A ranakun 17-20 ga watan Yuni, 2015, an yi nasarar gudanar da taron Lymphoma na kasa da kasa karo na 13 a kasar Switzerland. Wakilai 3700 daga kasashe 90 ne suka halarci taron. A taron, binciken da aka yi a kan lymphoma ya kasance mai haske, ba wai kawai taƙaitaccen gwaje-gwajen gwaje-gwajen da aka tsara ba, amma har ma da sakamakon binciken farko na sabon maganin miyagun ƙwayoyi, da rahoton sakamakon bincike na pathogenesis, da dai sauransu, wanda babu shakka. ganewar asali da ganewar asali na lymphoma. Maganin ya kara nuna alkibla kuma ya gabatar da liyafar cin abinci ga likitan.
1. Lymphoma follicular: sabon wurin ƙarshen jiyya
progression-free survival (PFS) is the primary endpoint of first-line treatment of follicular lymphoma, but because of the longer follow-up period (expected ≥ 7 years), there are certain limitations . The FLASH team conducted a prospective meta-analysis (abstract number: 122), and the results showed that a complete response at 30 months (CR30) may be the primary endpoint of the first-line treatment study of follicular lymphoma. The study included 13 clinical trials and a total of 3837 patients were available for evaluation. The results showed that the linear correlation coefficient of CR30 and PFS at the trial level was 0.88, and the Copula model correlation coefficient was 0.86; the risk ratio at the patient level was 0.703. In the subgroup with invasive disease (stage IV or high FLIPI score), the correlation between the two is more obvious.
2. Hodgkin's lymphoma: matsakaici-lokaci PET-CT magani jagora
The international multi-center prospective RATHL study (abstract number: 008) included 1214 patients with newly-treated adult Hodgkin lymphoma, all of which were stage ⅡB-Ⅳ, or ⅡA combined with large masses, or ≥3 affected sites. All patients were given 2 cycles of ABVD chemotherapy followed by PET-CT (PET2). PET2 negative patients were randomly given 4 cycles of ABVD regimen or AVD regimen chemotherapy, and then entered the follow-up period. PET2-positive patients were given 4-cycle BEACOPP-14 regimen or 3-cycle enhanced BEACOPP regimen chemotherapy, and then performed PET-CT examination again (PET3); PET3-negative patients continued to receive 2-cycle BEACOPP-14 regimen or 1-cycle enhanced BEACOPP regimen chemotherapy; Patients with PET3 positive were given radiotherapy or salvage chemotherapy. Regardless of whether there is a large mass at baseline or whether there are residual lesions after treatment, if the mid-term PET-CT test is negative, no radiotherapy will be given. Results PET2 was negative in 84% of patients, with a median follow-up of 32 months, 3-year PFS was 83%, and overall survival rate (OS) was 95%. The 3-year PFS of the ABVD regimen group and the AVD regimen group were similar (85.45% and 84.48%, respectively), and the 3-year OS was not statistically different (97.0% and 97.5%, respectively), but the lung toxicity of the ABVD regimen was significantly higher than that of AVD The protocol suggests that it is safe and effective to remove bleomycin in the ABVD protocol.
3. Primary lymphoma na tsakiyar juyayi tsarin: Titipe da rituximab ƙara da inganci.
IELSG32 gwaji ne na tsaka-tsaki na kasa da kasa da yawa na gaba na II (lamba mara iyaka: 009), gami da marasa lafiya 227 tare da sabbin jiyya na tsarin jijiya na farko, tare da matsakaicin shekaru 58 shekaru (shekaru 18-70). An kasu kashi uku bazuwar: Rukunin A an ba shi 4 hawan keke na MTX 3.5g / m2 (d1), Ara-C 2g / m2 (d2-3); An ba rukunin B rituximab 375mg / m2 (d -5, d0); An ba rukunin C Titipipe 30 mg / m2 (d4) akan rukunin B; Wadanda suka yi tasiri an raba su cikin bazuwar zuwa rukunin rukunin rediyo na kwakwalwa gaba daya da kuma carmustine hade da Titipi pretreatment hade da rukunin dashen kwayar halitta mai sarrafa kansa. Sakamako Jimillar ingantattun ƙimar ƙungiyoyin uku sun kasance 53%, 74%, da 87%, ƙimar CR sun kasance 23%, 31%, da 49%, kuma ƙimar tsira na shekaru 5 marasa gazawa sun kasance 34%, 43%, da kuma 54%, bi da bi. OS ya kasance 27%, 50%, da 66%, bi da bi, yana ba da shawarar cewa ƙara rituximab da titipe zuwa tsarin jiyya na iya inganta ingantaccen inganci da haɓaka tsinkaya na dogon lokaci.
