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[非霍奇金淋巴瘤近期进展的最新情况]

[An update on recent developments in non-Hodgkin's lymphoma].

作者信息

Bouabdallah Krimo, Milpied Noël

机构信息

Service des maladies du sang, Hôpital Haut-Lévèque, 33604 Pessac.

出版信息

Bull Cancer. 2007 Jan;94(1):43-52.

Abstract

The management of non-Hodgkin's lymphoma (NHL) has changed considerably over the last 15 years with the recognition of independent prognostic factors leading to the development of a predictive model of outcome, the International Non-Hodgkin's Lymphoma Prognostic Factors Index (IPI) and more recently gene array studies. Since then, the therapeutic approaches have tried to improve the outcome of patients with adverse prognostic factors with the building of intensified regimens rather than the classical CHOP regimen. The introduction of monoclonal antibodies (MoAb) into the management of NHL has dramatically improved the response rates and rituximab is now approved for the treatment of diffuse large B-cell lymphoma and follicular lymphoma. Subsequently, MoAb have been conjugated to radioisotopes to target radiotherapy to tumor sites and improve overall survival. The advantages of these radiolabeled antibodies are not only to enhance the therapeutic potency of MoAb by targetting specifically CD20+ tumour cells but also to protect the neighbouring normal organs from cytotoxicity. Finally, the initial staging as well as the evaluation of the response after treatment has been better defined with the introduction of positron emission tomography (PET) into the assessment of NHL. The accuracy of PET imaging in the detection of residual disease and extranodal localizations appears to be the most helpful non-ivasive modality in NHL. The aim of this review is to focus on recent and most significant improvements in the management of lymphomas.

摘要

在过去15年里,非霍奇金淋巴瘤(NHL)的治疗发生了很大变化,这得益于对独立预后因素的认识,从而开发出了一种预后预测模型——国际非霍奇金淋巴瘤预后因素指数(IPI),以及最近的基因阵列研究。从那时起,治疗方法试图通过构建强化方案而非经典的CHOP方案来改善具有不良预后因素患者的治疗效果。单克隆抗体(MoAb)引入NHL治疗后显著提高了缓解率,利妥昔单抗现已获批用于治疗弥漫性大B细胞淋巴瘤和滤泡性淋巴瘤。随后,单克隆抗体与放射性同位素结合,将放射治疗靶向肿瘤部位,提高总生存率。这些放射性标记抗体的优势不仅在于通过特异性靶向CD20 +肿瘤细胞增强单克隆抗体的治疗效力,还在于保护邻近正常器官免受细胞毒性影响。最后,随着正电子发射断层扫描(PET)引入NHL评估,初始分期以及治疗后反应评估得到了更好的界定。PET成像在检测残留疾病和结外定位方面的准确性似乎是NHL中最有用的非侵入性检查方法。本综述的目的是关注淋巴瘤治疗中近期最重要的进展。

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