Veterinary medicine - Repository of PHD, master's thesis
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Patients admitted in the intensive care unit after solid organ or bone marrow transplantation: Retrospective cohort study
No full textBackground: Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) revolutionized the survival and quality of life of patients with malignant diseases, various immunologic, and metabolic disorders or those associated with a significant impairment in a patient's quality of life.
Aim: To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit (ICU).
Methods: We conducted a single-center, retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb, Croatia covering the period from January 1, 2018 to December 31, 2023.
Results: The study included 91 patients with either SOT [28 patients (30.8%)] or HSCT [63 patients (69.2%)]. The median age was 56 (43.2-64.7) years, and 60.4% of the patients were male. Patients with SOT had more comorbidities than patients after HSCT [χ² (5, n = 141) = 18.513, P < 0.001]. Sepsis and septic shock were the most frequent reasons for admission, followed by acute respiratory insufficiency in patients following HSCT. Survival rate significantly differed between SOT and HSCT [χ² (1, n = 91) = 21.767, P < 0.001]. ICU survival was 57% in the SOT and 12.7 % in the HSCT group. The need for mechanical ventilation [χ² (1, n = 91) = 17.081, P < 0.001] and vasopressor therapy [χ² (1, n = 91) = 36.803, P < 0.001] was associated with survival. The necessity for acute renal replacement therapy did not influence patients' survival [χ² (1, n = 91) = 0.376, P = 0.54]. In the subgroup of patients with infection, 90% had septic shock, and the majority had positive microbiological samples, mostly Gram-negative bacteria. The ICU survival of patients with sepsis/septic shock cumulatively was 15%. The survival of SOT patients with sepsis/shock was 45%.
Conclusion: Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock. Despite advancements in critical care, the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high. Early recognition and timely ICU admittance might improve the outcome of patients, especially after HSCT
European Consensus on Malabsorption—UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption
No full textMalabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work‐up for identifying the cause of malabsorption. A patient's medical and pharmacological history is essential for identifying risk factors. Several examinations such as endoscopy with small intestinal biopsies, non‐invasive functional tests and radiological imaging are useful in diagnosing malabsorption. Because of its high prevalence, CD should always be looked for in cases of malabsorption with no other obvious explanations and in high‐risk individuals. Nutritional support is key in the management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians play a central role in the early detection of malabsorption and should be involved in multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving ten scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high‐risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2)
Primary prevention in hospitals in 20 high-income countries in Europe – A case of not “Making Every Contact Count”?
No full textThis article provides a snapshot of primary prevention activities in hospitals in 20 European high-income countries, based on inputs from experts of the Observatory's Health Systems and Policies Monitor (HSPM) network using a structured questionnaire. We found that in the vast majority of countries (15), there are no systematic national policies on primary prevention in hospitals. Five countries (Cyprus, Finland, Ireland, Romania and the United Kingdom) reported systematic primary prevention activities in hospitals, although in one of them (Cyprus) this was due to the fact that small hospitals in rural areas or less populated districts host providers of primary care. In two of the five countries with systematic national policies on primary prevention, there are no incentives (financial or otherwise) to provide these interventions. The remaining three countries (Finland, Romania and the United Kingdom) report the existence of incentives, but only two of them (Romania and the United Kingdom) provide financial incentives in the form of additional funding. Only two of the 20 countries (Ireland and the United Kingdom) make explicit use of the Making Every Contact Count (MECC) approach. Overall, it can be concluded that there is little focus on primary prevention in hospitals in Europe, which may be seen as a missed opportunity
Equivalent: How Do Changes in the Family Structure and Dynamics Reflect on Health: The Socio-Ecological Model of Health in the Family
No full textFamily is one of the most important socio-demographic factors when it comes to understanding health differences between individuals. Despite significant changes in family structure in recent decades, the influence of family as a social determinant of health on health outcomes remains strong and consistent. Family relationships’ role in shaping individuals’ health and vice versa highlights the multidimensional nature of health, which encompasses both objective and subjective elements. Throughout life, from early childhood to old age, the family, with its structure and dynamics, significantly reflects on the individual’s physical, mental, and social well-being. In this sense, the aim of this paper is to explore how the family, with its structure and dynamics, reflects on individuals’ health and health behaviour from early childhood through adulthood and into old age in the context of significant life events or transitions such as marriage, divorce, widowhood, andObitelj je jedan od najvažnijih sociodemografskih čimbenika kada je riječ o razumijevanju zdravstvenih razlika među pojedincima. Unatoč značajnim promjenama u oblicima obitelji tijekom proteklih desetljeća, utjecaj obitelji kao društvene odrednice zdravlja snažan je i trajan. Uloge obiteljskih odnosa u oblikovanju zdravlja pojedinaca, ali i obrnuto, predstavljaju zdravlje kao višeznačan ishod s nepristranim i pristranim čimbenicima. Tijekom života, od ranog djetinjstva do duboke starosti, obitelj se svojim sastavom i dinamikom značajno odražava na tjelesno, psihičko i socijalno blagostanje pojedinca. U tom smislu, cilj ovog rada je istražiti kako obitelj svojim sastavom i dinamikom utječe na zdravlje i zdravstveno ponašanje pojedinca od ranog djetinjstva, preko odrasle dobi, pa sve do starije dobi u okviru značajnih životnih događaja ili prijelaza poput braka, razvoda, udovištva i roditeljstva predočavanjem konceptualnog modela zdravlja pojedinca u obitelji
Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry
No full textBackground and aim: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.
