Lymphoma, Non-Hodgkin

淋巴瘤, 非霍奇金
  • 文章类型: Review
    非霍奇金淋巴瘤(NHL)包括广泛的临床,表型和遗传上不同的肿瘤。成熟B细胞非霍奇金淋巴瘤的准确诊断依赖于整合形态学、表型和遗传特征以及临床特征。细胞遗传学分析仍然是成熟B细胞淋巴瘤诊断工作的重要组成部分。核型分析对识别标志易位特别有用,典型的细胞遗传学特征以及复杂的核型,所有这些都带来了有价值的诊断和/或预后信息。除了众所周知的复发性染色体异常,例如,例如,t(14;18)(q32;q21)/IGH::滤泡性淋巴瘤中的BCL2,最近的证据支持复杂核型在套细胞淋巴瘤和Waldenström巨球蛋白血症中的预后意义。荧光原位杂交也是在疾病识别中起核心作用的关键分析,尤其是在基因定义的实体中,而且还可以预测转型风险或预测。这可以通过MYC的关键作用来说明,BCL2和/或BCL6重排诊断侵袭性或大B细胞淋巴瘤。这项工作依赖于世界卫生组织和国际血液淋巴样肿瘤共识分类以及最近的细胞遗传学进展。这里,我们回顾了确定的成熟B细胞非霍奇金淋巴瘤实体以及新发现的遗传亚型的各种染色体异常,并为成熟B细胞淋巴瘤的诊断管理提供了细胞遗传学指南.
    Non-Hodgkin lymphomas (NHL) consist of a wide range of clinically, phenotypically and genetically distinct neoplasms. The accurate diagnosis of mature B-cell non-Hodgkin lymphoma relies on a multidisciplinary approach that integrates morphological, phenotypical and genetic characteristics together with clinical features. Cytogenetic analyses remain an essential part of the diagnostic workup for mature B-cell lymphomas. Karyotyping is particularly useful to identify hallmark translocations, typical cytogenetic signatures as well as complex karyotypes, all bringing valuable diagnostic and/or prognostic information. Besides the well-known recurrent chromosomal abnormalities such as, for example, t(14;18)(q32;q21)/IGH::BCL2 in follicular lymphoma, recent evidences support a prognostic significance of complex karyotype in mantle cell lymphoma and Waldenström macroglobulinemia. Fluorescence In Situ Hybridization is also a key analysis playing a central role in disease identification, especially in genetically-defined entities, but also in predicting transformation risk or prognostication. This can be exemplified by the pivotal role of MYC, BCL2 and/or BCL6 rearrangements in the diagnostic of aggressive or large B-cell lymphomas. This work relies on the World Health Organization and the International Consensus Classification of hematolymphoid tumors together with the recent cytogenetic advances. Here, we review the various chromosomal abnormalities that delineate well-established mature B-cell non-Hodgkin lymphoma entities as well as newly recognized genetic subtypes and provide cytogenetic guidelines for the diagnostic management of mature B-cell lymphomas.
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  • 文章类型: Journal Article
    抗CD19嵌合抗原受体T细胞疗法(CART)彻底改变了复发性和/或难治性B细胞非霍奇金淋巴瘤的结果。然而,CART仍然受到其可用性的限制,毒性,和响应耐久性。由于疾病进展,并非所有患者都进入CART输注阶段。在那些接受CART的人中,大量患者经历危及生命的细胞因子释放综合征毒性,不到一半的人保持持久的反应,大多数人在CART之前存在的疾病部位复发。放射治疗是一种有前途的CART和挽救性治疗,可以改善这些患者的预后。证据表明,CART之前的桥接放射治疗在制造期间控制了疾病,提高反应率和本地控制,细胞减少/消除疾病并降低细胞因子释放综合征的严重程度,并可能延长无病间隔和生存期,尤其是在患有大病患者中。CART后残留疾病的综合放疗改变了复发模式,并改善了无局部复发和无进展生存率。CART后复发疾病的挽救性放射治疗对有限复发疾病的患者进行全面治疗时具有良好的生存结果,对弥漫性复发性疾病的患者缓解症状。在CART期间,对该疾病的生物学了解甚少,需要进一步研究放射治疗(RT)的最佳时机和剂量。在这次审查中,我们应对CART最重大的挑战,回顾并提出RT如何帮助缓解这些挑战,并提供梅奥诊所专家关于将RT与CART相结合的方法。
    Anti-CD19 chimeric antigen receptor T-cell therapy (CART) has revolutionized the outcomes of relapsed and/or refractory B-cell non-Hodgkin lymphoma. However, CART is still limited by its availability, toxicity, and response durability. Not all patients make it to the CART infusion phase due to disease progression. Among those who receive CART, a significant number of patients experience life-threatening cytokine release syndrome toxicity, and less than half maintain a durable response with the majority relapsing in pre-existing sites of disease present pre-CART. Radiation therapy stands as a promising peri-CART and salvage treatment that can improve the outcomes of these patients. Evidence suggests that bridging radiotherapy prior to CART controls the disease during the manufacturing period, augments response rates and local control, cytoreduces/debulks the disease and decreases the severity of cytokine release syndrome, and may prolong disease-free