B Hücreli Lenfoma
Özet
B hücreli non Hodgkin lenfomalar düşük dereceli ve yüksek dereceli olmak üzere iki ana grupta değerlendirilir. B-hücreli lenfomalar, histopatolojik olarak birbirinden farklı antitelerden oluşmaktadır. Bu nedenle, tanı aşamasında yeterli doku örneğinin deneyimli bir hematopatolog tarafından değerlendirilmesi ve çoğu olguda moleküler biyolojik yöntemlerin kullanılması büyük önem taşır. Tedavi planlamasında ise dikkatli bir evrelendirme yapılmalı ve hastalar prognostik indekslere göre değerlendirilmelidir. Düşük dereceli lenfomalarda seçilmiş olgular uzun süre tedavisiz takip edilebilmektedir. İlk basamak tedavide monoklonal antikorlar (genellikle rituksimab), kemoterapi ve lokal kontrolün gerekli olduğu durumlarda radyoterapi tercih edilmektedir. Yüksek dereceli lenfomalarda tedavi genellikle kemoterapi monoklonal antikor (genellikle rituksimab) içerem kombinasyonları kapsamaktadır. Tedaviye yanıt vermeyen primer dirençli hastalarda yeni kimerek antijen reseptör T-hücre (CAR T-Cell) tedaviler kullanılmaktadır. 12 aydan sonra nüks eden hastalarda ise, salvage kemoterapisi sonrası otolog hematopoetik hücre transplantasyonu önerilmektedir Özellikle ilk 2 yıl, nükslerin en sık görüldüğü dönemde 3 aylık kontroller önerilir. Kontroller sırasında, öykü, fizik muayene, laboratuvar tesleri ( tam kan sayımı, biyokimya, Laktat dehidrogenaz) ve klinik şüphe durumdan görüntüleme yapılması önemlidir. Yüksek dereceli lenfomalarda, nükslerin çoğu semptomatik olarak ortaya çıkar ve rutin görüntüleme yöntemleriyle tespitten önce fark edilir. Radyasyon maruziyeti ve sekonder malignite riskini azaltmak amacıyla rutin görüntüleme yapılmasından kaçınılması önerilmektedir. Ancak, bu hastaların indolent lenfomalara kıyasla daha yakın takibe alınması gereklidir.
B-cell non-Hodgkin lymphomas are classified into two main categories: low-grade and high-grade. B-cell lymphomas consist of different antibodies histopathologically. Therefore, it is crucial to ensure that adequate tissue samples are evaluated by an experienced hematopathologist and, in most cases, molecular biological methods are employed during the diagnostic phase. In treatment planning, careful staging should be performed, and patients should be assessed based on prognostic indices. In low-grade lymphomas, selected cases can be followed for extended periods without treatment. First-line treatment typically includes monoclonal antibodies (usually rituximab), chemotherapy, and, when local control is necessary, radiation therapy. In high-grade lymphomas, treatment generally involves combinations of chemotherapy and monoclonal antibodies (typically rituximab). In patients who are primary refractory and do not respond to treatment, new therapies such as Chimeric Antigen Receptor T-cell (CAR T-cell) therapy are utilized. In patients with relapse after 12 months, autologous hematopoietic cell transplantation is recommended following salvage chemotherapy. During the first two years, which is the period with the highest relapse rates, 3-monthly follow-ups are advised. During follow-up, patient history, physical examination, laboratory tests (complete blood count, biochemistry, lactate dehydrogenase), and imaging should be performed in cases of clinical suspicion. In high-grade lymphomas, most relapses present symptomatically and are detected before routine imaging methods. It is recommended that caution be exercised in routine imaging to minimise the risks of radiation exposure and secondary malignancy. However, these patients require closer monitoring compared to those with indolent lymphomas.
Referanslar
Müller, Antonia MS, et al. "Epidemiology of non-Hodgkin’s lymphoma (NHL): trends, geographic distribution, and etiology." Annals of hematology 84 (2005): 1-12.
Matsuo, Koji, et al. "Assessment of severe maternal morbidity and mortality in pregnancies complicated by cancer in the US." JAMA oncology 8.8 (2022): 1213-1216.
Gloeckler Ries, Lynn A., et al. "Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program." The oncologist 8.6 (2003): 541-552.
