gpoh-hd 2002
TRANSCRIPT
GPOH-HD 2002
hojkinis limfomis
optimizirebuli
Terapiis oqmi bavSvTa asakSi
1
oqmis saxeli
hojkinis limfomis mkurnalobis optimizirebuli sqema bavSvTa asakSi
Semoklebuli saxeli
GPOH-HD 2002
Cveneba
hojkinis limfoma bavSvTa asakSi ( 0 ndash 18w)
oqmis mizani
maRali dozis qimioTerapiis da misgan gamomdinare mogvianebiTi garTulebebis Tavidan acileba pirveladi daavadebis da recidivis mkurnalobis dros
oqmis pirveladi kiTxvebi
1SesaZlebelia Tu ara Terapiis pirveli jgufis pacientebs romlebic kompleqsur remisiaSi arian qimioTerapiis dasrulebis Semdeg sxivuri Terapiis ar Catarebis SemTxvevaSi ar gauaresdeT EFS
2 SesaZlebelia Tu ara Terapiis meore da mesame jgufis pacientebSi COPP-ciklSi prokarbazini Seicvalos dakarbaciniT ise rom ar gauaresdes EFS
3riskTan da Terapiis pasuxze adaptirebuli samkurnalo oqmis Sedegebis aRwera recidivis mkurnalobisas
oqmis meoradi kiTxvebi
1 SesaZlebelia Tu ara OEPA-ciklSi etopozidis dozis 20-iT gazrda da amiT adre arsebuli gansxvavebis gauqmeba biWebis da gogonebis samkurnalo sqemebSi
2 SesaZlebelia Tu ara COPP-ciklSi prokarbazinis Secvla dakarbaziniT arsebuli toqsikuri gverdiTi movlenebis pirobebSi
3rogori zemoqmedeba aqvs DHAP-s recidivis mkurnalobis dros IEP-ABVD-sTan SedarebiT
4mosalodnelia Tu ara pozitiuri Sedegi arasasurveli prognozis maCvenebeli maRali dozis qimioTerapiis Catarebis win autologiuri Rerovani ujredebis gadanergviT
2
mkurnaloba
meore da mesame jgufSi randomizirebuli mkurnaloba recidivis optimizirebuli mkurnaloba
samkurnalo populaciebi
bull Aaranamkurnalebi 18-wlamde asakis pacientebi klasikuri hojkinis limfomiT
bull pacientebi asakiT SezRudvis gareSe romlebsac ganuviTardaT pirveladi an meoradi recidivi hojkinis limfomis mkurnalobis Semdeg
pacientebis raodenoba
1200 pacienti Semdegi TanafardobiT jgufebis mixedviT 362836
Terapia
bull yvela pacients diagnozis dasmis Semdeg utardeba ori cikli OEPA(biWebSi) an ori cikli OPPA(gogonebSi) Amis Semdeg Terapiis pirvel jgufSi mkurnalobis Sedegebis mixedviT mkurnaloba an mTavrdeba an grZeldeba sxivuri TerapiiT
bull Terapiis meore da mesame jgufis pacientebi ki iReben COPP-is an COPDIC-is 2 an 4 kurss Semdeg ki sxivur Terapias
bull recidivis mqone pacientebis mkurnaloba xdeba riskTan da Terapiis pasuxze adaptirebuli sqemis mixedviT
samkurnalo oqmis pirveladi mizani
Terapiis ZiriTadi ganmsazRvreli kriteriumia daavadebisagan uSemTxvevo gadarCena (EFS- Event Free Survival)
samkurnalo oqmis saboloo mizani
1mTliani gamojamrTeleba (OS) 2daavadebis progresisagan Tavisufali periodi (PFS) 3Terapiis elementebis toqsiurobis xarisxi (CTC) 4mogvianebiTi Sedegebi
drois monakveTi
dasawyisi 2002 xangrZlivoba 2010 wlamde weliwadSi 180-dan 200 pacientamde mkurnalobis damTavrebidan minimaluri meTvalyureobis dro 5 welia gansazRvruli SeZlebisdagvarad yoveli pacienti mTeli sicocxlis manZilze unda iqnes meTvalyureobis qveS
3
protokolis dizaini gogonebisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
protokolis dizaini biWebisaTvis
4
1 5 9 13 17 21 kvira
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
3 cvlilebebi GPOH-HD95-Tan SedarebiT
5
1 5 9 13 17 21 kvira
I yvela pacientisTvis 1limfocitebiT predominanturi hojkinis limfomis mkurnaloba am sqemiT ar xdeba
2reducirebuli radioTerapia 50-100ml simsivnuri masis dros 2 kursi qimioTerapiis Semdeg(20Gy-nacvlad 35Gy)
3paraaortaluri limfuri jirkvlebis dazianebis SemTxvevaSi elenTis dasxiveba ar xdeba
4radioTerapiis maqsimaluri Semcireba (30Gy-nacvlad 35Gy-sa)
5standartizebuli riskTan da Terapiis efeqturobasTan adaptirebuli recidivis Terapis yvela im pacientisaTvis romelTac ganuviTardaT pirveladi an meoradi recidivi
6 CT-bazirebuli 3D konformaluri sxivuri Terapia
II yvela biWisaTvis etopozidis 5-micema nacvlad 4-sa
OEPA-s ciklSi
III pirveli Terapiuli jg pacientebi kompleqsuri remisiiT ar iReben radioTerapias
IV II da III Terapiuli jg 1randomizacia yvela pacientisaTvis
COPDIC- COPP-is winaaRmdeg 2pirveli ori qimioTerapiuli ciklis
Semdeg radioTerapiis dozis myari gansazRvra
3 radioTerapia yvepacientisTvis romlebic kompleqsur rearian
Tu ra cvlilebebi ganicada hojkinis limfomis samkurnalo gegmam HD-78-dan HD2002-mde mocemulia tabula 1(abg)-Si
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tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
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yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
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1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
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inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
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limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
oqmis saxeli
hojkinis limfomis mkurnalobis optimizirebuli sqema bavSvTa asakSi
Semoklebuli saxeli
GPOH-HD 2002
Cveneba
hojkinis limfoma bavSvTa asakSi ( 0 ndash 18w)
oqmis mizani
maRali dozis qimioTerapiis da misgan gamomdinare mogvianebiTi garTulebebis Tavidan acileba pirveladi daavadebis da recidivis mkurnalobis dros
oqmis pirveladi kiTxvebi
1SesaZlebelia Tu ara Terapiis pirveli jgufis pacientebs romlebic kompleqsur remisiaSi arian qimioTerapiis dasrulebis Semdeg sxivuri Terapiis ar Catarebis SemTxvevaSi ar gauaresdeT EFS
2 SesaZlebelia Tu ara Terapiis meore da mesame jgufis pacientebSi COPP-ciklSi prokarbazini Seicvalos dakarbaciniT ise rom ar gauaresdes EFS
3riskTan da Terapiis pasuxze adaptirebuli samkurnalo oqmis Sedegebis aRwera recidivis mkurnalobisas
oqmis meoradi kiTxvebi
1 SesaZlebelia Tu ara OEPA-ciklSi etopozidis dozis 20-iT gazrda da amiT adre arsebuli gansxvavebis gauqmeba biWebis da gogonebis samkurnalo sqemebSi
2 SesaZlebelia Tu ara COPP-ciklSi prokarbazinis Secvla dakarbaziniT arsebuli toqsikuri gverdiTi movlenebis pirobebSi
3rogori zemoqmedeba aqvs DHAP-s recidivis mkurnalobis dros IEP-ABVD-sTan SedarebiT
4mosalodnelia Tu ara pozitiuri Sedegi arasasurveli prognozis maCvenebeli maRali dozis qimioTerapiis Catarebis win autologiuri Rerovani ujredebis gadanergviT
2
mkurnaloba
meore da mesame jgufSi randomizirebuli mkurnaloba recidivis optimizirebuli mkurnaloba
samkurnalo populaciebi
bull Aaranamkurnalebi 18-wlamde asakis pacientebi klasikuri hojkinis limfomiT
bull pacientebi asakiT SezRudvis gareSe romlebsac ganuviTardaT pirveladi an meoradi recidivi hojkinis limfomis mkurnalobis Semdeg
pacientebis raodenoba
1200 pacienti Semdegi TanafardobiT jgufebis mixedviT 362836
Terapia
bull yvela pacients diagnozis dasmis Semdeg utardeba ori cikli OEPA(biWebSi) an ori cikli OPPA(gogonebSi) Amis Semdeg Terapiis pirvel jgufSi mkurnalobis Sedegebis mixedviT mkurnaloba an mTavrdeba an grZeldeba sxivuri TerapiiT
bull Terapiis meore da mesame jgufis pacientebi ki iReben COPP-is an COPDIC-is 2 an 4 kurss Semdeg ki sxivur Terapias
bull recidivis mqone pacientebis mkurnaloba xdeba riskTan da Terapiis pasuxze adaptirebuli sqemis mixedviT
samkurnalo oqmis pirveladi mizani
Terapiis ZiriTadi ganmsazRvreli kriteriumia daavadebisagan uSemTxvevo gadarCena (EFS- Event Free Survival)
samkurnalo oqmis saboloo mizani
1mTliani gamojamrTeleba (OS) 2daavadebis progresisagan Tavisufali periodi (PFS) 3Terapiis elementebis toqsiurobis xarisxi (CTC) 4mogvianebiTi Sedegebi
drois monakveTi
dasawyisi 2002 xangrZlivoba 2010 wlamde weliwadSi 180-dan 200 pacientamde mkurnalobis damTavrebidan minimaluri meTvalyureobis dro 5 welia gansazRvruli SeZlebisdagvarad yoveli pacienti mTeli sicocxlis manZilze unda iqnes meTvalyureobis qveS
3
protokolis dizaini gogonebisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
protokolis dizaini biWebisaTvis
4
1 5 9 13 17 21 kvira
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
3 cvlilebebi GPOH-HD95-Tan SedarebiT
5
1 5 9 13 17 21 kvira
I yvela pacientisTvis 1limfocitebiT predominanturi hojkinis limfomis mkurnaloba am sqemiT ar xdeba
2reducirebuli radioTerapia 50-100ml simsivnuri masis dros 2 kursi qimioTerapiis Semdeg(20Gy-nacvlad 35Gy)
3paraaortaluri limfuri jirkvlebis dazianebis SemTxvevaSi elenTis dasxiveba ar xdeba
4radioTerapiis maqsimaluri Semcireba (30Gy-nacvlad 35Gy-sa)
5standartizebuli riskTan da Terapiis efeqturobasTan adaptirebuli recidivis Terapis yvela im pacientisaTvis romelTac ganuviTardaT pirveladi an meoradi recidivi
6 CT-bazirebuli 3D konformaluri sxivuri Terapia
II yvela biWisaTvis etopozidis 5-micema nacvlad 4-sa
OEPA-s ciklSi
III pirveli Terapiuli jg pacientebi kompleqsuri remisiiT ar iReben radioTerapias
IV II da III Terapiuli jg 1randomizacia yvela pacientisaTvis
COPDIC- COPP-is winaaRmdeg 2pirveli ori qimioTerapiuli ciklis
Semdeg radioTerapiis dozis myari gansazRvra
3 radioTerapia yvepacientisTvis romlebic kompleqsur rearian
Tu ra cvlilebebi ganicada hojkinis limfomis samkurnalo gegmam HD-78-dan HD2002-mde mocemulia tabula 1(abg)-Si
6
tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
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Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
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outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
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644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