intervals and survival especially in patients with bulky disease. Consolidative radiotherapy for residual post-CART disease alters the pattern of relapse and improves local recurrence-free and progression-free survivals. Salvage radiotherapy for relapsed post-CART disease has favorable survival outcomes when delivered comprehensively for patients with limited relapsed disease and palliates symptoms for patients with diffuse relapsed disease. The biology of the disease during the peri-CART period is poorly understood, and further studies investigating the optimal timing and dosing of radiation therapy (RT) are needed. In this review, we tackle the most significant challenges of CART, review and propose how RT can help mitigate these challenges, and provide The Mayo Clinic experts\' approach on incorporating RT with CART.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: English Abstract
    Indolent B-cell non-Hodgkin lymphoma (B-iNHL) is a group of mature B-cell lymphomas that develop slowly. It is characterized by low immune function and could be risky when complicated with novel coronavirus infection (COVID-19). In order to guide the prevention and treatment of B-iNHL combined with COVID-19, China Anti-Cancer Association Hematological malignancies Committee, the Chinese Society of Hematology Medical Association and Chinese Chronic lymphoproliferative Diseases Working Group formed consensus on COVID-19 vaccination, prognosis, treatment and follow-up of B-iNHL patients for clinician reference.
    惰性B细胞非霍奇金淋巴瘤(B-iNHL)是一组进展相对缓慢的成熟B细胞淋巴瘤,其免疫功能低下,合并新型冠状病毒感染(COVID-19)问题不容忽视。为指导B-iNHL合并COVID-19防治,中国抗癌协会血液肿瘤专业委员会、中华医学会血液学分会,中国慢性淋巴增殖性疾病工作组对B-iNHL患者COVID-19疫苗接种、预后、治疗等内容进行梳理形成共识,供临床医生参考。.
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  • 文章类型: Journal Article
    使用嵌合抗原受体(CAR)T细胞的过继性细胞免疫疗法已成为治疗复发性和/或难治性B细胞非霍奇金淋巴瘤(B-NHL)的新方法。随着越来越多的CART细胞产品的批准和CART细胞疗法的进步,预计CART细胞将用于越来越多的病例。然而,CAR-T细胞相关的毒性可能是严重的,甚至是致命的。从而损害了这种疗法的生存益处。规范和研究这些毒性的临床管理势在必行。与其他血液恶性肿瘤相比,如急性淋巴细胞白血病和多发性骨髓瘤,抗CD19CART细胞相关毒性在B-NHL有几个独特的特征,最值得注意的是局部细胞因子释放综合征(CRS)。然而,先前发布的指南对CAR-T细胞治疗B-NHL相关毒性的分级和管理提供了很少的具体建议.因此,我们达成了预防的共识,认可,以及这些毒性的管理,根据已发表的有关抗CD19CART细胞相关毒性管理的文献和多个中国机构的临床经验。该共识完善了B-NHL中CRS的分级体系和分类以及CRS管理的相应措施,并描述了除CRS外,管理抗CD19CART细胞相关毒性的综合原则和探索性建议。
    Adoptive cellular immunotherapy with chimeric antigen receptor (CAR) T cells has emerged as a novel modality for treating relapsed and/or refractory B-cell non-Hodgkin lymphoma (B-NHL). With increasing approval of CAR T-cell products and advances in CAR T cell therapy, CAR T cells are expected to be used in a growing number of cases. However, CAR T-cell-associated toxicities can be severe or even fatal, thus compromising the survival benefit from this therapy. Standardizing and studying the clinical management of these toxicities are imperative. In contrast to other hematological malignancies, such as acute lymphoblastic leukemia and multiple myeloma, anti-CD19 CAR T-cell-associated toxicities in B-NHL have several distinctive features, most notably local cytokine-release syndrome (CRS). However, previously published guidelines have provided few specific recommendations for the grading and management of toxicities associated with CAR T-cell treatment for B-NHL. Consequently, we developed this consensus for the prevention, recognition, and management of these toxicities, on the basis of published literature regarding the management of anti-CD19 CAR T-cell-associated toxicities and the clinical experience of multiple Chinese institutions. This consensus refines a grading system and classification of CRS in B-NHL and corresponding measures for CRS management, and delineates comprehensive principles and exploratory recommendations for managing anti-CD19 CAR T-cell-associated toxicities in addition to CRS.
