16例非霍奇金淋巴瘤合并乙肝病毒感染患者化疗发生肝功能损害的探讨

非霍奇金淋巴瘤是一种起源于淋巴造血组织的实体瘤,化疗是治疗非霍奇金淋巴瘤的主要手段之一。但是临床上非霍奇金淋巴瘤患者常感染HBV(乙肝病毒),化疗后出现肝功能损害,甚至出现重症肝炎。为了探讨非霍奇金淋巴瘤合并HBV感染患者化疗发生严重肝功能损害的防治,我们选择2004至2005年武汉大学中南医院放化疗科和孝感市中心医院肿瘤科收治的16例非霍奇金淋巴瘤患者进行回顾性研究,现报告如下。一、资料与方法1.一般资料:本组16例均为经病理组织证实的非霍奇金淋巴瘤患者,呈中高度恶性,分期为Ⅱ~Ⅳ期。男10例,女6例。年龄35~62岁,中位年龄42…     

HBsAg阴性HBcAb阳性肿瘤患者化疗后HBV再激活3例报道并文献复习

目的：探讨乙肝表面抗原（HBsAg）（-）核心抗体（HBcAb）（+）肿瘤患者化疗后引起乙型肝炎病毒（HBV）再激活的治疗与监控。方法：报道3例HBsAg（-）HBsAg（+）的肿瘤患者化疗过程中出现HBV再激活的病例,针对可行的治疗监控措施进行文献复习。结果：1例最初乙肝表面抗体（HBsAb）（+）、HBcAb（+）的非霍奇金淋巴瘤（NHL）患者经过多次化疗后转变为HBsAg（+）、e抗原（HBeAg）(+)、HBcAb（+）;1例乙肝e抗体（HBsAb）（+）、HBcAb(+)的霍奇金淋巴瘤（NL）患者化疗后乙肝模式未改变,乙肝病毒载量（HBV-NDA）定量结果增高;1例HBsAb(+)、HBeAb(+)、HBcAb(+)的肝癌患者性肝动脉化疗栓塞术（TACE）后出现HBV-DNA定量结果增高。3例HBsAg(-)患者化疗后均出现HBV再激活,经抗病毒治疗后获得良好转归。结论：不仅对于HBsAg（+）的患者,对于即使处于康复期的既往有急性或慢性乙肝病史的HBsAg(-)、HBcAb（+）患者,在应用化疗或免疫抑制剂治疗时均需严密监测血清HBsAg、肝功能及HBV-DNA定量的动态变化,必要时实施预防性抗病毒治疗,以免中止原有治疗计划延误病情。     

感染乙肝病毒的非霍奇金淋巴瘤化疗方案的研究

目的杂乙肝病毒（HBV）的非霍奇金淋巴瘤患者的化疗方案。方法回顾性分析96例非霍奇金淋巴瘤（NHL）及39例感染乙肝病毒的其它实体瘤（肝癌除外）患者化疗后肝损害及乙型肝炎的发生情况。结果经过2个周期正规化疗后，HBV阳性的NHL患者经化疗后肝损害发生率为52．2％（12／23），HBV阴性的NHL患者后肝损害发生率23／3％（17／73），P＜0．01；HBV阳性的NHL患者用含有类因醇激素方案化疗后乙直炎发生率39．1％（9／23），HBV阳性的其它实体瘤（肝癌除外）患者用不含类固醇激素方案化疗后乙型肝炎发生率12．8％（5／39），P＜0．05／。结论HBV阳性的NHL患者化疗后易发生肝损害及乙型肝炎，故在化疗时应尽量避免选用含皮质激素的方案。     