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Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
mkurnaloba
meore da mesame jgufSi randomizirebuli mkurnaloba recidivis optimizirebuli mkurnaloba
samkurnalo populaciebi
bull Aaranamkurnalebi 18-wlamde asakis pacientebi klasikuri hojkinis limfomiT
bull pacientebi asakiT SezRudvis gareSe romlebsac ganuviTardaT pirveladi an meoradi recidivi hojkinis limfomis mkurnalobis Semdeg
pacientebis raodenoba
1200 pacienti Semdegi TanafardobiT jgufebis mixedviT 362836
Terapia
bull yvela pacients diagnozis dasmis Semdeg utardeba ori cikli OEPA(biWebSi) an ori cikli OPPA(gogonebSi) Amis Semdeg Terapiis pirvel jgufSi mkurnalobis Sedegebis mixedviT mkurnaloba an mTavrdeba an grZeldeba sxivuri TerapiiT
bull Terapiis meore da mesame jgufis pacientebi ki iReben COPP-is an COPDIC-is 2 an 4 kurss Semdeg ki sxivur Terapias
bull recidivis mqone pacientebis mkurnaloba xdeba riskTan da Terapiis pasuxze adaptirebuli sqemis mixedviT
samkurnalo oqmis pirveladi mizani
Terapiis ZiriTadi ganmsazRvreli kriteriumia daavadebisagan uSemTxvevo gadarCena (EFS- Event Free Survival)
samkurnalo oqmis saboloo mizani
1mTliani gamojamrTeleba (OS) 2daavadebis progresisagan Tavisufali periodi (PFS) 3Terapiis elementebis toqsiurobis xarisxi (CTC) 4mogvianebiTi Sedegebi
drois monakveTi
dasawyisi 2002 xangrZlivoba 2010 wlamde weliwadSi 180-dan 200 pacientamde mkurnalobis damTavrebidan minimaluri meTvalyureobis dro 5 welia gansazRvruli SeZlebisdagvarad yoveli pacienti mTeli sicocxlis manZilze unda iqnes meTvalyureobis qveS
3
protokolis dizaini gogonebisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
protokolis dizaini biWebisaTvis
4
1 5 9 13 17 21 kvira
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
3 cvlilebebi GPOH-HD95-Tan SedarebiT
5
1 5 9 13 17 21 kvira
I yvela pacientisTvis 1limfocitebiT predominanturi hojkinis limfomis mkurnaloba am sqemiT ar xdeba
2reducirebuli radioTerapia 50-100ml simsivnuri masis dros 2 kursi qimioTerapiis Semdeg(20Gy-nacvlad 35Gy)
3paraaortaluri limfuri jirkvlebis dazianebis SemTxvevaSi elenTis dasxiveba ar xdeba
4radioTerapiis maqsimaluri Semcireba (30Gy-nacvlad 35Gy-sa)
5standartizebuli riskTan da Terapiis efeqturobasTan adaptirebuli recidivis Terapis yvela im pacientisaTvis romelTac ganuviTardaT pirveladi an meoradi recidivi
6 CT-bazirebuli 3D konformaluri sxivuri Terapia
II yvela biWisaTvis etopozidis 5-micema nacvlad 4-sa
OEPA-s ciklSi
III pirveli Terapiuli jg pacientebi kompleqsuri remisiiT ar iReben radioTerapias
IV II da III Terapiuli jg 1randomizacia yvela pacientisaTvis
COPDIC- COPP-is winaaRmdeg 2pirveli ori qimioTerapiuli ciklis
Semdeg radioTerapiis dozis myari gansazRvra
3 radioTerapia yvepacientisTvis romlebic kompleqsur rearian
Tu ra cvlilebebi ganicada hojkinis limfomis samkurnalo gegmam HD-78-dan HD2002-mde mocemulia tabula 1(abg)-Si
6
tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
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inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
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limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
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pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
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Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
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citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
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meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
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COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
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qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
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Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
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Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
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chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
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German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
protokolis dizaini gogonebisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
protokolis dizaini biWebisaTvis
4
1 5 9 13 17 21 kvira
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
3 cvlilebebi GPOH-HD95-Tan SedarebiT
5
1 5 9 13 17 21 kvira
I yvela pacientisTvis 1limfocitebiT predominanturi hojkinis limfomis mkurnaloba am sqemiT ar xdeba
2reducirebuli radioTerapia 50-100ml simsivnuri masis dros 2 kursi qimioTerapiis Semdeg(20Gy-nacvlad 35Gy)
3paraaortaluri limfuri jirkvlebis dazianebis SemTxvevaSi elenTis dasxiveba ar xdeba
4radioTerapiis maqsimaluri Semcireba (30Gy-nacvlad 35Gy-sa)
5standartizebuli riskTan da Terapiis efeqturobasTan adaptirebuli recidivis Terapis yvela im pacientisaTvis romelTac ganuviTardaT pirveladi an meoradi recidivi
6 CT-bazirebuli 3D konformaluri sxivuri Terapia
II yvela biWisaTvis etopozidis 5-micema nacvlad 4-sa
OEPA-s ciklSi
III pirveli Terapiuli jg pacientebi kompleqsuri remisiiT ar iReben radioTerapias
IV II da III Terapiuli jg 1randomizacia yvela pacientisaTvis
COPDIC- COPP-is winaaRmdeg 2pirveli ori qimioTerapiuli ciklis
Semdeg radioTerapiis dozis myari gansazRvra
3 radioTerapia yvepacientisTvis romlebic kompleqsur rearian
Tu ra cvlilebebi ganicada hojkinis limfomis samkurnalo gegmam HD-78-dan HD2002-mde mocemulia tabula 1(abg)-Si
6
tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
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anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
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Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
TG ndash Terapiuli Gjgufi B - B simptomebi A - B simptomebis ar arseboba
3 cvlilebebi GPOH-HD95-Tan SedarebiT
5
1 5 9 13 17 21 kvira
I yvela pacientisTvis 1limfocitebiT predominanturi hojkinis limfomis mkurnaloba am sqemiT ar xdeba
2reducirebuli radioTerapia 50-100ml simsivnuri masis dros 2 kursi qimioTerapiis Semdeg(20Gy-nacvlad 35Gy)
3paraaortaluri limfuri jirkvlebis dazianebis SemTxvevaSi elenTis dasxiveba ar xdeba
4radioTerapiis maqsimaluri Semcireba (30Gy-nacvlad 35Gy-sa)
5standartizebuli riskTan da Terapiis efeqturobasTan adaptirebuli recidivis Terapis yvela im pacientisaTvis romelTac ganuviTardaT pirveladi an meoradi recidivi
6 CT-bazirebuli 3D konformaluri sxivuri Terapia
II yvela biWisaTvis etopozidis 5-micema nacvlad 4-sa
OEPA-s ciklSi
III pirveli Terapiuli jg pacientebi kompleqsuri remisiiT ar iReben radioTerapias
IV II da III Terapiuli jg 1randomizacia yvela pacientisaTvis
COPDIC- COPP-is winaaRmdeg 2pirveli ori qimioTerapiuli ciklis
Semdeg radioTerapiis dozis myari gansazRvra
3 radioTerapia yvepacientisTvis romlebic kompleqsur rearian
Tu ra cvlilebebi ganicada hojkinis limfomis samkurnalo gegmam HD-78-dan HD2002-mde mocemulia tabula 1(abg)-Si
6
tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
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National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
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German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
I yvela pacientisTvis 1limfocitebiT predominanturi hojkinis limfomis mkurnaloba am sqemiT ar xdeba
2reducirebuli radioTerapia 50-100ml simsivnuri masis dros 2 kursi qimioTerapiis Semdeg(20Gy-nacvlad 35Gy)
3paraaortaluri limfuri jirkvlebis dazianebis SemTxvevaSi elenTis dasxiveba ar xdeba
4radioTerapiis maqsimaluri Semcireba (30Gy-nacvlad 35Gy-sa)
5standartizebuli riskTan da Terapiis efeqturobasTan adaptirebuli recidivis Terapis yvela im pacientisaTvis romelTac ganuviTardaT pirveladi an meoradi recidivi
6 CT-bazirebuli 3D konformaluri sxivuri Terapia
II yvela biWisaTvis etopozidis 5-micema nacvlad 4-sa
OEPA-s ciklSi
III pirveli Terapiuli jg pacientebi kompleqsuri remisiiT ar iReben radioTerapias
IV II da III Terapiuli jg 1randomizacia yvela pacientisaTvis
COPDIC- COPP-is winaaRmdeg 2pirveli ori qimioTerapiuli ciklis
Semdeg radioTerapiis dozis myari gansazRvra
3 radioTerapia yvepacientisTvis romlebic kompleqsur rearian
Tu ra cvlilebebi ganicada hojkinis limfomis samkurnalo gegmam HD-78-dan HD2002-mde mocemulia tabula 1(abg)-Si
6
tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
tabula 1 Terapiuli oqmis modifikacia HD 78 ndashdan GPOH-HD 2003-mde
a) Terapiuli jgufi 1
oqmi stadia qimioTeraia radioTerapia
HD-78 ΙΙΙ A 2xOPPA 36-40GGy vrceli velis
DAL-HD 82
ΙΙΙ A 2xOPPA 35GGy pirveladi dazianebis velis
DAL-HD 85
ΙΙΙ A 2xOPA 35GGy
DAL-HD 87
ΙΙΙ A 2xOPA 30GGy
narCeni simsivnis dros35Gy
DAL-HD 90
ΙΙΙ A gogonebi 2xOPPAbiWebi2x OEPA
25GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara- 20GGy
narCeni simsivnis dros3035Gy
GPOH-HD 2002
ΙΙΙ A gogonebi 2xOPPAbiWebi 2x OEPA
remisia radioTerapia ar tardeba
remisi ara 20GGy narCeni simsivnis dros3035Gy
lowastEtoposidi-s gadidebuli doza
b) Terapiuli jgufi 2
7
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
