利妥昔单抗鞘内注射治疗弥漫大B细胞淋巴瘤中枢神经系统侵犯二例并文献复习

目的 探讨弥漫大B细胞淋巴瘤（DLBCL）中枢神经系统（CNS）侵犯的治疗方法.方法 报道接受利妥昔单抗鞘内注射治疗的2例DLBCL CNS侵犯患者,并复习相关文献.结果 2例患者中1例达脑脊液完全反应,随访15个月仍无病生存;1例颅内肿块完全消失,目前仍在治疗中.结论 鞘内注射利妥昔单抗治疗DLBCL CNS侵犯安全、有效.     

弥漫性大B细胞淋巴瘤经利妥昔单抗联合化疗后进展伴CD20抗原表达丢失1例报道并文献复习

目的探讨B细胞恶性肿瘤利妥昔单抗（rituximab）治疗后进展伴CD20抗原表达丢失患者的生物学特性。方法分析1例弥漫大B细胞淋巴瘤利妥昔单抗联合化疗进展伴CD20抗原表达丢失及文献复习。结果1例45岁男性弥漫大B细胞淋巴瘤患者,初治时病理免疫组化（IHC）：CD5-、CD20＋、CD45RO-、CD10-、CycinD1弱表达。染色体46,XY。利妥昔单抗联合化疗达CR。利妥昔单抗维持治疗出现进展及白血病转化。流式细胞仪（FCAS）检测：CD19＋、CD79a＋、CD22＋而CD20-;免疫组化（IHC）染色CD20个别阳性细胞;核型为46,XY。结论B细胞恶性肿瘤经利妥昔单抗治疗后进展可能与CD20抗原表达丢失有关,应重新进行病理组织学、免疫表型和细胞分子遗传学检测。     

来那度胺联合利妥昔单抗治疗弥漫大B细胞淋巴瘤一例并文献复习

目的：提高对来那度胺联合利妥昔单抗（R2）为基础治疗弥漫大B细胞淋巴瘤（DLBCL）的认识。方法回顾性分析1例使用以R2为基础治疗的DLBCL患者的病例资料并复习相关文献。结果该患者为非生发中心来源的难治、复发DLBCL,接受R2联合化疗获得完全缓解,未见明显不良反应。结论 R2联合化疗治疗初治DLBCL可以显著提高缓解率,延长无进展生存期,改善非生发中心来源患者的不良预后。 R2方案对于难治、复发患者亦有效、安全。     

利妥昔单抗治疗弥漫大B细胞淋巴瘤的临床观察

目的观察利妥昔单抗治疗弥漫性大B细胞淋巴瘤(DLBCL)的疗效和不良反应。方法采用R-CHOP-21方案对40例DLBCL患者进行联合化疗。结果治疗2周期后近期疗效评价,CR 15例（37.5%）,PR 14例（35%）,有效率（RR）为72.5%。在不良反应中,Ⅳ度皮疹和心律失常各1例。结论利妥昔单抗近期疗效好;在不良反应中,Ⅳ度皮疹和心律失常必须及时发现和治疗。     

利妥昔单抗联合化疗治疗弥漫大B细胞淋巴瘤临床分析

 目的　观察利妥昔单抗（商品名：美罗华）联合化疗治疗弥漫大B细胞淋巴瘤（DLBCL）的临床疗效及淋巴瘤国际预后指数（IPI）评分对预后的影响;探讨利妥昔单抗在DLBCL自体外周血干细胞移植（APBSCT）中的应用。方法　DLBCL 患者21例,IPI评分低危和中低危（0～2分）14例,中高危和高危（3～5分）7例。采用利妥昔单抗联合CHOP（环磷酰胺、多柔比星、长春新碱、泼尼松）方案4～8个疗程,其中有5例接受APBSCT,动员方案为利妥昔单抗联合环磷酰胺加依托泊苷,预处理方案为CBV （环磷酰胺、卡莫司汀、依托泊苷）方案。结果　21例患者中CR 13例（61.9 %）,总有效率90.5 %（19／21）;2年疾病无进展生存率为（69.74±10.43）%,2年总生存率为（84.44±8.35）%。IPI评分0～2分患者CR率92.9 %,总有效率100 %,3～5分患者CR率0,总有效率71.4 %,IPI 0～2分患者CR率高于3～5分患者（P＜0.01）;5例接受APBSCT的患者采集的中位单个核细胞（MNC）为7.34×108／kg,中位CD+34细胞为8.82×106／kg,造血恢复中性粒细胞＞0.5×109／L的中位时间＋9天,血小板＞20×109／L的中位时间＋12天;主要不良反应是输注相关的不良反应（14.3 %）以及化疗相关的血液学不良反应。结论　利妥昔单抗联合化疗治疗DLBCL疗效满意,IPI 0～2分患者的完全缓解率明显高于3～5分患者;利妥昔单抗不影响外周造血干细胞的采集及造血重建;利妥昔单抗应用安全性较好。     

