T Hücreli Lenfoma
Özet
T hücreli lenfomalar (TCL), T lenfositlerinden veya doğal öldürücü (NK) hücrelerden kaynaklanır. TCL'nin alt türleri, periferik T hücreli lenfoma (PTCL), kutanöz T hücreli lenfoma (CTCL), ve diğer spesifik alt tiplere ayrılmıştır. TCL, sistemik semptomlar ve ileri evre hastalıkla ilişkilidir. Prognoz belirlemede "International Prognostic Index (IPI)" ve "Prognostic Index for T-cell Lymphoma (PIT)" gibi indeksler kullanılır. Bazı biyobelirteçlerin yüksek düzeyde ekspresyonu kötü prognozla ilişkilidir (ör. p53 mutasyonu, CD56). Tedavi seçenekleri arasında kemoterapi, hedefe yönelik tedaviler, immunoterapi, kök hücre nakli, radyoterapi ve diğer destekleyici tedaviler yer alır. Takip sıklığı ilk 2 yıl her 3-6 ayda bir, 3-5 yıl arası her 6-12 ayda bir ve 5 yıldan sonra yılda bir kez yapılır. Hastanın aldığı tedavilere bağlı geç yan etkiler göz önünde bulundurularak takipte ayrıntılı fizik muayene ile beraber B semptomları (örn. kilo kaybı, gece terlemeleri, enfeksiyon olmadan ateş) sorgulanır. Tedavi sonrası ortaya çıkabilecek yan etkiler değerlendirilir. Başta tam kan olmak üzere laboratuvar testleri görülür. LDH ve immünoglobulin G (IgG) düzeyleri, özellikle progresyon şüphesi durumunda yapılır. Görüntüleme yöntemi olarak genellikle ultrason ve bilgisayarlı tomografi (BT) kullanılırken pozitron emisyon tomografisi (PET) gibi ileri görüntülemeler yalnızca nüks şüphesinde yapılır. Takip süreçleri, her hastanın klinik durumu ve aldığı tedavilere göre kişiselleştirilir. Amaç, nüks ve yan etkilerin erken teşhis edilmesi, hastanın yaşam kalitesinin korunmasıdır.
T-cell lymphomas (TCL) originate from T lymphocytes or natural killer (NK) cells. Subtypes of TCL are divided into peripheral T-cell lymphoma (PTCL), cutaneous T-cell lymphoma (CTCL), and other specific subtypes. TCL is associated with systemic symptoms and advanced disease. Indices such as “International Prognostic Index (IPI)” and “Prognostic Index for T-cell Lymphoma (PIT)” are used to determine prognosis. High expression of some biomarkers is associated with poor prognosis (e.g. p53 mutation, CD56). Treatment options include chemotherapy, targeted therapies, immunotherapy, stem cell transplantation, radiotherapy and other supportive therapies. The frequency of follow-up is every 3-6 months for the first 2 years, every 6-12 months between 3-5 years and once a year after 5 years. B symptoms (e.g. weight loss, night sweats, fever without infection) are questioned together with a detailed physical examination at follow-up, taking into account late side effects related to the treatments the patient has received. Laboratory tests, especially whole blood, are seen. LDH and immunoglobulin G (IgG) levels, especially if progression is suspected. Ultrasound and computed tomography (CT) are usually used as imaging modalities, while advanced imaging such as positron emission tomography (PET) is only performed in cases of suspected recurrence. Follow-up processes are personalized according to each patient's clinical condition and treatments. The aim is early detection of recurrence and side effects and preservation of the patient's quality of life.
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