Lege Artis Medicinae

[Gene polymorphisms in drug metabolism in diffuse large BCL patients]

PÁL Ildikó, ZILAHI Erika, ILLÉS Árpád, GERGELY Lajos, RADNAY Zita, VÁRÓCZY László

DECEMBER 20, 2014

Lege Artis Medicinae - 2014;24(12)

[Diffuse large B-cell lymphoma (DLBCL) accounts for 30% of all non-Hodgkin lymphoma (NHL) and 80% of agressive lymphomas. Besides the Traditional International Prognostic Index (IPI), some other factors may also influence the prognosis of DLBCL patients. Aims - Our purpose was to study how the genetic polymorphism in metabolic pathway influence the eventfree and overall survival and therapeutic response in diffuse large B-cell lymphoma. Method and patients - Fifty-one patient, 32 men and 19 women, were involved in the study. The average age was 53.1 years. DLBCL was diagnosed between 2006 and 2011 and the average follow up time was 3.78 years. These patients received 1-8 cycles (an average of 6-2 cycles) of R-CHOP immunochemotherapy. REAL Time PCR was used to determine the genetic polymorphisms of CYP2E1, GSTP1, NAT1 and NAT2 genes. Results - Our results showed that the polymorphisms of CYP2E1, GSTP1 and NAT1 genes did not influence the prognosis of DLBCL patients. In terms of the NAT2 gene, GG homozygous patients showed slightly better therapeutic response and survival results compared to those bearing an A allele, however, the differences were not statistically significant. Conclusion - Our results could not confirm that genetic polymorphism in metabolic pathways has any predictive role in diffuse large B-cell lmphoma.]

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[INTRODUCTION - Continuous Ambula­tory Peritoneal Dialysis (CAPD) treatment is widespread used over the years as a result of technical progress. As with any renal replacement therapy, in hemodialysis patients in time made vascular access, also the success of the CAPD depends on the in time inserted catheter for peritoneal dialysis. PATIENTS AND METHOD - Inserting a catheter for chronic peritoneal dialysis in Hungary is currently exclusively surgical procedure. The successfully CAPD treatment is so essential to insert the peritoneal dialysis catheter by dedicated surgeon. The intervention is often not a priority in the surgical tender, and in many places queues delaying the surgery. Proposed as an alternative to the percutaneous technique introduction. If nephrologist are familiar with basic surgical procedures by providing appropriate means, the percutaneous catheter insertion technique can be performed. RESULTS - In the spring of 2014, we introduced in Hungary first this procedure, which reported in the international literature as percutaneous PD-catheter insertion method. The technique was modified to the primary entry point determined by the typical abdominal puncture site. Puncture of the abdomen is performed by physicians as a routine intervention, which is widely accepted. After selecting the appropriate patient population and detailed medical information, patients are prepeared, under x-ray fluoroscopy imaging the implants were made. So far 10 catheter were implanted under this technique, all of them successfully. Thanks to the minimal invasive intervention, the patients healing was significantly faster, after the day of catheter-insertion we were able to start drainage. By the traditional surgical implantation the recovery time is six weeks. CONCLUsiONS - In all cases, when a surgeon not willing to insert the peritoneal dialysis catheter, the percutaneous technique can be safe. All of the catheters made by us are working well. Of course, the surgical procedure is still indispensable, however, and this is the percutaneous technique’s advantage, the CAPD treatment can be started after the intervention. ]

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