Rad se temelji na direktnom iskustvu obrade i digitalizacije škrinja iz Zbirke pokućstva
Etnografskoga muzeja u Zagrebu. Prikazani su kvantitativni i kvalitativni podatci (opisi,
usporedbe) koji ...ukazuju na trenutačno stanje škrinja unutar navedene zbirke Muzeja. U
radu se navode daljnje mogućnosti za stručnu obradu i valorizaciju te interpretaciju ovih
predmeta u budućnosti. Također, rad donosi povijesni razvoj, tipologiju te ulogu i značaj
škrinje kao uporabnoga predmeta tradicijske kulture s kraja 19. i početka 20. stoljeća.
The paper is based on direct experience of processing and digitisation of chests from
the Furniture Collection of the Ethnographic Museum in Zagreb. Quantitative (numerical) and qualitative data ...(descriptions, comparisons) has been presented that show the
current status of the chests within the previously mentioned collection of the Museum.
The paper lists further opportunities for professional processing and valorisation and
interpretation of these objects in the future. Moreover, the paper provides historical
development, typology and the role and the importance of chests as usable objects
of traditional culture from the end of the 19th and the beginning of the 20th century.
- The aim of this review is to present data on bendamustine, a non-cross resistant alkylating agent, alone or in combination for treatment of non-Hodgkin lymphoma (NHL) and chronic lymphocytic ...leukemia (CLL). Bendamustine is currently approved for rituximab-resistant indolent NHL and CLL in patients not fit for conventional chemotherapy. Recent studies have shown superiority of bendamustine combination with rituximab (B-R) in first line treatment of indolent NHLs and mantle cell lymphoma, suggesting a shift of the standard of care in this setting. B-R regimen has also shown efficacy in relapsed setting suggesting the possible treatment option for patients failing conventional chemotherapy. In rituximab-resistant NHL, the recent GADOLIN study exploring the addition of obinutuzumab to bendamustine has yielded impressive result changing the standard of care in this hard-to-treat population. Concerning CLL, despite inferiority to the standard of care in young fit patients, as defined in CLL10 study, B-R has yielded a more beneficial toxicity profile and its use in first line treatment should be decided individually. In relapsed setting, the addition of ibrutinib to B-R has shown superior results compared to B-R alone, possibly changing the paradigm of treatment of relapsed CLL. In conclusion, bendamustine as a single agent or in combinations has shown activity with acceptable toxic profile in the treatment of patients with indolent NHLs or CLL without del(17p) mutation.
U bolesnika s kroničnom limfoproliferativnom bolesti (LPB) veća je učestalost nastanka sekundarnih neoplazma. Istodobna pojava limfoproliferativne neoplazme (LPN) i mijelodisplastičnog sindroma (MDS) ...vrlo je rijetka. Druga hematološka neoplazma dijagnosticira se slučajno tijekom kontrola ili pri dodatnim analizama zbog
nesukladnih kliničkih ili laboratorijskih nalaza. Prikazujemo dijagnostički postupak, tijek bolesti i liječenje 65-godišnje bolesnice s kroničnom limfoproliferativnom neoplazmom i MDS-om sa suviškom blasta tipa 2
(MDS-EB2). Vodeći nalaz bila je neutropenija, a tek su citološkim analizama koštane srži i periferne krvi dijagnosticirane navedene neoplazme. Liječenje jedne i druge hematološke neoplazme nije dalo zadovoljavajuće rezultate i MDS je progredirao u akutnu mijeloičnu leukemiju. U bolesnika s limfoproliferativnom neoplazmom i citopenijom
valja tragati za mogućim drugim uzrocima takvih aberantnih nalaza. Pri liječenju tih bolesnika razumno je liječiti dominantnu bolest.