Methods and results: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7 %) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8 % vs 7.2 %, adjusted OR [95 % CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1 % vs 4.8 %, Adjusted OR [95 % CI] = 1.70 [1.43-2.02], p < 0.001; 30-day mortality: 10.8 % vs 6 %, Adjusted HR [95 % CI] = 1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic.
Conclusions: Our study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic
Spinal muscular atrophy type 3 and treatment adherence in a changing therapeutic landscape: a national-center experience
No full textAim: To report on treatment outcomes in adult patients with spinal muscular atrophy type 3 (SMA3) who had their nusinersen treatment initiated in adulthood.
Methods: The study enrolled 11 adults treated with nusinersen for SMA3 at the Croatian National Referral Centre for Neuromuscular Disorders from 2019 to 2022. We prospectively collected validated SMA outcome measures: Revised Hammersmith score (RHS), Revised Upper Limb Module, and 6-minute walk test (6MWT) as motor function outcomes and the Individualized Neuromuscular Quality of Life questionnaire. Baseline outcomes were compared with the outcomes after three years of treatment.
Results: All patients reported subjective improvement, and 9/11 reported an increased quality of life. Overall, 10/11 patients experienced clinically significant improvement in at least one measured outcome, while the remaining 1 patient reported the absence of disease progression. The mean increase in RHS was 2.7 points (P=0.062), and the mean increase in 6MWT was 39.7 m (P=0.239). Younger age and shorter disease duration correlated with better treatment outcomes (r=-0.543 and r=-0.666, respectively). After the approval of risdiplam in 2022, a third of patients chose to switch therapies despite observed subjective and objective positive nusinersen treatment effects.
Conclusion: Nusinersen had a positive treatment effect despite missed doses during the COVID-19 pandemic. Although the most significant improvements can be expected in patients treated the earliest, nusinersen treatment can be beneficial even in long-standing SMA
Peripancreatic collections as complications of acute pancreatitis
No full textAkutni pankreatitis je upalni proces gušterače koji se, u otprilike četvrtini slučajeva, razvija u umjereno teški ili teški oblik bolesti, čime se značajno povećava rizik od komplikacija i smrtnog ishoda. Jedna od najozbiljnijih komplikacija su peripankreatičke kolekcije, koje nastaju kao posljedica oštećenja parenhima i okolnih struktura. Ovisno o vremenu nastanka i prisutnosti nekroze,
kolekcije se klasificiraju kao akutna peripankreatička tekuća kolekcija (APFC), akutna nekrotična kolekcija (ANC), pseudocista gušterače i kasna ograđena nekroza (WON). Dijagnostika se temelji na radiološkim metodama, pri čemu je kontrastom pojačana kompjutorizirana tomografija (CECT) zlatni standard. U procjeni sadržaja kolekcija te prisutnosti krutih nekrotičnih komponenti osobito su korisne magnetska rezonancija (MR) i endoskopski ultrazvuk (EUS). Terapijski pristup ovisi o vrsti i zrelosti kolekcije, prisutnosti infekcije i kliničkoj stabilnosti bolesnika. Sterilne kolekcije većinom se liječe konzervativno uz odgovarajuću hidraciju, nutritivnu potporu i analgeziju, dok se invazivne metode poput drenaže ili nekrozektomije primjenjuju kod infekcije, pritiska na okolne organe ili neuspjeha konzervativne terapije. Endoskopski i perkutani pristupi sve češće zamjenjuju kirurške metode zbog manje invazivnosti i boljih ishoda. U slučaju inficirane nekroze, preporučuje se minimalno invazivni “step-up” protokol: prva linija je endoskopska transmuralna drenaža (ETD), a u bolesnika s velikim udjelom čvrstog nekrotičnog sadržaja (> 40 %) nužna je direktna endoskopska nekrozektomija (DEN) ili kirurška nekrozektomija (npr. VARD). Perkutana drenaža kateterom te kombinirani radiološki i kirurški zahvati rezervirani su za komplicirane ili nepristupačne lokalizacije.Acute pancreatitis is an inflammatory process of the pancreas which, in approximately one quarter of cases, progresses to a moderately severe or severe form of the disease, significantly increasing the risk of complications and mortality. One of the most serious complications is the development of peripancreatic collections, which arise as a result of damage to the pancreatic parenchyma and surrounding structures. Depending on the timing of onset and the presence of necrosis, these collections are classified as acute peripancreatic fluid collection (APFC), acute necrotic collection (ANC), pancreatic pseudocyst, and walled-off necrosis (WON). Diagnosis is based on imaging techniques, with contrast-enhanced computed tomography (CECT) remaining the gold standard. Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are particularly useful for assessing collection contents and detecting solid necrotic components. The therapeutic approach depends on the type and maturity of the collection, the presence of infection, and the patient’s clinical stability. Sterile collections are largely managed conservatively with adequate hydration, nutritional support, and analgesia, whereas invasive interventions such as drainage or necrosectomy are reserved for infection, compression of adjacent organs, or failure of conservative therapy. Endoscopic and percutaneous techniques increasingly replace surgical methods due to their minimally invasive nature and better outcomes. In cases of infected necrosis, a minimally invasive “step-up” protocol is recommended: first-line therapy is endoscopic transmural drainage (ETD), and patients with a high proportion of solid necrotic debris (> 40 %) often require direct endoscopic necrosectomy (DEN) or surgical necrosectomy (e.g., video-assisted retroperitoneal debridement, VARD). Percutaneous catheter drainage and combined radiologic-surgical approaches are reserved for complicated or inaccessible locations
Corrective osteotomies around the knee
No full textKorektivne osteotomije u području koljenog zgloba operacijski su zahvati na femuru i/ili tibiji koji ispravljanjem osovine donjeg ekstremiteta utječu na biomehaniku koljenog zgloba. Pomicanjem mehaničke osi opterećenja rasterećuje se preopterećeni odjeljak koljenog zgloba, smanjuje ili otklanja bol te poboljšava funkcija koljenog zgloba. Za ispravljanje deformiteta u frontalnoj ravnini najčešće izvođeni zahvati su osteotomija proksimalne tibije i osteotomija distalnog femura, a primjenjuju se kod mlađih i aktivnih pacijenata koji još nisu kandidati za totalnu ili parcijalnu artroplastiku koljena. Obje metode mogu se izvoditi tehnikama
otvaranja ili zatvaranja pri čemu svaka ima specifične indikacije, prednosti i komplikacije. Prekomjerno zakretanje femura i/ili tibije oko svoje uzdužne osi uz simptomatsku patelofemoralnu nestabilnost indikacija je za derotacijsku osteotomiju distalnog femura i/ili proksimalne tibije. Osteotomije tuberozitas tibije, pomakom hvatišta ligamenta patele, osiguravaju pravilno kretanje patele unutar trohlearnog kanala, rasterećuju patelofemoralni zglob, smanjuju bol u prednjem dijelu koljena te povoljno utječu na biomehaniku
patelofemoralnog zgloba. Korektivne osteotomije mogu učinkovito odgoditi potrebu za totalnom ili parcijalnom endoprotezom koljena za 10–15 godina kod pažljivo odabranih pacijenata, te su vrijedna terapijska opcija u liječenju simptomatskih pacijenata sa nepravilnim usmjerenjem osovine donjeg ekstremiteta.Corrective osteotomies around the knee are surgical procedures performed on the femur and/or tibia that restore proper alignment of the lower limb axis, thereby improving the biomechanical function of the knee. By shifting the mechanical load-bearing axis, these procedures unload the overloaded compartment of the knee, reduce or eliminate pain, and
enhance joint function. The most commonly performed procedures to correct deformities in the coronal plane are proximal tibial osteotomy and distal femoral osteotomy, typically indicated in younger, active patients who are not yet candidates for total or partial knee arthroplasty. Both procedures can be performed using opening or closing wedge techniques,
each with specific indications, advantages, and complications. Excessive torsion of the femur and/or tibia along their longitudinal axes, combined with symptomatic patellofemoral instability, indicates derotational osteotomy of the distal femur and/or proximal tibia. Tibial tubercle osteotomies, by repositioning the insertion of the patellar ligament, enable proper patellar tracking within the trochlear groove, reduce anterior knee pain, and improve patellofemoral joint biomechanics. Corrective osteotomies can effectively delay the need for total or partial knee arthroplasty by 10–15 years in carefully selected patients and represent a valuable therapeutic option in the treatment of symptomatic individuals with malalignment of the lower limb
Infectious complications in the treatment of hematologic patients