利妥昔单抗联合化疗治疗非霍奇金淋巴瘤19例

 【摘要】 目的 探讨利妥昔单抗联合化疗治疗非霍奇金淋巴瘤（NHL）的临床效果及患者不良反应。 方法 回顾性分析了2005年8月至2011年1月应用利妥昔单抗联合化疗治疗19例NHL住院患者的临床资料。结果 1例患者因不能耐受过敏反应停用,1例老年患者使用1个周期后死于混合感染。17例可评价疗效患者中,完全缓解（CR）10例（58.8 %）,部分缓解（PR）4例（23.5 %）,总有效率 82.3 %。结论 利妥昔单抗联合化疗治疗NHL的疗效显著,不良反应未见明显增加,但乙肝病毒（HBV）携带者可引起HBV复燃,需使用抗病毒药物,可增加老年患者感染概率,使用时需慎重。     

乙型肝炎病毒表面抗原阴性伴核心抗体阳性非霍奇金淋巴瘤患者免疫化疗后肝炎病毒再激活的临床分析

目的探讨乙型肝炎病毒(HBV)表面抗原(HBs Ag)阴性(-)伴核心抗体(Hbc Ab)阳性(+)非霍奇金淋巴瘤患者免疫化疗后肝炎病毒再激活的临床意义。方法选择2005年1月至2012年1月间就诊并接受2个以上疗程免疫化疗的HBs Ag(-)伴HBc Ab(+)非霍奇金淋巴瘤患者105例为研究对象,对其予以含利妥昔单抗的免疫化疗,观察免疫化疗后HBV再激活的发生情况。结果 105例HBs Ag(-)伴HBc Ab(+)非霍奇金淋巴瘤患者中,HBV表面抗体(HBs Ab)(+)者67例,占63.8%。105例患者中,肝功能损害Ⅰ~Ⅲ度者13例,其中1例患者出现了HBV再激活(1.0%),12例证实与HBV再激活引起肝损害无关。1例出现了HBV再激活患者为男性、50岁,病理组织学提示为非霍奇金氏淋巴瘤,弥漫大B细胞性,在4次化疗后10 d发生HBV再激活,经治疗后病情好转。结论 HBs Ag(-)伴HBc Ab(+)淋巴瘤患者免疫化疗后肝炎病毒再激活的临床发生率相对较小,目前对该类患者仍以常规HBV DNA检查、肝功能监测为主,以便更早的发现HBV携带者及感染者。     

小儿原发性胃肠道非霍奇金淋巴瘤5例报告并文献复习

目的：对5例原发性胃肠道非霍奇金淋巴瘤（NHL）引发急腹症的临床资料进行分析,讨论其临床病理特点及手术效果。方法：收集2001年1月-2006年5月我院收治的5例原发性胃肠道非霍奇金淋巴瘤引发急腹症的病例,结合文献对其临床表现、诊断、治疗及预后等进行总结分析。结果：5例均为经病理、免疫组化等检查确诊的胃肠道非霍奇金淋巴瘤,其中肠梗阻2例,肠套叠3例（其中回结型2例,节结型1例）;病理免疫类型：5例均为B细胞性非霍奇金氏淋巴瘤。5例均急诊行手术治疗,1例术中死亡,术后辅以联合化疗,方案为COP或CHOP。4例可随访,随访率80%。结论：小儿胃肠道非霍奇金淋巴瘤以B细胞性最多见,本病术前诊断率较低,往往以急腹症就诊。完整手术切除是NHL的治疗关键,术后辅以化（放）疗及综合性治疗措施,可以提高患者生存期。     

