利妥昔单抗联合多柔比星脂质体治疗复发难治性非霍奇金淋巴瘤的疗效观察

目的探讨利妥昔单抗注射液联合多柔比星脂质体治疗复发难治性非霍奇金淋巴瘤的临床疗效和不良反应。方法选取2014年1月—2015年1月沧州市中心医院收治的复发难治性非霍奇金淋巴瘤患者60例为研究对象,所有患者随机分为对照组和治疗组,每组各30例。对照组静脉滴注盐酸多柔比星脂质体注射液,20 mg/m~2,1次/2周。治疗组在对照组的基础上静脉滴注利妥昔单抗注射液375 mg/m~2,1次/周。两组患者均连续治疗6周。观察两组的临床疗效,比较两组的无进展生存期(PFS)、总生存期(OS)和患者Karnofsky(KPS)评分。结果治疗后,对照组和治疗组的总有效率分别为36.67%、66.67%,疾病控制率分别为56.67%、80.00%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组PFS、OS和KPS评分均显著高于对照组,两组比较差异有统计学意义(P0.05)。治疗组发生白细胞计数降低、贫血的例数显著低于对照组,两组比较差异有统计学意义(P0.05)。结论利妥昔单抗注射液联合多柔比星脂质体治疗复发难治性非霍奇金淋巴瘤具有较好的临床疗效,可延长患者生存时间,改善生活质量,安全性较好,具有一定的临床推广应用价值。     

Lamivudine for the prevention of hepatitis B virus reactivation after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for patients with advanced or relapsed non-Hodgkin's lymphoma single institution experience

Objective: Hepatitis B virus (HBV) reactivation is a well-known complication in cancer patients receiving cytotoxic chemotherapy, resulting in varying degrees of liver damage. The objective of this study was to investigate the efficacy of lamivudine for the prevention of HBV reactivation in non-Hodgkin's lymphoma (NHL) patients undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT). Research design and methods: Thirty-two patients with NHL who were HBV surface antigen (HBsAg)-positive were enrolled in this pilot study. They were divided into two groups: 20 patients received prophylactic oral lamivudine 100 mg/day before, and until at least 6 months after transplantation. The historical control group comprised 12 patients who received high-dose chemotherapy and AHSCT without lamivudine. The incidence and severity of hepatitis due to HBV reactivation, as well as other adverse clinical outcomes, were compared between the two groups. Results: Most baseline clinical characteristics were similar in the two groups, except for HBV e-antigen (HBeAg)-positive status (85% in the lamivudine group vs 33.3% in the control group, p = 0.006) and the type of AHSCT. There was a lower incidence of hepatitis due to HBV reactivation in the lamivudine group than in the control group (10 vs 50%, p = 0.030), less severe hepatitis (0 vs 25%, p = 0.009), and lower mortality (0 vs 25%, p = 0.236). An HBV variant with tyrosine methionine aspartate aspartate (YMDD) mutation was detected in one patient in the lamivudine group (5%) after administration of lamivudine for 9 months. No significant adverse events were associated with the use of prophylactic lamivudine, and hematopoietic reconstitution was not affected by the intervention. Conclusions: Prophylactic lamivudine may reduce the incidence and severity of chemotherapy-related HBV reactivation and hepatitis-related mortality in HBsAg-positive NHL patients receiving high-dose chemotherapy and AHSCT. Additional randomized, multicenter trials are warranted.     

New agents and approaches to the treatment of B-cell non-Hodgkin lymphoma

Importance of the field: B-cell non-Hodgkin lymphoma (NHL) is a significant public health problem as the most common hematologic malignancy in many areas of the world. Current treatments are generally effective, but only a minority of this large group of patients can be cured.

Areas covered in this review: Progress in clinical development of novel, targeted agents and newer cytotoxic agents has led to improved, more durable responses in all major subtypes of NHL. This article covers novel therapeutic agents, which are investigational or registered recently for NHL and/or other cancers. Subtypes of B-cell NHL are addressed separately including relevant papers over the past 20 years.