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National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
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German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
oqmi Stadia qimioTeraia radioTerapia
HD-78 gtΙΙA 2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIBIIIA 2xOPPA 2xCOPP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 85
ΙIBIIIA 2xOPA2xCOMP
30GGy
narCeni simsivnis dros35Gy
DAL-HD 87
ΙIBIIIA 2xOPA 2xCOPP
25 Gy
narCeni simsivnis dros35Gy
DAL-HD 90
IniIIB IIniAIIIA
gogonebi 2xOPPA 2xCOPPbiWebi 2x OEPA 2xCOPP
25 Gy GnarCeni simsivnis dros3035Gy
GPOH-HD95
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPPbiWebi 2xOEPA2xCOPP
remisia- radioTerapia ar tardeba
arasruli remisia-20Gy
narCeni simsivnis dros3035Gy
GPOH-HD 2002 Pilot
ΙniIIBΙΙniAIIIA
gogonebi 2xOPPA2xCOPP biWebi 2xOEPPA2xCOPDIC
yvela 20Gy
narCeni simsivnis dros3035Gy
8
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
g) Terapiuli jgufi 3oqmi Stadia qimioTeraia radioTerapia
HD-78 rogorc jg-2
2xOPPA4xCOPP
36-40GGy
DAL-HD 82
ΙIIBIV 2xOPPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 85
ΙIIBIV 2xOPA2xCOMP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 87
ΙIIBIV 2xOPA 2xCOPP
25GGy
narCeni simsivnis dros30Gy
DAL-HD 90
IIniBIIIBIIIniAIV
gogonebi 2xOPPA 2xCOPPbiWebi2x OEPA 2xCOPP
20GGy
narCeni simsivnis dros3035Gy
GPOH-HD95
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPPbiWebi2xOEPA 2xCOPP
20Gy
narCeni simsivnis drosmax30Gy
GPOH-HD 2002
IIniBIIIBIIIniAIV
gogonebi 2xOPPA2xCOPP biWebi 2xOElowastPA2xCOPDIC
yvela 20Gy
narCeni simsivnis drosmax30Gy
cvlilebebi radioTerapiaSi
9
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
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Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
wina samkurnalo sqemebTan SedarebiT GPOH-HD 2002-Si radioTerapiam ganicada Semdegi cvlilebebi GPOH-HD95-is monacemebma aCvenesrom Mmeore da mesame Terapiuli jgufis pacientebSiromlebsac radioTerapia ar miuRiaTsakmaod maRalia recidivis ganviTarebis riski bolo 2003wlis gamoTvlebze dayrdnobiT DSF-i Mmeore da mesame Terapiuli jgufis pacientebSi radioTerapiiT 92-s aRwevs maSin roca igive monacemebiT pacientebSi-komleqsuri remisiiT magram radioTerapiis gareSe DSF-78(Doumlrffel et al2003)aqedan gamomdinare aucilebelia Mmeore da mesame Terapiuli jgufis pacientebs- kompleqsuri remisiiT CautardeT radioTerapia
cvlilebebi invaziur diagnostikaSi
uari eTqva laparatomiasa da spleneqtomias invaziur diagnostikis aucileblobas saWiroa mxolod erTeul sadao SemTxvevaSi roca sonografiuli kompiuteruli magnitur-rezonansuli tomografiis gamokvlevis Sedegebis axsna gaZnelebulia dasaSvebia laparaskopia laparatomia ki mTlianad iqna uaryofili
specifiuri cvlilebebi meore da mesame biWebisTvis - prokarbazinis eliminaciaadre arsebulma gamokvlevebma aCvenes rom prokarbazini biWebSi unayofobis gamowvevia prokarbazinis kumulaciur dozasa da hormonalur darRvevas Soris arsebobs garkveuli urTierTdamokidebuleba ase magaliTad ori cikli OPPA-s Semdeg unayofoba SeiniSneboda 289 pacientebSi ori cikli OPPA-sa da ori cikli COPP-is Semdeg 438-Si ori cikli OPPA-sa da 4COPP-is Semdeg 625-Si maSasadame dozaze damokidebuli hormonuli darRvevebi asocirdeba permanentul unayofobasTan rac Seexeba qalebs qimioTerapia maT unayofobaze naklebad moqmedebs axalgazrda qalebSi arsebobs sakvercxis ukmarisobis da prematuruli menopauzis ganviTarebis garkveuli riski yovelive aqedan gamomdinare am samkurnalo sqemaSi aris mcdeloba prokarbazini Seicvalos sxva moqmedi substanciiT romelic ar gamoiwvevs unayofobisa da adreuli menopauzas hojkinis limfomis dros prokarbazini aris ara marto Zlier efeqturi preparati romelic pacientTa 38-Si kompleqsur remisias iwvevs aramed ixmareba rogorc monoTerapiuli saSualeba da agreTve kombinaciaSi TumcaRa samedicino gamocemebSi arsebuli informaciaze dayrdnobiT dakarbacini(DTIC) SeiZleba prokarbazinis Semcvleli iyosdakarbacinis moqmemedebis meqanizmi prokarbazinis msgavsia igi inhibirebas ukeTebs rogorc dnm-s ise rnm-sinTezs dakarbacini aris hojkinis limfomis dros aprobirebuli da daSvebuli preparati 6ABVD-ciklis Semdegac ar uviTardebaT mamrobiTi sqesis pacientebs rogorc wesi azospermia Pprokarbazinisgan gansxvavebiT DTIC-is aplikacia xdeba intravenurad 1972 wels dakarbacini aprobirebuli iqna rogorc moniTerapiuli saSualeba-250mgmsup2sup2sup2 doziT yovel dRe 5dRis manZilze samkviriani SualedebiT 56-Si miiRweoda bdquoobieqturildquo remisia Kleineri da doneri (1977w) mkurnalobdnen 10 pacients DTIC-is 300mgmsup2sup2doziT 5 erTmaneTze
10
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
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German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
miyolebuli dRe 4 kviriani SualediT 2 pacients ganuviTarda kompleqsuri remisiaxolo 7-s parcialuri maTi namuSevrebidan dadginda is faqti rom DTIC-s minimalur mielosupresiul zemoqmedeba axasiaTebs am da sxva monacemebze dayrdnobiT gamoangariSebul iqna eqvivalent-faqtori DTIC-Tvis daaxloebiT 24 ABVD-ciklSi gamoyenebuli 750mgmsup2 dakarbacini 1800mgmsup2sup2prokarbacins Seesabameba da mas SeuZlia COPP-ciklSi 1400mgmsup2sup2prokarbazini Secvalos am samkurnalo sqemaSi dakarbacini miiReba 250mgmsup2sup2doziT sami dRis manZilze 30 wuTis ganmavlobaSi intravenurad raTa SeZlebisdagvarad miRweul iqnas moqmedi maRali dozarac Seexeba qimioTerapiis toqsiur zemoqmedebis xarisxs GPOH-HD2002 Pilot-is monacemebze dayrdnobiT COPDIC-Terapiis dros maRali ar aris aRniSnuli gamosaxulia tab3
toqsiuroba
Sedegebis raodenoba cru Sedegi
0 Iordm IIordm IIIordm Vordm
zogadi mdgomareoba 4 11 44 3 0 0Hhemoglobini 0 15 31 14 2 0leikocitebi 0 37 19 5 1 0neitrofilebi 17 33 3 6 2 1Trombocitebi 0 58 4 0 0 0infeqcia 8 46 3 4 1 0temperatura 2 47 9 4 0 0gulisreva 4 47 11 0 0 0Rebineba 1 55 3 2 0 0stomatiti 1 54 6 1 0 0obstipacia 0 56 2 4 0 0diarea 0 60 1 1 0 0alergia 2 60 0 0 3 0tkivilebi 2 44 7 5 0 1sensoruli neirotoqsiuroba
5 42 14 1 0 0
motoruli neirotoqsiuroba
6 44 12 0 0 0
centraluri neirotoqsiuroba
3 59 0 0 0 0
kardiotoqsiuroba 49 13 0 0 0 0kreatinini 1 56 2 3 0 0proteinuria 14 45 3 0 0 0hematuria 12 50 0 0 0 0
kreatininis klirensi 34 26 2 0 0 0
es monacemebi naTlad cxadyofs rom COPDIC- bloki da DTIC pacientebSi naklebad toqsiur gverdiT movlenebs iwvevensamkurnalo sqemaSi miRebis kriteriumebi da pirveladi Terapia
miRebis kriteriumebi
11
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
yvela pacientebi 18 wlamde asakis hojkinis limfomis diagnoziT yvela isini unda akmayofilebdnen Semdeg pirobebs1hojkinis limfomis diagnozi
2asaki diagnozis dasmisas lt18 welze
3klinikis axsna-ganmarteba unda axldes Tan
4mSoblispacientis werilobiTi dasturi am samkurnalo sqemaSi monawileobaze
am samkurnalo sqemaSi ar CaerTvebianroca pacients aqvs
1zemgrZnobeloba an ukuCveneba medikamentebis mimarT
2nodularuli paragranulomis diagnozi
3sxva Terapiul sqemaSi ukve gawevrianebulia
4qimio- an radioTerapia Catarebuli aqvs
5aReniSneba sxva simsivnuri daavadeba
6orsuloba an ZuZuTi wovis periodi
7mZime TandarTuli daavadeba (magimunodefeqti)
8cnobili aiv-infeqcia
9pacientis an mSoblebis Tanxmobis ar arseboba
Ddiagnostika
12
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
1 histologiuri diagnozi
hojkinis limfomaze daeWvebis dros rac SeiZleba swrafad unda Catardes biopsia histologiuri diagnozis dasma xdeba limfuri jirkvlis biopsiis an pirveladad dazianebuli organos biopsiis Sedegad am dros unda iqnes mTliani limfuri jirkvali an didi nawili qsovilisa amoRebuliadgilze paTologebis mier diagnozis dadasturebis SeTxvevaSi gamokvleuli masala srulad igzavneba referens -laboratoriaSi
2klinikuri da laboratoriuli diagnostika
Aanamnezis Segroveba -adre arsebulian Tanmxlebi daavadebis Sesaxeb(nefrozuli sindromi da sxva autoimunuri daavadebebi) -zogadi simptomatika (B-simptomebi bolo 6Tvis manZilze wonis dakleba 10-ze meti persistirebadi ucnobi etiologiis temperatura Tanmxlebi oflianobiT Rame) - Catarebuli mkurnaloba
klinikuri gamokvleva - yvela im limfuri kvanZebis registrireba romelic isinjeba da regionis miTiTeba - RviZlis da elenTis palpacia (ramdeni santimetriT scildeba nekTa rkals) - yel-yur-cxviris eqimTan gamokvleva
laboratoriuli kvlevebi -sisxlis klinikuri suraTi sruli eds alati asati gamaglutamattransferaza tute fosfataza kreatinini albumini LDH -serologiuri kvleva Semdeg antisxeulebze VZV EBV CMV HSV HIV toqsoplazma da ABC hepatitebi instrumentuli gamokvlevebi
-gulmkerdis rendgenografia-muclis Rrus sonografia -eleqtrokardiografia -exokardiografia -encefalografia
danarCeni diagnostikuri zomebi(iseTi rogoricaa ekg filtvebis funqciis kvleva da aS) tardeba individualurad pacientis mdgomareobis mixedviT
13
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
inicialuri stadirebisaTvis gansazRvruli radiologiuri kvlevebi
kisris valdeieris rgolis laviwzeda da laviwqeda iRliis sazardulis muxlqveSa limfuri kvanZebis Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
muclis da mcire menjis Rrus Sreobrivi kompiuteruli tomografia an magnitur resonansuli tomografia
gulmkerdis kompiuteruli tomografia
