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Venetoclax for the treatment of mantle cell lymphoma Venetoclax治疗套细胞淋巴瘤
Pub Date : 2019-04-15 DOI: 10.21037/AOL.2019.03.02
V. Lin, M. Anderson, D. Huang, A. Roberts, J. Seymour, C. Tam
While the last decade has seen an explosion in improved therapies for mantle cell lymphoma (MCL), the outlook for patients with relapsed or refractory MCL (R/R MCL) remains poor, especially for those who are older with comorbidities or harbour dysfunction in the TP53 pathway. MCL is one of the B cell malignancies in which there is a high frequency of BCL2 overexpression, and the selective BCL2 inhibitor venetoclax has shown particular promise in the treatment of patients with R/R MCL. As a single agent, the drug is associated with a close to 80% response rate in early phase studies. However, secondary progression due to the development of resistance remains a limiting factor in the usefulness of this agent. Preclinical data has driven the push to combine venetoclax with other novel agents, particularly the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib. This therapeutic combination has increased the rate of complete remissions to over 60% and provides a promising route to meaningful long-term disease control with non-chemotherapy-based treatment.
虽然在过去的十年中,套细胞淋巴瘤(MCL)的治疗方法得到了巨大的改进,但复发或难治性MCL (R/R MCL)患者的前景仍然很差,特别是那些年龄较大且伴有合并症或TP53通路中港口功能障碍的患者。MCL是一种BCL2高频率过表达的B细胞恶性肿瘤,选择性BCL2抑制剂venetoclax在治疗R/R MCL患者中显示出特别的希望。作为单一药物,该药物在早期研究中有接近80%的反应率。然而,由于耐药性的发展而导致的继发性进展仍然是该药物有效性的限制因素。临床前数据推动了venetoclax与其他新型药物,特别是布鲁顿酪氨酸激酶(BTK)抑制剂伊鲁替尼的联合应用。这种治疗组合将完全缓解率提高到60%以上,并为非化疗治疗提供了有意义的长期疾病控制的有希望的途径。
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引用次数: 1
Mantle cell lymphoma pathology update in the 2016 WHO classification 2016年世卫组织套细胞淋巴瘤病理分类更新
Pub Date : 2019-03-18 DOI: 10.21037/AOL.2019.03.01
L. Veloza, Inmaculada Ribera‐Cortada, E. Campo
Mantle cell lymphoma (MCL) is an aggressive mature B-cell neoplasm genetically characterized by the presence of the t(11;14)(q13;q32) that leads to the constitutive overexpression of cyclin D1. The pathological and biological spectrum of this neoplasm has been expanded in recent years. This improvement in the knowledge of the disease has provided a better understanding of the diverse clinical evolution of the patients. The characterization of cyclin D1-negative MCL has led to the identification of cyclin D2 and D3 translocations as alternative mechanisms in this variant. Two major biological and clinical subtypes of the disease have been recognized, conventional and leukemic non-nodal MCL (nnMCL). MCL derives from CD5+ mature B-cells that have bypassed or experienced the germinal center microenvironment, retain a naive or memory-like epigenetic signature and carry a variable load of somatic mutations in the IGHV region; from truly unmutated to highly mutated, respectively. These two subtypes of tumors also differ in their genomic alterations, and clinical behavior, the conventional MCL (cMCL) being more aggressive than the leukemic nnMCL. This review will focus on the new aspects of the pathology of MCL in the updated 2016 WHO classification and its relevance for the clinical practice.
套细胞淋巴瘤(MCL)是一种侵袭性成熟b细胞肿瘤,其遗传特征是t(11;14)(q13;q32)的存在导致细胞周期蛋白D1的组成性过表达。近年来,这种肿瘤的病理和生物学范围已经扩大。这种疾病知识的改进提供了对患者不同临床演变的更好理解。细胞周期蛋白d1阴性MCL的特征导致细胞周期蛋白D2和D3易位作为该变体的替代机制。该疾病的两种主要生物学和临床亚型已被确认,即常规和白血病非淋巴结MCL (nnMCL)。MCL来源于CD5+成熟b细胞,这些细胞绕过或经历了生发中心微环境,保留了幼稚或记忆样的表观遗传特征,并在IGHV区域携带了可变的体细胞突变负荷;分别从完全未突变到高度突变。这两种肿瘤亚型在基因组改变和临床行为上也有所不同,常规MCL (cMCL)比白血病nnMCL更具侵袭性。本综述将重点关注2016年WHO更新的MCL分类中病理学的新方面及其与临床实践的相关性。
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引用次数: 11
Is there a role for immunomodulatory drugs in the treatment of mantle cell lymphoma? 免疫调节药物在套细胞淋巴瘤的治疗中是否有作用?