No full textInfektivne komplikacije važan su uzrok morbiditeta i mortaliteta kod liječenja hematoloških bolesnika. Najčešće se javljaju pri liječenju malignih bolesti, ali i neke benigne hematološke bolesti mogu imati nepovoljan učinak na stanice mijeloidne i limfoidne loze, koje su ključne za obrambeni sustav organizma protiv patogena. Dodatni čimbenik imunosupresije kod hematoloških bolesnika jest terapija koja, iako sve naprednija i preciznija, uzrokuje duboku sekundarnu imunodeficijenciju koja dodatno pojačava negativan učinak osnovne bolesti na imunološki sustav. Glukokortikoidi, zbog svoje široke primjene u različitim granama medicine, poznati su po svom snažnom imunosupresivnom učinku. Kemoterapija može dovesti do izražene neutropenije, povećavajući time sklonost bolesnika bakterijskim i gljivičnim infekcijama, dok radioterapija brojnim patofiziološkim mehanizmima narušava funkciju koštane srži. Različite vrste imunoterapije, iako ciljane, također mogu izazvati imunosupresiju. Na osnovi takvih stanja razvijaju se bakterijske, virusne, gljivične i parazitske infekcije. Među bakterijskim infekcijama posebno se ističu sepsa i respiratorne infekcije koje mogu biti iznimno opasne, a u tim je slučajevima presudna pravovremena primjena adekvatne antibiotske terapije. Virusne infekcije često proizlaze iz reaktivacije latentnih herpesvirusa, pa se kod bolesnika nakon transplantacije krvotvornih matičnih stanica provodi antivirusna profilaksa, uz mogućnost primjene antivirusne terapije ako dođe do progresije bolesti. Antifungalni i antiparazitski lijekovi također čine važan dio liječenja bolesnika s hematološkim bolestima.Infectious complications are a significant cause of morbidity and mortality in the treatment of hematologic patients. They most commonly occur during the treatment of malignant diseases, but certain benign hematologic disorders can also have an adverse effect on the myeloid and lymphoid cell lineages, which play a crucial role in the immune system’s defense against pathogens. An additional factor contributing to immunosuppression in these patients is the therapy itself which, despite its ever-increasing precision and advancement, induces profound secondary immunodeficiency that further amplifies the negative impact of the underlying disease on immune function. Glucocorticoids, widely used in various medical disciplines, are well known for their potent immunosuppressive effect. Chemotherapy can lead to significant neutropenia, thereby increasing the patient’s susceptibility to bacterial and fungal infections, while radiotherapy, through numerous pathophysiological mechanisms, compromises bone marrow function. Various types of immunotherapy, although targeted, can also cause immunosuppression. Such conditions create a fertile ground for the development of bacterial, viral, fungal, and parasitic infections. Among bacterial infections, sepsis and respiratory infections are particularly notable as they can be extremely dangerous, making the timely initiation of appropriate antibiotic therapy crucial in such cases. Viral infections often result from the reactivation of latent herpesviruses, which is why antiviral prophylaxis is implemented in patients undergoing hematopoietic stem cell transplantation, along with the possibility of antiviral treatment should the infection progress. Antifungal and antiparasitic agents also form an essential part of the treatment of patients with hematologic diseases
The history of lymphoma
No full textLimfomi su definirani klonskom proliferacijom neoplastično promijenjenih limfatičnih stanica u određenoj fazi razvoja. Dijele se na različite entitete ovisno o tome u kojoj fazi razvoja limfocita nastaju. Povijest limfoma započinje opažanjima Thomasa Hodgkina 1832. godine. Krajem 19. i početkom 20. stoljeća Reed i Sternberg opisuju klasične R-S stanice karakteristične za Hodgkinov limfom. Povijest limfoma usko je povezana s razvojem njihovih klasifikacija. Prva značajnija klasifikacija Hodgkinovog limfoma (bolesti) bila je Jacksonova i Parkerova (1947.). Klasifikacija Lukesa i Butlera ubrzo je modificirana u Rye klasifikaciju (1966.) koja donosi četiri osnovna podtipa Hodgkinove bolesti. Kod ne-Hodgkinovih limfoma Rappaportova klasifikacija iz 1956. donosi prvi sustavni morfološki pristup. Iduće važne klasifikacije su Lukesova i Collinsova i Kielska (1974.). Radna formulacija za kliničku primjenu (1982.) temelji se na stupnju malignosti tumora. Na REAL klasifikaciji temelji se WHO klasifikacija (2001.) koja svaki entitet definira prema B- ili T/NK-staničnom porijeklu, morfologiji, imunofenotipu, genetskim značajkama, pretpostavljenom normalnom staničnom podrijetlu i kliničkim obilježjima. Danas se limfomi klasificiraju prema petom izdanju WHO klasifikacije (WHO-HAEM5) i ICC klasifikaciji objavljenima 2022. godine.
