資源描述:
《利妥昔單抗與彌漫大b細胞淋巴瘤》由會員上傳分享,免費在線閱讀,更多相關(guān)內(nèi)容在教育資源-天天文庫。
1、Rituximab(利妥昔單抗)andDLBCL(彌漫大B細胞淋巴瘤)報告人:指導(dǎo)老師:Outline:LymphomaNonHodgkin’slymphomaDiffuselargeBcelllymphomaRituximab--Mechnism--ClinicaltrialWhatisLymphoma?淋巴瘤(lymphoma)是起源于淋巴結(jié)和淋巴組織的免疫系統(tǒng)惡性腫瘤,其發(fā)生大多與免疫應(yīng)答過程中淋巴細胞增殖分化產(chǎn)生的某種免疫細胞惡變有關(guān)。淋巴瘤可發(fā)生在身體的任何部位,其中淋巴結(jié)、扁桃體、脾及骨髓是最易受到累及的部位。按組織病理學(xué)可分為:霍奇金
2、淋巴瘤和非霍奇金淋巴瘤AetiologyofNHLVirusesEBVHumanT-cellleukaemiavirustypeIKaposisarcoma-associatedvirusImmunosuppressionGeneticandoccupationalfactorsClinicalmanifestationWidespreadpainlesslymphadenopathy(無痛性淋巴結(jié)腫大)ismorecommon.Superiorvenacavasyndrome(上腔靜脈壓迫綜合征)causedbyabulkymediastinalm
3、assisalsomorefrequentin.Hepatosplenomegaly(肝脾腫大)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:環(huán)磷酰胺,長春新堿,潑尼松CHOP:環(huán)磷酰胺,阿霉素,長春新堿,潑尼松m-BACOB:博來霉素,阿霉素,環(huán)磷酰胺,長春新堿,地塞米松,甲氨蝶呤,四氫葉酸HyperCVAD
7、A方案:環(huán)磷酰胺,美斯納,長春新堿,阿霉素,地塞米松B方案:甲氨蝶呤,四氫葉酸,阿糖胞苷14臨床試驗NHLDLBCL3741GELALNH98.5研究10年隨訪406R-CHOP14vsR-CHOP21治療老年DLBCL:LNH03-6BGELA研究的中期分析2316309例年輕高危DLBCL長期隨訪404CHOEP-14+R或HDT(MegaCHOEP)+R用于年輕高危侵襲性B細胞淋巴瘤:德國高度淋巴瘤研究組(DSHNHL)MegaCHOEP方案研究3714R-CHOP治療失敗的老年DLBCL治療結(jié)果:R+HDT二線治療的作用.一項RICOVER6
8、0試驗回顧性分析FLCLLOthers:MCL,WMPTLD153741GELALNH98.5研究10年隨訪