Pub Date : 2019-01-14 DOI: 10.21037/AOL.2019.01.01
A. Albertsson-Lindblad, M. Jerkeman
Although survival has improved in patients with mantle cell lymphoma (MCL) during the last two decades, thanks to intensified approach upfront and with anti-CD20 targeted treatment, the disease is still regarded as incurable and for the elderly/unfit patient population, there is need for more tolerable and effective treatment options. Immunomodulatory drugs (IMiDs) have demonstrated activity in MCL and could be regarded as attractive components of combinatory regimens for MCL, in light of their broad spectrum of activity and the potency to synergize with monoclonal antibody treatment. This review focus on the role of lenalidomide (L) as single agent in R/R MCL and in combinatory regimens. To date, one can conclude that L is an active agent in MCL, preferably when combined with anti-CD20 antibody, and may have a role as upfront treatment of elderly/unfit patients. Moreover, regimens including lenalidomide in combination with immunochemotherapy and in chemo-free regimens have shown activity, albeit associated with an increased risk of dose-limiting toxicity in untreated patient populations. Randomized trials evaluating the addition of L upfront, and phase I/II trials on L combined with other novel agents such as BTK- and bcl-2 inhibitors are underway and will further bring insight into the role of IMiDs in MCL.
尽管在过去的二十年中,由于加强了前期治疗和抗cd20靶向治疗,套细胞淋巴瘤(MCL)患者的生存率有所提高,但该疾病仍然被认为是无法治愈的,对于老年人/不适合患者群体,需要更耐受和有效的治疗方案。免疫调节药物(IMiDs)已被证明对MCL有活性,鉴于其广谱的活性和与单克隆抗体治疗协同的效力,可以被视为MCL联合治疗方案的有吸引力的组成部分。本文综述了来那度胺(L)作为单药在R/R MCL和联合治疗方案中的作用。到目前为止,我们可以得出结论,L是MCL中的一种活性剂,最好与抗cd20抗体联合使用,并且可能在老年/不适合患者的前期治疗中发挥作用。此外,来那度胺与免疫化疗和无化疗联合使用的方案显示出活性,尽管在未经治疗的患者群体中与剂量限制性毒性风险增加有关。评估L前期添加的随机试验,以及L与其他新型药物(如BTK-和bcl-2抑制剂)联合的I/II期试验正在进行中,将进一步深入了解IMiDs在MCL中的作用。
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引用次数: 0
Aggressive B-cell lymphomas—from morphology to molecular pathogenesis 侵袭性b细胞淋巴瘤——从形态学到分子发病机制
Pub Date : 2019-01-08 DOI: 10.21037/AOL.2018.12.02
Bo-Jung Chen, F. Fend, E. Campo, L. Quintanilla‐Martinez
The2016 revised World Health Organization (WHO) classification of lymphoidmalignancies recognizes several distinct entities within the group of diffuselarge B-cell lymphoma (DLBCL) characterized by unique clinical and pathologicalfeatures. Nevertheless, diffuse large B-cell lymphoma, not otherwise specified(DLBCL, NOS) is the most common aggressive B-cell lymphoma. In the last 20 yearsour understanding of the genetic changes and biology of DLBCL has increasedtremendously. According to the 2016 WHO classification, the diagnosis of DLBCL,NOS, should include cell of origin (COO); germinal centre B-cell (GCB) oractivated B-cell (ABC)/non-GCB subtypes, because of their different molecularfeatures, biologic behavior, prognosis and treatment. High-grade B-celllymphoma (HGBL) with MYC and BCL2 and/or BCL6 rearrangements (i.e., double-hit or triple-hit lymphoma, DHL or THL) as well asHGBL, NOS, are two new categories in the 2016 revised WHO classification thatsubstituted the provisional category of B-cell lymphoma, unclassifiable (BCLU)with features intermediate between DLBCL and Burkitt lymphoma (BL), which wasintroduced in the 2008 WHO classification. The pathogenesis and molecularchanges of BL are better understood and led to the recognition of a newprovisional entity called Burkitt-like lymphoma with 11q aberration. In thisarticle, we will review the progress made in the last years within the mostcommonly encountered aggressive B-cell lymphomas, highlighting the betterunderstanding of the underlying disease mechanisms that eventually might be translatedinto more rational and effective therapeutic strategies. Controversial issuesabout fluorescent in situ hybridization (FISH) for the detection of MYC , BCL2 and BCL6 translocations will be addressed, as well as newmolecular techniques used to improve diagnosis and prognostication inaggressive B-cell lymphomas.