Cilj je ovoga preglednog rada prikazati suvremeno stajalište struke, ali i prijepore u svezi s medicinskom skrbi za bolesnike s klasičnim Hodgkinovim limfomom u prvoj remisiji. Većina bolesnika s ...klasičnim Hodgkinovim limfomom izliječena je prvom linijom terapije i u nastavku je važan medicinski pristup radi otkrivanja mogućeg relapsa. Pregledom literature nismo našli jednoznačne smjernice za rutinsko praćenje bolesnika slikovnim metodama, tj. kompjutoriziranom tomografijom ili pozitronskom emisijskom tomografijom. Prema dokazima u literaturi, otkriće asimptomatskog relapsa nije povezano s poboljšanim ishodom liječenja. Za sada se može smatrati da su standardne kliničke i radiološke metode dostatne za praćenje ovih bolesnika. Kasne toksičnosti uzrokovane mnogim lijekovima i zračenjem znatno pridonose morbiditetu bolesnika. To uključuje pojavu sekundarnih solidnih malignoma (ponajprije karcinoma pluća i dojke) i hematoloških neoplazma koštane srži te pojavu benignih toksičnosti kao što su poremećaji funkcije štitnjače, fertiliteta i kardiovaskularnih bolesti. Usprkos obilju literature i smjernica za praćenje ovih bolesnika nakon završetka liječenja, za sada ne postoje rezultati prospektivnih istraživanja koji bi pružili temelj zasnovan na dokazima za nove smjernice i preporuke. Smatramo da otkrivanje kasne toksičnosti treba biti prilagođeno pojedinačnom bolesniku, sukladno specifičnom liječenju i kasnijem utjecaju te toksičnosti na mogući morbiditet u ovih bolesnika.
Myelodysplastic syndromes (MDS) are heterogeneous group of hematologic disorders of mostly elderly and based on distinct clinical phenotypes. Current paradigm of their pathogenesis relies on somatic ...gene mutations combined with the predisposing defective osteohematopoietic niche, but due to the breakout in epigenetic research scientific focus has steered toward two most common epigenetic modifications: methylation mechanisms and histone modification. At the same time, relatively few studies have been undertaken regarding the third epigenetic pathway – microRNAs – in MDS. The main aim of this review is to provide the basics of microRNA biology and function in oncogenesis, showing the complexity of mechanisms behind this single‐stranded 22 nucleotides long RNA molecule, with further focus on its implication in MDS pathology and clinical context. By extensive literature search, we have shown enough evidence for their deregulation in MDS. However, few studies have addressed the issue on pathogenic events in MDS and its association with specific microRNAs. Preliminary research in clinical setting has shown the possible utility of microRNAs in terms of prognosis and therapy, although we are only beginning to understand various implications of microRNAs in MDS and further extensive research is warranted to answer multiple questions arising from interconnection of this epigenetic mechanism in MDS.
Glavni cilj ovog preglednog rada je predstaviti novu klasu lijekova u kroničnoj limfocitnoj leukemiji (KLL), najčešćoj leukemiji odrasle dobi, inhibitore staničnog signaliziranja B receptora (BCR). ...KLL se klasično liječila imunokemoterapijom, no pojedini bolesnici (poodmakla životna dob, nepovoljni biološki faktori) imali su lošu prognozu. S boljim razumijevanjem patogeneze unutarstaničnih putova pojavila se mogućnost selektivne inhibicije i ciljane terapije u KLL. Prvi lijek u svojoj klasi ibrutinib, inhibitor bruton kinaze, pokazao se superiornim u fazama III kliničkih pokusa te je eliminirao negativne prognostičke faktore u liječenju KLL, pogotovo del (17p), s adekvatnim profi lom toksičnosti što su prepoznale regulatorne agencije. Drugi BCR inhibitori idelalisib i venetoklaks su iznimno aktivni u relapsnom okruženju, no idelalisib se pokazao neprihvatljivo toksičnim u prvoj liniji liječenja što nam može poslužiti kao lekcija u dizajnu kliničkih pokusa s ovim lijekovima. Usprkos učinkovitosti, potreban je dodatni napredak u ovom području koji se nalazi u kombinacijama s imunoterapijom ili imunokemoterapijom, te mogućoj međusobnoj kombinaciji kako bismo dodatno poboljšali ishode. No, najveća zapreka BCR inhibitorima da uđu u široku praksu je njihova cijena i utjecaj na zdravstveni sustav što nažalost ograničuje našu mogućnost da liječimo bolesnike s KLL u eri bez kemoterapije.
