Musi waChikumi 17-20, 2015, iyo 13th International Lymphoma Musangano yakabudirira kuitirwa muSwitzerland. Vamiririri mazana matatu nemakumi matatu nemazana matatu vakabva kunyika makumi mapfumbamwe vakapinda muchiitiko ichi Pamusangano, kutsvagiswa kwe lymphoma kwaive kupenya, kwete chete pfupiso yeakawandisa-epakati maitiro akasarudzika miedzo, asiwo yekutanga mhedzisiro yekuongororwa kwemishonga mitsva yekurapa, uye mushumo wemhedzisiro yekutsvaga kwepathogenesis, nezvimwewo, izvo pasina mubvunzo kuongororwa uye kuongororwa kwe lymphoma. Mushonga uyu wakaramba uchinongedzera mafambiro uye wakapa mabiko ehusimbe kukiriniki.
1. Follicular lymphoma: iyo nyowani yekurapa magumo
kufambira mberi-kusina kupona (PFS) ndiyo magumo ekutanga ekurapa kwefollicular lymphoma, asi nekuda kwenguva yakareba yekutevera (inotarisirwa ≥ makore manomwe), pane zvimwe zvinogumira. Chikwata cheFLASH chakaita chinotarisirwa meta-analysis (abstract number: 7), uye zvigumisiro zvakaratidza kuti mhinduro yakakwana pamwedzi ye122 (CR30) inogona kunge iri mhedziso yekutanga yekuongorora mutsara wekutanga we follicular lymphoma. Chidzidzo chacho chaisanganisira 30 miedzo yemakiriniki uye huwandu hwevarwere ve13 vaivapo kuti vaongororwe. Mhedzisiro yakaratidza kuti mutsara wekubatanidza mutsara weCR3837 uye PFS padanho rekuedzwa yaive 30, uye Copula yemhando yekubatanidza coefficient yaive 0.88; chiyero chengozi pachiyero chemurwere chaive 0.86. Muboka diki rine chirwere chinopinda (chikamu IV kana chakakwira FLIPI mamakisi), kuwirirana pakati pezviviri izvi kunonyanya kuoneka.
2. Hodgkin's lymphoma: yepakati-nguva PET-CT kurapwa kwakatungamirwa
The international multi-center prospective RATHL study (abstract number: 008) yaisanganisira varwere ve1214 vane vanhu vakuru vachangobva kurapwa Hodgkin lymphoma, iyo yose yaiva nhanho ⅡB-Ⅳ, kana ⅡA yakasanganiswa nevanhu vakawanda, kana ≥3 nzvimbo dzakakanganiswa. Vose varwere vakapiwa 2 maitiro eABVD chemotherapy yakateverwa nePET-CT (PET2). PET2 varwere vasina kunaka vakapiwa 4 maitiro eABVD regimen kana AVD regimen chemotherapy, ndokubva vapinda munguva yekutevera. PET2-positive varwere vakapiwa 4-cycle BEACOPP-14 regimen kana 3-cycle yakasimbiswa BEACOPP regimen chemotherapy, uye ndokuzoita PET-CT kuongorora zvakare (PET3); PET3-negative varwere vakaramba vachigamuchira 2-cycle BEACOPP-14 regimen kana 1-cycle inowedzera BEACOPP regimen chemotherapy; Varwere vane PET3 yakanaka vakapihwa radiotherapy kana salvage chemotherapy. Pasinei nokuti pane hukuru hukuru pane yekutanga kana kuti kune zvipembenene zvakasara mushure mekurapa, kana yepakati-temu PET-CT test isina kunaka, hapana radiotherapy ichapiwa. Mhedzisiro PET2 yaive isina kunaka mu84% yevarwere, nekutevera kwepakati kwemwedzi ye32, 3-gore PFS yaive 83%, uye huwandu hwekupona (OS) hwaive 95%. Iyo 3-gore PFS yeABVD regimen boka uye AVD regimen boka raive rakafanana (85.45% uye 84.48%, zvichiteerana), uye 3-gore OS yakanga isiri yenhamba dzakasiyana (97.0% uye 97.5%, zvichiteerana), asi mapapu huturu hwechirongwa cheABVD hwaive hwakanyanya kupfuura hweAVD Iyo protocol inoratidza kuti yakachengeteka uye inoshanda kubvisa bleomycin muABVD protocol.
