20.500.12556/DKUM-65281 Preprečevanje in zdravljenje zapletov kronične limfocitne levkemije (prikaz primera) Prevention and treatment of complications of chronic lymphocytic leukemia (Case presentation) Izhodišča: Najpogostejši zapleti kronične limfocitne levkemije (KLL) so: okužbe, avtoimunski pojavi in pojav sekundarnega raka, kar vse je posledica spremenjenega delovanja imunskega sistema. Vzroki za oslabljeno humoralno in celično imunost so kvalitativne in kvantitativne napake limfocitov B in T, nevtrofilcev, naravnih celic ubijalk in monocitno/makrofagnega sistema. Prikaz primera: Prikazan je bolnik s KLL, pri katerem je bila v času okužbe dihal ugotovljena avtoimunska hemolitična anemija (AIHA). Bolnik je bil uspešno zdravljen s steroidi, intravenskimi imunoglobulini (IVIG), antibiotikiin transfuzijami eritrocitov. Nekaj let kasneje ob ponovni okužbiin AIHA je bil zdravljen na enak način. Ker je imel stranske učinke po zdravljenju s steroidi, je bil uspešno zdravljen z rituximabom. Zaradi hipogamaglobulinemije in številnih prehladov brez ponovitve AIHA je prejemal profilaktično IVIG. Bolnik je že nekaj let v remisiji, brez anemije, pred leti je bil operiran zaradi karcinoma ledvice, letos pa zaradi karcinoma kože. Zaključki: Med avtoimunskimi pojavi sta najpogostejši AIHA in imunska trombocitopenija (IT). Zdravljenje AIHA in IT temelji na podpornem zdravljenju, zdravljenju s steroidi, IVIG, splenektomiji, v zadnjih letih pa na monoklonskih protitelesih. Pri večini bolnikov opažamo hipogamaglobulinemijo s posledičnimi pogostimi okužbami. Pri teh bolnikih je profilaktično dajanje IVIG priporočljivo, vendar ne zmanjša smrtnosti. Cepljenje je koristno v začetnih stopnjah bolezni. Background: Infections, autoimmune complications and secondary cancers are the most frequent complications of chronic lymphocytic leukemia (CLL) . All are the result of modified immune system. The causes of attenuated humoral and cellular immunity lay in the qualitative and quantitative defects of B and T lymphocytes, as well as of neutrophils and monocytes/ macrophages. Case report: A patient with CLL is shown, in whom autoimmune hemolytic anemia (AIHA) was found at the time of respiratory infection . The patient was succesfully treated with steroids, intravenous immunoglobulins (IVIG), antibiotics and blood transfusions. Some years later, having respiratory infection and AIHA again, he was treated in the same way, but had side effects after steroid therapy. So he was succesfully treated with rituximab. Because of hypogammaglobulinaemia and repeated colds without worsening of AIHA he was receiving prophylactic IVIG monthly. He has been in remission for a couple of years now without AIHA, but in the last time he underwent surgery for renal and skin carcinoma. Conclusion: Among autoimmune complications, AIHA and immune thrombocytopenia (IT) are most frequent. The treatment is based on supportive care, corticosteroids, IVIG, splenectomy, and in last years also on monoclonal antibodies. Hypogammaglobulinemia is present in virtually all patients with consequent frequent and serious infections. In this group of patients prophylactic use of IVIG is recommended, but it does not reduce mortality. Vaccination is useful if used in earlier stages of CLL. kronična limfocitna levkemija hipogamaglobulinemija avtoimunska hemolitična anemija imunska trombocitopenija okužbe cepljenje chronic lymphocytic leukemia hypogam maglobulinemia aut oimmune hemolytic anemia immune thrombocytopenia infections vaccination true false true Slovenski jezik Angleški jezik Znanstveno delo 2017-03-28 11:58:02 2017-03-28 11:59:02 2022-07-07 03:09:05 2019-07-11 15:13:21 2011 0 0 str. 957-962 št. 12 Letn. 80 dec. 2011 0000-00-00 Zaloznikova NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1318-0347 616.1 32893696 4158527 1318-0347 URN:SI:UM:DK:IP8UA1JO Zdravniski_vestnik_2011_Glaser,_Glaser_Preprecevanje_in_zdravljenje_zapletov_kronicne_limfocitne_levkemije_(prikaz_primera).pdf Zdravniski_vestnik_2011_Glaser,_Glaser_Preprecevanje_in_zdravljenje_zapletov_kronicne_limfocitne_levkemije_(prikaz_primera).pdf 1 85BE01D92F12986AFE73037278B20CCE 6b312efae50b79619cbd2dab7ce9d8372e688280635e3ce602efa3c8e554cee5 0772d1b9-7c0e-11eb-bb7a-00155d0001ca https://dk.um.si/Dokument.php?lang=slv&id=110257 http://vestnik.szd.si/index.php/ZdravVest/article/view/829 1 https://dk.um.si/Dokument.php?lang=slv&id=110256 Medicinska fakulteta 0 0 0