伴TP53基因突变的套细胞淋巴瘤的治疗进展

套细胞淋巴瘤(MCL)是恶性淋巴系统肿瘤中基因组最不稳定的类型,主要为DNA修复基因发生突变。而其中TP53基因突变是独立于sMIPI评分和Ki-67增殖指数的明确不良预后因素;存在TP53基因突变的患者无法通过含有利妥昔单抗和大剂量阿糖胞苷的强诱导方案和自体造血干细胞移植获得生存受益。虽然伊布替尼是近年来在MCL的治疗中推荐地位不断提高的小分子BTK抑制剂,但并未克服TP53突变的不良预后影响。目前研究表明,新药联合治疗,如BCL-2抑制剂联合伊布替尼或来那度胺、伊布替尼和利妥昔单抗的三联方案或许可以克服TP53基因突变带来的不良预后影响,对该类患者安全有效的治疗方法正在探索中。

伴TP53基因异常的弥漫大B细胞淋巴瘤的研究进展

弥漫大B细胞淋巴瘤(DLBCL)是一种高度异质性的侵袭性恶性肿瘤,影响因素繁多,其中TP53突变被认为是DLBCL预后不良的独立因素,常提示DLBCL对一线免疫化疗不敏感、易表现为难治或复发,也无法通过DA-EPOACH-R等强化化疗方案获得生存受益。目前针对TP53基因异常的形式对DLBCL发病、治疗抵抗机制以及治疗方案的探索仍在继续,已有的研究表明,一些新药的加入,如HDAC抑制剂单药或者联合用药,以及新的治疗策略,如CAR-T细胞治疗等均为伴TP53突变的DLBCL的治疗开辟了新途径。虽然其中一些策略显示了初步的改善效果,对疾病的实际获益以及安全性仍在进一步的探索中。

Potential advantages of a combination of Chinese Medicine and bone marrow mesenchymal stem cell transplantation for removing blood stasis and stimulating neogenesis during ischemic stroke treatment

Combined treatment of ischemic stroke with Chinese medicine and exogenous bone marrow mesenchymal stem cell(BMSC) transplantation may improve the removal of blood stasis and stimulation of neogenesis.Chinese medicines that remove blood stasis not only promote blood circulation but also calm the endopathic wind,remove heat,resolve phlegm,remove toxic substances and strengthen body resistance.The medicinal targeting effect of Chinese medicine can promote the homing of BMSCs,and the synergistic therapeutic effects of drugs can contribute to BMSC differentiation.As such,exogenous BMSC transplantation has potential advantages for neogenesis.Chinese medicines and exogenous BMSCs provide complementary functions for the removal of blood stasis and stimulation of neogenesis.Therefore,a combination of Chinese medicine and transplantation of exogenous BMSCs may be particularly suited to ischemic stroke treatment.