非霍奇金淋巴瘤患者化疗中胸腺肽治疗作用的评价

机体免疫功能降低在恶性肿瘤的发生和发展过程中起重要作用。肿瘤患者Ｔ细胞数量减少和功能改变及Ｔ细胞亚群比例失调 ,导致Ｔ细胞功能不全和抑制 ,是肿瘤细胞无限增殖的重要因素之一。本组资料对非霍奇金淋巴瘤 (ＮＨＬ)患者在化疗的同时给予胸腺肽治疗 ,使被抑制的细胞免疫功能得到部分恢复 ,并以外周血Ｔ淋巴细胞亚群作为评价其疗效的指标。对象与方法1.对象 :ＮＨＬ患者 12 0例 ,为武汉大学中南医院 1997年 3月～ 2 0 0 1年 5月收治的患者 ,均经病理学检查证实。将 12 0例患者分为对照组和用药组 ,对照组 48例 ,中位年龄 49岁 ;用药组 7…     

美罗华治疗难治性非霍奇金淋巴瘤3例

非霍奇金淋巴瘤(NHL)是最常见的淋巴系统恶性肿瘤，其中绝大多数来源于B细胞，90％的病例表达CD20抗原。常规化疗、放疗难以延长NHL患者生存期，且复发率高，治愈率低。近年来针对B细胞CD20抗原研制的特异性单抗美罗华，用于治疗B细胞淋巴瘤，能导致B细胞溶解，并能抑制其增殖，诱导凋亡和提高肿瘤化疗的敏感性。据国内外临床证明，对B细胞淋巴瘤有肯定疗效。现将我科应用美罗华治疗的3例难治性NHL报告如下。     

13例AIDS合并非霍奇金淋巴瘤的临床分析

目的分析13例艾滋病相关非霍奇金淋巴瘤(ARL)病人的临床资料,探讨其治疗时机和治疗方案。方法采用回顾性分析的方法,对龙潭医院2008年10月至2013年6月收治的艾滋病(AIDS)合并ARL住院病人的临床特点、免疫水平、并发症、病理检查及治疗情况、转归等进行分析。结果 13例ARL病人中,男性11例,女性2例,年龄24~71岁。10例在淋巴瘤诊治中首次发现艾滋病病毒(HIV)感染,2例分别在抗病毒治疗(ART)1个月和4个月后发现ARL,1例在诊断HIV感染后4个月发现ARL(未行ART)。发病时CD+4T淋巴细胞计数为21~340个/μL。10例为B细胞淋巴瘤,其中1例为Burkitt淋巴瘤,1例为黏膜相关性淋巴样组织淋巴瘤(MALT),6例为弥漫大B细胞性淋巴瘤,2例未能进一步分型;2例未分型,1例为T细胞淋巴瘤。以颈部肿物、腹股沟肿物、腋下包块、盆腔肿块及锁骨上肿物等为首发症状的7例,上消化道出血、便血、腹胀及腹痛、吞咽时胸骨后灼热痛、发热伴咽痛、发热伴头痛等起病6例。8例进行了ART,4例进行了化疗。4例未随访,7例死亡。结论HIV感染者若出现不明原因的淋巴结肿大、发热、消化道出血等,应考虑并发淋巴瘤的可能,必要时行淋巴结活检以明确诊断。积极的ART联合规范性化疗,以及适当的治疗时机仍需要补充更多的临床实践资料进行讨论。     

AIDS合并非霍奇金淋巴瘤8例临床治疗分析

艾滋病(Acquired immunodeficiency syndrome,AIDS)合并非霍奇金淋巴瘤多见于青年,多为局部淋巴结的无痛性、进行性肿大。肿大致一定程度,可压迫周围组织,引起相应的症状。最常累及颈部、腋下、锁骨上、纵隔等淋巴结,晚期可累及肝、脾、头颅等处。现将2年内诊治AIDS合并非霍奇金淋巴瘤报告如下。     

062无症状晚期非霍奇金淋巴瘤观察与治疗的长期对比研究

无论是单个烷化剂化疗或是强烈的联合化疗，甚至联合应用放疗均难以治愈进展期低度恶性非霍奇金淋巴瘤(NHL)，对于某些低度恶性无症状NHL，确诊后继续观察还是治疗?本文对无症状进展期低度恶性NHL患者的长期随访结果进行评估。     

原发性卵巢非霍奇金淋巴瘤2例及文献复习

卵巢是转移性肿瘤的好发部位,可来源于胃肠道、乳腺、生殖器、肺、肾、胰腺、淋巴瘤等,原发于女性生殖系统的非霍奇金淋巴瘤临床较为少见,原发于卵巢者更为罕见。目前对卵巢淋巴瘤的临床诊断、分期及治疗尚无统一标准,现将我院收治的2例患者结合文献复习报告如下。     

