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The Evolving Role of Brentuximab Vedotin in Classical Hodgkin Lymphoma. Brentuximab Vedotin在经典霍奇金淋巴瘤中的作用。
IF 2.8 Pub Date : 2019-12-09 eCollection Date: 2019-01-01 DOI: 10.2147/BLCTT.S231821
Catherine Lai, Adrese Michael Kandahari, Chaitra Ujjani

The arrival of the CD30 directed antibody-drug conjugate, brentuximab vedotin (BV), has altered the approach to patients with classical Hodgkin lymphoma. Since initial approval in 2011, BV has been extensively studied in previously untreated and relapsed/refractory patients. Treatment indications for the antibody-drug conjugate have been expanded from the previously treated population to include maintenance therapy after autologous stem cell transplantation and recently, combination with chemotherapy in newly diagnosed advanced stage patients. This article will review the evolution of BV in classical Hodgkin lymphoma, detailing the studies that led to the approved indications and discussion of recent trials in combination with chemotherapy and immunotherapy.

CD30定向抗体-药物偶联物brentuximab vedotin (BV)的出现改变了经典霍奇金淋巴瘤患者的治疗方法。自2011年首次批准以来,BV已在未经治疗和复发/难治性患者中进行了广泛的研究。抗体-药物结合物的治疗适应症已经从以前的治疗人群扩展到包括自体干细胞移植后的维持治疗,以及最近新诊断的晚期患者的化疗联合治疗。本文将回顾经典霍奇金淋巴瘤BV的演变,详细介绍导致批准适应症的研究,并讨论最近联合化疗和免疫治疗的试验。
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引用次数: 10
Knockout Of BIRC5 Gene By CRISPR/Cas9 Induces Apoptosis And Inhibits Cell Proliferation In Leukemic Cell Lines, HL60 And KG1. CRISPR/Cas9敲除BIRC5基因可诱导白血病细胞系HL60和KG1细胞凋亡并抑制细胞增殖。
IF 2.8 Pub Date : 2019-11-27 eCollection Date: 2019-01-01 DOI: 10.2147/BLCTT.S230383
Manizheh Narimani, Mohammadreza Sharifi, Ali Jalili

Introduction: Human Baculoviral inhibitor of apoptosis repeat-containing 5 (BIRC5) which encodes survivin exhibits multiple biological activities, such as cell proliferation and apoptosis. Survivin is overexpressed in numerous malignant diseases including acute myeloid leukemia (AML). Recent studies have shown that the CRISPR/Cas9 nuclease-mediated gene-editing systems are suitable approach's for editing or knocking out various genes including oncogenes.

Methods and materials: We used CRISPR-Cas9 to knockout the BIRC5 in the human leukemic cell line, HL60, and KG1, and these cell lines were transfected with either the Cas9- and three sgRNAs expressing plasmids or negative control (scramble) using Lipofectamine 3000. The efficacy of the transfection was determined by quantitative reverse transcription-polymerase chain (RT-qPCR) and surveyor mutation assays. Cell proliferation and apoptosis were measured by MTT assay and flow cytometry, respectively.

Results: We have successfully knocked out the BIRC5 gene in these leukemic cells and observed that the BIRC5-knocked out cells by CRISPR/Cas9 showed a significant decrease (30 folds) of survivin at mRNA levels. Moreover, cell death and apoptosis were significantly induced in BIRC5-CRISPR/Cas9-transfected cells compared to the scramble vector.

Conclusion: We demonstrated for the first time that targeting BIRC5 by CRISPR/Cas9 technology is a suitable approach for the induction of apoptosis in leukemic cells. However, further studies targeting this gene in primary leukemic cells are required.