What the reader will gain: This review provides a better understanding of studies that have formed the basis for current treatment approaches for B-cell NHL. Also, areas of unmet need are covered. Novel agents are described along with their mechanisms of action, as well as how they might advance the treatment of B-cell NHL.

Take home message: This review highlights advancements and the current state of knowledge by presenting clinical trial results as well as preclinical data and advances in prognostic and predictive factors that will pave the way to further progress in NHL.     

Pixantrone for the treatment of aggressive non-Hodgkin lymphoma

Importance of the field: At present there is no standard treatment for patients with relapsed or refractory aggressive non-Hodgkin's lymphoma who progress following second-line therapy. Anthracyclines are highly active drugs, but their use in this setting is limited by cumulative cardiac toxicity. Pixantrone is a new aza-anthracenedione structurally similar to mitoxantrone and anthracyclines. This compound has been developed to minimize cardiac toxicity without reducing efficacy.

Areas covered in this review: This review summarizes the preclinical and clinical trial data for the use of pixantrone for the treatment of aggressive non-Hodgkin lymphoma.

What the reader will gain: An overview of the mechanism of action of pixantrone, preclinical data, clinical efficacy, safety data and future developments for this compound.

Take home message: Pixantrone has been shown to be superior to other single-agent therapies for the salvage treatment of relapsed/refractory aggressive non-Hodgkin lymphoma. The pixantrone application will be submitted to the regulatory authorities in the USA and in Europe.     

吉西他滨联合奥沙利铂治疗复发和难治性弥漫性大B细胞淋巴瘤的疗效观察

目的 探讨GEMOX方案(吉西他滨联合奥沙利铂)治疗复发和难治性弥漫性大B细胞淋巴瘤(DLBCL)的近期疗效和不良反应.方法 27例复发和难治性DLBCL采用GEMOX方案治疗:吉西他滨(GEM) 1000 mg/m2静脉滴注,第1、8天;奥沙利铂(L-OHP)100 mg/m2静脉滴注,第2天.2组均21 d为1个周期,疗程不少于2个周期.观察疗效和不良反应,并随访疾病进展情况.结果 27例均能评价疗效(其中复发17例,难治10例),复发者总缓解率为64.7％(11/17),中位肿瘤进展时间(TTP)为7.5个月(95％ CI 6.8 ～8.2个月);难治者总缓解率为60.0％ (6/10),中位肿瘤进展时间为6.2个月(95％ CI 5.3～7.1个月).复发和难治患者总缓解率比较差异无统计学意义(P＞0.05),但中位肿瘤进展时间差异有统计学意义(P＜0.05);化疗不良反应程度较轻,主要不良反应为白细胞和血小板减少,但均为可逆,未出现因化疗毒性而死亡病例.结论 GEMOX方案是治疗复发和难治性DLBCL安全有效的可行性解救方案.     

Bortezomib for the treatment of non-Hodgkin’s lymphoma

Introduction: Bortezomib, the first proteasome inhibitor (PI) to be evaluated in humans, is approved in the USA and Europe for the treatment of patients with multiple myeloma, and in the USA for patients with relapsed mantle cell lymphoma (MCL).

Areas covered: This review examines the role of bortezomib in the therapy of non-Hodgkin’s lymphoma (NHL). Bortezomib may be particularly effective against the NF-κB-dependent activated B-cell subtype of diffuse large B-cell lymphoma. The combination of bortezomib with rituximab and dexamethasone represents a standard approach for the treatment of Waldenström’s macroglobulinemia, and that with bendamustine and rituximab has demonstrated excellent efficacy in follicular lymphoma. Combinations with other novel agents, such as inhibitors of cyclin-dependent kinases or histone deacetylases, also hold substantial promise in NHL. Unmet needs in NHL, competitor compounds, chemistry, pharmacokinetics, pharmacodynamics and safety and tolerability of bortezomib are also discussed.

