NgoJuni 17-20, 2015, i-13th International Lymphoma Conference yabanjwa ngempumelelo eSwitzerland. Abamele abangama-3700 abavela emazweni angama-90 babambe iqhaza kulo mcimbi. Emhlanganweni, ucwaningo lwe-lymphoma lwalukhazimula, hhayi nje isifinyezo sezilingo eziningi ezilawulwa ngokungahleliwe, kepha nokuhlaziywa kokuqala komphumela wokwelashwa kwezidakamizwa ezintsha, kanye nombiko wemiphumela yocwaningo lwe-pathogenesis, njll, ngokungangabazeki ukuxilongwa nokuxilongwa kwe-lymphoma. Ukwelashwa kwaqhubeka nokukhomba ukuqondiswa futhi kwaletha idili lokuminza kudokotela.
1. I-lymphoma elandelayo: indawo yokugcina yokwelashwa entsha
i-progression-free survival (PFS) isiphetho esiyinhloko somugqa wokuqala we-follicular lymphoma, kodwa ngenxa yesikhathi eside sokulandelela (okulindelekile ≥ iminyaka engu-7), kunemikhawulo ethile. Ithimba le-FLASH lenze ukuhlaziywa kwemeta okulindelwe (inombolo engabonakali: i-122), futhi imiphumela yabonisa ukuthi impendulo ephelele ezinyangeni ze-30 (CR30) ingaba isiphetho esiyinhloko socwaningo lokwelapha lokuqala lwe-follicular lymphoma. Ucwaningo lwaluhlanganisa izivivinyo zemitholampilo eziyi-13 kanye nenani leziguli ezingama-3837 ezazitholakala ukuze zihlolwe. Imiphumela ibonise ukuthi i-coefficient yokuhlobanisa yomugqa ye-CR30 ne-PFS ezingeni lesivivinyo yayingu-0.88, futhi i-coefficient yokulinganisa ye-Copula yayingu-0.86; isilinganiso sengozi ezingeni lesiguli sasingu-0.703. Eqeqebeni elingaphansi elinesifo esihlaselayo (isigaba IV noma amaphuzu aphezulu e-FLIPI), ukuhlobana phakathi kwakho kokubili kusobala kakhulu.
2. I-Hodgkin's lymphoma: ukwelashwa okuqondiswa okwesikhashana okuphakathi kwe-PET-CT
Ucwaningo lwe-RATHL oluzoba yizikhungo eziningi (inombolo engabonakali: 008) luhlanganisa iziguli ezingu-1214 ezine-Hodgkin lymphoma yabantu abadala esanda kwelashwa, zonke ezaziyisiteji esingu-ⅡB-Ⅳ, noma ⅡA ezihlanganiswe noquqaba olukhulu, noma ≥3 amasayithi athintekile. Zonke iziguli zanikezwa imijikelezo ye-2 ye-ABVD chemotherapy elandelwa yi-PET-CT (PET2). Iziguli ezingezinhle ze-PET2 zanikezwa ngokungahleliwe imijikelezo ye-4 ye-ABVD noma i-AVD regimen chemotherapy, bese ingena esikhathini sokulandelela. Iziguli ezine-PET2-positive zanikezwa uhlobo lwe-4-cycle BEACOPP-14 noma i-3-cycle ethuthukisiwe ye-BEACOPP ye-chemotherapy regimen, bese yenze ukuhlolwa kwe-PET-CT futhi (PET3); Iziguli ezine-PET3-negative zaqhubeka zithola uhlobo lwe-2-cycle BEACOPP-14 noma umjikelezo we-1-umjikelezo othuthukisiwe we-BEACOPP we-chemotherapy regimen; Iziguli ezine-PET3 positive zanikezwa i-radiotherapy noma i-salvage chemotherapy. Kungakhathaliseki ukuthi kunenqwaba enkulu ekuqaleni noma kukhona izilonda ezisele ngemva kokwelashwa, uma ukuhlolwa kwe-PET-CT kwaphakathi nethemu kungenayo, akukho kwelashwa nge-radiotherapy okuzonikezwa. Imiphumela ye-PET2 yayingemihle ku-84% weziguli, ngokulandelelwa okumaphakathi kwezinyanga ezingama-32, i-PFS yeminyaka emi-3 yayingama-83%, kanti izinga lokusinda lilonke (OS) lalingu-95%. I-PFS yeminyaka emi-3 yeqembu le-ABVD leqembu kanye neqembu le-AVD lalifana (85.45% no-84.48%, ngokulandelana), kanye ne-OS yeminyaka engu-3 yayingahlukanga ngokwezibalo (97.0% kanye ne-97.5%, ngokulandelana), kodwa iphaphu ubuthi berejimeni ye-ABVD babuphezulu kakhulu kune-AVD Iphrothokholi iphakamisa ukuthi kuphephile futhi kuyasebenza ukususa i-bleomycin kuphrothokholi ye-ABVD.