引言:编码生存素的人细胞凋亡重复抑制因子5(BIRC5)具有多种生物学活性,如细胞增殖和凋亡。Survivin在许多恶性疾病中过表达,包括急性髓细胞白血病(AML)。最近的研究表明,CRISPR/Cas9核酸酶介导的基因编辑系统是编辑或敲除包括致癌基因在内的各种基因的合适方法。方法和材料:我们使用CRISPR-Cas9敲除人白血病细胞系HL60和KG1中的BIRC5,并用表达Cas9-和三种sgRNA的质粒或使用Lipofectamine 3000的阴性对照(加扰)转染这些细胞系。通过定量逆转录聚合酶链反应(RT-qPCR)和检测突变测定来确定转染的效果。分别用MTT法和流式细胞仪检测细胞增殖和凋亡。结果:我们成功地敲除了这些白血病细胞中的BIRC5基因,并观察到CRISPR/Cas9敲除的细胞在mRNA水平上显示出生存素的显著降低(30倍)。此外,与加扰载体相比,BIRC5-CRISPR/Cas9转染的细胞中显著诱导了细胞死亡和凋亡。结论:我们首次证明CRISPR/Cas9技术靶向BIRC5是诱导白血病细胞凋亡的合适方法。然而,还需要在原代白血病细胞中针对该基因进行进一步的研究。
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引用次数: 13
Strategies For Targeting Chronic Myeloid Leukaemia Stem Cells 靶向慢性髓系白血病干细胞的策略
IF 2.8 Pub Date : 2019-11-01 DOI: 10.2147/BLCTT.S228815
Giovanna Carrá, A. Cartellà, B. Maffeo, A. Morotti
Abstract Chronic Myeloid Leukaemia is a myeloproliferative disorder driven by the t(9;22) chromosomal translocation coding for the chimeric protein BCR-ABL. CML treatment represents the paradigm of molecular therapy of cancer. Since the development of the tyrosine kinase inhibitor of the BCR-ABL kinase, the clinical approach to CML has dramatically changed, with a stunning improvement in the quality of life and response rates of patients. However, it remains clear that tyrosine kinase inhibitors (TKIs) are unable to target the most immature cellular component of CML, the CML stem cell. This review summarizes new insights into the mechanisms of resistance to TKIs.
慢性髓系白血病是一种由t(9;22)染色体易位编码嵌合蛋白BCR-ABL驱动的骨髓增殖性疾病。CML治疗代表了肿瘤分子治疗的典范。自BCR-ABL激酶酪氨酸激酶抑制剂的开发以来,CML的临床治疗方法发生了巨大变化,患者的生活质量和反应率都有了惊人的改善。然而,酪氨酸激酶抑制剂(TKIs)无法靶向CML中最不成熟的细胞成分,即CML干细胞,这一点仍然很清楚。本文综述了对TKIs耐药机制的新认识。
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引用次数: 1
Prognostic analysis of CD5 expression in double-hit diffuse large B-cell lymphoma and effectiveness comparison in patients treated with dose-adjusted EPOCH plus rituximab/R-CHOP regimens 双击弥漫性大b细胞淋巴瘤CD5表达的预后分析及剂量调整EPOCH +利妥昔单抗/R-CHOP方案治疗的疗效比较
IF 2.8 Pub Date : 2019-08-01 DOI: 10.2147/BLCTT.S216292
Fangwen Zhang, Ling Li, Lei Zhang, Xin Li, Xiaorui Fu, Xinhua Wang, Jingjing Wu, Zhenchang Sun, Fei Kong, L. Ren, Mingzhi Zhang
Objectives To compare the efficacy of rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) with traditional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) regimens in CD5+ double-hit lymphoma (DHL) and to evaluate prognostic factors. Methods We retrospectively studied 139 patients with newly diagnosed DHL/THL diffuse large B-cell lymphoma (including 20 cases CD5+ and 119 cases CD5−), 87 cases were MYC/BCL2 DHL, 30 cases were MYC/BCL6 DHL, 22 cases were THL. MYC, BCL2 and BCL6 rearrangements were examined by fluorescence in-situ hybridization. CD5 is detected by immunohistochemistry (IHC). Results The objective response rate (ORR) difference between CD5+ and CD5− was significant (80.0% vs 63.8%, P=0.003). The median follow-up time was 18 months (range: 4–39 months). Progression-free survival (PFS) of CD5+ group was significantly worse than that of CD5- (28.1% vs 59.0%, P=0.028), while no significant difference was observed in overall survival (OS) (32.1% vs 59.9%, P=0.057). Compared with the two regimens, the 2-year survival rate of DA-EPOCH-R group was significantly superior than that of R-CHOP (63.6% vs 45.4%, P=0.034 for PFS; 67.4% vs 47.8%, P=0.038 for OS). Besides, CD5+ patients receiving DA-EPOCH-R had survival benefits compared with R-CHOP in PFS (85.7% vs 23.0%, P=0.029), but there was no statistical difference in OS (87.7% vs 34.4.0%, P=0.064). However, in DA-EPOCH-R protocol, there was no significant difference between CD5+ DHL (MYC/BCl2 and MYC/BCL6) and triple-hit lymphoma (P=0.776 for PFS; P=0.728 for OS). Multivariate analysis showed that CD5+ treatment regimen and disease stage were independent prognostic factors. Conclusion Our retrospective study shows that CD5+ has a poorer prognosis than CD5− patients. Based on its improved lifetime and good tolerance on CD5+ patients, which is expected to become the first-line treatment for high-risk DLBCL types based on more clinical research.