3. Primary lymphoma yepakati yetsinga system: Titipe uye rituximab inowedzera kushanda
IELSG32 inzvimbo yepasi rose yakawanda-yepakati inotarisira chikamu chechipiri kutongwa (nhamba isingabvumirwe: 009), kusanganisira varwere mazana maviri nemakumi maviri nenomwe vachangobva kurapwa kurapwa kwepakati yenheremu lymphoma, vane zera repakati pemakore makumi mashanu nemasere (makore 227-58) Nenguva isipi akapatsanurwa mumapoka matatu: Boka A rakapihwa mana macircuit eMTX 18g / m70 (d4), Ara-C 3.5g / m2 (d1-2); Boka B rakapihwa rituximab 2mg / m2 (d -3, d375); Boka C rakapihwa Titipipe 2 mg / m5 (d0) pahwaro hweBoka B; avo vaibudirira vaiwanzopatsanurwa kuita huropi hwese radiotherapy boka uye carmustine pamwe chete neTitipi prereatment inosanganiswa ne autologous Stem cell transplantation boka. Mhedzisiro Huwandu hwese hunoshanda hwemapoka matatu aive 30%, 2%, uye 4%, CR mwero yaive 53%, 74%, uye 87%, uye makore mashanu-ekusafa-emahara ekupona-emahara aive 23%, 31%, uye 49%, zvichiteerana. Iyo OS yaive 5%, 34%, uye 43%, zvichiteerana, zvichiratidza kuti kuwedzera rituximab uye titipe kuchirongwa chekurapa kunogona kuvandudza zvakanyanya kugona uye kugadzirisa kufungidzira kwenguva refu.
4. Antigen chimeric receptor T cell (CAR-T) kurapwa: kutanga mhedzisiro
CTL019 masero maCAR-T masero anotarisa CD19 uye anoratidza akanaka anti-bundu mhedzisiro kune varwere vane vakadzokazve uye vanokanganisa leukemia. Chikamu chechipiri chemakiriniki ekuyedzwa (nhamba isingabvumirwe: 139) yakasimbisa kushanda kweCTL019 masero mukurapa CD19-yakanaka isiri-Hodgkin's lymphoma. Chidzidzo chacho chaisanganisira varwere makumi maviri nemapfumbamwe vakadzoka zvakare refractory lymphoma, kusanganisira makumi mapfumbamwe nematanhatu ekupararira kukuru B-cell lymphoma, masere masere e follicular lymphoma, uye 29 mamiriro e mantle cell lymphoma. Nguva yepakati ndeye makore makumi mashanu nematanhatu. 19-8 mazuva mushure memakemikari, 2 × 56 CTL1 masero akapihwa mukati. Mhedzisiro Iyo yakazara inoshanda mwero yaive 4%. Pakati pavo, iyo CR mwero wekuparadzira hombe B-cell lymphoma yaive 5%, uye chikamu chekuregererwa (PR) chiyero chaive 108%; iyo CR mwero we follicular lymphoma yaive 019% uye PR chiyero chaive 68%. 42 varwere vakagadzira cytokine release syndrome. Nekutevera kwepakati kwemwedzi mitanhatu, PFS yaive 8%. Zano CTL57 cell kurapwa yakachengeteka uye inoshanda.
5. Kurwisa kaviri pakurwisa kupararira kwakakura B-cell lymphoma: Selinexor inoshanda mu vitro uye mu vivo
Selinexor inyanzvi yekusarudza inhibitor yekutengesa kunze kwenyika, inhibits XPO1, inokurudzira kuchengetedza kwenyukireya nekumisikidza kweanopfuura gumi bundu rinodzvinyirira mapuroteni, uye inoderedza c-myc uye BCL10 / 2 mapuroteni mazinga kuburikidza nekuchengetedza kwenyukireya kweEif6e. Mune in vitro test (nhamba isingabvumike: 4), Selinexor ine yakanaka yekuzvidzivirira pamabatiro maviri anoparadzira yakakura B-cell lymphoma cell mutsara DoHH146, uye zvakare ine yakanaka yekudzivirira mhedzisiro paMYC kana BCL2 mutant masero mitsara. Muchikamu chekutanga chekiriniki, varwere vatanhatu vakagamuchira kurapwa kweSelinexor, uye varwere vatatu vakawana kuregererwa, uko murwere mumwe akasimbiswa neCR paPET-CT uye vaviri varwere vakagamuchira PR.
Mukuwedzera, iyo prognostic index ye chronic lymphocytic leukemia uye mantle cell lymphoma yakakurukurwawo uye yakaongororwa pamusangano uyu, uye mamwe makiriniki ehutachiona hwehutachiona akaiswa kuti atonge kufungidzira kwenguva refu; uye World Health Organization Lymphoma Classification 2016 Zvinyorwa zvakagadziridzwa zvechinyorwa zvakaratidzwawo mberi pamusangano. Muchidimbu, kukokwa kwechiitiko ichi chikuru kwakaratidza gwara idzva rekuongororwa uye kurapwa kwelymphoma, uye zvichanyatso wedzera kurapa kwega kwega kunoenderana neuchapupu-hwakavakirwa mushonga.