利妥昔单抗和挽救性自体造血干细胞移植治疗失败的原发性CD5+弥漫大B细胞淋巴瘤经验分享

目的 分析原发性CD5+弥漫大B细胞淋巴瘤(DLBCL)的特点及其特殊性.方法 对1例初诊时病理漏检CD5的原发性CD5+ DLBCL患者的诊疗过程进行总结,并复习相关文献.结果 本例初诊和复发均按照NCCN指南推荐进行,分别选用含有利妥昔单抗的标准剂量一线、二线化疗方案.并在二次复发时行挽救性自体造血干细胞移植,仍无法阻止病情进展,最终在移植后1 a内死亡.结论 原发性CD5+ DLBCL预后差,加入利妥昔单抗的化疗方案治疗不能改善其生存,挽救性自体造血干细胞移植亦无法改善其预后.     

利妥昔单抗治疗弥漫大B细胞淋巴瘤诱发急性肿瘤溶解综合征一例并文献复习

目的 提高对利妥昔单抗诱发急性肿瘤溶解综合征（ATLS）的认识.方法 回顾性分析1例利妥昔单抗治疗弥漫大B细胞淋巴瘤诱发ATLS患者的临床资料并复习相关文献.结果 患者ATLS确诊后,立即暂缓化疗,补液、碱化尿液,但患者肾功能持续恶化,后经血液透析,肾功能逐渐恢复正常.2周后患者再次接受R-CHOP方案化疗,未再发生ATLS.经外周血造血干细胞移植,患者淋巴瘤完全缓解.结论 在应用利妥昔单抗治疗血液系统恶性肿瘤时需警惕肿瘤溶解综合征的发生,及时诊治可使患者获得较好预后.     

R2-CHOP方案治疗肠切除弥漫大B细胞淋巴瘤一例并文献复习

目的:探讨R2-CHOP（来那度胺+利妥昔单抗+环磷酰胺+长春地辛+表柔比星+地塞米松）方案治疗肠切除弥漫大B细胞淋巴瘤（DLBCL）的效果及安全性。方法:回顾性分析江苏省泰兴市人民医院2020年11月收治的1例小肠DLBCL患者治疗经过,并复习相关文献。结果:该患者为原发性小肠DLBCL,接受R2-CHOP方案和R2-ECHOP（R2-CHOP+依托泊苷）方案化疗各1个疗程后,疗效良好,颈部、肺门及纵隔淋巴结缩小,其余淋巴结未见增大,且未出现严重不良反应。结论:R2-CHOP方案是非生发中心型c-myc阳性DLBCL的有效治疗方案,可提高缓解率、总生存率,延长无进展生存期,且无明显不良反应。     

以泽布替尼和利妥昔单抗为基础联合化疗治疗伴复杂核型及TP53基因突变的CD5阳性弥漫大B细胞淋巴瘤并发噬血细胞综合征1例并文献复习

目的探讨以泽布替尼和利妥昔单抗为基础联合化疗治疗伴复杂核型及TP53基因突变CD5阳性弥漫大B细胞淋巴瘤(CD5+ DLBCL)并发噬血细胞综合征患者的效果。方法回顾性分析黑龙江省医院2021年8月收治的1例伴复杂核型及TP53基因突变CD5+ DLBCL并发噬血细胞综合征患者的临床资料, 使用以泽布替尼和利妥昔单抗为基础联合化疗方案治疗, 并对相关文献进行复习。结果该患者结合病史、骨髓穿刺、流式细胞术等检查确诊为双表达、非生发中心B细胞型DLBCL ⅣB期并发噬血细胞综合征。接受4个周期以泽布替尼和利妥昔单抗为基础联合化疗方案治疗后, 复查骨髓及彩色超声、CT提示完全缓解, 染色体核型、基因突变、流式分析结果均转阴, 疗效评价为完全缓解;8个周期后复查PET-CT仍提示完全缓解。后续给予来那度胺维持治疗, 至2022年4月无进展生存10个月。结论在二代测序技术指导下, 应用以泽布替尼和利妥昔单抗为基础联合化疗方案治疗可改善CD5+ DLBCL患者预后并延长生存期。     