Expert opinion: The success of bortezomib in MCL has validated the proteasome as a therapeutic target in NHL. Rational combinations, for example, with Bruton’s tyrosine kinase inhibitors or BH3-mimetics, may hold the key to optimizing the therapeutic potential of PIs in NHL. Future trials are likely to involve newer agents with improved pharmacodynamic (e.g., carfilzomib, marizomib) or pharmacokinetic (e.g., ixazomib, oprozomib) properties.     

Phase II study of elsamitrucin (BMY-28090) for the treatment of patients with refractory/relapsed non-Hodgkin's lymphoma

Summary Purpose: To determine the response rate of patients withrefractory/relapsed non-Hodgkin's lymphoma to treatment with elsamitrucin and to further characterize the toxic effects of elsamitrucin in this group of patients. Patients and methods: Eligibility required pathologically verified relapsed or refractory non-Hodgkin's lymphoma with no more than two prior chemotherapy regimens for patients with tumors classified by the International Working Formulation (IWF) as A-C and no more than one prior chemotherapy for those with IWF grades D-G. Patients were entered with either normal or impaired bone marrow function, but normal liver function tests were required unless clearly related to lymphomatous involvement of the liver. Elsamitrucin 25 mg/m² was administered intravenously over 5–10 minutes weekly. Results: Thirty-one patients entered the study and were treated for a median of six weeks (range 1–42). All patients were évaluable for toxicity and 30 for response. Mild nausea and/or vomiting and asthenia were the most frequently reported adverse events. Four (13%, 95% CI 4.4–31.6%) partial responses were seen along with two (7%) minor responses while 9 (30%) patients had stable disease. Conclusion: Elsamitrucin showed modest activity in patients with relapsed or refractory non-Hodgkin's lymphoma. Toxicity was relatively mild, consisted mainly of asthenia, nausea and vomiting and did not include myelosuppression. The activity of elsamitrucin in this group of patients and its lack of myelosuppression suggest utility in this disease especially when combined with other proven agents.Presented in part at the 8th NCI-EORTC Symposium on New Drugs in Cancer Therapy, Amsterdam, The Netherlands, March 1994.     

弥漫性大B细胞淋巴瘤化疗后沙利度胺维持治疗疗效

目的比较中高危、高危弥漫性大B细胞淋巴瘤（IPI≥3）化疗后加与不加口服沙利度胺维持治疗的疗效。方法经病理学证实的弥漫性大B细胞淋巴瘤行CHOPE21或CHOPl4方案化疗6周期后完全缓解（CR）40例,随机分为口服沙利度胺维持组（n：20）与观察组（n=20）。主要观察终点为无进展生存（PFS）,次要观察终点为总生存（OS）和不良反应。结果维持组中位PFS为10．6个月,观察组为6．7个月（P=0．036）。维持组1、2、3年0s分别为80％、55％、45％,观察组分别为75％、45％、40％（P分别为0．705、0．527、0．749）。维持组仅有轻微血液学毒性。结论中高危、高危弥漫性大B细胞淋巴瘤（IPI≥3）化疗后予口服沙利度胺维持治疗可以延长PFS,但不能提高生存率,能否改善长期生存有待临床进一步加以研究。     

复发/难治性套细胞淋巴瘤治疗进展

套细胞淋巴瘤（MCL）是一种罕见的B细胞恶性肿瘤,占所有非霍奇金淋巴瘤（NHL）的3%~10%,常见于男性,中位发病年龄67岁,具有不可治愈、易复发和耐药等特点,复发后患者预后常较差,治疗选择有限。近年来,随着布鲁顿酪氨酸激酶抑制剂（BTKi）、B细胞淋巴瘤因子2抑制剂（BCL-2i）等为代表的靶向药物的应用,以及嵌合抗原受体T细胞（CAR-T）及异基因干细胞移植（allo-SCT）等疗法的进展,复发难治性（R/R）MCL患者的生存期明显延长。本文拟对目前R/R MCL的治疗进展进行综述。     