ConCxis scintigrafia es ukanaskneli aucilebeli Catardes maSinac roca klinikurad pacients aReniSneba Zvlis tkivili
Zvlis biopsiaZvlis biopsia ori adgilidan ukeTdeba yvela im pacients romelTac aqvT gtIIA stadia
seleqtiuri laparaskopiawina samkurnalo oqmis-GPOH-HD95 monacemebze dayrdnobiT laparatomia winamdebare sqemaSi aRar gamoiyeneba Zalzed iSviaT SemTxvevebSi roca yvela arsebuli gamokvlevebi ar iZleva axsnas tardeba seleqtiuri laparaskopia igi gamoiyeneba gansakuTrebiT maSin roca saeWvoa gogonebSi iliakaluri limfuri jirkvlebis dazianebaovaropeqsiamaSin roca eWvgareSea iliakaluri limfuri jirkvlebis dazianeba tardeba operacia ovaropexsia erTi sakvercxis fiqsireba ureTrusis ukan kaudalurad roca erT mxarezea limfuri jirkvlebi CaTreuli da orive sakvercxis roca dazianeba ormxriviaAaucilebelia es operacia Catardes infradiafragmaluri dasxivebamde
fakultaturi gamokvlevebimamrobiTi sqesis pacientebSi aucilebelia nayofierebaze gamokvlevis Catareba da spermis konservireba qimioTerapiis dawyebamde
miRebuli Sedegebis Sefaseba
14
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
limfuri jirkvlebis Sefaseba
rogorc damoukidebeli limfuri jirkvlebis regionebi iTvlebian
1 sasis rkalis limfuri qsovilebi (marjvena da marcxena cal-calke)
2 cervikalurad (marjvena da marcxena cal-calke) bull kisris zeda bull kisris qveda
3 supraklavikularulad (marjvena da marcxena cal-calke)4 infraklavikularulad (marjvena da marcxena cal-calke)5 aqsilarulad (marjvena da marcxena cal-calke)6 filtvebis hilusi (marjvena da marcxena cal-calke) bronqo-
pulmonaluri limfuri jirkvlebi7 mediastinumis limfjirkvlebi
bull zeda nawili bifurkaciamdebull SuaSi hilusi subkarinalur regionamdebull qveda nawili diafragmamde
8 supradiafragmalurad9 elenTa10 elenTis hilusi11 RviZlis hilusi12 mezenterialurad mezenteriumi da mezokoloni13 paraaortalurad14 iliakalurad (marjvena da marcxena cal-calke)15 inguinalurad (marjvena da marcxena cal-calke)
Tu limfuri jirkvalis diametri 1sm-ze naklebia igi ar CaiTvleba simsivnurad dazianebulad
Tu limfuri jirkvalis diametri 2sm-ze metia igi CaiTvleba rogorc simsivnurad dazianebuli
Tu limfuri jirkvalis diametri 1sm-dan 2sm-mdea erTerT regionSi aseTi regioni CaiTvleba
eqstranodaluri dazianebebis Sefaseba
plevra da perikardiplevris simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma aramkveTrad cximovani firfitis gareSe plevris pirdapir SemoisazRvreba an limfoma gulmkerdis kedelzea gamozneqili an limfoma gulmkerdis kedelSia infiltrirebuli an aris plevraluri eqsudati romelic ar aixsneba venuri SegubebiT
15
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
perikardiumis simsivnuri dazianeba CaiTvleba Semdeg SemTxvevebSi roca limfoma kontaqtSia gulis zedapirTan sarqvelebis sibrtyeze an aris perikaris eqsudati
organoTa dazianeba
organoTa dazianebaze maSin saubroben roca simsivnuri limfuri jirkvlebi romelime organoSi arian infiltrirebuli
filtvebidiseminirebul filtvebis dazianebaze da meoTxe stadiaze saubroben roca samze meti simsivnuri qsovilebis grovaa an intrapulmonaluri grovis diametri 8mm-s aRemateba
RviZli da elenTa RviZlis dazianeba yovelTvis meoTxe stadiaa marto elenTis dazianeba periferiuli limfuri kvanZebis dazianebis gareSe niSnavs pirvel stadias elenTisa da RviZlis mxolod zomebSi momateba ar miuTiTebs maT simsivnur procesSi CaTrevaze RviZlsa da elenTaSi grovis formis msgavsisimsivneze saeWvo struqturuli cvlileba iTvleba rogorc organos dazianeba
Zvlisa da Zvlis tvinis dazianebaZvlisa da Zvlis tvinis dazianebazea saubari maSin roca scintigrafiis Sedegad iqna naxuli erTidaigive ZvalzeZvlis tvinze simsivnuri grovebi es raTqmaunda CaiTvleba Zvlisa da Zvlis tvinis dazianebad da ganisazRvreba rogorc meoTxe stadia Uufro dawvrilebiTi lokalizaciis dasadgenad gamoiyeneba kompiuteruli da magnitur-rezonansuli tomografi Tu Zvlis biopsiis Sedegad naxuli iqna simsivnuri ujredebi es ueWvel dazianebasa da meoTxe stadiaze miuTiTebs
stadiis gansazRvra
16
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
I stadia roca dazianebuli erTaderTi limfuri jirkvlis regioni (I) an dazianebulia erTaderTi eqstra limfaturi organo an regioni (IE)
II stadia roca dazianebulia 2 an meti limfuri jirkvlebis regionebi diafragmis erTidaigive mxareze (II) an lokalurad dazianebulia eqstralimfaturi organo Tavisi regionaluri limfuri jirkvlebiT diafragmis erTidaigive mxareze (IIE)
III stadia roca dazianebulia limfuri jirkvlebi diafragmis orive mxares (III) romelsac SeiZleba Tan axldes elenTis dazianebac(IIIS) daan lokalurad eqstralimfaturi organoebis an qsovilebis (IIIE) an orTave erTdroulad (IIIES)
IV stadia roca adgili aqvs disseminirebul eqstralimfaturi organoTa dazianebas romelsac SeiZleba Tan axldes an ar axldes limfuri jirkvlebis dazianebac an izolirebulad erTi eqstralimfaturi organos dazianeba araregionaluri limfuri jirkvlebis procesSi CaTreviT
Y yoveli stadia A da B kategoriad aris dayofili
A zogadi simptomebis ar arseboba
B araumcires erT-erTi qvemoT moyvanili zogadi simptomebidan
a) bolo 6Tvis manZilze umizezod wonaSi kleba 10-ze metad
b) auxsneli persistirebadi temperatura 38ordmC
g) Zlieri oflianoba RamiT
Terapiul jgufebad dayofa
17
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
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National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
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German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
pacientebi onkokonferenciaze studiencentralSi Semdeg Terapiul jgufebad iyofian
pirveli Terapiuli jgufi (TG-1)
pacientebi romlebsac aqvT stadia I AB da IIA
meore Terapiuli jgufi (TG-2)
pacientebi romlebsac aqvT stadia I EAB IIEA IIB an IIIA
mesame Terapiuli jgufi (TG-3)
pacientebi romlebsac aqvT stadia IIEB IIIEAB IIIB an IVAB
Terapiis stratificireba da dawyeba
18
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Terapiis droulad Catareba Zalzed mniSvnelovania iSviaT SemTxvevebSi-laparaskopiis aucileblobis dros operaciidan me-5 dRes unda iqnes dawyebuli qimioTerapiayoveli qimioTerapiis ciklebi daiwyeba im SemTxvevaSi Tu pacienti akmayofilebs Semdeg kriteriumebs
a zogadi mdgomareoba damakmayofilebelib leikocitebis raodenoba gt2000mmsup3c granulocitebis raodenoba gt500mmsup3d Trombocitebis raodenoba gt80000mmsup3e medikamentebis mimarT ukuCvenebis ar arseboba
raime gansakuTrebuloba OEPA-s OPPA-s COPP-sa da COPDIC-is dawyebis win saWiro ar aris vinaidan rogorc gamocdilebam aCvena mkveTrad gamoxatuli toqsiuri gverdiTi movlenebi ar aris mosalodneli iseTi interkurentuli daavadebebis arsebobisas rogoricaa sicxe 385ordmC-ze meti pnevmonia sepsisze eWvi varicela zosteri da sxva msgavsi qimioTerapiia unda Sewydes
TG-1yvela pacienti TG-1_dan gogonebi-2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben qimioTerapiis Semdeg maT uterdebaT restadireba postTerapiul kompiuterul tomografiasa da magnitur rezonansul tomografiiT Tu progresi ar SeiniSneba maSin es pacientebi iyofian or samkurnalo qvejgufad
- pirveli qvejgufi moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg pirveladad dazianebul regionebSi CTMRT-kriteriumebiT ganuviTardaT kompleqsuri remisia isini ar iReben radioTerapias
- qvejgufi B moicavs yvela im pacients romelTac qimioTerapiis damTavrebis Semdeg CTMRT-kriteriumebiT kompleqsur remisiaSi ar arian Rebuloben radioTerapias
pirveli jgufis pacientebisTvis dasxiveba qimioTerapiis damTavrebidan araugvianes 35-e dRes unda Catardes misi dasrulebas mosdevs Follow-up
TG-2 da TG-3
meore da mesame Terapiuli jgufis yvela pacienti gogonebi kvlav -2blok OPPA-s da biWebi-2 blok OEPA ndashs iReben Semdeg ki Staging-onkikonferenciaze isini gadian randomizacias COPP-sa da COPDIC-s Soris meore Terapiuli jgufis pacientebi iReben or cikls xolo mesame jgufis oTx ciklsyvela pacienti iRebs radioTerapias Mmanmade ki tardeba Restaging radioTerapia unda qimioTerapiis meoTxe an meeqvse ciklis Semdeg 25-e dRes daiwyos
941 OEPA OPPA
19
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
citostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia sqemebSi ixqvemoTpirveli ciklis Semdeg modis me-16 dRidan 28-e dRemde Sesveneba rasac mohyveba Semdgomi cikli
OEPA-sqema
Prednisoloni 60mgm2 po gayofili sam miRebazedRe1 - 15 Etoposid 125mgm2 iv 2saaTSidRe 3-7
+ + + + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8=15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
OPPA-sqema
Prednisoloni 60mgm2 pogayofili sam miRebazedRe1 - 15 Procarbazin 100mgm2po 2-3 miRebaze dRe 1 ndash 15 Vincristin 15mgm2 iv maqs 2mgdRe 1+8 +15
+ + +
Adriamicyn 100mgm2infuzia 4saaTSidRe 1+15
+ +
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
642 COPP COPDIC
20
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
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the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
meore Terapiul jgufis mkurnalobis sqemaSi OEPA OPPA-ciklebs emateba ori COPP an COPDIC-cikli xolo mesame Terapiul jgufis pacientebs utardebaT oTxi COPP an COPDIC-cikli yoveli ciklis Semdeg me-16 dRidan 28-e dRis CaTvliT aris Sesvenebacitostatikuri medikamentebis aplikaciis saxe da dozireba mocemulia Sesabamis sqemebSiciklofosfamidis yoveli micemisas aucilebelia uroproteqtor-mesnas micema dakarbacinis emetogenuri efeqtis Sesamcireblad ki naCvenebia 5-HT3-antagonistis an deqsametazonis an romelime neuroleptikis daniSvna