目的比较利妥昔单抗、剂量调整的脚泊苷、强的松、长春新碱、环磷酰胺和阿霉素(DA-EPOCH-R)与传统的利妥昔单抗、环磷酰胺、阿霉素、长春新碱和强的松(R-CHOP)治疗CD5+双发淋巴瘤(DHL)的疗效,并评价影响预后的因素。方法回顾性分析139例新诊断的DHL/THL弥漫性大b细胞淋巴瘤(CD5+ 20例,CD5−119例),其中MYC/BCL2型DHL 87例,MYC/BCL6型DHL 30例,THL 22例。荧光原位杂交检测MYC、BCL2和BCL6重排。免疫组化(IHC)检测CD5。结果CD5+组和CD5−组的客观有效率(ORR)差异有统计学意义(80.0% vs 63.8%, P=0.003)。中位随访时间为18个月(范围4-39个月)。CD5+组的无进展生存期(PFS)显著低于CD5-组(28.1% vs 59.0%, P=0.028),而总生存期(OS)无显著差异(32.1% vs 59.9%, P=0.057)。两种方案比较,DA-EPOCH-R组2年生存率显著优于R-CHOP组(63.6% vs 45.4%, PFS组P=0.034;67.4% vs 47.8%, OS组P=0.038)。此外,与R-CHOP相比,接受DA-EPOCH-R的CD5+患者在PFS (85.7% vs 23.0%, P=0.029)中有生存获益,但在OS (87.7% vs 34.4.0%, P=0.064)中无统计学差异。然而,在DA-EPOCH-R方案中,CD5+ DHL (MYC/BCl2和MYC/BCL6)和三打淋巴瘤之间没有显著差异(PFS的P=0.776;OS的P=0.728)。多因素分析显示CD5+治疗方案和疾病分期是独立的预后因素。结论我们的回顾性研究表明CD5+患者的预后比CD5 -患者差。基于其延长的生存期和对CD5+患者良好的耐受性,基于更多的临床研究,有望成为高危DLBCL类型的一线治疗药物。
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引用次数: 6
IDH1-mutated relapsed or refractory AML: current challenges and future prospects idh1突变的复发或难治性AML:当前挑战和未来前景
IF 2.8 Pub Date : 2019-06-01 DOI: 10.2147/BLCTT.S177913
J. Megías-Vericat, O. Ballesta-López, E. Barragán, P. Montesinos
Abstract The prognosis of patients with relapsed or refractory acute myeloid leukemia (R/R AML) is discouraging with salvage standard approaches. Mutations of isocitrate dehydrogenase 1 (IDH1mut), present in 7–14% of AML patients, have been discovered recently, opening the door to targeted agents aiming to improve the outcomes in this setting. Several oral selective IDH1mut inhibitors are under investigation, ivosidenib being the first approved for R/R AML. We performed a systematic review to analyze the clinical outcomes and safety reported with IDH1mut inhibitors and other agents in adult patients with IDH1mut R/R AML. Ivosidenib in monotherapy achieved complete remission (CR) of 24%, overall response of 42%, and median overall survival of 9 months in R/R AML, and promising outcomes were reported with IDH305 and FT-2102. IDH1mut inhibitors were generally well tolerated, but some therapy-related toxicities should be monitored, including IDH-differentiation syndrome, prolongation of the QT interval, and leukocytosis, all manageable and reversible. Also, venetoclax, CB-839, PARP inhibitors, and IDH1 peptide vaccine are being studied in IDH1mut AML. The results of the ongoing and upcoming clinical trials will bring new evidence to establish the role of IDH1mut inhibitors in therapeutic strategies of AML.
复发或难治性急性髓性白血病(R/R AML)患者的预后令人沮丧。最近在7-14%的AML患者中发现了异柠檬酸脱氢酶1 (IDH1mut)突变,这为靶向药物改善这种情况的结果打开了大门。几种口服选择性IDH1mut抑制剂正在研究中,ivosidenib是第一个被批准用于R/R AML的药物。我们进行了一项系统综述,分析IDH1mut抑制剂和其他药物治疗IDH1mut R/R AML成人患者的临床结果和安全性。Ivosidenib单药治疗R/R AML的完全缓解(CR)为24%,总缓解率为42%,中位总生存期为9个月,IDH305和FT-2102的结果令人鼓舞。IDH1mut抑制剂通常耐受性良好,但应监测一些与治疗相关的毒性,包括idh分化综合征、QT间期延长和白细胞增多症,这些都是可控和可逆的。此外,venetoclax、CB-839、PARP抑制剂和IDH1肽疫苗正在IDH1mut AML中进行研究。正在进行和即将进行的临床试验的结果将为确定IDH1mut抑制剂在AML治疗策略中的作用提供新的证据。
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引用次数: 21
The expanding role of venetoclax in chronic lymphocytic leukemia and small lymphocytic lymphoma. venetoclax在慢性淋巴细胞白血病和小淋巴细胞淋巴瘤中的扩展作用。
IF 2.8 Pub Date : 2019-03-12 eCollection Date: 2019-01-01 DOI: 10.2147/BLCTT.S177009
Michael Schieber, Shuo Ma

