鼻型nkt細(xì)胞淋巴瘤的診治講義

1、Pathogenesis and Treatment of Extranodal Natural Killer/T-Cell Lymphoma,Semin Hematol. 2014, 51:42–51. —— Li Ye,PATHOGENESIS OF NK/T-CELL LYMPHOMA,1. Chromosomal abnormalities

2、,2. Genetic aberrations,3. The Epstein-Barr virus(EBV),Br J Haematol. 1997;98:922-6.,Chromosomal abnormalities,Br J Haematol.1997;97:621-5.,Genetic aberrations,FOXO3, PRDM1, TP53,CDKN2A,FAS,SHP1,TP73, and KIT,J Clin Exp

3、Hematopathol. 2005;45:51-70.,PATHOLOGY OF NK/T-CELL NEOPLASMS,1. diffuse proliferation of lymphoma cells with anangiocentric or angiodestructive growth pattern2. Infiltration of inflammatory cells and sometimes accom

4、pany necrotic changes 3. NK cell markers (CD2, cytoplasmic CD3 (cyCD3), CD7, and CD56 )4. Cytotoxic molecules such as TIA-1, granzyme B, and perforin,DISEASE FEATURES OF NK/T-CELL LYMPHOMA,1. origin for ENKL: the nos

5、e and paranasal area skin, gastrointestinal tract, et al.2. Stage I/II : Approximately half of the patients 3. Nasal and extranasal ENKLs in the same category of disease accor

6、ding to the current WHO classification,,Ann Oncol. 2010;21:1032-40.,Nasal ENKL more frequently presents as a localized disease, whereas extranasal ENKL is more frequently detected at an advanced stage.,,Blood.2009;113:3

7、931-3937,,A. Limited-stage (I/II) disease,B. advanced-stage (III/IV) disease,Blood.2009;113:3931-3937,TREATMENT OF EXTRANODAL NK/T-CELL LYMPHOMA,1. Limited Stages,2. Advanced Stages, Relapsed or Refractory State,3. Hemat

8、opoietic Stem Cell Transplantation (autologous and allogeneic HSCTs),Cancer. 1995;76:2351-6.,β-actin,MDR3,MDRl,Drug : vincristine and doxorubicin,J Clin Oncol. 2000;18:54-63.,J Clin Oncol. 2000;18:54-63.,(median 56 m

9、onths)Treatment failure 57/92 (62%)(median 8 months) Relapsed rate 14/61 (23%),Ann Oncol. 2001;12:349-52.,New treatment strategies, such as high-dose chemotherapy with stem-cell transplantation, early adm

10、inistration of radiation treatment, or concomitant chemo-radiotherapy, need to be investigated to improve the treatment outcomes, particularly in patients with patients with B symptoms.,1. The planned sequential chemo-ra

11、diotherapy 6/17 (35%) 2. Estimated overall three-year survival 59%,74 patients receiving CT 64 CHOP (cyclophosphaminde, doxorubicin, vincristine, prednisone) or CHOP-bleo (CHOP+bleomycin) 9 COB

12、VP-16 (cisplatin, vincristine, bleomycin, prednisone) 1 COPP (cyclophosphaminde, vincristine, procarbazine, prednisone),37 patients received RT after CT. Before RT, 20 one to two cycles of CT, 16 t

13、hree to four cycles, 1 five cycles of CT,J Clin Oncol. 2006;24:181-9.,1. Limited Stages,J Clin Oncol. 2006;24:181-9.,Response after initial therapy RT vs. CT 83% vs. 20% (P =0.0001)Response after therapy

14、 RT and RT+CT vs. CT+RT 92% vs. 81% (P=0.387),1. Limited Stages,RT as primary therapy resulted in good outcome in early-stage disease,J Clin Oncol. 2009;27:5594-600.,1. Limited Stages,J Clin Oncol. 2009;27:5594-600.,CR

15、 20/26 (77%) OS at 5 years ＞50% ORR 21/26 (81%) PFS at 5 years ＞50%,Overall survival and (B) progression-free survival of patients treated with radiotherapy and two thirds dose of

16、 dexamethasone, etoposide, ifosfamide, and carboplatin.,J Clin Oncol. 2009;27:5594-600.,J Clin Oncol. 2009;27:5594-600.,The most common grade 3 nonhematologic toxicity was mucositis related to radiation (30%). No treatme

17、nt-related deaths were observed.,J Clin Oncol. 2009;27:6027-32.,1. Limited Stages,J Clin Oncol. 2009;27:6027-32.,J Clin Oncol. 2009;27:6027-32.,CCRT CR 22/30 (73.3%) ORR 30/30 (100%) CCRT+VIPD CR 22/26

18、(84.6%),OS at 3 years 85.19%PFS at 3 years 85.19%,J Clin Oncol. 2009;27:6027-32.,Only one patient experienced grade 3 toxicity during CCRT (nausea), whereas 12 of 29 patients experienced grade 4 neutropenia.,2. Adva

19、nced Stages, Relapsed or Refractory State,J Clin Oncol. 2011;29:4410-6.,ORR 79%1-year survival rate 55%,A 3-year OS of 50%,Hematol Oncol. 2013;31 suppl.S1:175 [abstract 235].,,SMILE VS. historical controls,L-aspara

20、ginase (Kidrolase, Eusa Pharma) 6000 units/m2 of body surface area on days 2, 4, 6, and 8, intramuscularly (unless contraindicated), methotrexate 3 g/m2 on day 1, oral dexamethasone 40 mg from day 1 to 4.,,ROLE OF EBV-

21、DNA,To predict the prognosisTo predict the degree of adverse reactions,Blood. 2011;118:6018-22.,RELATED DISEASES,1. Aggressive NK-cell leukemia(ANKL)2. Lymphomatoid gastroenteropathy 3. Chronic NK-cell lymphocytosi

22、s,J Clin Exp Hematopathol.2005;45:51-70.,,人有了知識(shí)，就會(huì)具備各種分析能力，明辨是非的能力。所以我們要勤懇讀書，廣泛閱讀，古人說“書中自有黃金屋?！蓖ㄟ^閱讀科技書籍，我們能豐富知識(shí)，培養(yǎng)邏輯思維能力；通過閱讀文學(xué)作品，我們能提高文學(xué)鑒賞水平，培養(yǎng)文學(xué)情趣；通過閱讀報(bào)刊，我們能增長見識(shí)，擴(kuò)大自己的知識(shí)面。有許多書籍還能培養(yǎng)我們的道德情操，給我們巨大的精神力量，鼓舞我們前進(jìn)。,