3. I-lymphoma eyinhloko yesistimu yezinzwa eziphakathi: I-Titipe ne-rituximab kwandisa ukusebenza kahle
IELSG32 yisivivinyo sesigaba II samazwe omhlaba wonke esizoba phakathi kwamazwe amaningi (inombolo engabonakali: 009), kufaka phakathi iziguli ezingama-227 ezinesistimu yezinzwa eyinhloko esanda kwelashwa esanda kuphathwa, eneminyaka yobudala engama-58 yeminyaka (18-70 yeminyaka). Ngokungahleliwe ihlukaniswe ngamaqembu amathathu: Iqembu A lanikezwa imijikelezo emi-4 yeMTX 3.5g / m2 (d1), Ara-C 2g / m2 (d2-3); Iqembu B lanikezwa i-rituximab 375mg / m2 (d -5, d0); Iqembu C lanikezwa iTitipipe 30 mg / m2 (d4) ngesisekelo seQembu B; labo ababephumelela bahlukaniswa ngokungahleliwe baba yiqembu eliphelele le-radiotherapy group kanye ne-carmustine elihlanganiswe nokwelashwa kweTitipi kuhlanganiswe neqembu le-autologous Stem cell transplantation. Imiphumela Inani eliphelele elisebenza kahle lamaqembu amathathu lalingu-53%, 74%, no-87%, amazinga e-CR angama-23%, ama-31%, nama-49%, kanti iminyaka emi-5 yokusinda ngaphandle kokuhluleka kwaba ngama-34%, ama-43%, no-54%, ngokulandelana. I-OS ibiyi-27%, 50%, ne-66%, ngokulandelana, iphakamisa ukuthi ukungeza i-rituximab ne-titipe kuhlelo lokwelashwa kungathuthukisa kakhulu ukusebenza kahle futhi kuthuthukise ukubikezelwa kwesikhathi eside.
4. Ukwelashwa kwe-Antigen chimeric receptor T cell (CAR-T): imiphumela yokuqala
Amaseli we-CTL019 ngamaseli we-CAR-T abhekise ku-CD19 futhi akhombisa imiphumela emihle yokulwa nesimila ezigulini ezine-leukemia ebuyile futhi ephikisayo. Isivivinyo somtholampilo sesigaba II (inombolo engaqondakali: 139) siqinisekise ukusebenza kwamaseli we-CTL019 ekwelapheni i-CD19-positive non-Hodgkin's lymphoma. Ucwaningo lubandakanya iziguli ezingama-29 ezine-lymphoma ephindaphindekayo ebuyile, kufaka phakathi amacala ayi-19 okusabalalisa i-B-cell lymphoma enkulu, amacala ayi-8 e-follicular lymphoma, namacala ama-2 we-mantle cell lymphoma. Iminyaka ephakathi nendawo ineminyaka engama-56. Izinsuku eziyi-1-4 ngemuva kokwelashwa ngamakhemikhali, amaseli ama-5 × 108 CTL019 anikezwa ngemithambo yegazi. Imiphumela Isilinganiso sokusebenza okuphelele saba ngu-68%. Phakathi kwabo, izinga le-CR lokusabalalisa okukhulu kwe-B-cell lymphoma lalingama-42%, kanti isilinganiso sokuxolelwa (PR) esinqunyelwe sasingu-8%; isilinganiso se-CR se-follicular lymphoma sasingu-57% kanti isilinganiso se-PR sasingu-43%. Iziguli eziyi-15 zenze i-cytokine release syndrome. Ngokulandelwa okuphakathi kwezinyanga eziyisithupha, i-PFS yayingu-6%. Ukwelashwa kwamathiphu we-Tip CTL59 kuphephile futhi kuyasebenza.
5. Isiteleka esiphindwe kabili sokulwa ne-B-cell lymphoma enkulu: I-Selinexor iyasebenza ku-vitro naku-vivo
I-Selinexor iyi-inhibitor ekhethwe ngomlomo yokuthunyelwa kwenyukliya, ivimbela i-XPO1, ikhuthaza ukugcinwa kwenuzi kanye nokusebenza kwamaprotheni angaphezulu kwe-10 we-tumor suppressor, futhi inciphisa amazinga wamaprotheni e-c-myc ne-BCL2 / 6 ngokugcina i-Eif4e. Ekuhlolweni kwe-in vitro (inombolo engabonakali: 146), i-Selinexor inomphumela omuhle wokuvimbela isiteleka esiphindwe kabili esisabalalisa umugqa omkhulu weseli le-B-cell lymphoma i-DoHH2, futhi futhi inomphumela omuhle wokuvimbela imigqa yamaseli we-MYC noma ye-BCL2. Esivivinyweni seSigaba I somtholampilo, iziguli ezi-6 zathola ukwelashwa kwe-Selinexor, kwathi ezi-3 zathola ukuxolelwa, lapho isiguli esisodwa saqinisekiswa yi-CR kwi-PET-CT kwathi ezi-1 zathola i-PR.
Ukwengeza, inkomba ye-prognostic ye-chronic lymphocytic leukemia kanye ne-mantle cell lymphoma nayo yaxoxwa futhi yahlaziywa kule ngqungquthela, futhi izinkomba eziningi ze-pathological zemitholampilo zethulwa ukuze kwahlulelwe ukubikezelwa kwesikhathi eside; kanye ne-World Health Organization Lymphoma Classification 2016 Okuqukethwe okubuyekeziwe kohlelo nakho kwethulwe kusenesikhathi engqungqutheleni. Ngamafuphi, ukubizwa kwalo mcimbi omkhulu kuveze isiqondiso esisha sokuxilongwa nokwelashwa kwe-lymphoma, futhi ngokuqinisekile kuzothuthukisa ukwelashwa komuntu ngamunye ngokusekelwe emithini esekelwe ebufakazini.