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  • 文章类型: Journal Article
    弥漫性大B细胞淋巴瘤(DLBCL)约占美国每年B细胞非霍奇金淋巴瘤新病例的24%。高达50%的患者复发或难以接受标准一线治疗(R/R)。R-CHOP.抗CD19单克隆抗体他法西他单抗,联合来那度胺(LEN),是针对R/RDLBCL移植不合格患者的NCCN首选方案,并在美国(2020年7月)获得了加速批准,并在欧洲(2021年8月)和其他国家获得了有条件的营销授权,基于L-MIND研究的数据。他他他单抗的推荐剂量为12mg/kg,通过静脉输注,与LEN25mg联合给药12个周期,然后是他法他他单抗单药治疗,直到疾病进展或不可接受的毒性。Tafasitamab+LEN与R/RDLBCL患者的持续反应相关。大多数临床上显着的治疗相关不良事件可归因于LEN,可以通过剂量调整和支持疗法进行管理。我们为常规临床实践中使用他法他单抗和LEN治疗的R/RDLBCL患者提供管理指南。包括老年患者和肾和肝损害患者,以及关于患者教育的建议,作为全面患者参与计划的一部分。我们的建议包括如果不能耐受推荐剂量的患者需要以减少的剂量给予LEN。在特殊患者人群中,塔法他单抗不需要剂量修改。
    Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 24% of new cases of B-cell non-Hodgkin lymphoma in the US each year. Up to 50% of patients relapse or are refractory (R/R) to the standard first-line treatment option, R-CHOP. The anti-CD19 monoclonal antibody tafasitamab, in combination with lenalidomide (LEN), is an NCCN preferred regimen for transplant-ineligible patients with R/R DLBCL and received accelerated approval in the US (July 2020) and conditional marketing authorization in Europe (August 2021) and other countries, based on data from the L-MIND study. The recommended dose of tafasitamab is 12 mg/kg by intravenous infusion, administered in combination with LEN 25 mg for 12 cycles, followed by tafasitamab monotherapy until disease progression or unacceptable toxicity. Tafasitamab + LEN is associated with durable responses in patients with R/R DLBCL. The majority of clinically significant treatment-associated adverse events are attributable to LEN and can be managed with dose modification and supportive therapy. We provide guidelines for the management of patients with R/R DLBCL treated with tafasitamab and LEN in routine clinical practice, including elderly patients and those with renal and hepatic impairment, and advice regarding patient education as part of a comprehensive patient engagement plan. Our recommendations include LEN administration at a reduced dose if required in patients unable to tolerate the recommended dose. No dose modification is required for tafasitamab in special patient populations.