2016年修订的世界卫生组织(WHO)淋巴恶性肿瘤分类确认了弥漫性大b细胞淋巴瘤(DLBCL)组中具有独特临床和病理特征的几种不同实体。然而,弥漫性大b细胞淋巴瘤(DLBCL, NOS)是最常见的侵袭性b细胞淋巴瘤。在过去的20年里,我们对DLBCL的遗传变化和生物学的理解有了极大的提高。根据2016年WHO分类,DLBCL的诊断,NOS,应包括起源细胞(COO);生发中心b细胞(GCB)或活化b细胞(ABC)/非GCB亚型,因其不同的分子特征、生物学行为、预后和治疗。具有MYC和BCL2和/或BCL6重排的高级别b细胞淋巴瘤(HGBL)(即双重或三重打击淋巴瘤,DHL或THL)以及asHGBL, NOS,是2016年修订的WHO分类中的两个新类别,取代了2008年WHO分类中引入的b细胞淋巴瘤的临时类别,不可分类(BCLU),其特征介于DLBCL和Burkitt淋巴瘤(BL)之间。BL的发病机制和分子变化得到了更好的了解,并导致了一种新的临时实体的认识,即11q畸变的burkitt样淋巴瘤。在本文中,我们将回顾近年来在最常见的侵袭性b细胞淋巴瘤中取得的进展,强调对潜在疾病机制的更好理解,最终可能转化为更合理有效的治疗策略。关于荧光原位杂交(FISH)检测MYC, BCL2和BCL6易位的争议问题将得到解决,以及用于改善无侵袭性b细胞淋巴瘤诊断和预后的新分子技术。
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引用次数: 21
Risk stratification of mantle cell lymphoma (MCL) 套细胞淋巴瘤(MCL)风险分层
Pub Date : 2018-12-01 DOI: 10.21037/AOL.2018.12.03
Nora Liebers, P. Dreger, M. Dreyling, S. Dietrich
Despite of a better understanding of the biology of mantle cell lymphoma (MCL), it remains an incurable disease with very variable disease courses. The biological heterogeneity of MCL requires the identification of prognostic markers for risk stratification and tailored treatment of MCL. The combined MCL International Prognostic Index (MIPI-c) represents a well-established clinical risk stratification model. Based on four clinical parameters: age, performance status, lactate dehydrogenase and leucocyte count combined with the percentage of Ki-67 positive MCL cells the model distinguishes four MCL subgroups with very different outcomes. Further prognostic markers, in particular molecular lesions might help to further improve clinical scoring. We discuss the value of clinical and molecular markers to predict outcome of MCL and how these markers could influence treatment decisions.
尽管对套细胞淋巴瘤(MCL)的生物学有了更好的了解,但它仍然是一种无法治愈的疾病,病程变化很大。MCL的生物学异质性要求确定预后标志物,进行风险分层,并对MCL进行针对性治疗。联合MCL国际预后指数(MIPI-c)代表了一个完善的临床风险分层模型。该模型根据年龄、运动状态、乳酸脱氢酶和白细胞计数以及Ki-67阳性MCL细胞百分比等4个临床参数,区分出4个预后差异很大的MCL亚组。进一步的预后标记,特别是分子病变可能有助于进一步提高临床评分。我们讨论临床和分子标记物预测MCL预后的价值,以及这些标记物如何影响治疗决策。
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引用次数: 6
Immunotherapy in non-Hodgkin lymphoma 非霍奇金淋巴瘤的免疫治疗
Pub Date : 2018-12-01 DOI: 10.21037/AOL.2018.12.01
C. Jacobson, P. Armand
The concept of co-opting an immune response to treat cancer has existed for centuries. Modern advances in our understanding of how the immune system is regulated, how a tumor evolves to evade an immune response, and how the immune system can be manipulated, both pharmacologically as well as genetically, have moved this concept from an ideal to reality, sparking a revolution in cancer therapeutics and the field of immuno-oncology. This review will focus both on cellular therapeutics, and specifically chimeric antigen receptor (CAR) T-cells, as well as immune checkpoint inhibition, in non-Hodgkin lymphoma (NHL). The former has had remarkable efficacy in a large number of patients, whereas the benefit of the latter has been restricted to specific histologies. As we learn more about the tumor microenvironment for each of the NHL histologies, mechanisms of resistance, and predictors of response, we will undoubtedly identify new combinations, or new ways to manipulate the immune system, to improve outcomes in these diseases.