十全大补丸联合化疗用于弥漫大B细胞淋巴瘤的临床观察

目的 探究十全大补丸联合化疗用于弥漫大B细胞淋巴瘤的临床效果。方法 回顾性分析武汉大学人民医院在2013年5月—2016年6月期间治疗的弥漫大B细胞淋巴瘤患者152例作为该研究的对象,其中十全大补丸联合化疗的患者为观察组80例,选择常规的化疗治疗的患者为对照组72例,分别测定患者治疗前、治疗结束后的生活质量、心脏功能、免疫功能、化疗的不良反应,并进行对比分析,探究其疗效。结果 观察组患者完全缓解24例（30.00%）,部分缓解30例（37.50%）,总有效率67.50%,对照组完全缓解22例（30.55%）,部分缓解28例（38.89%）,总有效率（69.44%）,差异无统计学意义。对照组患者的神经毒性、肝功能异常、血小板降低、贫血、白细胞减少、乏力等的不良反应的发生率和严重程度与观察组的患者比较显著较高,差异有统计学意义（P<0.05）。治疗结束后,两组患者的左心室射血分数（LVEF）水平均有下降,同组治疗前后比较差异有统计学意义（P<0.05）,但组间比较差异并不明显;两组患者在治疗前后B型脑钠肽（BNP）和心肌肌钙蛋白T（cTnT）无明显变化。治疗结束后,两组患者CD4⁺/CD8⁺、自然杀伤（NK）细胞活性明显改善（P<0.05）,观察组患者CD4⁺/CD8⁺、NK细胞活性略高于对照组,无统计学意义。对照组患者治疗结束的生活质量的改善率为52.77%,观察组患者的生活质量改善率为80.00%,治疗后生活质量明显提升,且观察组明显优于对照组,有统计学的意义（P<0.05）。结论 十全大补丸联合化疗用于弥漫大B细胞淋巴瘤,增强患者机体的免疫功能,可以减少化疗过程对人体的带来不良反应,改善患者的生活质量,值得临床推广。     

环磷酰胺作用B细胞非霍奇金淋巴瘤对抑癌基因PTEN的影响

目的 探索环磷酰胺作用非霍奇金淋巴瘤对抑癌基因PTEN的影响,为治疗B细胞非霍奇金淋巴瘤寻找新治疗途径提供实验依据.方法 免疫沉淀(IP)技术提取细胞中的PTEN蛋白,采用高效液相色谱(HPLC)法分别检测不同时间(10、30、60min)不同浓度的环磷酰胺(0、25、50 μmol·L-1)作用Namalwa细胞株时PTEN基因的活性;Western-blot技术检测PTEN,磷酸化PTEN,Akt及磷酸化Akt的表达;基因芯片技术筛选环磷酰胺作用Namalwa细胞后基因表达谱的改变;q-PCR技术检验基因谱表达的改变.结果 不同浓度的环磷酰胺作用Namalwa细胞后PTEN活性降低;Western-blot结果显出磷酸化PTEN及磷酸化Akt表达降低;基因芯片筛选发现上调的基因有13个,下调的基因有16个.环磷酰胺作用B细胞非霍奇金淋巴瘤Namalwa细胞后引起基因表达谱广泛改变.对差异基因的分析得出环磷酰胺作用Namalwa细胞引起基因表达谱重要信号通路上基因的改变.结论 环磷酰胺治疗B细胞非霍奇金淋巴瘤具有较低的缓解率,可能与环磷酰胺作用细胞使PTEN基因活性减弱,同时引起信号通路上基因表达改变有关.     

