Franceschetti Silvia, Annunziata Maria Antonietta, Agostinelli Giulia, Gerardi Chiara, Allocati Eleonora, Minoia Carla, Guarini Attilio
Haematology Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, 20025 Legnano, Italy.
Oncological Psychology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy.
Cancers (Basel). 2021 Jul 7;13(14):3401. doi: 10.3390/cancers13143401.
The continuously improving treatment outcome for classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) over the last 25 years has led to a high number of long-term survivors. The impact of treatment, however, can sometimes be dramatic and long-lasting. Focusing on peripheral neuropathy (PN), cognitive impairment, fatigue, anxiety, and depression, researchers of the Fondazione Italiana Linfomi conducted a systematic review of the literature to collect the available data on sequelae incidence as well as evidence of follow-up strategies for long-term cHL and DLBCL survivors.
The review was carried out under the methodological supervision of the Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. The literature search was conducted on three databases (MEDLINE, Embase, and the Cochrane Library) updated to November 2019. The selection process and data extraction were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
A total of 2236 abstracts were screened, 247 full texts were analyzed, and 35 papers were included in the final analysis. Fatigue was the most extensively studied among neuropsychological sequelae, with a mean prevalence among cHL survivors of 10-43%. Although many of the papers showed an increased incidence of PN, cognitive impairment, and anxiety and depression in long-term cHL and DLBCL survivors, no definite conclusions can be drawn because of the methodological limitations of the analyzed studies. No data on monitoring and follow-up strategies of PN and other neuropsychological sequelae were highlighted.
Based on our findings, future studies in this setting should include well-defined study populations and have a longitudinal trial design to assess the outcomes of interest over time, thus as to structure follow-up programs that can be translated into daily practice.
在过去25年中，经典型霍奇金淋巴瘤（cHL）和弥漫性大B细胞淋巴瘤（DLBCL）的治疗效果不断改善，导致大量长期存活者出现。然而，治疗的影响有时可能是巨大且持久的。意大利淋巴瘤基金会的研究人员聚焦于周围神经病变（PN）、认知障碍、疲劳、焦虑和抑郁，对文献进行了系统回顾，以收集有关长期cHL和DLBCL存活者后遗症发生率的现有数据以及随访策略的证据。
该综述在意大利米兰“马里奥·内格里”药理研究所的方法学监督下进行。对截至2019年11月更新的三个数据库（MEDLINE、Embase和Cochrane图书馆）进行了文献检索。选择过程和数据提取按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。
共筛选了2236篇摘要，分析了247篇全文，最终纳入35篇论文进行分析。在神经心理后遗症中，疲劳是研究最广泛的，cHL存活者中的平均患病率为10% - 43%。尽管许多论文显示长期cHL和DLBCL存活者中PN、认知障碍、焦虑和抑郁的发生率增加，但由于所分析研究的方法学局限性，无法得出明确结论。未突出显示关于PN和其他神经心理后遗症监测及随访策略的数据。
基于我们的研究结果，该领域未来的研究应包括明确界定的研究人群，并采用纵向试验设计来评估随时间推移的相关结局，从而构建可转化为日常实践的随访计划。