以肾上腺占位为主要表现的非霍奇金淋巴瘤21例临床分析

目的 通过分析肾上腺淋巴瘤的临床特点,拓展肾上腺占位诊断思路.方法 回顾性分析1994年1月—2012年12月于北京大学第一医院住院诊治的肾上腺占位及淋巴瘤患者,从中筛选肾上腺淋巴瘤患者并分析其临床特点.结果 期间共收治肾上腺占位患者1 100例,淋巴瘤患者1 002例,其中肾上腺淋巴瘤患者21例,男14例,女7例,年龄35 ～80岁,平均56岁.临床表现腰背部疼痛15例,发热3例,消瘦1例,体检发现2例.仅2例伴浅表淋巴结肿大,10例腹腔淋巴结肿大.其他结外器官受累11例,其中脾脏增大4例,肾脏受累3例,胃受累3例,精索受累1例.双侧肾上腺受累8例,左侧9例,右侧4例.肿物平均直径7.2 cm.CT、MRI表现无特异性.内分泌功能检查均为无功能瘤.病理检查结果:弥漫大B细胞型18例,T细胞型2例,间变性大细胞型1例.仅7例在手术前诊断淋巴瘤.2014年9月电话回访到17例,其中死亡14例,平均生存时间5.5个月,2例分别无瘤生存4、10个月,另1例化疗治疗中.结论 肾上腺淋巴瘤少见,较少侵犯浅表淋巴结,恶性程度高,进展快,预后差.临床及影像学表现均缺乏特异性,误诊率高.病理是诊断金标准,多为弥漫大B细胞型.     

北京协和医院对18年间病理诊断肺淋巴瘤患者的回顾分析

目的回顾性总结分析肺淋巴瘤的分类、分型特征及临床特点。方法收集北京协和医院1999年-2016年近18年期间病理诊断为肺淋巴瘤的全部病例,通过光镜、免疫组织化学染色及基因重排方法进行病理分析。结果本组共有肺淋巴瘤病例142例,男女比例1︰1.33,平均年龄48岁。123例(86.6%)诊断为非霍奇金淋巴瘤,19例(13.4%)诊断为霍奇金淋巴瘤。101例(69.2%)诊断为B细胞性淋巴瘤,其中45.6%(46例)为黏膜相关淋巴组织淋巴瘤或边缘区淋巴瘤,18.8%(19例)为弥漫大B细胞性淋巴瘤,11.9%(12例)为淋巴瘤样肉芽肿病。22例诊断为T细胞性淋巴瘤,其中27.3%为外周T细胞淋巴瘤(6例),13.6%(3例)为NK/T细胞淋巴瘤,9.1%(2例)为间变大细胞淋巴瘤。121例患者临床资料完善,其中64例(52.9%)为原发性肺淋巴瘤,男女比例1︰1.37,平均年龄50岁;57例(47.1%)为继发性肺淋巴瘤,男女比例1︰1.19,平均年龄45岁。在原发性肺淋巴瘤中,96.9%为非霍奇金淋巴瘤,3.1%为霍奇金淋巴瘤;在继发性肺淋巴瘤中,78.9%为非霍奇金淋巴瘤,21.1%为霍奇金淋巴瘤。65例手术切除或胸腔镜下肺活检病例全部进行了病理分类及分型,77例穿刺活检病例中有22例(28.6%)进一步分型困难。结论肺淋巴瘤中最常见类型依次为黏膜相关淋巴组织淋巴瘤、霍奇金淋巴瘤、弥漫大B细胞性淋巴瘤和淋巴瘤样肉芽肿病,其中黏膜相关淋巴组织淋巴瘤和淋巴瘤样肉芽肿病是主要的原发性肺淋巴瘤类型,而弥漫大B细胞性淋巴瘤和霍奇金淋巴瘤是主要的继发性肺淋巴瘤类型。开胸手术或胸腔镜下肺活检的病例易于明确病理分型,而穿刺活检病例中有小部分病例进一步分型困难。     

71例恶性淋巴瘤患者HBsAg表达测定及分析

目的探讨HBV感染与恶性淋巴瘤发病的关系。方法选择71例恶性淋巴瘤患者(恶性淋巴瘤组)及与其一般资料匹配的66例胃癌患者(胃癌组)、161例健康查体者(对照组),采用ELISA法检测血清HBsAg及HCV抗体阳性率。结果恶性淋巴瘤组HBsAg阳性率明显高于胃癌组和对照组(P均<0.01),后两组比较无明显差异;三组HCV抗体阳性率均无明显差异。恶性淋巴瘤组非霍奇金淋巴瘤(NHL)患者HBsAg阳性率显著高于霍奇金淋巴瘤(HL)患者,且B细胞来源的NHL(B-NHL)患者显著高于T细胞来源的NHL(T-NHL)患者,P均<0.01。结论 B细胞性NHL患者HBV感染率明显增高,提示HBV持续感染可能在NHL尤其是B细胞性NHL发病中起重要作用。     