复发难治B系淋巴瘤CAR-T治疗后细胞因子变化

目的分析于我中心行CAR-T治疗患者治疗前后细胞因子变化,评估相关细胞因子在免疫治疗中的作用及相关机制。方法分别在复发难治B系淋巴瘤患者CAR-T细胞回输前及回输后4、7、14 d采集外周血,利用流式细胞术监测患者相关细胞因子(Th1、Th17、Foxp3、TNF-α、TGF-β、IL-10、IFN-γ、T抑制细胞、NK细胞及CRP)水平,分析变化趋势。结果 4次CAR-T细胞回输数目分别为:8×10~7、10×10~7、9.6×10~7、10×10~7。CAR-T细胞回输前及回输后4、7、14 d,Th1、Th17及CRP变化趋势与临床疗效相关,NK细胞、CD8~+细胞未见明显相关性,而Tregs细胞作用尚未明确。结论应用CAR-T细胞回输后,Th1、Th17相关效应性T细胞细胞因子上升趋势与临床疗效密切相关,NK细胞、CD8+T细胞未见明显相关性,而Tregs细胞作用尚未明确。关于CAR-T治疗前后序贯治疗、移植与CAR-T治疗的关系,是否可以应用细胞因子制剂促进CAR-T细胞的扩增与效应,仍有待进行相关大样本临床研究。     

放疗在美罗华时代对局限期原发韦氏环弥漫大B细胞淋巴瘤的治疗价值

目的 分析在美罗华联合化疗背景下,放疗对局限期韦氏环弥漫大B细胞淋巴瘤的治疗价值。方法 收集2010年—2017年收治的93例Ⅰ-Ⅱ期原发韦氏环弥漫大B细胞淋巴瘤患者的临床资料,将仅接受美罗华联合CHOP或CHOP类似方案化疗的38例患者分为单纯化疗组,将接受化疗+巩固放疗的55例患者分为综合治疗组。采用Kaplan-Meier法计算无进展生存（PFS）、总生存（OS）、局部区域控制率（LRC）,并行单因素分析;采用Log-rank法检验两组患者生存差异,并行Cox多因素回归分析。结果 本研究患者随访中位时间47个月,3年存活病例67例。单纯化疗组和综合治疗组患者的3年PFS分别为76.1%和94.2%（P=0.036）,3年OS分别为78.6%和96.0%（P=0.032）,3年LRC分别为83.1%和98.1%（P=0.015）。其中62例化疗后疗效评估为完全缓解（CR）的患者中,单纯化疗组和综合治疗组的3年PFS、OS和LRC分别为87.8%和97.6%（P=0.164）、93.8%和97.4%（P=0.522）、87.8%和100.0%（P=0.028）。进一步单因素分析结果显示,年龄>60岁和化疗疗效未达CR是PFS和OS的不良预后因素,B症状和化疗疗效未达CR是LRC的不良预后因素。多因素分析结果显示,年龄>60岁、B症状、化疗疗效未达CR是患者PFS的不良预后因素,年龄>60岁、化疗疗效未达CR是OS的不良预后因素,B症状、化疗疗效未达CR和未放疗是LRC的不良预后因素。结论 Ⅰ-Ⅱ期原发韦氏环弥漫大B细胞淋巴瘤采用美罗华联合CHOP为主的化疗后的巩固性放疗可显著改善患者的PFS、OS和LRC,但仍需大样本和前瞻性研究进一步证实。     

弥漫大B细胞淋巴瘤骨髓侵犯形态学及免疫表型特点分析

目的 探讨弥漫大B细胞淋巴瘤（DLBCL）骨髓侵犯形态学及免疫表型特点,为临床DLBCL侵犯骨髓的准确诊断提供一定的科学依据。方法 收集2014年6月—2019年6月我院收治的59例DLBCL患者的骨髓组织和外周血,分析DLBCL患者的骨髓细胞形态学、骨髓病理学、流式细胞学、荧光原位免疫杂交及其他相关检测的结果与临床特征。结果 59例发生骨髓侵犯的DLBCL患者多数表现为白细胞增高、贫血、血小板减少,有43例（72.88%）外周血中可见数量不等的瘤细胞。59例患者骨髓涂片中瘤细胞占有核细胞比例≥10％的有31例（52.54%）。瘤细胞侵犯骨髓方式以弥漫性增生为主,造血组织明显减少或缺乏。免疫组化染色及流式细胞学检查示,淋巴瘤细胞 CD20、CD19、CD79b及 cCD79a均呈阳性表达,部分患者表达 HLA-DR、CD22、sIgM、CD43、CD10、FMC7及 CD123,均不表达CD38、TdT、CD103、CD25、CD3、CD2、MPO、CD33、CD13、CD7及CD56。12例患者进行FISH检测均未见C-myc基因重排。结论 骨髓形态学、病理学并结合免疫表型检测是DLBCL患者准确诊断的重要依据。     