Povijest terapija limfoma započinje sredinom 20. stoljeća sa zračenjem kao glavnom terapijskom metodom. Velika prekretnica u liječenju nastupa uvođenjem kemoterapije 1960-ih i 1970-ih godina. MOPP protokol bio je prvi učinkoviti kemoterapijski režim za Hodgkinov limfom, a kasnije ga zamjenjuje ABVD protokol. Za ne-Hodgkinove limfome, od sredine 1970-ih koristio se CHOP protokol, koji do danas ostaje temeljni režim liječenja, sada uglavnom u kombinaciji s novijim lijekovima. Važnu ulogu u liječenju agresivnih i relapsnih limfoma od 1990-ih godina imala je autologna (rjeđe alogenična) transplantacija matičnih stanica. Početkom 21. stoljeća dolazi do uvođenja monoklonskih protutijela koja se kombiniraju sa standardnom kemoterapijom i poboljšavaju preživljenje bolesnika. Prvi je bio rituksimab kod B-staničnih limfoma, a nešto kasnije brentuksimab vedotin kod Hodgkinovog limfoma. Daljnji napredak donose ciljane terapije, imunoterapija, bispecifična protutijela te u konačnosti CAR-T terapija.Lymphomas are defined as clonal proliferations of neoplastically transformed lymphatic cells at a specific stage of development. They are classified into distinct entities based on the stage of development at which they arise. The history of lymphomas begins with the observations of Thomas Hodgkin in 1832. In the late 19th and early 20th centuries, Reed and Sternberg described the classic R-S cells characteristic of Hodgkin lymphoma. The history of lymphomas is closely linked to the development of their classifications. The first significant classification of Hodgkin’s lymphoma (disease) was that of Jackson and Parker in 1947. The Rye classification (1966) introduced four main subtypes of Hodgkin’s disease. For non-Hodgkin lymphomas, the Rappaport classification (1956) introduced the first systematic morphological approach. The next important classifications were those by Lukes and Collins and the Kiel classification (1974). The Working Formulation for clinical use (1982) was based on the tumor’s grade of malignancy. The WHO classification (2001) is based on the REAL classification and defines each entity according to its B- or T/NK-cell origin, maturity, morphology, immunophenotype, genetic features, presumed normal cell of origin and clinical characteristics. Today, lymphomas are classified according to the fifth edition of the WHO classification (WHO-HAEM5) and the ICC classification.
The history of lymphoma therapy began with radiotherapy. A breakthrough in treatment occurred with the introduction of chemotherapy in the 1960s and 1970s. The MOPP protocol was the first effective chemotherapy regimen for Hodgkin lymphoma, later replaced by the ABVD protocol. For non-Hodgkin lymphomas, the CHOP protocol has been used since the mid-1970s and remains a foundational treatment regimen to this day, now typically combined with newer drugs. Autologous (less commonly allogeneic) stem cell transplantation has played an important role in the treatment of aggressive and relapsed lymphomas since the 1990s. At the beginning of the 21st century, monoclonal antibodies were introduced and when combined with standard chemotherapy, they significantly improve survival outcomes. The first was rituximab for B-cell lymphomas, followed by brentuximab vedotin for Hodgkin lymphoma. Further advances include targeted therapies, immunotherapy, bispecific antibodies and CAR-T cell therapy