Cheson Bruce D
Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
CA Cancer J Clin. 2004 Sep-Oct;54(5):260-72. doi: 10.3322/canjclin.54.5.260.
The lymphomas are a diverse group of malignant disorders that vary with respect to their molecular features, genetics, clinical presentation, treatment approaches, and outcome. Over the past few years, there have been major advances in our understanding of the biology of these diseases, leading to a universally adopted World Health Organization classification system. New therapies are now available with the potential to improve patient outcome, and the International Prognostic Index and standardized response criteria help make clinical trials interpretable. Most notably, the chimeric antiCD20 monoclonal antibody rituximab has altered our therapeutic paradigms for B-cell disorders. Combinations of this antibody with chemotherapy and other biologic agents have shown promise in treating lymphoma. Other antibodies, radioimmunoconjugates (such as Y-90 ibritumomab tiuxetan and I-131 tositumomab), and oblimerson sodium (a BCL-2 antisense oligonucleotide) have all shown promise. New chemotherapy regimens such as bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), agents such as gemcitabine, and monoclonal antibodies directed against CD30 are also being studied in Hodgkin Lymphoma. The challenge of clinical research is to optimize the use of these agents, select patients most likely to respond, and develop multitargeted strategies based on sound scientific rational, with the potential to increase the cure rate of patients with lymphomas.
淋巴瘤是一组多样的恶性疾病,在分子特征、遗传学、临床表现、治疗方法及预后方面各不相同。在过去几年中,我们对这些疾病生物学特性的理解取得了重大进展,从而形成了普遍采用的世界卫生组织分类系统。现在有了新的治疗方法,有可能改善患者预后,国际预后指数和标准化反应标准有助于使临床试验具有可解释性。最值得注意的是,嵌合抗CD20单克隆抗体利妥昔单抗改变了我们治疗B细胞疾病的模式。这种抗体与化疗及其他生物制剂联合使用在治疗淋巴瘤方面已显示出前景。其他抗体、放射免疫缀合物(如钇-90替伊莫单抗和碘-131托西莫单抗)以及奥布利森钠(一种BCL-2反义寡核苷酸)也都显示出前景。新的化疗方案如博来霉素、依托泊苷、阿霉素、环磷酰胺、长春新碱、丙卡巴肼和泼尼松(BEACOPP)、吉西他滨等药物以及针对CD30的单克隆抗体也正在霍奇金淋巴瘤中进行研究。临床研究面临的挑战是优化这些药物的使用,选择最可能有反应的患者,并基于合理的科学依据制定多靶点策略,以提高淋巴瘤患者的治愈率。