信迪利单抗联合DA-EPOCH-R方案治疗弥漫大B细胞淋巴瘤的效果及安全性评价

目的 评价信迪利单抗联合环磷酰胺＋表柔比星＋依托泊苷＋长春新碱＋泼尼松、利妥昔单抗无放射治疗（DA-EPOCH-R）方案治疗弥漫大B细胞淋巴瘤（DLBCL）的效果及安全性。方法 回顾性选取2019年3月—2022年2月洛阳市第三人民医院收治的经一线治疗方案治疗后疾病复发或进展的DLBCL患者103例,根据治疗方案分为试验组54例、对照组49例。对照组给予DA-EPOCH-R方案治疗,试验组在对照组基础上加用信迪利单抗治疗。比较两组治疗前后免疫相关指标、血管内皮生长因子（VEGF）、血清胸苷激酶1（TK1）、白细胞介素-2（IL-2）水平,统计疗效和不良反应。结果 试验组客观缓解率（ORR）达72.22%,高于对照组的53.06%,差异有统计学意义（P<0.05）。治疗后,试验组Treg细胞占比及VEGF、TK1水平低于本组治疗前（P<0.05）,Th17细胞占比、IL-2水平高于本组治疗前（P<0.05）;对照组NK细胞占比及VEGF、TK1水平低于本组治疗前（P<0.05）,Treg细胞占比及IL-2水平高于本组治疗前（P<0.05）;两组CD3⁺T、CD3⁺CD4⁺T、CD3⁺CD8⁺T与治疗前比较无统计学意义（P>0.05）。试验组治疗后IL-2水平、NK细胞占比、Th17细胞占比较对照组更高（P<0.05）,Treg细胞占比及VEGF、TK1水平较对照组更低（P<0.05）。试验组和对照组败血症、皮疹、肺部感染、黏膜炎、腹泻、恶心呕吐、脱发、肾功能损伤、肝功能损伤、血小板减少、白细胞减少、贫血、发热、甲状腺功能减退等不良反应方面比较,差异无统计学意义（P>0.05）。结论 信迪利单抗联合DA-EPOCH-R方案治疗DLBCL可改善患者免疫功能,降低VEGF、TK1的表达,加强疗效,安全性良好。     

外周T细胞淋巴瘤诊治进展

外周T细胞淋巴瘤是国内比较常见的非霍奇金淋巴瘤类型之一,近年来随着基因表达谱等分子生物学方法在淋巴瘤研究中日益广泛的应用,人们对外周T细胞淋巴瘤的发病机制与预后分型的认识也逐渐加深。造血干细胞移植及抗肿瘤新药在临床的普遍应用也大大提高了该类病人的临床疗效与预后。     

Treatment options for mantle cell lymphoma

Introduction: In this article, we provide an accurate overview of both standard treatment option and novel promising therapeutics. Major impact is on novel agents now being tested in randomized clinical trials. While the initial data are promising, they may rapidly expand treatment options, change existing paradigms and further improve outcomes for mantle cell lymphoma (MCL) patients.

Areas covered: MCL is a disease with indolent histology, but aggressive clinical course. However, for now, MCL remains incurable and the search for the most effective and tumor-specific treatment still represents a great challenge for oncohematologists. However, the implementation of chemotherapy together with the anti-CD20 antibody rituximab, as well as the growing use of autologous stem cell transplantation in first remission, have improved effects of treatment in MCL, including even some improvement in overall survival. Recently, treatment modalities for MCL have been expanded by strategies based on several biologically targeted agents, including m-TOR kinase or proteasome inhibitors and immunomodulatory agents, such as lenalidomide. B-cell receptor pathway inhibitors, such as ibrutinib and idelalisib, and histone deacetylase or cyclin-dependent kinase inhibitors have also shown promising activity in resistant or relapsed disease.