以吡柔比星为主联合化疗方案治疗老年非霍奇金淋巴瘤125例

非霍奇金淋巴瘤(NHL)标准治疗方案因其中的比柔比星毒副作用较大而影响其在临床上的应用[1],提高治疗效果的同时降低不良反应的发生率,给临床及药学工作者带来了新的要求[2].现将我科研究的以吡柔比星为主的联合化疗方案治疗NHL的临床资料进行分析.     

New treatment strategies in lymphomas: aggressive lymphomas

This review will cover the use of these monoclonal antibodies alone or in combination with chemotherapy for the treatment of aggressive lymphomas. Rituximab, an unconjugated anti-CD20 chimeric antibody, is certainly the most widely used but other unconjugated or radiolabeled monoclonal antibodies may catch up quickly. Rituximab combined with chemotherapy allows increasing the complete response rate, to decrease progression during treatment or relapse, to increase duration of response, event-free survival and overall survival. This benefit is now demonstrated in several randomized studies in different settings. Less data are available for the use of Rituximab in maintenance after chemotherapy or autologous transplant. The use of monoclonal antibodies (MAb) for the treatment of lymphoma patients appeared some 7 years ago and, firstly, they have been developed for so-called 'low-grade' or indolent lymphomas. Murine antibodies have been used with toxin or isotopes attached to them and, in this case, the antibody is used to specifically transport the active agent, often a radionucleide, to lymphoma cells. In the case of unmodified, naked, monoclonal antibodies, such as rituximab, the chimeric human-mouse antibody fixes the antigen on the membrane of lymphoma cells with the murine antibody part and stimulates the immune host mechanisms through the human Fc part. The fact of fixing the antigen on the cell surface may also trigger a cascade of biologic events leading to the cell death through the apoptotic process.     

单倍体相合造血干细胞移植在难治高度恶性淋巴瘤中的应用

目的 :探讨应用单倍体相合骨髓移植对难治高度恶性非霍奇金淋巴瘤 (NHL)治疗的可行性。方法 :6例难治高度恶性NHL伴有骨髓浸润患者接受人白细胞抗原 (HLA) 2～ 3个位点不合的单倍体相合移植 ,供者用粒细胞集落刺激因子 (G CSF)促进后采髓 ,急性移植物抗宿主病 (GVHD)预防例 1采用环孢菌素A(CSA)、短程甲氨蝶呤 (MTX)、霉酚酸酯 (MMF)和抗胸腺细胞球蛋白 ,余 5例除上述药物外 ,还加用CD2 5单克隆抗体。结果 :6例移植后均获造血重建 ,粒细胞绝对数 >0 .5× 10 9/L中位天数是 17d ,血小板 >2 0× 10 9/L的中位天数是 2 2d ,骨髓植活直接证据检测证实为完全供者造血。 1例于移植后 2 0d时发生急性Ⅳ度肠道GVHD ,可评价慢性GVHD病例4例 ,均发生慢性GVHD ,其中 1例广泛性慢性GVHD ,口服泼尼松和CSA病情控制。中位随访 2 0 (7～ 4 2 )个月 ,1例重度GVHD于移植后 2个月死亡 ,1例在移植后 4个月并发真菌感染死亡 ,无病存活 4例 ,Karnofshy生存质量评价为 10 0 %。结论 :研究表明单倍体相合未经体外去T细胞骨髓移植对难治高度恶性NHL具有一定治疗价值 ,能够降低急性重症aGVHD发生和减少移植相关死亡。     

Immunotherapy in aggressive B-cell lymphomas

The idea that the immune system could be co-opted to treat cancer is not new; it has existed for centuries. However, what is new is the advancement of our understanding of how the immune system is regulated and how a tumor evolves to evade an immune response. This knowledge, combined with modern technologies to manipulate the immune system, both pharmacologically and genetically, has led to the realization of immuno-oncology as a new frontier in cancer therapeutics. This review will focus on pharmacologic immunotherapies in aggressive B cell lymphomas: checkpoint inhibition and bispecific antibodies. The success of checkpoint inhibitors in this heterogenous collection of diseases has largely been limited to those that genetic aberrations involving genes for checkpoint ligands, whereas bispecific antibodies appear to be more broadly efficacious but responses are short-lived. Investigation into the tumor microenvironment for each of the aggressive B cell lymphoma histologies, and interrogation of mechanisms of resistance as well as predictors of response to these immunotherapy approaches, will undoubtedly identify rational combinations as well as new therapeutic targets such that outcomes can be improved across these diseases.     