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  • 文章类型: Journal Article
    原发性中枢神经系统淋巴瘤(PCNSL)是一种中枢神经系统限制性非霍奇金淋巴瘤,其组织病理学诊断主要是大B细胞淋巴瘤。提供具体的,为医疗专业人员提供基于证据的建议,并促进更加标准化,为PCNSL患者提供有效和安全的治疗,中华医学会中国神经外科学会和中国抗癌协会血液恶性肿瘤学会的专家小组共同制定了基于证据的共识。在全面检索文献并进行系统综述后,我们进行了两轮Delphi研究,就以下建议达成共识:应通过多模态断层扫描引导活检或微创手术,尽可能安全全面地获取PCNSL患者的组织病理学标本.皮质类固醇应该退出,或者不被管理,如果患者状态允许,在活检前怀疑PCNSL的患者。应进行MRI(增强和DWI)以诊断和评估在必要时间点使用全身PET-CT的PCNSL患者。简易精神状态检查可用于临床管理中的认知功能评估。新诊断的PCNSL患者应采用基于甲氨蝶呤的联合大剂量方案治疗,并可在诱导治疗时采用利妥昔单抗包涵方案治疗。自体干细胞移植可作为一种巩固疗法。难治性或复发性PCNSL患者可以用依鲁替尼治疗,有或没有大剂量化疗作为再诱导疗法。立体定向放射外科可用于复发性病变有限的PCNSL患者,这些患者对化学疗法难以治疗,并且以前曾接受过全脑放射疗法。疑似原发性玻璃体视网膜淋巴瘤(PVRL)的患者应通过玻璃体活检进行诊断。并发VRL的PVRL或PCNSL患者可采用全身和局部联合治疗。
    Primary central nervous system lymphoma (PCNSL) is a type of central nervous system restricted non-Hodgkin lymphoma, whose histopathological diagnosis is majorly large B cell lymphoma. To provide specific, evidence-based recommendations for medical professionals and to promote more standardized, effective and safe treatment for patients with PCNSL, a panel of experts from the Chinese Neurosurgical Society of the Chinese Medical Association and the Society of Hematological Malignancies of the Chinese Anti-Cancer Association jointly developed an evidence-based consensus. After comprehensively searching literature and conducting systematic reviews, two rounds of Delphi were conducted to reach consensus on the recommendations as follows: The histopathological specimens of PCNSL patients should be obtained as safely and comprehensively as possible by multimodal tomography-guided biopsy or minimally invasive surgery. Corticosteroids should be withdrawn from, or not be administered to, patients with suspected PCNSL before biopsy if the patient\'s status permits. MRI (enhanced and DWI) should be performed for diagnosing and evaluating PCNSL patients where whole-body PET-CT be used at necessary time points. Mini-mental status examination can be used to assess cognitive function in the clinical management. Newly diagnosed PCNSL patients should be treated with combined high-dose methotrexate-based regimen and can be treated with a rituximab-inclusive regimen at induction therapy. Autologous stem cell transplantation can be used as a consolidation therapy. Refractory or relapsed PCNSL patients can be treated with ibrutinib with or without high-dose chemotherapy as re-induction therapy. Stereotactic radiosurgery can be used for PCNSL patients with a limited recurrent lesion who were refractory to chemotherapy and have previously received whole-brain radiotherapy. Patients with suspected primary vitreoretinal lymphoma (PVRL) should be diagnosed by vitreous biopsy. PVRL or PCNSL patients with concurrent VRL can be treated with combined systemic and local therapy.
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  • 文章类型: Journal Article
    该计划的目的是提供来自淋巴瘤和成像领域的学术和行业专家联盟的共识建议,以确保成像评估与卢加诺分类的一致应用。方法:共识是通过由PINTaD(治疗和诊断药物成像网络)赞助的一系列会议获得的,作为ProLoG(淋巴瘤组织中的PINTaDRespOnse标准)共识计划的一部分。结果:共识建议涵盖卢加诺分类的所有技术成像方面。关于所需的成像系列和扫描访问,阐明了PET/CT和诊断CT的一些技术注意事项。以及PET图像的采集和重建以及病变大小和背景活动的影响。就影像学和临床审查员的作用以及培训和监测提出了建议。最后,提供了影像学病例报告表的示例模板,以支持卢加诺分类的有效数据收集。结论:提出了共识建议,以全面解决最终用户在分类中遇到的不一致和歧义的技术和成像领域。此类指南应用于支持卢加诺2014年的标准化采购和评估。
    The aim of this initiative was to provide consensus recommendations from a consortium of academic and industry experts in the field of lymphoma and imaging for the consistent application of imaging assessment with the Lugano classification. Methods: Consensus was obtained through a series of meetings from July 2019 to October 2021 sponsored by the PINTaD (Pharma Imaging Network for Therapeutics and Diagnostics) as part of the ProLoG (PINTaD RespOnse criteria in Lymphoma wOrking Group) consensus initiative. Results: Consensus recommendations encompass all technical imaging aspects of the Lugano classification. Some technical considerations for PET/CT and diagnostic CT are clarified with regards to required imaging series and scan visits, as well as acquisition and reconstruction of PET images and influence of lesion size and background activity. Recommendations are given on the role of imaging and clinical reviewers as well as on training and monitoring. Finally, an example template of an imaging case report form is provided to support efficient collection of data with Lugano Classification. Conclusion: Consensus recommendations are made to comprehensively address technical and imaging areas of inconsistency and ambiguity in the classification encountered by end users. Such guidance should be used to support standardized acquisition and evaluation with the Lugano 2014.
