Faculty of Medicine
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Item type:Publication, OBINUTUZUMAB FOR THE TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS: SINGLE CENTER EXPERIENCE(Faculty of Medicine, UKIM, Skopje, 2023); ; ; ; Popova Labacevska, MarijaMonoclonal antibodies (mAbs) targeting CD20 molecule on B lymphocyte are of great importance in the treatment of B-cell malignancies. In recent years a great effort has been put in developing novel mAbs that can provide greater efficacy than the well-known rituximab. A second class of mAbs obinutuzumab has been presented as a more powerful tool in the treatment of this group of patients. In this retrospective study 70 patients with symptomatic CLL were included. CLL patients were diagnosed and treated at the University Clinic for Hematology between January 2018 and January 2022. All patients were evaluated for traditional clinical and laboratory prognostic factors and newer prognostic factors including IGHV mutation status and CLL prognostic and predictive genetic abnormalities. Most of the patients treated with obinutuzumab had Binet B stage (56%). Mutational status of the immunoglobulin variable region heavy chain (IGHV) in most of CLLpatients treated with obinutuzumab was unmated IGHV gene. The most frequently encountered adverse events were tumor lysis syndrome and leukopenia. The analysis of the initial results of the application of obinutuzumab-based therapy allows us to conclude that this therapeutical modality is not associated with severe adverseevents that would limit the administration of therapy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CTLA-4 exon 1 polymorphism in patients with autoimmune blood disorders.(Wiley, 2003); ; ; ; Efremov, DCTLA-4 is a CD 28 homologue which plays an important role in negative regulation of T cell response. It’s transit expression on the surface of activated T-cells antagonizes the activating signals and terminates the T-cell response. An A to G polymorphism at position 49 of the CTLA-4 first exon has recently been associated with several autoimmune disorders. In the present study we have examined the prevalence of the A and G alleles of the CTLA-4 gene in 110 patients with autoimmune blood diseases, including 50 patients with autoimmune hemolytic anemia (20 patients with idiopathic AIHA and 30 patients with AIHA and CLL) and 60 patients with ITP. Control subjects were 100 healthy individuals and 100 CLL patients without clinical evidence for an autoimmune disease. Overall, the G allele was significantly more frequent among the patients with autoimmune disorders (p=0.016). However, this was entirely due to the higher prevalence of the G allele among patients with AIHA (p=0.003), whereas no difference was observed between patients with ITP and controls. The correlation between the CTLA-4 G allele and the development of AIHA was most significant when we compared only patients with CLL (p=0.004), and was lower when the comparison was done between DAT positive and DAT negative CLL patients, regardless of the presence of AIHA (p=0.021). The obtained data indicate that the G allele of CTLA-4 may predispose to the development of AIHA, possibly through the amplification of a prexisting autoimmune response. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CIRS-G score as a rapid way to determine the overall multimorbidity burden and to select optimal and individualized therapy in newly diagnosed eldery CLL patients(Македонско лекарско друштво = Macedonian Medical Association, 2020); ; ; ; Slobodanka Trpkovska TerzievaIntroduction. Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the elderly population. Many of these patients have multiple comorbidities, which might influence the choice of an adequate upfront chemoimmunotherapy option. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score seems to be a reliable tool for assessment of the burden of comorbidity in elderly cancer patients. Objectives. The primary objective of our study was to assess the distribution of CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used, and the effects it produced in each patients’ group, classified according to the CIRS score. Methods. In our prospective, single-center study, we focused on CLL patients that were referred to the University Clinic for Hematology in Skopje between 2017 and 2019. Comorbidity was assessed by the CIRS-G score in all patients included in our study (n=56) prior to the process of deciding on the most adequate treatment option. Results. The median age was 69 (±9.4) years. Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9. The three most common comorbidities were related to involvement of the vascular system (41.1%), endocrine-metabolic disorders (32.1%), and respiratory system disorders (17.9%). Only 16.1% of the patients had only 1 affected organ or system, other than hematological issues, while 64% of the patients had ≥2 affected systems. In 33.9% of the study patient cohort, the watch and wait initial approach was the standard of care. We considered 66.1% of patients to be requiring treatment, as follows: chemotherapy (chlorambucil, fludarabine+cyclophosphamide, bendamustine) only (30.4%), rituximab-based therapy (33.9%), and 1.8% of patients, due to the high comorbidity burden, were eligible only for supportive care. There was a stable trend of correlation between the CIRS score assessment and the treatment option prescribed (rs=0.7188, p<0.000001). Conclusions. The comorbidity status is a major consideration when treating elderly patients with CLL. Our study shows that comorbidity is quite a common feature in CLL patients and that it is increasing with age. CIRS is helpful in identifying the best treatment combination for the patients, that will enhance achieving long-term control of CLL, maintaining an optimal quality of life level. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Current status in management of patients with chronic lymphocytic leukemia (CLL) in Republic of Macedonia(Macedonian Medical Association/ Walter de Gruyter GmbH, 2016-01); ; ; ; Lidija CevreskaChronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. CLL is a disease of elderly, who often have multiple comorbidities. These factors affect further treatment decisions, despite the great progress in the therapy of CLL in the last two decades. The aim of this study was to evaluate the current status in the management of patients with CLL in the Republic of Macedonia and to compare it with CLL patients in other western countries. We analyzed 102 patients with CLL referred to our Institution for control and/or treatment in the period from January 2015 to October 2015. Median age of our group of patients at the time of diagnosis was 62.7 years with almost 40% of patients older than 64 years. Male to female ratio was 1.3:1 and 54% of patients were diagnosed in stage "0" according to Rai staging system. Watch and wait was the most common treatment approach (58.8%) at the time of diagnosis, but at the moment of analysis only 33% of patients were still without treatment. The most common treatment in this group of CLL patients was FCR protocol with 39.5% of patients treated with an average of 5 cycles of this immunochemotherapeutic regimen. The average time of progression free survival (PFS) in all treated patients was 32.8 months with range between 2-72 months. In summary, clinical characteristics of CLL patient in our clinical settings and the most common therapeutic approach at our Institution do not differ significantly from the characteristics of the average CLL patient in other studies.