Expert opinion: Although enormous progress was made in the treatment of MCL over the last year, the disease remains incurable. One chance for the significant life prolongation is intensive treatment with consolidative auto SCT. However, real progress may be afforded by developing the novel agents described in this article. In this way, MCL may soon become another potentially curable oncological malignancy.     

GLD 与 CHOP 方案一线治疗外周 T 细胞淋巴瘤的疗效分析

目的 探讨GLD(吉西他滨+奥沙利铂+地塞米松)与CHOP(环磷酰胺+多柔比星/表柔比星+长春新碱+泼尼松)方案一线治疗外周T细胞淋巴瘤的疗效与安全性。方法 回顾性分析2010年1月—2015年4月诊治的外周T细胞淋巴瘤患者35例。17例采用GLD方案,18例采用CHOP方案。对比两组的疗效与不良反应。结果 GLD组与CHOP组客观有效率(ORR)分别为64.7%和50.0%,差异无统计学意义(P>0.05)。但NK/T细胞淋巴瘤亚型的ORR分别为100%和50%,差异有统计学意义(P<0.05)。GLD组与CHOP组中位无进展生存期(PFS)(12月 vs 4月)及2年生存率(73.2% vs 36.1%)的差异均有统计学意义(P<0.05)。两组不良反应主要为骨髓抑制,差异无统计学意义(P>0.05)。 结论 GLD方案治疗外周T细胞淋巴瘤近期疗效与CHOP方案相似(NK/T细胞亚型疗效优于CHOP方案),远期疗效优于CHOP方案,不良反应可耐受,是值得推广的一线治疗方案。     

CARD11与Bcl-2在弥漫性大B细胞淋巴瘤中的表达与意义

目的观察弥漫性大B细胞淋巴瘤（diffuse large B-cell lymphoma）中CARD11与Bcl-2的表达情况,探讨它们在弥漫性大B细胞淋巴瘤中不同免疫分型中的表达及相互关系。方法选取弥漫性大B细胞淋巴瘤60例和反应性增生的淋巴结20例,采用组织芯片技术和免疫组织化学方法对弥漫性大B细胞淋巴瘤进行免疫分型并检测弥漫性大B细胞淋巴瘤免疫学类型GCB和ABC型中CARD11和Bcl-2表达情况。结果 （1）免疫分型60例弥漫性大B细胞淋巴瘤中免疫类型GCB25例,ABC35例。（2）60例弥漫性大B细胞淋巴瘤中免疫类型中CARD11与Bcl-2的表达情况：免疫类型GCB中CARD11的阳性率为24.0%,ABC中CARD11的阳性率为57.4%,两者之间P〈0.05;GCB中Bcl-2的阳性率为32.0%,ABC中Bcl-2的阳性率为62.9%,两者之间P〈0.05。结论①CARD11、NF-κB高表达与弥漫性大B细胞淋巴瘤的ABC类型相关。     

Richter’s syndrome of T-cell lineage (T rex lymphoma)

Abstract

By definition, Richter’s syndrome represents the transformation of low-grade B-cell lymphoma into high-grade B-cell lymphoma, usually refractory to treatment. Exceptional cases of transformation into very aggressive mature T-cell lymphomas have been described as an unusual manifestation of the syndrome in patients died after few months from the diagnosis, despite chemotherapy. The time is ripe to regroup these T lymphomas under a new pathological subset, through the unequivocal alternate naming of ‘T rex lymphoma’, by analogy with the aggressive behavior of the famous dinosaur (T. rex). In practice, it represents the transformation of low-grade B-cell lymphoma into high-grade T-cell lymphoma, burdened by a very poor prognosis, because of the underlying B-cell lymphoma, which negatively interferes with the immune response of the patient. Against this distinct lymphomatous T clone, the major therapeutic efforts should be addressed.