Hematologic malignancies

恶性血液病
  • 文章类型: Journal Article
    单纯疱疹病毒或水痘带状疱疹病毒的临床再激活经常发生在恶性肿瘤患者中,特别是在接受强化化疗治疗的急性白血病患者中表现为单纯疱疹性口炎,在淋巴瘤或多发性骨髓瘤患者中表现为带状疱疹。近年来,对于常规化疗药物和许多新的抗肿瘤药物,对再激活率和临床表现的了解有所增加。本指南总结了目前关于未接受异基因或自体造血干细胞移植或其他细胞治疗(包括诊断、预防性,和治疗方面。特别是,概述了针对不同患者组的风险适应药物预防和疫苗接种策略.该指南更新了2015年德国血液和医学肿瘤学会(DGHO)传染病工作组(AGIHO)的指南“实体瘤和血液恶性肿瘤患者的抗病毒预防”,重点是单纯疱疹病毒和水痘带状疱疹病毒。
    Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 \"Antiviral prophylaxis in patients with solid tumours and haematological malignancies\" focusing on herpes simplex virus and varicella zoster virus.
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  • 文章类型: Journal Article
    自从世卫组织在2016年将具有种系易感性的髓系肿瘤视为一个新实体以来,越来越清楚的是,诊断家族性白血病对患者及其家人都具有重要意义。血液学家和临床遗传学家的跨学科团队应该为这一特定的患者群体提供护理。这里,我们总结了血液系统恶性肿瘤遗传易感性患者的鉴定和筛查的共识标准,由不同的工作组提供,例如,由北欧MDS集团和AACR。除了典型的临床特征,靶向深度测序的结果可能表明遗传倾向.我们回顾了区分体细胞和种系变异的策略,并讨论了遗传分析的建议,旨在识别应遵循既定质量标准的潜在遗传变异,以检测SNV和CNV并确定遗传变异的致病性。为了增强有关具有种系易感性的血液肿瘤的知识,我们建议将临床和遗传数据存档并将其存档在国际注册中心。
    Since WHO has recognized myeloid neoplasms with germline predisposition as a new entity in 2016, it has become increasingly clear that diagnosing familial leukemia has critical implications for both the patient and his/her family, and that interdisciplinary teams of hematologists and clinical geneticists should provide care for this specific patient group. Here, we summarize consensus criteria for the identification and screening of patients with genetic predisposition for hematologic malignancies, as provided by different working groups, e.g. by the Nordic MDS group and the AACR. In addition to typical clinical features, results from targeted deep sequencing may point to a genetic predisposition. We review strategies to distinguish somatic and germline variants and discuss recommendations for genetic analyses aiming to identify the underlying genetic variant that should follow established quality criteria to detect both SNVs and CNVs and to determine the pathogenicity of genetic variants. To enhance the knowledge about hematologic neoplasms with germline predisposition we recommend archiving clinical and genetic data and archiving them in international registries.
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  • 文章类型: Practice Guideline
    For cord blood transplantation (CBT), appropriate patient and conditioning regimen selection is necessary to achieve long-term disease-free survival. This review aims to provide comprehensive guidelines on these issues using evidence from the literature and experience at dedicated CBT centers. Topics include patient and disease characteristics that make CBT a good or poor choice and a review of outcomes in commonly used conditioning regimens in CBT. This is accompanied with recommendations on regimen intensity based on disease, organ function, and patient performance status and age. In addition, the use of antithymocyte globulin in CBT is discussed, as is the choice of conditioning in aplastic anemia patients who have access to acceptable CB units.
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  • 文章类型: Guideline
    下一代测序(NGS)目前在临床环境中用于血液系统恶性肿瘤的靶向治疗和诊断。由于肿瘤的纯度,准确检测体细胞变体具有挑战性,异质性,遗传改变的复杂性,从高检测设计到测试实施的各种问题。本文介绍了韩国遗传诊断学会专家小组通过共识制定的指南。它们基于基于NGS的血液系统恶性肿瘤体细胞面板的验证过程的经验,参考以前的国际建议。这些指南描述了基本参数,重点是在实践中使用的基于NGS的体细胞面板的验证方案的设计。此外,他们提出了关键指标的阈值,包括最低覆盖率,平均覆盖率与均匀性指数,和最小变异等位基因频率,用于血液系统恶性肿瘤的初步诊断。
    Next-generation sequencing (NGS) is currently used in the clinical setting for targeted therapies and diagnosis of hematologic malignancies. Accurate detection of somatic variants is challenging because of tumor purity, heterogeneity, and the complexity of genetic alterations, with various issues ranging from high detection design to test implementation. This article presents guidelines developed through consensus among a panel of experts from the Korean Society for Genetic Diagnostics. They are based on experiences with the validation processes of NGS-based somatic panels for hematologic malignancies, with reference to previous international recommendations. These guidelines describe basic parameters with emphasis on the design of a validation protocol for NGS-based somatic panels to be used in practice. In addition, they suggest thresholds of key metrics, including minimum coverage, mean coverage with uniformity index, and minimum variant allele frequency, for the initial diagnosis of hematologic malignancies.
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  • 文章类型: Journal Article
    关于血液恶性肿瘤的生物学以及免疫系统在控制这些疾病中的作用的知识的增加导致了免疫疗法的开发和批准,这些免疫疗法产生了令人印象深刻的临床反应。因此,癌症免疫治疗协会(SITC)召集了一个由医生组成的血液恶性肿瘤癌症免疫治疗指南小组,护士,耐心的倡导者,并为多发性骨髓瘤患者免疫治疗的临床应用制定共识建议,淋巴瘤和急性白血病.这些建议是根据医学研究所的临床实践指南按照先前建立的流程制定的。在这样做的时候,我们对2004年至2014年的高影响力研究进行了系统的文献检索,并补充了小组确定的进一步文献.共识小组于2014年12月举行会议,目标是为血液系统恶性肿瘤患者的免疫治疗临床应用提供共识建议。在这次会议期间,使用共识小组投票和讨论对文献检索的支持证据的强度进行评分和审查.这些共识建议侧重于与患者选择相关的问题,毒性管理,临床终点,以及测序或疗法的组合。总的来说,免疫治疗正在迅速成为血液系统恶性肿瘤的有效治疗策略.提供了有关其临床应用的循证共识建议,并将随着该领域的发展而更新。
    Increasing knowledge concerning the biology of hematologic malignancies as well as the role of the immune system in the control of these diseases has led to the development and approval of immunotherapies that are resulting in impressive clinical responses. Therefore, the Society for Immunotherapy of Cancer (SITC) convened a hematologic malignancy Cancer Immunotherapy Guidelines panel consisting of physicians, nurses, patient advocates, and patients to develop consensus recommendations for the clinical application of immunotherapy for patients with multiple myeloma, lymphoma, and acute leukemia. These recommendations were developed following the previously established process based on the Institute of Medicine\'s clinical practice guidelines. In doing so, a systematic literature search was performed for high-impact studies from 2004 to 2014 and was supplemented with further literature as identified by the panel. The consensus panel met in December of 2014 with the goal to generate consensus recommendations for the clinical use of immunotherapy in patients with hematologic malignancies. During this meeting, consensus panel voting along with discussion were used to rate and review the strength of the supporting evidence from the literature search. These consensus recommendations focus on issues related to patient selection, toxicity management, clinical endpoints, and the sequencing or combination of therapies. Overall, immunotherapy is rapidly emerging as an effective therapeutic strategy for the management of hematologic malignances. Evidence-based consensus recommendations for its clinical application are provided and will be updated as the field evolves.
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