COPP-sqema Prednisoloni 40mgm2 pogayofili sam miRebazedRe 1 - 15 Procarbazin 100mgm2 po 2-3 miRebazedRe 1 - 15Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2ivinfuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
21
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
COPDIC-sqema
Prednisoloni 40mgm2 pogayofili sam miRebaze1 - 15 dReDcarbazin 250mgkg ivinfuzia 30wTdRe 1 - 3
+ + +
Vincristin 15mgm2 iv maqs 2mgdRe 1+8
+ +
Cyclofosfamidi 500mgm2iv infuzia 60wTmesna 150mgm2 0saaTzemesna 500mgm2 24 sTSi+1500mlm2 NaCl09+1500mlm2 Gluc51+8 dRe
+
+
+
+
dReebi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dozis modifikacia da kontracefcia
am samkurnalo sqemaSi mocemuli qimioTerapiuli saSualebebs kargad itanen pacientebi da amdenad dozis modificireba ar aris saWiro im erTeul SemTxvevebSi roca saxezea medikamentebis gamo gamowveuli mkveTrad gamoxatuli arasasurveli gverdiTi movlenebi unda moxdes alternatiuli saSualebis gamoZebna studiis xelmZRvanelobasTan erTadQqimio an radioTerapiis dros da maT Semdeg erTi wlis manZilze pacientebma unda moeridon bavSvis Casaxvas vinaidan drois am monakveTSi mavnebeli zemoqmedeba qimio da radioTerapiisa jer kidev mosalodnelia Kkontracefciuli saSualebebis Sesaxeb gadawyvetilebas eqimi iRebs individualurad TiToeul SemTxvevaSi
qimioTerapiis gverdiTi movlenebi
22
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
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Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
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National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
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Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
qimioTerapiis zogadi gverdiTi movlenebia gulisrevaRebineba wonaSi kleba Tmis cvena da meoradi simsivnis ganviTarebis riski
etopozidietopozidis mwvave gverdiTi movlenebi SeiZleba iyos alergiuli reaqciebi mukoziti periferiuli neiropaTiebi cns-toqsiuroba msubuqi Zvlis tvinis depresia etopozidiT inducirebuli meoradi leikozis ganviTarebis vada SeiZleba iyos ramodenime Tvidan wlamde FAB-klasifikaciiT M4M5 morfologiiT da 11q23-translokaciiT Tumca leikozis es forma dRemde ar dafiqsirebula
dakarbacinidakarbacini iwvevs Zlier gulisrevas da Rebinebas iSviaTad diareas gripis msgavs simptomebs alergiul egzanTemas kanze sicxes da fotosensibilizacias SesaZlebelia adgilobrivad ineqciis adgilze venebis gaRizianeba gamoiwvios misi Zvlis tvinze toqsiuri zemoqmedeba sustia iSviaTia aseve RviZlze Tirkmelebze da cns-ze misi mavne gavlena gansakuTrebiT mniSvnelovania aRiniSnos rom is ABVD-TerapiiT ar iwvevs permanentul azospermias aseve iSviaTia meoradi leikozis ganviTarebis SemTxvevebic
vinkristinivinkristinis mwvave gverdiTi movlenebia periferiuli neiropaTia obstipacia iSviaTad ewaraadeqvaturi ADH-sekreciis sindromi mkveTrad gamoxatuli periferiuli neiropaTiis dros romelsac axlavs siarulis darRvevac vinkristini SeiZleba Seicvalos vinblastinis 6mgmsup2ndashdoziT
ciklofosfamidiciklofosfamidis Sedegad SeiZleba ganviTardes Zvlis tvinis depresia hemoragiuli cistiti da maRalia infeqciebisadmi midrekileba
adriamiciniadriamicinis zemoqmedebiT SesaZlebelia ganviTardes gulis kunTis funqciis darRveva gulze mogvianebiTi garTulebebis Sesaxeb qimioTerapiis dasrulebis Semdeg informacia jerjerobiT ar aris qimioTerapiis dawyebamde aucilebelia eqokardiografiis Catareba gulis dazianebis SemTxvevaSi saWiroa alternatiuli Terapiuli saSualebis moZebna studiis xelmZRvanelobasTan erTad
prednizoloni rogorc leikoziani pacientebze dakvirvebebma aCvena rom prednizoloni iwvevs osteonekrozebs da SesaZlebelia xelovnuri saxsris aucileblobac Seiqnes garda aRniSnulisa SeiZleba ganviTardes Sesupeba wonaSi momateba maRalia infeqciebisadmi midrekileba da fsiqiuri cvlilebebis ganviTareba
23
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
prokarbazini prokarbazinis Sedegad SeiZleba ganviTardes gulisreva interstinaluri pnevmonia cns garTulebebi(neirotoqsiuri) alergiuli reaqciebi gonadebis dazianeba da Seuqcevadi azospermia
24
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Terapiis warmatebis gansazRvra restadirebiT
Restadireba
pirveli restadireba yvela pacientisaTvis tardeba 2cikli qimioTerapiis Semdeg Restaging-i2cikli qimioTerapiis Semdeg yvela dazianebuli adgili xelaxla unda daTvalierdesCTMRT gamokvlevebi-qimioTerapiis damTavrebidan me-10 dRidan me14-dRis ganmavlobaSi unda Catardes yvela pacients me-14dRes utardeba FDG-PET gamokvleva pirveli Terapiuli jgufis pacientebis monacemebi igzavneba centrSi raTa ganisazRvros Semdgomi moqmedebani meore da mesame Terapiuli jgufis pacientebis agrZeleben Terapias is pacientebi romlebsac SeeniSnebaT daavadebis progresi gadian srul kompleqsur xelaxal gamokvlevas da Sedegebis mixedviT gadawydeba mkurnalobis Semdegi taqtika meore restadireba4cikli qimioTerapiis Semdeg meore meore Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia yvela limfuri jirkvlisakomleqsuri gamokvlevamesame restadireba6cikli qimioTerapiis Semdeg mesame Terapiuli jgufis pacientebSi Yyvela dazianebuli adgilebi eqvemdebarebian kvlevas CTMRT da eqografia unda Catardes bolo qimioTerapiuli ciklis miRebidan me-10 me-14 dRis vadebSi am jgufis pacientebs ewyebaT agreTve radioTerapia progresis SemTxvevaSi ki aucilebelia komleqsuri gamokvleva yvela limfuri jirkvlisa
nebismieri restadirebis dros Terapiis warmatebis gansazRvra Semdegi kriteriumebis mixedviT xorcieldeba
kompleqsuri remisia(CR)
Terapiis Sedegi rogorc kompleqsuri remisia fasdeba im SemTxvevaSi rocabull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis- pirveladi simsivnuri masis 95-ze meti ukuganviTarebulia- narCeni masa naklebia 2ml-ze
25
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
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Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
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National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
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Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
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German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
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Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
daudgeneli kompleqsuri remisia
Terapiis Sedegi rogorc kompleqsuri remisia-daudgeneli fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia da bull daavadebis yvela simptomi gamqralia da bull ar aris axali limfuri Tu eqstralimfuri regionebi dazianebuli dabull yvela nacnobi limfomregionebisTvis
- pirveladi simsivnuri masis 75-ze meti magram 95 naklebi ukuganviTarebulia an
- narCeni masa naklebia 2ml-ze
parcialuri remisia
Terapiis Sedegi rogorc parcialuri remisia fasdeba im SemTxvevaSi rocabull ar aris kompleqsuri remisia an daudgeneli kompleqsuri remisiabull ar SeiniSneba daavadebis progresirecidivTerapiis Cveneba aris mxolod imSemTxvevaSi roca damtkicebuli progresi an recidivia saxeze
progresi recidivi
daavadebis progresia rocabull daavadebis simptomebis xelaxali an sruliad axali auxsneli gamoCena anbull axali limfuri an eqstarlimfaturi regionebis gaCena an bull araumcires erTi limfomregionis simsivnuri masis mateba 25-ze metad da () bull vitaluri limfomujredebis aRmoCena zrdaSi myof an axlad aRmocenebul regionebSi
daavadebis progresi recidivi qviabullTerapiis dasrulebidan (qimioTerapiis bolo dRe prednizolonis CaTvliT an sxivuri Terapiis bolo dRe) sam TveSi ganviTarebuli procesi- progresibull Terapiis dasrulebidan sami Tvidan Tormet Tvemde ganviTarebuli- adreuli recidivibull Terapiis dasrulebidan Tormet Tvis Semdeg ganviTarebuli- mogvianebiTi recidivi
26
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
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nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
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Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
sxivuri Terapia
Cvenebebi da dozireba
1 pacientebs romlenic ganekuTvnebian pirvel Terapiul jgufs sruli remissiis SemTxvevaSi ar sxivdebian
2 pacientebi romlebic ganekuTvnebian pirvel Terapiul jgufs arasruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
3 pacientebs romlenic ganekuTvnebian meore da mesame Terapiul jgufs sruli remissiis SemTxvevaSi sxivdebian doziT 20 grei
4 yvela pacienti romelTa narCeni masa sawyisTan SedarebiT 25 metia anu 75 isev rCeba sxivdebian doziT 30 grei
5 yvela pacienti romelTa narCeni masa 100 ml ia sxivdebian dosiT35 grei
6 eqstralimfuri organoebi Zvlis tvinis gamoklebiT eqvemdebarebian sxivur TerapiasdoziT 12 ndash 15 grei
7 sxivuri Terapia tardeba fraqciulad da dRiuri doza aris 18 grei gaminaklis warmoadgens filtvebi da am SemTxvevaSi dRiuri doza ar und aRematebodes 1-12 greis
8 recidivis SemTxvevaSi sayuradReboa pirveladi doza da ganmeorebiTi Terapiis sumaruli doza ar unda aRematebodes 40 greis
sxivuri Terapiis dawyeba
bolo qimioterapiuli reJimis damTavrebidan 3 kviris Semdeg
