自体造血干细胞移植治疗复发难治的双重打击和双重表达淋巴瘤的研究进展

Impact of double-hit and double-expressor phenotypes in relapsed aggressive B-cell lymphomas treated with autologous hematopoietic stem cell transplantation

双重打击淋巴瘤(double-hit lymphomas,DHL)和双重表达淋巴瘤(double-expressor lymphomas,DEL)是弥漫性大B细胞淋巴瘤(DLBCL)的特殊分类,预后极差,是淋巴瘤治疗的一个瓶颈,标准的CHOP(环磷酰胺、多柔比星、长春新碱、泼尼松)联合美罗华方案效果不佳。对于如何治疗DHL和DEL现仍然受到争议,WHO未给出明确的治疗方案。自体造血干细胞移植(autologous hematopoietic stem cell transplantation,a HSCT)自20世纪80年代兴起以来,成为治疗淋巴瘤的标准方案。到20世纪90年代,ASCT能使50%的对化疗敏感的复发侵袭性非霍奇金淋巴瘤(non-hodgkin ymphoma,NHL)患者得到治愈,但如今对于利妥昔单抗诱导治疗后1年内复发的患者,治愈率低至20%。至于什么样的患者适合进行a HSCT、何时进行效果最佳、如何最大程度减少aHSCT的不良反应以及寻找替代aHSCT的治疗方法,需要大规模的临床试验来证实其作用并验证最佳诱导、动员及维持治疗方案,从而指导临床治疗,提高患者预后。本文综述了目前aHSCT治疗DHL和DEL的进展。

Double-hit lymphoma （DHL） and double-expressor lymphomas （DEL） are special classifications of diffuse large B-cell lymphoma （DLBCL） with poor prognosis and difficulty in treatment，the standard CHOP （cyclophosphamide，doxorubicin，vincristine，prednisone） combined with the rituximab seem to be ineffective.WHO does not give a clear treatment regimen.It is still controversial on how to treat DHL and DEL.Autologous hematopoietic stem cell transplantation （aHSCT） has been an important regimen for lymphoma treatment since the 1980s.In the 1990s，aHSCT could cure 50% of relapsed chemosensitive aggressive NHL，now the percentage maybe as low as 20% for patients relapsing within 1 year of completing rituximab-containing induction.As to what kind of patients are suitable for aHSCT？When to perform is the best？How to minimize the adverse effects of aHSCT and to seek alternative for aHSCT？These problems are expected to solve through a large number of clinical trials and guide clinical treatment to improve prognosis.This review concludes the current progress of aHSCT in the treatment of DHL and DEL.