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  • 文章类型: Journal Article
    我们的目标是提供来自淋巴瘤和成像领域的学术和行业专家联盟的共识建议,以一致地应用Lugano分类。方法:共识是通过2019年7月至2021年9月由治疗和诊断药物成像网络(PINTaD)赞助的一系列会议获得的,作为淋巴瘤工作组(PRoLoG)共识计划的一部分。结果:共识建议从Lugano分类中阐明了PET/CT和诊断CT的技术考虑因素,包括更新不同淋巴瘤实体的FDG代谢,澄清响应命名法,并细化病变分类和评分,特别是关于分数4和5以及5分量表的X类别。代谢和解剖反应的组合是明确的,以及评估不一致或缺失的情况下的反应评估。在分类中使用临床数据,特别是骨髓评估的要求,在淋巴瘤实体的基础上进一步更新。提供了关于脾脏和肝脏测量和评估的澄清,以及节点响应。结论:提出了共识建议,以全面解决最终用户在响应评估过程中遇到的分类不一致和歧义的领域,这样的指导应该作为2014年卢加诺分类的配套。
    Our objective was to provide consensus recommendations from a consortium of academic and industry experts in the field of lymphoma and imaging for consistent application of the Lugano classification. Methods: Consensus was obtained through a series of meetings from July 2019 until September 2021 sponsored by the Pharma Imaging Network for Therapeutics and Diagnostics (PINTaD) as part of the PINTaD Response Criteria in Lymphoma Working Group (PRoLoG) consensus initiative. Results: Consensus recommendations clarified technical considerations for PET/CT and diagnostic CT from the Lugano classification, including updating the FDG avidity of different lymphoma entities, clarifying the response nomenclature, and refining lesion classification and scoring, especially with regard to scores 4 and 5 and the X category of the 5-point scale. Combination of metabolic and anatomic responses is clarified, as well as response assessment in cases of discordant or missing evaluations. Use of clinical data in the classification, especially the requirement for bone marrow assessment, is further updated on the basis of lymphoma entities. Clarification is provided with regard to spleen and liver measurements and evaluation, as well as nodal response. Conclusion: Consensus recommendations are made to comprehensively address areas of inconsistency and ambiguity in the classification encountered during response evaluation by end users, and such guidance should be used as a companion to the 2014 Lugano classification.
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  • 文章类型: Journal Article
    本指南是根据英国血液学协会(BSH)在2016年BSH指南流程(b-s-h.org。英国)。建议评估的分级,使用开发和评估(GRADE)命名法评估证据水平并评估建议的强度。等级标准可在http://www上找到。gradeworkinggroup.org.建议是基于使用Medline对文献的回顾,PubMed/Medline和Cochrane搜索从2013年开始到2021年1月。使用以下搜索词:[霍奇金淋巴瘤或霍奇金病]非霍奇金;和[化疗或放疗];和[老年人];和[青少年或青少年或年轻成年人];和[怀孕]。过滤器只适用于英文出版物,在人类中进行的研究,临床会议,国会,临床试验,临床研究,荟萃分析,多中心研究和随机对照试验。2013年之前的参考文献取自本指南的先前版本。1手稿的审查由英国血液学学会(BSH)指南委员会血液学肿瘤学特别工作组进行,BSH指南委员会和BSH血液学肿瘤学共鸣板。
    This guideline was compiled according to the British Society for Haematology (BSH) process at BSH Guidelines Process 2016 (b-s-h.org.uk). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Recommendations are based on a review of the literature using Medline, PubMed/Medline and Cochrane searches beginning from 2013 up to January 2021. The following search terms were used: [Hodgkin lymphoma OR Hodgkin disease] NOT non-Hodgkin; AND [chemotherapy OR radiotherapy]; AND [elderly]; AND [teenage OR adolescent OR young adult]; AND [pregnancy]. Filters were applied to include only publications written in English, studies carried out in humans, clinical conferences, congresses, clinical trials, clinical studies, meta-analyses, multicentre studies and randomised controlled trials. References pre-2013 were taken from the previous version of this guideline.1 Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haematology Oncology Taskforce, the BSH Guidelines Committee and the Haematology Oncology sounding board of BSH.
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