Publications by authors named "Vibor Milunovic"

Hodgkin lymphoma is characterized by a high cure rate in the modern era of medicine regardless of stage, but patients suffer from a high risk of comorbidity associated with the administered therapy. The main aim of this review article is to assess and analyze the various comorbidities associated with Hodgkin lymphoma and address the survivorship of patients, including fertility, secondary cancers due to cardiovascular toxicity, and quality of life. Furthermore, this review explores the optimal strategy for detecting relapse.

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Article Synopsis
  • - A study analyzing 165 multiple myeloma (MM) patients found that those who developed second primary malignancies (SPMs), particularly hematological ones, generally had a shorter survival time and were more likely to have had previous cancer treatments.
  • - Patients with hematological SPMs tended to be younger and had a higher rate of prior autologous hematopoietic cell transplantation, with treatment often stopped upon SPM detection, especially in cases of hemato-SPM.
  • - Overall survival (OS) post-SPM detection was only 8.5 months, with the main cause of death being the SPM; hence, regular monitoring and early intervention are crucial for improving patient outcomes.
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  • This review focuses on summarizing the current first-line treatments for nodal T-cell non-Hodgkin lymphoma.
  • The standard CHOP chemotherapy has shown poor results, but recent advancements like the ECHELON-2 trial suggest that adding brentuximab vedotin could improve outcomes for certain subtypes of the disease.
  • Other promising developments include increased use of autologous stem cell transplantation for better disease control, though CHOP remains the primary treatment while new trials are exploring alternative options.
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Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient's fitness and decide whether to pursue a curative or palliative approach.

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Obinutuzumab (G) has become part of front-line treatment of follicular lymphoma (FL) based on results of a large randomized study. Data on patients treated outside of clinical trials are lacking. We have retrospectively investigated efficacy and safety of G-based immunochemotherapy regimens in 114 patients treated in a real-life setting during a period of 2 years, largely coinciding with the COVID-19 pandemic.

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Introduction: Chronic lymphocytic leukemia (CLL) is the most common leukemia in Western countries occurring typically in elderly patients. These patients often present with comorbidities limiting treatment options. During the last decade, the treatment paradigm has rapidly changed with the introduction of novel oral targeted agents and monoclonal antibodies.

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The current study assesses the characteristics and outcomes of multiple myeloma (MM) patients, treated with novel agents for hematogenous extramedullary (HEMM) relapse. Consecutive patients diagnosed with HEMM between 2010-2018 were included. Patients' characteristics at diagnosis and at HEMM presentation, response to treatment, survival and factors predicting survival were recorded and analyzed.

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- 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.

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ECHELON-1 study is a randomized open-labeled controlled trial investigating whether addition of brentuximab vedotin to chemotherapy offers benefit over the standard chemotherapy regimen in advanced Hodgkin lymphoma. After a median follow-up of 24.6 months, it has met its primary endpoint the reduction of modified progression-free survival being 23 percent.

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Article Synopsis
  • * In a study of 52 young patients, 68% had International Scoring System (ISS) stage 1 MM, and 85% were treated with novel therapies, including high rates of autologous stem cell transplantation.
  • * The median overall survival for these patients was 166 months, with a strong 5-year survival rate of 77%, suggesting they may have a better prognosis than older MM patients.
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This multicenter retrospective study included 101 patients (median age 62 years) with secondary plasma cell leukemia (sPCL). The median time from initial multiple myeloma diagnosis to sPCL was 31 months. Fifty-five out of 72 patients (75%) who received any therapy were treated with immunomodulators (IMiDs) and/or proteasome inhibitors (PIs), and 14/72 (19%) underwent salvage autologous stem cell transplantation (ASCT).

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In this observational study, direct and indirect (moderator and mediator) relationships between sociodemographic (age, gender, life partner, education level, income and length of treatment) and psychological (Hospital Anxiety and Depression Scale, HADS) variables and satisfaction with hospital care (EORTC INPATSAT32) in adult (advanced cancer) patients were investigated. Study sample consisted of 75 hospitalized advanced cancer patients recruited at the Zagreb University Hospital Centre and Sestre milosrdnice University Hospital Centre in 2015. Statistically significant negative correlations were found between HADS and elementary school education level, as well as with all satisfaction variables (satisfaction with physicians, nurses and organization).