VB-CHEP chemotherapy regimen for aggressive non-Hodgkin's lymphomas

Abstract: Despite intensive search for the optimal combination chemotherapy for aggressive non-Hodgkin's lymphoma (NHL), the CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) regimen is still the standard therapy. We investigated the clinical efficacy of a new combination regimen consisting of vincristine, bleomycin–cyclophosphamide, adriamycin, etoposide and prednisolone (VB-CHEP) in patients with aggressive NHL. A total of 29 patients with aggressive NHL was enrolled into the protocol. Eight patients were consolidated with cisplatin and cytarabine and 5 patients received radiotherapy for bulky disease. Objective response was achieved in 82.8% of the patients. Complete remission (CR) and partial remission rates were 72.4%, and 10.3%, respectively. CR rate was significantly lower in patients with advanced stage, extranodal disease and bone marrow involvement. Median follow-up time is 34+ months; 17 patients are disease-free while 12 died and only 2 patients with CR have relapsed so far. Median response duration is 29+ months and the median survival is 48+ months. The survival rate is 69% in the first year and 66% in the second year. A total of 152 cycles were evaluated for toxicity. Major hematological toxicity was myelosuppression and neutropenia, detected in 50.65%, was mostly grades 1–2. Neutropenic fever occurred in only 11 cycles. The side effects of the consolidation therapy were also acceptable. We conclude that the VB-CHEP regimen with consolidation therapy for high-risk patients may be an effective treatment for advanced stage aggressive NHL.     

非霍奇金淋巴瘤中肺耐药相关蛋白的表达及意义

目的 研究非霍奇金淋巴瘸（NHL）中肺耐药相关蛋白（LRP）的表达及其临床意义。方法 应用免疫组化S-P法检测43例NHL患者（其中初治病例32例,复发病例11例）和10例坏死增生性淋巴结炎患者组织中的LRP水平。结果 LRP在NHL患者中表达明显高于坏死增生性淋巴结炎患者（P〈0．05）,而且NHL复发组高于初治组（P〈0．05）。12例随访患者中LRP阴性者治疗效果优于LRP阳性者。结论 LRP过度表达与NHL临床耐药及疗效相关。     

The significance of a residual mediastinal mass following treatment for aggressive non-Hodgkin's lymphomas.

The chest radiographs of 252 patients with aggressive non-Hodgkin's lymphoma, prospectively treated according to one of three protocols of combination chemotherapy, were reviewed to determine the incidence and prognostic significance of mediastinal abnormalities following treatment. Residual mediastinal masses were defined as any abnormality, greater than 2 cm in diameter, that had initially responded to chemotherapy and then remained stable in size for at least three months after its maximal response, together with the disappearance of all other clinical and biological signs of active lymphoma. At the end of treatment, 21 (8%) patients had some residual mediastinal abnormality. The predominant histological pattern was the diffuse large cell subtype (p less than 0.001). Disease free survival and overall survival for these patients were similar to those observed among patients in complete remission without a persisting radiological mass after treatment. We conclude that mediastinal residual masses after completion of treatment for aggressive lymphoma are frequent and do not indicate a poorer prognosis. Such patients can be observed clinically without any need for additional chemotherapy or radiotherapy.     

Impact of cachexia on outcomes in aggressive lymphomas

Cancer cachexia is defined as a state of involuntary weight loss, attributed to altered body composition with muscle mass loss and/or loss of adiposity. Identifying the association between cancer cachexia and outcomes may pave the way for novel agents that target the cancer cachexia process. Clinical parameters for measurement of cancer cachexia are needed. We conducted a single-institution retrospective analysis that included 86 NHL patients with the aim of identifying an association between cancer cachexia and outcomes in aggressive lymphomas using the cachexia index (CXI) suggested by Jafri et al. (Clin Med Insights Oncol 9:87–93, 15). Impact of cachexia factors on progression-free survival (PFS) and overall survival (OS) were assessed using log-rank test and Cox proportional hazards regression. Patients were dichotomized around the median CXI into “non-cachectic” (CXI ≥49.8, n = 41) and “cachectic” (CXI <49.8, n = 40) groups. Cachectic patients had significantly worse PFS (HR 2.18, p = 0.044) and OS (HR = 4.05, p = 0.004) than non-cachectic patients. Cachexia as defined by the CXI is prognostic in aggressive lymphomas and implies that novel therapeutic strategies directed at reversing cachexia may improve survival in this population.