Hodgkin lymphoma: 2014 Update on diagnosis, risk-stratification, and management
Hodgkin lymphoma: 2014 Update on diagnosis, risk-stratification, and management
复制标题
DOI：
10.1002/ajh.23750
复制
发表时间：
2014-07-01
影响因子：
12.8
通讯作者：
Ansell, Stephen M.
中科院分区：
文献类型：
--
作者：
Ansell, Stephen M.
疾病概述：霍奇金淋巴瘤（HL）是一种罕见的b细胞淋巴细胞恶性肿瘤，每年影响9,200名新患者，约占美国所有淋巴瘤的11.5%。诊断：HL由两种不同的疾病实体组成；更常见的诊断为经典HL和罕见的以结节淋巴细胞为主的HL。结节硬化、混合细胞性、淋巴细胞耗损和淋巴细胞丰富的HL是典型HL的亚群。风险分层：准确评估HL患者的疾病分期对于选择合适的治疗方法至关重要。预后模型用于确定复发风险低或高的患者，以及通过正电子发射断层扫描确定的治疗反应，以优化治疗。风险适应治疗：HL患者的初始治疗是基于疾病的组织学、解剖分期和存在不良预后特征。早期疾病患者采用联合治疗策略，采用缩短疗程的联合化疗，然后进行涉及野放射治疗，而晚期疾病患者则接受较长疗程的化疗，通常不进行放射治疗。复发/难治性疾病的治疗：高剂量化疗（HDCT）后自体干细胞移植（ASCT）是大多数初始治疗后复发患者的标准治疗方案。对于HDCT合并ASCT失败的患者，应考虑brentuximab vedotin、姑息性化疗、非清髓性同种异体移植或参与临床试验。(C) 2014 Wiley期刊公司
Disease overview: Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 9,200 new patients annually and representing approximately 11.5% of all lymphomas in the United States.Diagnosis: HL is composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte-predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups under the designation of classical HL.Risk stratification: An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography scan, are used to optimize therapy.Risk-adapted therapy: Initial therapy for HL patients is based on the histology of the disease, the anatomical stage, and the presence of poor prognostic features. Patients with early stage disease are treated with combined modality strategies using abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy.Management of relapsed/refractory disease: High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, palliative chemotherapy, nonmyeloablative allogeneic transplant, or participation in a clinical trial should be considered. (C) 2014 Wiley Periodicals, Inc.