拉米夫定预防B细胞非霍奇金淋巴瘤患者利妥昔单抗化疗后乙型肝炎病毒再激活的临床分析

 【摘要】　目的　研究利妥昔单抗联合化疗治疗B细胞非霍奇金淋巴瘤（B-NHL）合并乙型肝炎病毒（HBV）携带患者的安全性,探讨拉米夫定预防性治疗的价值。方法　回顾性分析含利妥昔单抗联合化疗前后B-NHL患者乙型肝炎五项、HBV-DNA和肝功能指标变化。将39例HBV核心抗体（HBcAb）（+）／HBV表面抗体（HBsAb）（-）的B-NHL患者分为拉米夫定预防组和对照组,比较两组化疗后HBV再激活、肝功能损害等指标。结果　108例接受利妥昔单抗联合化疗的B-NHL患者中,15例患者为HBV表面抗体（HBsAg）（+）,占所有患者的13.89 %;39例为HBsAg（-）／HBcAb（+）患者,占所有患者的36.11 %。15例HBsAg（+）的患者中HBV再激活率为13.3 %,13例拉米夫定预防患者中1例（7.7 %）HBV再激活,2例未预防的患者中1例HBV再激活。39例HBsAg（-）／HBcAb（+）患者中HBV再激活率为7.7 %（3例）,14例拉米夫定预防组HBV再激活率为0,25例未预防的患者中3例（12 %）HBV再激活。结论　B-NHL合并HBV携带患者在利妥昔单抗联合化疗导致HBV再激活的风险是可控的,预防性使用拉米夫定能明显降低HBV再激活。     

感染乙肝病毒的恶性淋巴瘤应用拉米夫定预防性治疗的临床观察

目的探讨感染乙肝病毒的非霍奇金淋巴瘤患者化疗前预防应用拉米夫定在降低HBV再激活、减少肝功能损害方面的作用。方法 21例感染HBV的NHL接受CHO方案化疗4～6周期及预防应用拉米夫定抗病毒治疗（A组）,69例NHL接受CHOP方案化疗4～6周期（B组）。结果 A组CR率为38.1%（8/21）,B组CR率为42.0%（29/69）（P=0.2579）;A组有19.0%（4/21）化疗后肝功能损害,B组有14.5%（10/69）化疗后肝功能损害（P=0.0725）;A、B组均未发生HBV再激活。结论感染HBV的NHL应用CHO联合方案治疗及在化疗前预防抗病毒治疗能明显降低HBV再激活、减少肝功能损害。     

非霍奇金淋巴瘤患者化疗后肝功能损害与乙肝病毒标志物的相关性分析

目的探讨非霍奇金淋巴瘤患者化疗期间肝功能损害与乙肝病毒（HBV）标志物阳性表达的相关性。方法 65例非霍奇金淋巴瘤患者,其中乙肝病毒阳性32例,均采用EPOCH方案化疗。结果乙肝病毒阳性非霍奇金淋巴瘤患者,化疗期间肝功能损害较乙肝病毒阴性者明显,肝功能损害总体发生率为46.9%VS18.2%,P值=0.013,差异有统计学意义。合并乙肝大三阳或乙肝小三阳者Ⅲ～Ⅳ度肝功能损害发生率较高,达33.3%,无化疗相关死亡病例。结论乙肝病毒阳性非霍奇金淋巴瘤患者化疗后肝功能损害发生率较乙肝病毒阴性者高。乙肝大三阳、乙肝小三阳患者尤其明显。建议非霍奇金淋巴瘤患者化疗前进行乙肝两对半检查,并监测肝功能。     

DICE方案解救治疗侵袭性非霍奇金淋巴瘤的临床观察

目的：观察DICE方案解救治疗23例侵袭性非霍奇金淋巴瘤的客观缓解率和不良反应。方法：23例复发、难治的侵袭性非霍奇金淋巴瘤患者接受DICE方案治疗2周期,观察客观缓解率和主要不良反应。结果：23例患者总有效率65．2％,CR6例（26．1％）,PR9例（39．1％）。IPI为2分的低中危组5例,IPI为3分的高中危组11例,IPI为4—5分的高危组7例。3组RR分别为100％、72．7％、57．1％。骨髓毒性Ⅲ至Ⅳ度为8例（34．8％）。结论：复发、难治的侵袭性非霍奇金淋巴瘤采用DICE方案解救治疗是安全、有效的。     