Rituximab and chemotherapy in diffuse large B-cell lymphoma

Rituximab is an anti-CD20 chimeric monoclonal antibody with activity in nearly all subtypes of B-cell lymphomas. Association of rituximab with chemotherapy (mostly the cyclophosphamide, doxorubicin, vincristine and prednisolone [CHOP] regimen) in diffuse large B-cell lymphoma (DLBCL) represents an extraordinary revolution in the prognosis of DLBCL, and is the new standard of therapy in elderly and young, low-risk patients. Despite the lack of randomized, clinical trials in younger patients with high risk, rituximab is also a standard of care in these patients in clinical practice, at least in North America. The practice is based on observational trials (e.g., the British Columbia Registry) and the missing logic in classifying patients as ‘younger’ or ‘older’: 60 years old or 65 years old. In Europe, trials are ongoing to establish the best treatment for young, high-risk patients. Association of rituximab and chemotherapy deeply modifies prognostic factors defined before the rituximab era.     

Rituximab in treatment of primary gastric diffuse large B-cell lymphoma

Abstract In the rituximab era, the optimal treatment modality for primary gastric diffuse large B-cell lymphoma (PG-DLBCL) still remains unclear. We performed a retrospective, multicenter analysis of 65 patients with PG-DLBCL to assess the efficacy and toxicity of the addition of rituximab to conventional chemotherapy. When compared with conventional chemotherapy, there was a trend that rituximab plus chemotherapy yielded a higher complete response rate, 5-year event-free survival (EFS) rate and 5-year overall survival (OS) rate, but this was not statistically significant. In subgroup analysis, better OS was observed only for patients with advanced-stage disease when rituximab was added. When involved-field radiotherapy (IFRT) was included, EFS and OS were significantly prolonged in the conventional chemotherapy group, but not in the immunochemotherapy group. If focusing on patients with localized-stage disease receiving immunochemotherapy, the efficacies of short-course rituximab (R)-chemotherapy plus IFRT and 6-8 courses of R-chemotherapy without IFRT were comparable. In conclusion, it is necessary to carry out prospective randomized trials to help further illuminate the role of rituximab in the PG-DLBCL treatment landscape. If a patient has been treated with a non-rituximab-containing regimen, additional IFRT should be considered, and for patients with advanced-stage disease, rituximab should be considered.     

血管免疫母细胞性T细胞淋巴瘤并发EB病毒阳性弥漫大B细胞淋巴瘤二例并文献复习

目的:探讨血管免疫母细胞性T细胞淋巴瘤（AITL）并发EB病毒（EBV）阳性弥漫大B细胞淋巴瘤（DLBCL）患者的临床病理特征、治疗及预后。方法:回顾性分析解放军总医院第五医学中心2例AITL并发EBV阳性DLBCL患者的临床资料,并进行文献复习。结果:例1为混合淋巴瘤（CL）患者,以低热伴全身浅表淋巴结肿大起病,右侧腋窝肿物活组织检查示AITL并发EBV阳性DLBCL,予以8个周期化疗后达不确定的完全缓解;后续应用西达本胺维持治疗,仍生存中。例2为不一致性淋巴瘤（DL）患者,以皮下结节起病,后出现浅表淋巴结进行性肿大;皮下结节病理检查诊断为DLBCL,右腹股沟淋巴结病理检查诊断为AITL;接受7个周期化疗,因合并噬血细胞综合征而死亡。结论:AITL合并EBV阳性DLBCL罕见,临床症状主要以AITL的表现为主,存在T细胞及B细胞免疫表型特征,预后差,治疗方案主要依据预后较差的淋巴瘤进行选择。     

原发性脾弥漫大B细胞淋巴瘤一例并文献复习

目的 探讨原发性脾弥漫大B细胞淋巴瘤(DLBCL)的临床病理学特征及治疗策略.方法 回顾性分析1例原发性脾DLBCL患者的临床资料及病理切片,并复习相关文献.结果 患者主要表现为左上腹疼痛,无发热及浅表淋巴结肿大,CT证实脾多发占位性病变伴脾门多发肿大淋巴结.行脾、胰尾切除术,病理确诊为DLBCL,免疫分型为生发中心B细胞型.外周血和骨髓检查结果正常.脾切除术后给予联合化疗,随访1年处于完全缓解期.结论 原发性脾DLBCL罕见,患者早期无明显症状,手术探查是早期诊断的首选方法,病理学检查是诊断金标准.治疗首选脾切除术,术后辅助化疗及放疗可以提高患者生存率.     

