美罗华联合CHOP方案治疗B细胞性非霍奇金淋巴瘤的临床观察

目的观察美罗华联合CHOP方案治疗CD20阳性B细胞性非霍奇金淋巴瘤的临床疗效及不良反应。方法回顾性分析我科采用美罗华联合化疗治疗13例B细胞非霍奇金淋巴瘤的疗效及影响因素。结果完全缓解率69.2%（9/13）,部分缓解（PR）23%（3/13）,总有效率92.3%（12/13）。结论美罗华联合CHOP方案治疗B细胞性非霍奇金淋巴瘤疗效好,且未增加不良反应。     

卵巢原发非霍奇金淋巴瘤的临床病理分析

目的观察卵巢原发非霍奇金淋巴瘤的临床病理表现,探讨该类肿瘤的临床病理特征及病理诊断。方法对15例卵巢原发非霍奇金淋巴瘤作临床病理观察及随访,按WHO关于淋巴造血组织肿瘤分类（2001）进行组织学分型和诊断。采用SP法进行免疫表型检测。结果该类肿瘤占同期收治的非霍奇金淋巴瘤的0．56%（15／2679）,其中,临床Ⅲ期或Ⅳ期者有12例（80%）,临床Ⅰ期或Ⅱ期者3例（20%）。组织学分型：15例（100％）均为弥漫大B细胞淋巴瘤,中心母细胞性或免疫母细胞性。所有病例均接受了手术治疗,3例术后分别用CHOP或COMP方案治疗。4例有随访资料者均死亡,生存时间为21d～18月。结论卵巢原发非霍奇金淋巴瘤少见,预后差。肿瘤的确诊依赖病理学检查和免疫表型检测。     

T-cell Lymphomas: Updates in Biology and Diagnosis

Nodal-based peripheral T-cell lymphomas are heterogeneous malignancies with overlapping morphology and clinical features. However, the current World Health Organization classification scheme separates these tumors into prognostically relevant categories. Since its publication, efforts to uncover the gene expression profiles and molecular alterations have subdivided these categories further, and distinct subgroups are emerging with specific profiles that reflect the cell of origin for these tumors and their microenvironment. Identification of the perturbed biologic pathways may prove useful in selecting patients for specific therapies and associating biomarkers with survival and relapse.     

Phase 2 Study of Daratumumab in Relapsed/Refractory Mantle-Cell Lymphoma,Diffuse Large B-Cell Lymphoma,and Follicular Lymphoma

BackgroundDaratumumab is a CD38 monoclonal antibody approved for treating relapsed/refractory and newly diagnosed multiple myeloma. Preclinical daratumumab studies demonstrated cytotoxic activity and reduced tumor growth in B-cell non-Hodgkin lymphoma (NHL) subtypes, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and mantle-cell lymphoma (MCL).Patients and MethodsThis was a phase 2, open-label, multicenter, 2-stage trial. Patients with relapsed/refractory DLBCL, FL, or MCL with ≥ 50% CD38 expression were eligible for stage 1. Daratumumab (16 mg/kg; 28-day cycles) was administered intravenously weekly for 2 cycles, every 2 weeks for 4 cycles, and every 4 weeks thereafter. Overall response rate was the primary end point. Pharmacokinetic and safety were also evaluated. Stage 2 was planned to further assess daratumumab in larger populations of NHL subtypes if futility criteria were not met. The study was registered with ClinicalTrials.gov (NCT02413489).ResultsThe trial screened 138 patients resulting in accrual of 15 patients with DLBCL, 16 with FL, and 5 with MCL. Median CD38 expression across treated patients was 70%. Overall response rate was 6.7%, 12.5%, and not evaluable in DLBCL, FL, and MCL cohorts, respectively. The most common grade 3/4 treatment-emergent adverse event was thrombocytopenia (11.1%), and 4 (11.1%) patients discontinued treatment because of treatment-emergent adverse events. Infusion-related reactions occurred in 72.2% of patients (3 patients with grade 3; no grade 4).ConclusionIn NHL, the safety and pharmacokinetics of daratumumab were consistent with myeloma studies. Screen-fail rates were high, prespecified futility thresholds were met in 2 cohorts, and the study was terminated. Studies in other hematologic malignancies and amyloidosis are ongoing.     

Rituximab desensitization in three patients with severe rituximab allergy

Rituximab is a chimeric monoclonal antibody that targets CD20 positive B cells and has a positive effect on both overall and progression-free survival in B-cell lymphoid malignancies. Combination rituximab with chemotherapy treatment provide survival improvement. Although rituximab is an important treatment option in hematological malignancies, the risk of allergic reactions is high. These reactions are usually IgE-mediated and can be varied in regard of severity from urticaria to anaphylaxis. It is an option to interrupt the treatment and ommit rituximab therapy who had allergic reactions. Drug desensitization is another option and successful results have been reported by applying desensitization to such reactions. Drug desensitization alters the immune response to induce a state of temporary clinical tolerance to the allergic drug by giving gradual increasing of doses of drug at fixed time intervals. Herein, we present 3 cases successfully treated with rituximab desensitization. The cases were using rituximab with the diagnosis of Burkitt lymphoma, follicular lymphoma, and marginal zone lymphoma, respectively. Two cases had grade 2 and 1 case had grade 3 systemic allergic reaction with rituximab. There was no known allergy history in all 3 cases. All patients tolerated the desensitization protocol. The subsequent treatments of the patients were also given by desensitization protocol. A total of 12 desensitizations were administered to 3 cases. No severe or life-threating reactions were observed in subsequent applications. To date applying desensitization protocols ensure rituximab treatment safely. Rituximab desensitization can be performed at trained allergy centers, and it may be an appropriate option for rituximab allergic patients.