sxivuri Terapiis principebi
sxivuri Terapia pirveladi dagegmarebiT kompiuteruli simulaciiT da sxivuri aqseleratoris gamoyenebiT aris SesaZlebeli esYyovelive emsaxureba janmrTeli qsovilebis maqcimalur dacvas sxivebis mavne moqmedebisgan da samizne qsovilebis efeqtur dasxivebasTeqnikuri procesebis srul dacvaze pasuxismgebelia radioTerapevti
velebi
mkacrad aris gansazRvruli protokolis mixedviT da maqsimalurad moicavs mxolod inicialurad dazianebul limfur kvanZebs da eqstralimfur organoebs velebis SerCeva dagegmareba da pirobiTi sqemis Semoxazva xdeba radiologTa onkologTa da ratioTerapevTa erToblivi gadawyvetilebiT
27
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
helliphelliphelliphelliphelliphellip
28
valdeieris rgoli
kisris laviwzeda
laviwqveSaaqsilarulipeqtoruli
mediastinaluri
paraaortalurielenTis kariRviZlis kari
iliakaluri
sazardulisbarZayis
elenTa
limfuri kvanZebis regionebi
karis
mezenterialuri
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Terapia im pacientebisTvis visTanac standartulma mkurnalobam ar uCvena efeqturoba da gamoixata daavadebis progresireba (Salvage Therapy)
mkurnaloba iwyeba kvlav qimioTerapiiT Ggamoiyeneba IEPABVD kursebi COPP da ChICEP reJimebTan erTad Pacientebis am jgufisTvis blokebis raodenoba winacwar ar aris mkacrad gansaxRvruli da damokidebulia pasuxze Tu pacients aReniSneba kargi pasuxi pirvel IEPABVD Terapiaze qimioTerapia sruldeba sxivuri TerapiiT cudi pasuxis SemTxvevaSi emateba COPP da ChICEP Terapia Semdgomi dasxivebiT
recidivis sawinaaRmdego Terapia
gamoiyofon recidivis or Tearapiul jgufs romlebic Tavis mxriv iyofa sam-sam qvejgufebad
1pirveli recidivi im pacientebSi vinc inicialurad miekuTvnebodnen pirvel Terapiul jgufs
bull pacientebi romelTac inicialurad ar Cautardad sxivuri Terapia unda miiRon IEP- ABVD- COPP-(IEP) + dazianebuli velebis dasxiveba doziT 25-30 grei
bull pacientebi romelbmac inicialurad miiRes dazianebuli velebis radioTerapia 20greiT da ganuviTrdad recidivi ukve dasxivebuli an axali velebis kombinaciiT IEP- ABVD- COPP-IEP + dasxiveba 20-25 grei dasxivebuli da 25-30 axali velebisaTvis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- COPP-IEP ndashABVD ndash COPP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
2pirveladi recidivi im pacientebSi vinc inicialurad miekuTvnebodnen meore da mesame Terapiul jgufebs
bull pacientebi romelTac ganuvitardad recidivi axali aradausxivebel regionebSi utardebaT IEP - ABVD - IEP ndashABVD ndash (IEP) + radioTerapia doziT 25-30grei
bull pacientebi romelTac ganuviTardaT ukve 20 greiT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- IEP- ABVD - IEP + sxivuri Terapia 20-25 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
bull pacientebi romelTac ganuviTardaT ukve 20 greize meti doziT dasxivebuli an dausxivebeli regionebiT utrdebaT IEP- ABVD- -IEP ndashABVD ndash IEP + sxivuri Terapia 10- 15 grei ukve dasxivebuli da 25-30 greiT dausxivebeli velebis
recidivian pacientebs romelTac Terapiaze aReniSnebaT simsivnis neli an araefeqturi regresi SeZlebisdagvarad ezrdebaT sxivuri Terapiisdoza an Tu igi ar aris SeZlo ( sumaruli doza ar unda aRematebides 45
29
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
greis) sxivuri Terapiis Semdeg pacients eZleva ori damatebiTi qimioTerapiuli kursi ChICEP
antirecidiuli qimoTerapiis sqemebi
1Ifosfamidi 2000mgm2 24 saaTis ganmavlobaSi+mesna 1ndash5 dRe
2Etoposidi 125mgm2 iv 2 saaTis ganmavlobasi 1-5 dRe
3Prednisone 100mgm2Ppo sam miRebaze 1-5 dRe
1Adriamycin 25mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
2Dacarbazin 375mgm2 iv 2saaTis ganmavlobasi 1+15 dRe
3bleomocyni 10mgm2 iv neli nakadiT 1+15 dRe
4Vinblastini 6mgm2 iv neli nkadiT 1+15 dRe
1CCNU 80mgm2 po 1 dRe
2Etoposid 100mgm2 po 1-5 dRe
3Prednison 40mgm2 po 1-5 dRe
4Chlorambuzil 6mgm2 po 1-5 dRe
30
IEP=IfosfamidEtoposidPrednison
ABVD=AdriamicynDacarbazinBleomycinVinblastin
ChICEP=CCNUEtoposidPrednisonChlorambuzil
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
pacientTa meTvalyureoba da kvlevebi mkurnalobis dasrulebis Semdeg
gamokvleva qimiodan 1kv-sSemdeg
Ddasxiv-dan 4kv-s Semdeg
1 welSi 2welSi 3welSi 4welSi
Aanamnezi times times Y yovel 6kviraSi yovel 3TveSi
yovel 6TveSi
sisxlis klanalizi times times Y yovel 3 TveSi yovel 6TveSi
times
muclis sonografia times times Y yovel 3 TveSi Yyovel 6 TveSi
CT MRT times times yovel3 TveSi yovel 3 TveSi
yovel 6TveSi
individualurad
CT-gulmkerdis times Yyovel3TveSi Yyovel 6TveSi
individualurad
Yyelis dasxivebis Semdeg farisjirksono da fT4 TSHTG
times 1 x weliwadSi
sakvercxis karcinomos skriningi(sono MRT)
25-wlidan qalebSi 1 x weliwadSi suprainfraklavikularuli regionis aqilaruli mediastinumis an filtvis dasxivebis Semdegs
Eekg eqokardiograf times times
LH-RH FSH prolaqtini testosteroni estradiolispermiograma
18wlis zemoT biWebSi 15 wlis zemoT gogonebSi
Llufu filtvebis an mediastinumis dasxivebis Semdeg
Terapiis dasrulebidan 1wlis Semdeg
times individua-lurad
times
radioTerapiis specialisti
times Terapiis dasrulebidan 1wlis Semdeg
1 x weliwadSi times
sicocxlis xarisxi Terapiis dasrulebidan 1wlis Semdeg
times
31
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
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nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
dokumentacia romelic unda warmoebdes da mkacrad unda iqnes daculi yvelaSemTxvevisaTvis
1 paTologis saboloo da oficialuri daskvnis originali2 yvela radiologiuri kvlevis daskvnis originali3 Terapiuli gegmis dizaini konkretuli pacientisTvis4 Terapiuli gegmebi TiToeuli qimioTerapiuli reJimisaTvis5 sxivuri Terapiis pirobiTi sqema pirveladi velebis moniSvniT6 dignozis stadirebis mkurnalobis da Semdgomi dakvirvebis midinareobisa
eqimis mier dawerili etapuri epikrizebi7 pacientis da misi meurvis Tanxmobis damadasturebeli specialuri werili
32
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
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Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
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nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
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Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
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60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
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Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
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Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Terapiuli gegmis dizaini konkretuli gogona pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOPPA
2xOPPA 2xCOPP
2xOPPA 4 x COPP
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
33
1 5 9 13 17 21 kvira
pacientis gvari saxeli ------------------------------------------------------------------------------------------
dabadebis TariRi ----------------------------------------------------------------------------------------------------
histologiuri diagnozi ----------------------------------------------------------------------------------------
stadia ----------------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ---------------------------------------------------------------------------------------------------
dasxivebis doza ------------------------------------------------------------------------------------------------------
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Terapiuli gegmis dizaini konkretuli biWi pacientisTvis
TG 1IABIIA
TG 2IEABIIEA
IIBIIIA
TG 3IIEBIIIEABIIIBIVAB
2xOEPA
2xOEPA 2xCOPDIC
2xOEPA 4 x COPDIC
sruli remisia - dasxiveba ara
Aarasruli remisia -dasxiveba
Ppirveladi velebisdasxiveba
34
1 5 9 13 17 21 kvira
pacientis gvari saxelihelliphellip__________________________________________
dabadebis TariRi -------------------------------------------------------------------------------------------
histologiuri diagnozi --------------------------------------------------------------------------------
stadia --------------------------------------------------------------------------------------------------------------
Terapiuli jgufi ________________________________________________
dasxivebis doza ----------------------------------------------------------------------------------------------
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi -------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
prokarbazini 100mgm2 po gay2-3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
K kursi OPPA
35
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ------------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 60mgm2 po gay 3 miRebaze
vinkristini 15mgm2 iv maqs2mg
adriamicini 40mgm2 iv infuzia 4sT
etopozidi 125mgm2 iv infuzia 2sT
36
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8M2 M5
K kursi OEPA
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi --------
wona ----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 40mgm2 pogay 3 miRebaze
prokarbazini100mgm2 pogay2-3 miRebaze
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224 sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPP
37