Rituximab is a chimeric monoclonal CD20 antibody used in the treatment of
CD20 positive non-Hodgkin lymphomas and has revolutionized treatment approach to these hematologic
malignancies in the last ...decade. The main aim of this review is to present data on the use of
rituximab in the treatment of follicular lymphoma (FL). We will focus on rituximab maintenance
strategies in the first and second line treatment. This approach has improved the outcome in FL patients
with better progression-free survival in all patients and better overall survival in relapsed setting.
Regardless of good results, this strategy has generated controversies in medical community in the
range from the lack of overall survival benefit in first line setting, adverse effects of possible overtreatment
and toxicities to its unknown role in the era of novel agents. The existing data suggest that
rituximab maintenance should be a rational therapeutic option for all patients with FL responding to
fi rst line therapy and transplant-ineligible patients responding to reinduction.
Limfom plaštene zone (engl. Mantle cell lymphoma – MCL) četvrti je najučestaliji ne-Hodgkinov limfom. Karakteriziran je agresivnim tokom s multiplim relapsima. Cilj je rada literaturnim pregledom ...opisati suvremeni pristup liječenju ovog limfoma. U mlađih bolesnika zlatni je standard intenzivna kemoterapija visokim dozama citarabina. Pri kompletnoj ili parcijalnoj remisiji kao konsolidacija je indicirana autologna transplantacija perifernih matičnih stanica. U starijih bolesnika kemoterapija CHOP-R-om nije prikladno rješenje. Ove bolesnike treba liječiti bendamustinom u kombinaciji s rituksimabom. Pri kompletnoj ili parcijalnoj remisiji opcija je konsolidacija odgovora održavanjem rituksimabom. Većina će bolesnika s MCL-om relabirati pa je njihovo liječenje izazov i teškoća u daljnjim postupcima. Liječenje relapsnog MCL-a može se podijeliti u dvije skupine: kemoterapija i biološki lijekovi. U bolesnika s dobrim općim statusom prikladna može biti kemoterapija temeljena na bendamustinu i citarabinu. U bolesnika s komorbiditetima moguća je opcija biološka terapija. Od biološke terapije treba istaknuti ibrutinib, inhibitor Brutonove kinaze, zbog najveće stope odgovora i trajanja učinka liječenja. S razvojem novih potentnih inhibitora B-staničnoga receptorskog puta aktivnih u MCL-u uskoro bi biološki lijekovi mogli postati zlatnim standardom i uvesti liječenje MCL-a u eru bez kemoterapije.
Mantle cell lymphoma (MCL) represents the fourth most common type of non-Hodgkin lymphomas. It is characterized by aggressive course and frequent relapses. The main aim of this review is to evaluate ...current treatment approach towards this type of lymphoma. In younger patients the chemotherapy including high doses of cytarabine is the gold standard. In case of complete or partial remission, the consolidation with autologous stem cell transplantation is indicated as consolidation approach. In older patients CHOP-R regimen is not the treatment of choice. These patients should be treated with bendamustine in combination with rituximab. In case of complete or partial remission, further therapy with rituximab maintenance as consolidation represents an option. The vast majority of patients with MCL will ultimately relapse which poses a challenge in treatment approach. The approach in relapsed MCL can be divided in two types: chemotherapy or biologic therapy. In young fit patients chemotherapy based on bendamustine and cytarabine is a reasonable option. In patients with comorbidities or poor performance status biologic agents are reasonable options. Ibrutinib, Bruton kinase inhibitor, is characterized by highest overall response rate and the longest duration of response and should be offered to these patients. With the development of novel potent inhibitor of B cell receptor signaling pathway, these agents may become the gold standard in future and introduce the treatment of MCL in „chemo-free“era.
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