利用免疫反应来治疗癌症的概念已经存在了几个世纪。我们对免疫系统如何调节,肿瘤如何进化以逃避免疫反应,以及如何在药理学和遗传学上操纵免疫系统的理解的现代进步,已经将这一概念从理想变为现实,引发了癌症治疗学和免疫肿瘤学领域的革命。这篇综述将集中在细胞治疗,特别是嵌合抗原受体(CAR) t细胞,以及免疫检查点抑制,在非霍奇金淋巴瘤(NHL)。前者在大量患者中具有显著的疗效,而后者的益处仅限于特定的组织学。随着我们对每一种NHL组织学、耐药机制和反应预测因子的肿瘤微环境的了解越来越多,我们无疑将确定新的组合或操纵免疫系统的新方法,以改善这些疾病的预后。
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引用次数: 0
Diffuse large B-cell lymphoma—who should we FISH? 弥漫性大b细胞淋巴瘤-我们应该检查哪些患者?
Pub Date : 2018-11-01 DOI: 10.21037/aol.2018.11.01
D. Stephens, Sonali M. Smith
Thepoor prognosis and adverse outcomes following standard chemoimmunotherapy forpatients with high-grade B-cell lymphomas harboring rearrangements of MYC and BCL2 and/or BCL6 (HGBL-DH/TH) is now well-established, withless than 20% estimated long term survival following standard therapies.Fortunately, the frequency of HGBL-DH/TH in unselected aggressive B-celllymphomas is relatively uncommon and estimated at 10% of all cases. Thesedouble- and/or triple-hit lymphomas are often, but not universally, associatedwith a clinically aggressive presentation, high-grade morphologic features, orincreased protein expression of the corresponding genes. However, a substantialnumber of patients have no clear indicators of underlying DH/TH. The paradox ofan exceedingly poor prognosis coupled with a relatively uncommon frequencyraises the practical challenge of determining which patient warrants FISHtesting and is an area of substantial controversy and emerging data. Theclinical consequence of missing HGBL-DH/TH is dire, as these patients arelikely undertreated by standard chemoimmunotherapy (RCHOP). However, in acost-conscious era, routine and widespread testing for biologic determinants ofoutcome may not be appropriate, and a critical appraisal of predictors iswarranted. This review will discuss the clinical implications of theserearrangements in aggressive B-cell lymphomas and the potential clinical, pathologic,or biologic predictors of underlying HGBL-DH/TH biology.
对于MYC、BCL2和/或BCL6 (HGBL-DH/TH)重排的高级别b细胞淋巴瘤患者,标准化学免疫治疗后的不良预后和不良结局现已得到证实,标准治疗后的估计长期生存率低于20%。幸运的是,在未选择的侵袭性b细胞淋巴瘤中,HGBL-DH/TH的频率相对不常见,估计占所有病例的10%。这些双重和/或三重打击淋巴瘤通常(但并非普遍)与临床侵袭性表现、高级别形态学特征或相应基因的蛋白质表达增加有关。然而,相当数量的患者没有明确的潜在DH/TH指标。预后极差与相对罕见的频率相结合的悖论提出了确定哪些患者需要进行fish检测的实际挑战,这是一个充满争议和新数据的领域。缺少HGBL-DH/TH的临床后果是可怕的,因为这些患者可能没有得到标准化学免疫治疗(RCHOP)。然而,在成本意识强烈的时代,对结果的生物学决定因素进行常规和广泛的测试可能不合适,对预测因素进行批判性评估是必要的。这篇综述将讨论这些基因排列在侵袭性b细胞淋巴瘤中的临床意义,以及潜在的HGBL-DH/TH生物学的临床、病理或生物学预测因素。
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引用次数: 3
A new tool in the cancer immunotherapy toolbox? 癌症免疫治疗工具箱中的新工具?
Pub Date : 2018-03-01 Epub Date: 2018-03-20 DOI: 10.21037/aol.2018.03.01
Xiaosheng Wu, Thomas E Witzig
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引用次数: 1
Disparities in lymphoma on the basis of race, gender, HIV status, and sexual orientation. 基于种族、性别、HIV感染状况和性取向的淋巴瘤差异。
Pub Date : 2017-11-01 Epub Date: 2017-11-17 DOI: 10.21037/aol.2017.11.01
Melody Becnel, Christopher R Flowers, Loretta J Nastoupil

Lymphoid malignancies account for the sixth leading cause of death in the US, and, although survival is improving overall, this trend is not applicable to all patients. In this review, we describe disparities in the initial presentation, treatment, and outcomes across a diverse group of lymphoma patients on the basis of gender, race, HIV status, and sexual orientation. Identifying these disparities will hopefully lead to improved outcomes in these groups of lymphoma patients in the future.

淋巴细胞恶性肿瘤是美国第六大死亡原因,尽管生存率总体上有所提高,但这一趋势并不适用于所有患者。在这篇综述中,我们描述了基于性别、种族、艾滋病毒状态和性取向的不同组淋巴瘤患者在初始表现、治疗和结局方面的差异。确定这些差异将有望在未来改善这些淋巴瘤患者的预后。
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引用次数: 13
期刊
Annals of lymphoma
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