The BCL-2 protein family members inhibit cellular apoptosis, and their overexpression represents a common survival adaption in cancer. Recently, a selective BCL-2 inhibitor ABT-199, venetoclax, has demonstrated remarkable activity in relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), both as a single agent and in combination with anti-CD20 immunotherapies, such as rituximab. In this article, we review the development and latest clinical data that have led to the expanded approval of venetoclax with rituximab in relapsed/refractory CLL/SLL. We also discuss ongoing and future clinical trials designed to evaluate the efficacy of venetoclax in previously untreated patients and to investigate venetoclax combinations with inhibitors of B-cell receptor signaling pathway. These studies hope to offer an expanded list of chemotherapy-free regimens for patients with CLL/SLL.

BCL-2蛋白家族成员抑制细胞凋亡,其过度表达代表了癌症中常见的生存适应。最近,选择性BCL-2抑制剂ABT-199 venetoclax在复发/难治性慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)中表现出显著的活性,无论是作为单一药物还是与抗CD20免疫疗法(如利妥昔单抗)联合使用。在这篇文章中,我们回顾了venetoclax联合利妥昔单抗治疗复发/难治性CLL/SLL的进展和最新临床数据。我们还讨论了正在进行和未来的临床试验,旨在评估venetoclax对先前未经治疗的患者的疗效,并研究Venetoclaz与B细胞受体信号通路抑制剂的组合。这些研究希望为CLL/SLL患者提供更多的无化疗方案。
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引用次数: 8
Strategies for minimal residual disease detection: current perspectives 最小残留疾病检测策略:当前观点
IF 2.8 Pub Date : 2019-02-01 DOI: 10.2147/BLCTT.S172693
G. Andreani, D. Cilloni
Abstract Currently, the post-remission treatment in acute leukemia is based on the genetic profile of leukemic cells at diagnosis (ie, FLT3 ITD positivity) and on the level of measurable residual disease (MRD) after induction and consolidation chemotherapy. Two methods are currently preferred for MRD evaluation in many centers: multiparameter flow cytometry and real-time quantitative PCR. Additional methods such as next-generation sequencing and digital PCR are under investigation, in an attempt to increase the sensitivity and thus allowing the detection of small clones. Many studies suggest that MRD positivity after chemotherapy is associated with negative prognosis, and the reappearance of MRD during follow-up allows impending relapse to be identified and consequently enables early intervention. Finally, MRD positivity before hematopoietic stem cell transplantation is predictive of the outcome. Although the significance of MRD in acute leukemia has been widely explored, the assessment of molecular MRD is not yet a routine practice. In this review, we describe the significance of MRD in different settings and the main markers and methods used for MRD detection.
目前,急性白血病的缓解后治疗是基于诊断时白血病细胞的遗传谱(即FLT3 ITD阳性)和诱导和巩固化疗后可测量的残留病(MRD)水平。目前在许多中心首选的MRD评估方法有两种:多参数流式细胞术和实时定量PCR。其他方法,如下一代测序和数字PCR正在研究中,试图提高灵敏度,从而允许检测小克隆。许多研究表明,化疗后MRD阳性与不良预后相关,随访期间MRD的复发可以识别即将复发,从而使早期干预成为可能。最后,造血干细胞移植前MRD阳性可预测结果。虽然MRD在急性白血病中的意义已被广泛探讨,但分子MRD的评估尚未成为常规做法。在这篇综述中,我们描述了MRD在不同情况下的意义以及MRD检测的主要标记物和方法。