4. Antigen chimeric receptor T cell (CAR-T) magani: sakamakon farko
Kwayoyin CTL019 sune ƙwayoyin CAR-T da ke niyya CD19 kuma suna nuna kyakkyawan tasirin rigakafin ƙari a cikin marasa lafiya tare da sake dawowa da cutar sankarar bargo. Gwajin asibiti na kashi na II (lambar ƙima: 139) ta tabbatar da ingancin ƙwayoyin CTL019 a cikin jiyya na CD19-tabbatacce wanda ba Hodgkin's lymphoma. Binciken ya haɗa da marasa lafiya 29 tare da ƙwayar lymphoma mai sake dawowa, ciki har da lokuta 19 na lymphoma mai girma B-cell, lokuta 8 na lymphoma follicular, da kuma lokuta 2 na lymphoma na mantle cell. Matsakaicin shekarun yana da shekaru 56. 1-4 days bayan chemotherapy, 5 × 108 CTL019 sel an ba su ta cikin jini. Sakamako Jimillar ƙimar tasiri ya kasance 68%. Daga cikin su, ƙimar CR na ƙwayar lymphoma mai girma B-cell ya kasance 42%, kuma adadin remission (PR) ya kasance 8%; ƙimar CR na lymphoma follicular shine 57% kuma ƙimar PR shine 43%. Marasa lafiya 15 sun sami ciwo na sakin cytokine. Tare da bin tsaka-tsaki na watanni 6, PFS ya kasance 59%. Tukwici CTL019 maganin salula yana da aminci da tasiri.
5. Yajin sau biyu akan yaduwa manyan ƙwayoyin lymphoma B-cell: Selinexor yana da tasiri a cikin vitro da in vivo
Selinexor shine mai hanawa na baka na fitarwa na nukiliya, yana hana XPO1, yana haɓaka riƙewar nukiliya da kunna ƙwayoyin cuta sama da 10, kuma yana rage matakan furotin na c-myc da BCL2/6 ta hanyar riƙe da makaman nukiliya na Eif4e. A cikin gwajin in vitro (lambar ƙididdiga: 146), Selinexor yana da tasiri mai kyau na hanawa akan bugun jini sau biyu yana watsa babban layin kwayar lymphoma B-cell DoHH2, kuma yana da tasiri mai kyau na hanawa akan MYC ko BCL2 mutant cell Lines. A cikin gwaji na asibiti na Phase I, marasa lafiya 6 sun sami magani na Selinexor, kuma marasa lafiya 3 sun sami gafara, wanda 1 mai haƙuri ya tabbatar da CR akan PET-CT kuma marasa lafiya 2 sun karɓi PR.
Bugu da ƙari, an kuma tattauna kuma an yi nazari akan ma'anar alamar cutar sankarar lymphocytic na yau da kullum da lymphoma na mantle cell a wannan taron, kuma an gabatar da ƙarin alamun cututtuka na asibiti don yin hukunci game da tsinkaye na dogon lokaci; da Ƙungiyar Lafiya ta Duniya ta Ƙungiyar Lymphoma 2016 An kuma gabatar da sabunta abubuwan da ke cikin bugu a gaba a taron. A takaice, taron wannan babban taron ya nuna sabon alkibla don ganewar asali da kuma maganin lymphoma, kuma tabbas zai kara inganta jiyya na daidaikun mutane bisa tushen shaida.
