used in the II line therapy carry a high risk of cardiac complications. In patients with refractory or recurrent disease, emergency treatment is used, aiming for the transplantation of hematopoietic cells. If the II line therapy fails, the prognosis is bad. A new chance for patients with refractory or recurrent B-cell lymphoma is pixantrone dimaleate, a drug structurally related to anthracyclines with a significantly lower cardiotoxic potential. The paper presents a case of a 65-year-old patient with relapsing DLBCL lymphoma, after two treatment lines: R-CHOP and R-DHAP, and after autologous transplantation of stem cells, in which the use of pixantrone in the treatment of recurrence allowed to achieve remission and prepare the patient for the allo-HSCT procedure.
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