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15M8
Mmg=
Mmg=
ml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ---------------
wona -----------------------------kg simaRle -------------------------sm sxeulis farTi ---------------m2
prednizoloni 40mgm2 pogay 3 miRebaze
dakarbazini250mgm2 ivInfusia 30wT123 dRe
vinkristini15mgm2 iv maqs2mg
ciclofosfamidi500mgm2 ivinfuzia 1sT
mesna 150mgm2 0sTmesna500mgm224sT+1500mlm2 NaCl09+1500mlm2 Gluc5
K kursi COPDIC
38
Mmg=
Mmg=
Mmg=
Mmg=
MdRe
M1 M15M8
Mmg=
Mmg=
Mml=
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ---------------------------- gvari ----------------------------------------------dabadTariRi ----------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
prednizoloni 100mgm2 pogay 3 miRebaze
ifosfamidi2000mgm2 ivmessna 700mgm2 0sTmesna 2000mgm2 24sT-Si2500ml siTxe 24sT-SiNaCl 09Cluc 5 +KCl 75 10ml500ml+laziqsi 10mg100ml
etopozidi125mgm2 ivinfuzia 2sTetopozidi iwyeba ifosfamidis dawyebi-dan 4sT is Semdegam dros ifosfamidi wydeba
K kursi IEP
39
Mmg=
mg=
mg=
MdRe
M1 M3M2 M4 M5 M6 M7
mg=
ml
M mg=
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona -----------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
adriamicini25mgm2 ivInfuzia 2sT
dacarbazini375mgm2 iv Infuzia 2sT
bleomicini10mgm2 ivinfuzia nelinakadiT
vinblastini6mgm2 ivInfusia nelinakadiT
40
K kursi ABVD
Mmg=
Mmg=
Mmg=
Mmg=
MdReM1 M15
M
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ------------------------ gvari ------------------------------------------dabadTariRi ------------------
wona ------------------------kg simaRle -------------------------sm sxeulis farTi --------------- m2
ccnu 40mgm2 po
etapozidi100mgm2 po
prednizoloni40mgm2 pogay 3 miRebaze
qlorambucili6mgm2 pogay 3 miRebaze
41
M mg=
mg=
MdRe
M1 M3M2 M4 M5
Mmg=
Mmg=
K kursi ChICEP
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
saxeli ------------------------ gvari ---------------------------------------dabadTariRi ------------------
Catarebuli qimioTerapia-----------------------------------------------------------
sxivuri Terapiis doza---------------------------------------------------------------
42
K sxivuri Terapiis sqema
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
literatuara
Anagnostopoulos I Hansmann ML Franssila K Harris M Harris NL Jaffe ES Han J van
Krieken JM Poppema S Marafioti T Franklin J Sextro M Diehl V Stein H (2000) European
Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease histological
and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a
nodular growth pattern and abundant lymphocytes Blood 96 1889-1899
Apperley JF Reddy N (1995) Mechanisms and management of treatment-related gonadal failure
in chemoradiotherapy Blood 9 93 -116
Bumann D Beyer W Herbst K Clausen M Hossfeld DK (1997) Whole-body positron emission
tomography (PET) for diagnosis of residual mass in patients with lymphoma Ann Oncol 8 57-
60
Brink I Reinhardt MJ Hoegerle S Altehoefer C Moser E Nitzsche EU (2001) Increased
metabolic activity in the thymus gland studied with 18F-FDG PET age dependency and
frequency after chemotherapy J Nucl Med 42 591-595
Benenson L Wickenhauser C Starostik P Staratschek-Jox A Muumlller-Hermelink HK Diehl V
Wolf J (2002) Proficient mismatch repair protein expression in Hodgkin and Reed Sternberg
cells Int J Cancer 97 205-210
Bernardo MP Weller E Backstrand KH Silver B Marcus KC Tarbell NJ Friedberg J Canellos
GP Mauch PM (2002) Long-term survival and competing causes of death in patients with early-
stage Hodgkins disease treated at age 50 or younger J Clin Oncol 20 2101ndash2108
Bonadonna G Santoro A Gianni AM Viviani S Siena S Bregni M Zucali R Lombardi F
Bonfante V Gianni L (1991) Primary and salvage chemotherapy in advanced Hodgkinrsquos disease
the Milan Cancer Institute experience Ann Oncol 1 9ndash16
Bohlen H Kessler M Sextro M Diehl V Tesch H (2000) Poor clinical outcome of patients with
Hodgkins disease and elevated interleukin-10 serum levels Clinical significance of interleukin-
10 serum levels for Hodgkins disease Ann Hematol 79110-113
Buzaid AC Lippman SM Miller TP (1987) Salvage therapy of advanced Hodgkinrsquos disease
Critical appraisal of curative potential Am J Med 83 523ndash532
43
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Baetz T Belch A Couban S Imrie K Yau J Myers R Ding K Paul N Shepherd L Iglesias J
Meyer R Crump M (2003) Gemcitabine dexamethasone and cisplatin is an active and non-toxic
chemotherapy regimen in relapsed or refractory Hodgkins disease a phase II study by the
National Cancer Institute of Canada Clinical Trials Group Ann Oncol 141762-1767
Cline MJ Berlin N (1963) Anemia in Hodgkinrsquos disease Cancer 16526-532
Carde P Koscielny S Franklin J Axdorph U Raemaekers J Diehl V Aleman B Brosteanu O
Hasenclever D Oberlin O Bonvin N Bjorkholm M (2002) Early response to chemotherapy a
surrogate for final outcome of Hodgkins disease patients that should influence initial treatment
length and intensity Ann Oncol 13 86-91
Carbone PP Kaplan HS Musshoff K Smithers DW Tubiana M (1971) Report of the
Committee on Hodgkins disease Staging Classification Cancer Res 31 1860-1861
Gajewski JL Phillips GL Sobocinski KA Armitage JO Gale RP Champlin RE Herzig RH
Hurd DD Jagannath S Klein JP Lazarus HM McCarthy PL Jr Pavlovsky S Peterson FB
Rowlings PA Russell JA Silver SM Vose JM Wiernik PH Bortin MM Horowitz MM (1996)
Bone marrow transplants from HLA-identical siblings in advanced Hodgkins disease J Clin
Oncol14 572-578
Claviez A Klingebiel T Beyer J Nurnberger W Ehninger G Suttorp M Dreger P Dorffel W
Schmitz N (2004) Allogeneic peripheral blood stem cell transplantation following fludrabine-
based conditioning in six children with advanced Hodgkinrsquos disease Ann Hematol 83 237-241
Dorffel W Luders H Ruhl U Albrecht M Marciniak H Parwaresch R Potter R Schellong G
Schwarze EW Wickmann L (2003) Preliminary results of the multicenter trial GPOH-HD 95 for
the treatment of Hodgkins disease in children and adolescents analysis and outlook Klin
Padiatr 215 139-145
Donaldson SS Link MP (1987) Combined modality treatment with low-dose radiation and
MOPP chemotherapy for children with Hodgkinrsquos disease J Clin Oncol 5 742- 749
Dieckmann K Potter R Hofmann J Heinzl H Wagner W Schellong G Pediatric Cooperative
Hodgkin Disease Study Group of the GPOH (2003) Does bulky disease at diagnosis influence
outcome in childhood Hodgkins disease and require higher radiation doses Results from the
44
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
German-Austrian Pediatric Multicenter Trial DAL-HD-90 Int J Radiat Oncol Biol Phys 56
644-652
Donaldson SS Kaplan HS (1982) Complications of treatment of Hodgkinrsquos disease in children
Cancer Treat Rep 66 977-989
Dobert N Pantel J Frolich L Hamscho N Menzel C Grunwald F (2004) Diagnostic value of
FDG-PET and HMPAO-SPET in patients with mild dementia and mild cognitive impairment
metabolic index and perfusion index Dement Geriatr Cogn Disord 20 63-70
Donaldson SS Link MP (1991) Hodgkinrsquos disease Treatment of the young child Pediatr Clin
North Am 38 457-473
Ferme C Mounier N Divine M Brice P Stamatoullas A Reman O Voillat L Jaubert J
Lederlin P Colin P Berger F Salles G (2002) Intensive salvage therapy with high-dose
chemotherapy for patients with advanced Hodgkinrsquos disease in relapse or failure after initial
chemotherapy results of the Groupe drsquoEtudes des Lymphomes de lrsquoAdulte H89 trial J Clin
Oncol 20 467ndash475
Grufferman SL Delzell E (1984) Epidemiology of Hodgkinrsquos disease Epidemiol 6 76
Green DM Gingell RL Pearce J Panahon AM Ghoorah J (1987) The effect of mediastinal
irradiation of cardiac function of patients treated during childhood and adolescence for
Hodgkinrsquos disease Clin Oncol 5239-245
Hancock SL Tucker MA Hoppe RT (1993) Factors affecting late mortality from heart disease
after treatment of Hodgkins disease JAMA 270 1949-1955
Harris NL Jaffe ES Diebold J Flandrin G Muller-Hermelink HK Vardiman J Lister TA
Bloomfield CD (1999) The World Health Organization classification of neoplastic diseases of
the hematopoietic and lymphoid tissues Report of the Clinical Advisory Committee meeting
Airlie House Virginia November 1997Ann Oncol 101419-1432
Hassel JU Braumlmswig JH Schlegel W Schelong G (1991) Testicular function after OPACOMP
chemotherapy without Procarbazin for boys and girls with Hodgkinrsquos disease Klin Paumldiat 203
268-272
45
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Henry-Amar M Pellae-Cosset B Bayle-Weisgerber C Hayat M Cosset JM Carde P Tubiana
M (1989) Risk of secondary acute leukaemia and preleukamia after Hodgkinrsquos disease The
Institute Gustave-Roussy experience Rec Results canser Res 117 270-283
Hoh CK Glaspy J Rosen P Dahlbom M Lee SJ Kunkel L Hawkin RA Maddahi J Phelps ME
(1997) Whole-body FDG-PET imaging for staging of Hodgkins disease and lymphoma J Nucl
Med 38 343-348
Howell SJ Radford JA Adams JE Shalet SM (2000) The impact of mild Leydig cell
dysfunction following cytotoxic chemotherapy on bone mineral density (BMD) and body
