精准医疗时代利用组织病理报告指导弥漫大B细胞淋巴瘤的初始治疗：第57届美国血液学会年会报道

Using the pathology report in initial treatment decisions for diffuse large B-ceU lymphoma in the era of precision medicine： reports from the 57th American Society of Hematology annual meeting

弥漫大B细胞淋巴瘤（DLBCL）是西方国家非霍奇金淋巴瘤中最常见的亚型，采用标准R-CHOP方案化疗可达到治愈。我们目前处于一个可从遗传学和分子学定义DLBCL异质性的时代，临床试验的目标是给予不同亚型患者合理的特异性治疗。原发性纵隔DLBCL是一种独特的临床病理类型，给予R-CHOP方案可达到良好疗效。但10％的DLBCL患者中存在myc基因重排，即使给予标准R-CHOP方案也存在预后不良，特别是同时存在bcl-2基因重排者，即双打击DLBCL。免疫组织化学显示DLBCL中一个较大的亚群同时存在myc和bcl-2的过表达。通过基因表达谱、免疫组织化学或新的Lymph2Cx方法可分析细胞的来源，以提供预后信息，指导初治和复发患者治疗方案的制定。文章介绍了2015年第57届美国血液学会（ASH）年会报道的关于如何定义DLBCL的特殊亚型及提供特异性的治疗方案，包括目前正在研究中的新方案。了解病理报告的关键特征和DLBCL亚型检测方法的局限性有助于DLBCL的精准治疗。

Diffuse large B-cell lymphoma （DLBCL） is the most common subtype of non-Hodgkin lymphoma in the Western world,and is potentially curable with standard R-CHOP chemoimmunotherapy. We are now in an era that the heterogeneity of DLBCL is defined genetically and molecularly,and rational subset- specific therapeutic targets are guiding clinical triMs.Primary mediastinal DLBCL is a unique clinicopathologic entity, and alternatives to R-CHOP may confer superior outcome. Rearrangement of the myc oncogene occurs in 10 % of patients with DLBCL, and confers a very poor prognosis with standard R-CHOP, particularly when there is concomitant rearrangement of bcl-2, a condition referred to as double-hit DLBCL. A larger subset of DLBCL demonstrates overexpression of both myc and bcl-2 by immunohistochemistry. Analyze the source of cells by gene expression profile, immunohistochemistry algorithms,or a novel Lymph2Cx platform,provides prognostic information, and guides therapeutic decisions in both relapsed and de novo disease. This article reviews latest research presented at the 57th American Society of Hematology （ASH） annual meeting on the definition of specific subsets of DLBCL and selection of subtype-specific treatment,including novel approaches under investigation. Understanding these key features of the pathology report, and limitations of these assays defining subsets of DLBCL, allows for a precision medicine approach to this disease.