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引用次数: 4
Plasmablastic lymphoma: current perspectives 浆母细胞淋巴瘤:目前的观点
IF 2.8 Pub Date : 2018-10-01 DOI: 10.2147/BLCTT.S142814
Andrés López, P. Abrisqueta
Plasmablastic lymphoma (PbL) is a rare and aggressive B-cell malignancy with large neoplastic cells, most of them resembling plasmablasts that have a CD20-negative phenotype. Although initially described as being associated with HIV, over the years it has also been identified in patients with solid organ transplant and immunocompetent patients. Little is known about molecular basis that drives PbL, and still its diagnosis remains challenging given its rarity. However, proper recognition of its clinical characteristics, localization, and morphological features can establish a correct diagnosis of PbL within the spectrum of CD20-negative large B-cell lymphomas (LBCLs). PbL is characterized by CD20 and PAX5 negativity together with the expression of CD38, CD138, MUM1/IRF4, Blimp1, and XBP1 plasmacytic differentiation markers. It is usually associated with Epstein–Barr virus infections, and MYC gene rearrangements. PbL should be carefully differentiated from other CD20-negative B-cell neoplasms, ie, primary effusion lymphoma, anaplastic lymphoma kinase-positive (ALK) large B-cell lymphoma, and LBCL in human herpesvirus 8-associated multicentric Castleman disease. Despite our improved understanding of this disease, its prognosis remains dismal with short overall survival. There is no standard of care for this entity. Several chemotherapy combinations have been used with hardly any differences on its outcome. Thus, new approaches with the addition of novel molecules are needed to overcome its poor prognosis. Our current understanding and knowledge of PbL relies primarily on case reports and small case series. In this review, we revise through an extensive literature search, the clinical and biological characteristics of this entity, and the potential therapeutic options.
浆母细胞淋巴瘤(PbL)是一种罕见的侵袭性b细胞恶性肿瘤,具有较大的肿瘤细胞,大多数类似于cd20阴性表型的浆母细胞。虽然最初被描述为与HIV有关,但多年来也在实体器官移植患者和免疫功能正常的患者中发现了它。人们对PbL的分子基础知之甚少,鉴于其罕见性,其诊断仍然具有挑战性。然而,正确认识其临床特征、定位和形态学特征可以在cd20阴性大b细胞淋巴瘤(LBCLs)谱系中建立PbL的正确诊断。PbL的特点是CD20和PAX5阴性,同时表达CD38、CD138、MUM1/IRF4、Blimp1和XBP1等质细胞分化标志物。它通常与eb病毒感染和MYC基因重排有关。PbL应与其他cd20阴性b细胞肿瘤,即原发性积液性淋巴瘤、间变性淋巴瘤激酶阳性(ALK)大b细胞淋巴瘤和人类疱疹病毒8相关多中心Castleman病的LBCL仔细区分。尽管我们对这种疾病的了解有所提高,但其预后仍然令人沮丧,总生存期较短。这个实体没有护理标准。已经使用了几种化疗组合,其结果几乎没有任何差异。因此,需要添加新分子的新方法来克服其预后不良。我们目前对PbL的理解和知识主要依赖于病例报告和小病例系列。在这篇综述中,我们通过广泛的文献检索,修订了该实体的临床和生物学特征,以及潜在的治疗选择。
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引用次数: 67
Recent advances in the biology and treatment of B-cell acute lymphoblastic leukemia. B细胞急性淋巴细胞白血病生物学和治疗的最新进展。
IF 2.8 Pub Date : 2018-09-25 eCollection Date: 2018-01-01 DOI: 10.2147/BLCTT.S170351
Mehrdad Hefazi, Mark R Litzow

