Freedman A S, Nadler L M
Harvard Medical School, Boston, Massachusetts.
Hematol Oncol Clin North Am. 1991 Oct;5(5):871-89.
The majority of non-Hodgkin's lymphomas (NHLs) are of B-cell lineage, with less than 20% of cases being of T-cell lineage. The B-cell NHLs phenotypically correspond to normal cells in the mid stages of normal differentiation. More specifically, by their expression of B-cell activation antigens, these tumors are the neoplastic counterparts of normal activated B cells. The follicular lymphomas--including the small cleaved, mixed small and large cell, and large cell types, as well as the small noncleaved cell (Burkitt's) lymphomas--represent malignant expansions of normal germinal center B cells by their expression of pan-B cell antigens, B-cell activation antigens, and CD10 (CALLA). The diffuse lymphomas also correspond to normal activated B cells. The small lymphocytic lymphomas express the low-affinity IL-2 receptor and CD5, both of which are induced on normal B cells following mitogen stimulation. The other diffuse B-cell NHLs similarly express activation antigens and resemble "transformed" B cells. The T-cell NHLs generally correspond to normal activated CD4+ T cells. These tumors--which include most peripheral T-cell lymphomas, cutaneous T-cell lymphomas, and HTLV-I-associated adult T-cell leukemias/lymphomas--express antigens induced on activated T cells, including IL-2 and transferrin receptors (CD25 and CD71, respectively), as well as HLA-DR. The lymphoblastic lymphomas, which are generally of T-cell lineage, phenotypically correspond to stages of intrathymic differentiation, often by their coexpression of CD4 and CD8, as well as expression of CD1. It remains controversial whether the immunophenotype of lymphoblastic lymphoma differs significantly from T-cell acute lymphoblastic leukemia. Since immunologic heterogeneity of NHL was first observed, attempts have been made to employ the data as a prognostic variable. Early studies suggested that lineage derivation or expression of markers of proliferating cells affected outcome in NHL. However, these reports were often retrospective, included various histologies, and did not treat patients uniformly. More recent prospective studies with relatively uniformly treated patients, predominantly involving DLCL, suggest that certain immunologically defined subgroups may have significantly different clinical outcomes. However, additional clinical studies will be necessary before treatment options are based upon immunologic markers.
大多数非霍奇金淋巴瘤（NHL）起源于B细胞系，T细胞系病例不到20%。B细胞NHL在表型上与正常分化中期的细胞相对应。更具体地说，通过表达B细胞活化抗原，这些肿瘤是正常活化B细胞的肿瘤对应物。滤泡性淋巴瘤——包括小裂细胞型、小细胞与大细胞混合型、大细胞型，以及小无裂细胞（伯基特）淋巴瘤——通过表达全B细胞抗原、B细胞活化抗原和CD10（CALLA），代表正常生发中心B细胞的恶性增殖。弥漫性淋巴瘤也与正常活化B细胞相对应。小淋巴细胞淋巴瘤表达低亲和力白细胞介素-2受体和CD5，这两者在正常B细胞经有丝分裂原刺激后均被诱导表达。其他弥漫性B细胞NHL同样表达活化抗原，类似于“转化”的B细胞。T细胞NHL通常与正常活化的CD4+T细胞相对应。这些肿瘤——包括大多数外周T细胞淋巴瘤、皮肤T细胞淋巴瘤以及HTLV-I相关的成人T细胞白血病/淋巴瘤——表达活化T细胞上诱导产生的抗原，包括白细胞介素-2和转铁蛋白受体（分别为CD25和CD71），以及HLA-DR。淋巴母细胞淋巴瘤通常起源于T细胞系，在表型上与胸腺内分化阶段相对应，通常是通过其CD4和CD8的共表达以及CD1的表达。淋巴母细胞淋巴瘤的免疫表型与T细胞急性淋巴细胞白血病是否存在显著差异仍存在争议。自从首次观察到NHL的免疫异质性以来，人们一直试图将这些数据用作预后变量。早期研究表明，细胞系起源或增殖细胞标志物的表达会影响NHL的预后。然而，这些报告往往是回顾性的，涵盖了各种组织学类型，并且对患者的治疗并不统一。最近针对治疗相对统一的患者进行的前瞻性研究，主要涉及弥漫性大B细胞淋巴瘤（DLCL），表明某些免疫定义的亚组可能具有显著不同的临床结局。然而，在基于免疫标志物确定治疗方案之前，还需要进行更多的临床研究。