composition Clin Endocrinol 52 609-616
Jerusalem G Beguin Y Fassotte MF Najjar F Paulus P Rigo P Fillet G (2001) Whole-body
positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures
for staging patients with Hodgkins disease Haematologica 86 266-273
Karapetis CS Strickland AH Yip D Walt JD Harper PG (2001) PET and PLAP in suspected
testicular cancer relapse Ann Oncol 121485-1488
Kupper M Joos S von Bonin F Daus H Pfreundschuh M Lichter P Trumper L (2001) MDM2
gene amplification and lack of p53 point mutations in Hodgkin and Reed-Sternberg cells results
from single-cell polymerase chain reaction and molecular cytogenetic studies Br J Haematol
1128-75
Kuppers R Schwering I Brauninger A Rajewsky K Hansmann ML (2002) Biology of
Hodgkins lymphoma Ann Oncol 13 11-18
Kuppers R Klein U Hansmann ML Rajewsky K (1999) Cellular origin of human B-cell
lymphomas N Engl J Med 3411520ndash1529
Lister TA Crowther D Sutcliffe SB Sutcliffe SBGlatstein E Canellos GP Young RC
Rosenberg SA Coltman CA Tubiana G (1989) Report of a committee convened to discuss the
evaluation and staging of patients with Hodgkins disease Cotswolds meeting J Clin Oncol 7
1630-1636
46
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Le Deley MC Leblanc T Shamsaldin A Raquin MA Lacour B Sommelet D Chompret A
Cayuela JM Bayle C Bernheim A de Vathaire F Vassal G Hill C (2003) Risk of secondary
leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and
anthracyclines a case-control study by the Socieacuteteacute Franccedilaise dOncologie Peacutediatrique J Clin
Oncol 21 1074-1081
Longo DL Duffey PL Young RC Hubbard SM Ihde DC Glatstein E Phares JC Jaffe ES
Urba WJ DeVita VT Jr (1992) Conventional-dose salvage combination chemotherapy in
patients relapsing with Hodgkinrsquos disease after combination chemotherapy the low probability
for cure J Clin Oncol 10 210 -218
Martin-Subero JI Gesk S Harder L Sonoki T Tucker PW Schlegelberger B Grote W Novo
FJ Calasanz MJ Hansmann ML Dyer MJ Siebert R (2002) Recurrent involvement of the REL
and BCL11A loci in classical Hodgkin lymphoma Blood 99 1474-1477
Meadows AT Obringer AC Marrero O Oberlin O Robison L Fossati-Bellani F Green D
Voute PA Morris-Jones P Greenberg M (1989) Second malignat neoplasms fillowing childhood
Hodgkinrsquos disease Med Prdiat Oncol 17 477-484
Milpied N Fielding AK Pearce RM Ernst P Goldstone AH (1996) Allogeneic bone marrow
transplant is not better than autologous transplant for patients with relapsed Hodgkins disease
European Group for Blood and Bone Marrow Transplantation J Clin Oncol 14 1291-1296
Nachman JB Sposto R Herzog P Gilchrist GS Wolden SL Thomson J Kadin ME Pattengale
P Davis PC Hutchinson RJ White K (2002) Randomized comparison of low-dose involved-
field radiotherapy and no radiotherapy for children with Hodgkins disease who achieve a
complete response to chemotherapy J Clin Oncol 18 3765-3771
Nadali G Tavecchia L Zanolin E Bonfante V Viviani S Camerini E Musto P Di Renzo N
Carotenuto M Chilosi M Krampera M Pizzolo G (1998) Serum level of the soluble form of the
CD30 molecule identifies patients with Hodgkins disease at high risk of unfavorable outcome
Blood 913011-3016
Partridge S Timothy A OrsquoDoherty MJ Hain SF Rankin S Mikhaeel G (2000) 2-fluorine-18-
fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of
Hodgkins disease influence on patient management in a single institution Ann Oncol 111273-
1279
47
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Pileri SA Ascani S Leoncini L Sabattini E Zinzani PL Piccaluga PP Pileri A Jr Giunti M
Falini B Bolis GB Stein H (2002) Hodgkins lymphoma the pathologists viewpoint J Clin
Pathol 55 162-176
Rehwald U Schulz H Reiser M Sieber M Staak JO Morschhauser F Driessen C Rudiger T
Muller-Hermelink K Diehl V Engert A (2003) Treatment of relapsed CD20+ Hodgkin
lymphoma with the monoclonal antibody rituximab is effective and well tolerated results of a
phase 2 trial of the German Hodgkin Lymphoma Study Group Blood 101 420ndash424
Ruhl U Albrecht M Dieckmann K Luders H Marciniak H Schellenberg D Wickmann L
Dorffel W (2001) Response-adapted radiotherapy in the treatment of pediatric Hodgkins disease
an interim report at 5 years of the German GPOH-HD 95 trial Int J Radiat Oncol Biol Phys 51
1209-1218
Rigo P Paulus P Kaschten BJ Hustinx R Bury T Jerusalem G Benoit T Foidart-Willems J
(1996) Ontological applications of positron emission tomography with fluorine-18 fluorodeoxy-
glucose Eur J Nucl Med 231641
Phillips JK Spearing RL Davies JM Hay CR Parry H Nash JR Cawley JC (1990) VIM-D
salvage chemotherapy in Hodgkinrsquos disease Cancer Chemother Pharmacol 27161-163
Schellong G Poumltter R Braumlmswig J Wagner W Prott F Doumlrffel W Koumlrholz D Mann G
Rath B Reiter A Weissbach G Riepenhausen M Thiemann M Schwarze EW (1999) High
Cure rates and reduced long-term toxicity in paediatric Hodgkins disease The German-Austrian
Multicenter Trial DAL-HD-90 J Clin Oncol 17 3736-3744
Schellong G Hornig-Franz I Rath B Ritter J Riepenhausen M Kabisch H Goldschmitt-Wuttge
B Schmidt P Niethammer D Gaedicke G (1994) Reduzierung der Strahlendosen auf 20-30Gy
im Rahmen einer kombinierten ChemoRadiotherapie beim Morbus Hodgkin im Kindesalter-ein
Bericht der kooperativen Therapiestudie DAL-HD-87 Klin Paumldiat 206 253-263
Schellong G Doumlrffel W Claviez A Koumlrholz D Mann G Scheel-Walter H-G Boumlkkerink JPM
Riepenhausen M Luumlders H Poumltter R Ruumlhl U (2005) Salvage therapy of progressive and
recurrent Hodgkinrsquos disease Results from a multicenter study of the pediatric DALGPOH-HD
Study Group J Clin Oncol 23 6181-6189
48
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Schelong G (1996) The balance between cure and late affects in childhood Hodgkinrsquos
Lymphoma The experience of the German-Austian-Study-Group since 1978 Annals of
Oncology 7 67-72
Schellong G Houmlrnig-Franz I (1993) Salvage therapy results in childhood Hodgkinrsquos disease In
Zander AR Barlogie B (eds) Autologous bone marrow transplantation for Hodgkinrsquos lymphoma
and multiple myeloma Springer Verlag BerlinHeidelberg Germany pp 8-10
Schwartz CL (2003) The management of Hodgkin disease in the young child Curr Opin Pediatr
15 10-16
Sklar C Whitton J Mertens A Stovall M Green D Marina N Greffe B Wolden S Robison L
(2000) Abnormalities of the thyroid in survivors of Hodgkins disease data from the Childhood
Cancer Survivor Study J Clin Endocrinol Metab 85 3227-3232
Schnell R Borchmann P Schulz H Engert A (2003) Current strategies of antibody-based
treatment in Hodgkinrsquos disease Ann Oncol 13 57ndash66
Shankar AG Ashley S Radford M Barrett A Wright D Pinkerton CR (1997) Does histology
influence outcome in childhood Hodgkins disease Results from the United Kingdom Childrens
Cancer Study Group J Clin Oncol1997 15 2622-2630
Stumpe KD Urbinelli M Steinert HC Glanzmann C Buck A Schulthess GK (1998) Whole-
body positron emission tomography using fluorodeoxyglucose for staging of lymphoma
effectiveness and comparison with computed tomography Eur J Nucl Med 25 721-28
Stein H Marafioti T Foss HD Laumen H Hummel M Anagnostopoulos I Wirth T Demel G
Falini B (2001) Down-regulation of BOB1OBF1 and Oct2 in classical Hodgkin disease but not
in lymphocyte predominant Hodgkin disease correlates with immunoglobulin transcription
Blood 97 496-501
Seitz V Hummel M Marafioti T Anagnostopoulos I Assaf C Stein H (2000) Detection of
clonal T-cell receptor gamma-chain gene-rearrangements in Reed-Sternberg cells of classic
Hodgkins disease Blood 95 3020ndash3024
Skinnider BF Mak TW (2002) The role of cytokines in classical Hodgkin lymphoma Blood
99 4283-97
49
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51
Schmitz N Pfistner B Sextro M Sieber M Carella AM Haenel M Boissevain F Zschaber R
Muller P Kirchner H Lohri A Decker S Koch B Hasenclever D Goldstone AH Diehl
V(2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with
autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkinrsquos
disease a randomised trial Lancet 359 2065ndash2071
Vassilev LT Vu BT Graves B Carvajal D Podlaski F Filipovic Z Kong N Kammlott U
Lukacs C Klein C Fotouhi N Liu EA (2004) In vivo activation of the p53 pathway by small-
molecule antagonists of MDM2 Science 303 844 -848
Weiss LM Movahed LA Warnke RA Sklar J (1989) Detection of EBV genomes in Reed
Sternberg cells of Hodgkinrsquos disease J Clin Oncol 320 502-504
Wiedmann E Baican B Hertel A Baum RP Chow KU Knupp B Adams S Hor G Hoelzer D
Mitrou PS(1999) Positron emission tomography (PET) for staging and evaluation of response to
treatment in patients with Hodgkins disease Leuk Lymphoma 34 545-551
Wolden SL Lamborn KR Cleary SF Tate DJ Donaldson SS Wolden SL Lamborn KR Cleary
SF (1998) Second cancers following pediatric Hodgkins disease J Clin Oncol 16 536-544
Yuen AR Rosenberg SA Hoppe RT Halpern JD Horning SJ (1997) Comparison between
conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory
Hodgkinrsquos disease Blood 89 814ndash22
Xiros N Binder T Anger B Bohlke J Heimpel H (1998) ITP in Hodgkinrsquos disease patients
Eur J Hematol 40 437-441
50
51