原发胃肠道非霍奇金淋巴瘤的研究现状

胃肠道是原发结外非霍奇金淋巴瘤（non-Hodgkin's lymphoma,NHL）最常见的发病部位,发病率逐年上升。虽然结内非霍奇金淋巴瘤的治疗模式已标准化,但是对于原发胃肠道非霍奇金淋巴瘤的治疗仍存在争议。手术、化疗、放疗等治疗方式可单独应用,或以不同组合联合应用,最佳治疗模式目前尚无定论,且影响原发胃肠道非霍奇金淋巴瘤预后的因素较多。现对原发胃肠道非霍奇金淋巴瘤的发病率、临床特点、组织学分类、治疗方案及预后进行综述,重点探讨该病的治疗及预后。     

侵袭性B细胞淋巴瘤新的标准治疗方案

实施CHOP方案(环磷酰胺、阿霉素、长春新碱和泼尼松)治疗20多年来,侵袭性B细胞淋巴瘤已成为可治愈的疾病,CHOP方案也已成为治疗这一疾病的标准方案。但其治愈率只有35%~40%,半数以上复发。随着抗B细胞表面抗原CD20的人鼠嵌合型单克隆抗体利妥昔(rituximab)的应用,侵袭性B细胞淋巴瘤的治疗已发生了根本改变。多项大型Ⅲ期随机临床研究结果证实,利妥昔与CHOP方案或CHOP样方案联合应用,比单纯联合化疗能明显改善侵袭性B细胞淋巴瘤的有效率,无事件生存和长期生存结果,无论是老年或年轻患者,低危预后还是高危预后患者,均有显著的统计学差异。因此,利妥昔加CHOP或CHOP样方案的联合治疗已成为侵袭性B细胞淋巴瘤新的标准治疗方案。     

Acute promyelocytic leukemia following treatment of non-Hodgkin's lymphoma

A case of acute promyelocytic leukemia (APL) 3 years following the treatment of diffuse mixed non-Hodgkin's lymphoma (NHL) is presented. This is the second time APL after NHL has been reported in the literature.     

AA-type amyloid tumor as an unsuspected cause of residual mass in a patient with large B-cell non-Hodgkin's lymphoma

Amyloidosis is a rare complication of non-Hodgkin's lymphoma (NHL). AL amyloid deposits are usually localized in areas adjacent to the lymphoma, despite the presence of circulating light chains. However, AA-type amyloidosis is extremely unfrequent as a residual mass in patients with NHL. We report a case with diffuse large B-cell non-Hodgkin's lymphoma in which a residual tumoral mass corresponding to AA-type amyloidosis was found.     

Late relapse with nodular lymphoma after treatment for diffuse non-Hodgkin's lymphoma

Histologic conversion from a low-grade non-Hodgkin's lymphoma (NHL) into a more aggressive histologic pattern is a common, well-documented event in NHL. The converse phenomenon, appearance of a low-grade, follicular NHL after treatment for diffuse, intermediate, or high-grade NHL, has only recently been recognized. The clinical, morphologic, and immunologic features of a patient in whom relapse with an indolent nodular lymphoma was noticed after combination chemotherapy for diffuse lymphoma are presented. Immunologic markers at presentation and relapse were similar. Other previously reported cases are reviewed. Implications for diagnosis and therapy as well as the pathogenesis of this unique form of conversion are discussed.     

Combined chemotherapy in 76 children with non-Hodgkin's lymphoma excluding Burkitt's lymphoma

From January 1983 to December 1986 seventy-six previously untreated children with non-Hodgkin's lymphoma (NHL) were treated by combination chemotherapy. Burkitt's lymphoma patients were ineligible. The treatment regimens include intermittent chemotherapy and for non-localized patients, prophylactic central nervous system chemotherapy. Intrathoracic non-Hodgkin's lymphoma patients also had cranial prophylactic radiotherapy. Sixty-six patients (86.8%) achieved complete remission. Two year failure-free survival rate was 82.1% for localized (stage I and II) NHL and 53.3% for non-localized (stage III and IV) NHL patients. Failure-free survival did not differ significantly for the two major histologic diagnoses, but two year survival rate was lower in diffuse poorly differentiated lymphoblastic than undifferentiated non-Burkitt's lymphoma (50% versus 66.8% respectively). Failure-free survival rate was 53.7% in mediastinal disease and, 73.2% in abdominal disease at 24 months. Relapse rate was higher in mediastinal cases (46.1%) than primary abdominal cases (24.3%) at 24 months. Eleven (13.5%) died of treatment related sepsis. Although the overall survival rate was 72.4% at 2 years we need novel or more intensive programmes for mediastinal and non-localized disease.     

