利妥昔单抗与弥漫大b细胞淋巴瘤

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1、Rituximab(利妥昔单抗)andDLBCL(弥漫大B细胞淋巴瘤)报告人：指导老师：Outline:LymphomaNonHodgkin’slymphomaDiffuselargeBcelllymphomaRituximab--Mechnism--ClinicaltrialWhatisLymphoma?淋巴瘤（lymphoma）是起源于淋巴结和淋巴组织的免疫系统恶性肿瘤，其发生大多与免疫应答过程中淋巴细胞增殖分化产生的某种免疫细胞恶变有关。淋巴瘤可发生在身体的任何部位，其中淋巴结、扁桃体、脾及骨髓是最易受到累及的部位。按组织病理学可分为：霍奇金

2、淋巴瘤和非霍奇金淋巴瘤AetiologyofNHLVirusesEBVHumanT-cellleukaemiavirustypeIKaposisarcoma-associatedvirusImmunosuppressionGeneticandoccupationalfactorsClinicalmanifestationWidespreadpainlesslymphadenopathy(无痛性淋巴结肿大)ismorecommon.Superiorvenacavasyndrome（上腔静脉压迫综合征）causedbyabulkymediastinalm

3、assisalsomorefrequentin.Hepatosplenomegaly（肝脾肿大）isfrequentatdiagnosis.Bsymptoms(unexplainedfeverof38°Corhigher,nightsweatsandlossofmorethan10%ofbodyweightin6months)AnnArborstagingsystemWhatisDLBCL?1.cellsarelarger2.roundnucleus3.prominentnucleoli,someadjacenttothenuclearmembran

4、eWhatisRituximab?Rituximab:chimericmurine/humananti-humanCD20(人鼠嵌合抗CD20)RituximabdestroysBcells,andisthereforeusedtotreatdiseaseswhicharecharacterizedbyhavingtoomanyBcells,overactiveBcellsordysfunctionalBcells.Thisincludeslymphomas, leukemias,transplantrejection andsome autoimm

5、unedisorders.WhatisCD20?CD20isahydrophobictransmembraneproteinwithamolecularweightofapproximately35kDlocatedonpre-BandmatureBlymphocytesTheantigenisexpressedonmostB-cellnon-Hodgkin’slymphomasbutisnotfoundonstemcells,pro-Bcells,normalplasmacellsorothernormaltissues.Themechanismo

6、frituximab1.Signalinginducedcelldeath2.CDC(complementdependentcytotoxicity)3.ADCC(antibodydependentcytotoxicity)4.InteractingmechanismsSignalinginducedcelldeathCDCandADCCTherapeuticstrategyCOP：环磷酰胺，长春新碱，泼尼松CHOP：环磷酰胺，阿霉素，长春新碱，泼尼松m-BACOB：博来霉素，阿霉素，环磷酰胺，长春新碱，地塞米松，甲氨蝶呤，四氢叶酸HyperCVAD

7、A方案：环磷酰胺，美斯纳，长春新碱，阿霉素，地塞米松B方案：甲氨蝶呤，四氢叶酸，阿糖胞苷14临床试验NHLDLBCL3741GELALNH98.5研究10年随访406R-CHOP14vsR-CHOP21治疗老年DLBCL:LNH03-6BGELA研究的中期分析2316309例年轻高危DLBCL长期随访404CHOEP-14+R或HDT(MegaCHOEP)+R用于年轻高危侵袭性B细胞淋巴瘤:德国高度淋巴瘤研究组(DSHNHL)MegaCHOEP方案研究3714R-CHOP治疗失败的老年DLBCL治疗结果:R+HDT二线治疗的作用.一项RICOVER6

8、0试验回顾性分析FLCLLOthers:MCL,WMPTLD153741GELALNH98.5研究10年随访