Acute lymphoblastic leukemia (ALL) is a hematologic malignancy arising from precursors of the lymphoid lineage. Conventional cytotoxic chemotherapies have resulted in high cure rates of up to 90% in pediatric ALL, but the outcomes for adult patients remain suboptimal with 5-year survival rates of only 30%-40%. Over the last decade, major advances have been made in our understanding and management of ALL. Identification of new prognostic genomic markers and incorporation of minimal residual diseases' assessment into therapeutic protocols have improved risk stratification and treatment strategies. The use of pediatric-inspired regimens for adolescent and young adults, and the advent of tyrosine kinase inhibitors and novel targeted therapies, including monoclonal antibodies and chimeric antigen receptor T cells, have redefined the therapeutic paradigm of ALL, and significantly improved the outcomes. In this article, we will provide an overview of the current knowledge regarding the biology and treatment of ALL, and highlight recent diagnostic and therapeutic advances made in this area over the past 5 years.

急性淋巴细胞白血病(ALL)是一种由淋巴系前体引起的血液系统恶性肿瘤。传统的细胞毒性化疗已导致儿童ALL的高治愈率高达90%,但成人患者的结果仍然不理想,5年生存率仅为30%-40%。在过去的十年里,我们在理解和管理ALL方面取得了重大进展。新的预后基因组标志物的鉴定和将最小残留疾病的评估纳入治疗方案改善了风险分层和治疗策略。针对青少年和年轻人的儿科启发方案的使用,酪氨酸激酶抑制剂和新型靶向疗法的出现,包括单克隆抗体和嵌合抗原受体T细胞,重新定义了ALL的治疗模式,并显著改善了结果。在这篇文章中,我们将概述目前有关ALL生物学和治疗的知识,并强调过去5年来在该领域取得的最新诊断和治疗进展。
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引用次数: 59
Current understanding of the role and regulation of miRNAs in Burkitt lymphoma 目前对mirna在伯基特淋巴瘤中的作用和调控的了解
IF 2.8 Pub Date : 2018-05-11 DOI: 10.2147/BLCTT.S129618
A. Videtta, V. Malagnino, G. De Falco
Since its discovery in 1958, Burkitt lymphoma (BL) has been extensively studied and has become a model for tumorigenesis, but its pathogenesis has not been completely explained and understood yet. The aim of this review was to summarize the current knowledge about BL and, in particular, to discuss the role of miRNAs in its pathogenesis and their possible use as diagnostic and prognostic indicators. The impact of viral-encoded miRNAs is also discussed, with the Epstein–Barr infection being almost invariably detected in the endemic variant of this tumor.
自1958年发现伯基特淋巴瘤(Burkitt lymphoma, BL)以来,人们对其进行了广泛的研究,并已成为肿瘤发生的一种模式,但其发病机制尚未得到完全的解释和理解。这篇综述的目的是总结目前关于BL的知识,特别是讨论mirna在其发病机制中的作用以及它们作为诊断和预后指标的可能用途。本文还讨论了病毒编码mirna的影响,在这种肿瘤的地方性变异中几乎总是检测到Epstein-Barr感染。
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引用次数: 1
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Blood and Lymphatic Cancer-Targets and Therapy
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