Yttrium 90 ibritumomab tiuxetan in lymphoma

Radioimmunoconjugates are radioisotope-bound monoclonal antibodies that target radiation specifically to sites of lymphoma involvement. Initial studies of 90Y-ibritumomab tiuxetan in non-Hodgkin's lymphoma (NHL) have suggested benefit in patients with relapsed or refractory indolent disease. However, the routine adoption of this agent is tempered by concerns of associated toxicities and unclear long-term benefit. A comprehensive search for studies on 90Y-ibritumomab tiuxetan use in lymphoma was completed. The aims of this systematic review were to summarize and evaluate the evidence on: (1) the benefits and risks of this novel therapy; (2) predictors for response and toxicity; and (3) the role of dosimetry and imaging studies prior to treatment. A total of twenty trials investigating the use of 90Y-ibritumomab tiuxetan for the treatment of adult patients with NHL were identified. In trials of patients with relapsed or refractory indolent NHL, overall response rates ranged from 67 - 83%. In patients with follicular NHL refractory to the monoclonal antibody, rituximab, response rates remained high (74%). However, in rituximab-na?ve patients with relapsed or refractory indolent or transformed NHL, the higher response rate seen with 90Y-ibritumomab tiuxetan therapy compared to rituximab monotherapy has not translated into clear improvements in time-to-progression or survival. 90Y-ibritumomab tiuxetan is an active agent in relapsed and refractory non-Hodgkin's lymphoma that should be considered in select patients.     

Non-Hodgkin's lymphoma of the ocular adnexa

This study investigates the relationship between the clinical features of lymphoma in the ocular adnexal region and the revised European and American lymphoma (REAL) classification. Specimens from 41 patients with ocular adnexal lymphoproliferative disease were reassessed pathologically using the REAL classification. Thirty-two patients with primary non-Hodgkin's lymphomas (NHL) were included in the study, almost all of them having been treated with radiotherapy with or without chemotherapy. Seven of the 32 patients with NHL showed distant recurrence after treatment: 3 out of 26 with extranodal marginal zone B-cell lymphoma, and 4 with other types of NHL. Although the three patients with recurrent marginal zone B-cell lymphomas all survived, other patients with recurrent lymphomas died of disease. The REAL classification provides a good indication of tumor control probability and survival of patients with ocular adnexal NHL. Radiation therapy is an effective treatment modality for extranodal marginal zone B-cell lymphoma of the ocular adnexa.     

滤泡性淋巴瘤研究进展

滤泡性淋巴瘤(FL)起源于生发中心B细胞,是我国最常见的惰性B细胞非霍奇金淋巴瘤(NHL),目前仍是一种不可治愈的疾病.在第59届美国血液学会(ASH)年会上,FL为NHL领域报道最多的亚型.目前FL的研究热点为诱导后维持治疗、新药联合诱导治疗及维持治疗、去化疗治疗FL以及寻找新的预后生物学标志.     

Radiotherapy as salvage treatment in patients with Hodgkin's disease or non-Hodgkin's lymphoma relapsing after initial chemotherapy

The prognosis of relapsing Hodgkin's disease (HD) and high grade aggressive non-Hodgkin's lymphoma (NHL) is generally poor since many of these patients fail to respond to second line chemotherapy. Radiation therapy has been reported as an effective but seldom used, alternative treatment. We have observed very encouraging results with salvage radiotherapy in a highly selected group of eight lymphoma patients (six with HD and two with high grade NHL), suffering mainly from nodal relapse. The literature on the use of radiation therapy after chemotherapy failures in HD and NHL is reviewed.