Current treatment approaches for diffuse large B-cell lymphoma
Current treatment approaches for diffuse large B-cell lymphoma
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DOI：
10.1080/10428190701882187
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发表时间：
2008-04-01
影响因子：
2.6
通讯作者：
Tolan, Shaun
中科院分区：
文献类型：
--
作者：
Illidge, Tim;Tolan, Shaun
在过去的十年中，有两个主要的进展导致了弥漫性大b细胞淋巴瘤（DLBCL）患者预后的改善和生存期的延长。这些发展首先是增加活性细胞毒性药物的剂量，缩短周期之间的时间，从而产生剂量密集和/或剂量密集的方案，其次是在化疗中添加抗cd20单克隆抗体利妥昔单抗。这两种策略都具有更高的缓解率、更低的复发率、更长的无事件生存期（EFS）和改善的总生存期（OS），特别是在预后较好的组中。目前正在对剂量密集和剂量密集化疗方案加利妥昔单抗的组合进行测试，以确认使用这两种方法可获得生存优势。高风险、预后较差的DLBCL仍然是一个挑战，这些患者需要新的治疗策略。通过更好地了解与预后较差的疾病相关的遗传异常，以及导致对化疗无反应的因素，可能会改善预后。目前放射治疗在DLBCL治疗中的作用比以往任何时候都不明确，因此对目前在该疾病中使用放射治疗的证据进行了严格审查。
There have been two major developments over the last decade that has led to improvements in outcome and longer survival for patients with diffuse large B-cell lymphoma (DLBCL). These developments have been firstly to increase the dose of active cytotoxic drugs and shorten the time between cycles, resulting in dose-dense and/or dose-intense regimens and secondly the addition of the anti-CD20 monoclonal antibody rituximab to chemotherapy. Both strategies have been associated with higher response rates, lower relapse rates, longer event-free survival (EFS) and improved overall survival (OS), particularly in better prognostic groups. A combination of dose-dense and dose-intense chemotherapy regimens plus rituximab is currently being tested to confirm that the use of both approaches confers survival advantage. High-risk, poorer-prognosis DLBCL remains a challenge, and new treatment strategies are required for these patients. Improvements in outcome may potentially be achieved through a greater understanding of the genetic abnormalities specifically associated with poorer-prognosis disease, and factors that lead to unresponsiveness to chemotherapy. The role of radiotherapy is currently less clearly defined than at anytime in the management of DLBCL and the current evidence for using radiotherapy in this disease is therefore rigorously reviewed.