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Background: Patients with cancer should be systematically screened for psychological problems at key points in their pathway. Usage of self-report scales for measuring anxiety and depression (such as Hospital Anxiety and Depression scale (HADS)) is a very practical methodfor detecting anxiety and depression. The aim of this research was to determine latent structure, reliability and cut-off scores of HADSin a Croatian sample of adult patients suffering from advanced metastatic cancer.

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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.

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Background: Immune thrombocytopenia (ITP) in adulthood is characterized by chronic relapsing course. Despite the efficacious first line treatment (corticosteroid, intravenous immunoglobulin), majority of patients will enter the chronic phase warranting another treatment approach. Until recently, splenectomy performed in ITP chronic phase represented the standard of care with longterm remissions in more than 70% of patients, but it has never been tested in clinical trials.

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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.

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In this review we present current evidence for the follow-up of patients treated for classical Hodgkin lymphoma (HL). Nowadays introduction of novel therapies enabled successful treatment in most patients with classical HL in first remission with 5-year overall survival rate estimation of 80%. We have performed extensive literature search on the methodological approach to detection of relapse.

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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.

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Autologous stem cell transplantation represents the gold standard in chemosensitive diffuse B large cell lymphoma in relapse or in refractory setting. The aim of this study was to present the outcome of peripheral autologous stem cell transplantation in patients with refractory or relapsed diffuse large B cell lymphoma. We retrospectively analysed the data of 62 patients, who underwent this procedure for the period 2000-2013.

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The aim of this review is to provide the Croatian medical public with novel insights into the definition, pathogenesis, diagnostic algorithms and treatment approaches to immune thrombocytopenia (ITP) in adults. Recently, primary ITP has been uniformly defined as an autoimmune disorder characterized by an isolated platelet count lower than 100 x 10(9)/L without preexisting disease or conditions, which could lead to thrombocytopenia. The recognition of primary and secondary ITP is important because they require different treatment strategies.

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Background: Empathy is a powerful and necessary skill for understanding another person's subjective experience. In this study we wanted to explore psychiatrists' attitudes towards PTSD, general empathy, possible differences related to age, sex and regional location in Croatia.

Subjects And Methods: 205 psychiatrists from different Croatian regions participated in this study.

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The goal of this study was to evaluate the association between self-perceived social support and chronic combat-related posttraumatic stress disorder (PTSD). The study included 262 male war veterans suffering from chronic PTSD. Their diagnosis was confirmed according to DSM-IV-TR.

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The main objective of this study was to examine an association of various symptoms in chronic combat-related post traumatic stress disorder (PTSD) and the quality of life in this population. 248 Croatian male war veterans all diagnosed with chronic PTSD were consecutively enrolled in this study as they showed up at the routine check-up. They were given self report questionnaires Trauma Symptom Inventory (TSI-A) evaluating different PTSD symptoms and WHO Quality of Life-BREF assessing four different domains of the quality of life.

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The main aim of this brief overview is to explore the concepts of person-centered medicine and personalized medicine in the areas of chronic pain research and management. Through several definitions and paradigms of pain, the authors introduce the complexity of pain phenomenology in order to establish the challenge of person-centered and personalized medicine in everyday practice. By providing deeper insight into fibromyalgia, its presentation, biology and treatment, several questions are addressed, ranging from person-centered diagnosis to personalizing the various processes of the fibromyalgia spectrum complex.

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Article Synopsis
  • B-cell chronic lymphocytic leukemia (B-CLL) and other B-cell neoplasms occurring in the same patient are rare, typically documented as isolated case reports.
  • Often, CLL is diagnosed years before a secondary condition, such as multiple myeloma, with some patients receiving no treatment and others already undergoing therapy for CLL prior to myeloma diagnosis.
  • The case presented involves a male patient diagnosed with multiple myeloma 11 years after being diagnosed with B-CLL, highlighting the diagnostic and therapeutic challenges posed by having two hematologic neoplasms simultaneously.
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