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[套细胞淋巴瘤的治疗]

[Treatment for mantle cell lymphoma].

作者信息

Izutsu Koji

机构信息

Department of Hematology, National Cancer Center Hospital.

出版信息

Rinsho Ketsueki. 2017;58(10):2026-2032. doi: 10.11406/rinketsu.58.2026.

Abstract

Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma characterized by CD5+, CCND1+, and the CCND1-IGH translocation. Although patients with MCL respond, at least temporarily, to conventional chemotherapy, they eventually have a relapse and the prognosis is generally poor. As a primary treatment option for patients with untreated MCL, a rituximab-containing chemotherapy regimen is administered according to the patient's eligibility for high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). For ASCT-eligible patients, an induction chemotherapy that includes high-dose cytarabine followed by ASCT is recommended. For ASCT-ineligible patients, a less intensive therapy, such as R-CHOP, bortezomib-containing therapy (VR-CAP), or bendamustine plus rituximab, is recommended. These induction therapies can be followed by rituximab maintenance. For those with relapsed/refractory MCL, fludarabine, bendamustine, 90Y-ibritumomab tiuxetan, and conventional cytotoxic agents can be used. Recently, ibrutinib, an inhibitor of Bruton tyrosine kinase, has been approved for relapsed/refractory MCL. Recent advances in the management of MCL will improve the prognosis of patients with MCL.

摘要

套细胞淋巴瘤(MCL)是一种侵袭性B细胞淋巴瘤,其特征为CD5阳性、CCND1阳性以及CCND1-IGH易位。尽管MCL患者对传统化疗至少有暂时反应,但最终会复发,且预后通常较差。作为未经治疗的MCL患者的主要治疗选择,根据患者接受大剂量化疗后进行自体干细胞移植(ASCT)的适用性,给予含利妥昔单抗的化疗方案。对于适合ASCT的患者,推荐采用包括大剂量阿糖胞苷随后进行ASCT的诱导化疗。对于不适合ASCT的患者,推荐采用强度较低的治疗,如R-CHOP、含硼替佐米的治疗(VR-CAP)或苯达莫司汀加 rituximab。这些诱导治疗后可进行利妥昔单抗维持治疗。对于复发/难治性MCL患者,可使用氟达拉滨、苯达莫司汀、90Y-伊布替膦酸钇和传统细胞毒性药物。最近,布鲁顿酪氨酸激酶抑制剂伊布替尼已被批准用于复发/难治性MCL。MCL治疗的最新进展将改善MCL患者的预后。

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