原发性肝脏弥漫性大B细胞淋巴瘤的特点分析--附4例报告及文献复习

目的报道4例原发性肝脏非霍奇金淋巴瘤，分析其病理组织形态学特点及临床表现。方法组织形态学结合免疫组织化学研究，对4例原发性肝脏非霍奇金淋巴瘤的临床表现、病理形态学特点进行探讨。结果本组原发性肝脏非霍奇金淋巴瘤均为弥漫性大B细胞淋巴瘤，患者为中老年人；组织学检查，病变具有身体其他部位弥漫性大B细胞淋巴瘤的特点；免疫组织化学染色显示，瘤细胞HCVAb、CD20、CD79a和CD30阳性表达，HBVAb、CD3和CD45RO阴性表达。结论原发性肝脏淋巴瘤发病率低，临床表现类似于肝脏炎症性疾病表现，并常被误诊为急性肝炎等疾病，导致临床处理不当，延误治疗。在结合临床检查的基础上，通过组织形态学和免疫组化检查可以作出正确的诊断。     

Rituximab in combination with platinum-containing chemotherapy in patients with relapsed or primary refractory diffuse large B-cell lymphoma

The aim of the study was to evaluate the efficacy of a regimen consisting of rituximab and a platinum-containing chemotherapy with either Ifosfamide, Carboplatin and Etoposide (ICE) or Cisplatin, high-dose Ara-C and Dexamethasone (DHAP) in patients with relapsed or primary refractory diffuse large B-cell lymphoma. Ten patients with relapsed or primary refractory diffuse large B-cell lymphoma were treated from June 2000 until May 2001 with a platinum-containing chemotherapy regimen according to the ICE- or DHAP-protocol in combination with rituximab at the University of Muenster. Two cycles of ICE or DHAP and rituximab were given. In case of at least a minor response after 2 cycles, 2 additional cycles of the same combination were applied. Response rate, remission duration and duration of survival were evaluated. All 10 patients could be analysed with respect to these endpoints. No treatment related mortality was observed. The response rate (CR/PR) was 60% (10/50%). Twenty percent of the patients had progressive disease. The median duration of remission and survival was 3 and 3.5 months, respectively (range: 1-6 and 1-7 months, respectively), the survival rate was 10%. Eight of 10 patients died because of their underlying disease with short remission duration, 1 patient died of complications of allogeneic transplantation in CR. In conclusion, the combination of platinum-containing chemotherapy (ICE or DHAP) with rituximab demonstrates significant activity in intensively pretreated patients with relapsed or primary refractory diffuse large B-cell lymphoma. Considering the short duration of remission and survival, respectively, other experimental therapeutic approaches (e.g. allogeneic stem cell transplantation, radioimmunotherapy) should be pursued following this treatment in order to induce long-term remission.     

EB病毒阳性老年人弥漫大B细胞淋巴瘤二例并文献复习

 目的　分析我国老年人EB病毒（EBV）阳性弥漫大B细胞淋巴瘤（DLBCL）的临床特点,提高对该病的认识。方法　报道2例老年人EBV阳性DLBCL患者临床、实验室资料及治疗经过。结果　老年人EBV阳性DLBCL高发年龄70～79岁,患者主要表现为全身淋巴结肿大,可伴结外器官受累,可出现巨脾和免疫性溶血性贫血,多伴有发热、体质量减轻等B症状,病理表现为多形性大细胞浸润,伴不同程度的反应性细胞,特别是T细胞增殖。结论　老年EBV阳性DLBCL患者肿瘤细胞CD20或CD79a阳性,EBV 编码的小RNA（EBER）阳性。疾病进展快,对标准化疗反应差。利妥昔单抗对CD20阳性病例短期有效,但疗效有限。患者的生存期短。死亡原因主要是感染所致的呼吸衰竭。