Armitage, James O., and Dennis D. Weisenburger. "New approach to classifying non-Hodgkin's lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin's Lymphoma Classification Project." Journal of Clinical Oncology 16.8 (1998): 2780-2795.
Freedman, Arnold S., et al. "Clinical presentation and initial evaluation of non-Hodgkin lymphoma." UpToDate [Internet]. Waltham, Mass.: UpToDate (2020).
Mackay, Donald R. "Commentary on: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Review of Epidemiology and Prevalence Assessment in Europe." Aesthetic Surgery Journal 41.9 (2021): 1026-1028.
Higdon, Mark L., Charles J. Atkinson, and Kelley V. Lawrence. "Oncologic emergencies: recognition and initial management." American family physician 97.11 (2018): 741-748.
Ansell, Stephen M., and James Armitage. "Non-Hodgkin lymphoma: diagnosis and treatment." Mayo Clinic Proceedings. Vol. 80. No. 8. Elsevier, 2005.
Alaggio, Rita, et al. "The 5th edition of the World Health Organization classification of haematolymphoid tumours: lymphoid neoplasms." Leukemia 36.7 (2022): 1720-1748.
Cheson, Bruce D., et al. "Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification." Journal of clinical oncology 32.27 (2014): 3059-3067.
Schaefer, Niklaus G., et al. "Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging—do we need contrast-enhanced CT?." Radiology 232.3 (2004): 823-829.
Weiler-Sagie, Michal, et al. "18F-FDG avidity in lymphoma readdressed: a study of 766 patients." Journal of Nuclear Medicine 51.1 (2010): 25-30.
Khan, Anjum Bashir, et al. "PET-CT staging of DLBCL accurately identifies and provides new insight into the clinical significance of bone marrow involvement." Blood, The Journal of the American Society of Hematology 122.1 (2013): 61-67.
Sehn, Laurie H., et al. "The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP." Blood 109.5 (2007): 1857-1861.
Bittenbring, Jörg Thomas, et al. "Vitamin D deficiency impairs rituximab-mediated cellular cytotoxicity and outcome of patients with diffuse large B-cell lymphoma treated with but not without rituximab." Journal of Clinical Oncology 32.29 (2014): 3242-3248.
Bruns, Heiko, et al. "Vitamin D–dependent induction of cathelicidin in human macrophages results in cytotoxicity against high-grade B cell lymphoma." Science translational medicine 7.282 (2015): 282ra47-282ra47.
Çetintepe T, Acar C, Solmaz Ş. (2018). Non-Hodgkin Lenfoma Tanılı Hastalarımızın Retrospektif Değerlendirilmesi. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi, 22(3), 119-124.
Isikdogan A, Ayyıldız O, Büyükçelik A, Arslan A, Tiftik N, Buyukbayram H. et al. (2004). NonHodgkin’s lymphoma in southeast Turkey: clinicopathologic features of 490 cases. Annals of Hematology, 83(5), 265-269.
Davids, Matthew S., and D. C. Fisher. "Overview of care for adult survivors of non-Hodgkin lymphoma." 2012,
Schuster, Stephen J., et al. "Chimeric antigen receptor T cells in refractory B-cell lymphomas." New England Journal of Medicine 377.26 (2017): 2545-2554.
Zucca, E., et al. "Marginal zone lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up✰." Annals of oncology 31.1 (2020): 17-29.
Else, Monica, et al. "Rituximab, used alone or in combination, is superior to other treatment modalities in splenic marginal zone lymphoma." British journal of haematology 159.3 (2012): 322-328.
Poeschel, Viola, et al. "Four versus six cycles of CHOP chemotherapy in combination with six applications of rituximab in patients with aggressive B-cell lymphoma with favourable prognosis (FLYER): a randomised, phase 3, non-inferiority trial." The Lancet 394.10216 (2019): 2271-2281.
Tilly, Hervé, et al. "Polatuzumab vedotin in previously untreated diffuse large B-cell lymphoma." New England Journal of Medicine 386.4 (2022): 351-363.
Kamdar, Manali, et al. "Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial." The Lancet 399.10343 (2022): 2294-2308.
Locke, Frederick L., et al. "Axicabtagene ciloleucel as second-line therapy for large B-cell lymphoma." New England Journal of Medicine 386.7 (2022): 640-654.
Swerdlow, Steven H., et al. "The 2016 revision of the World Health Organization classification of lymphoid neoplasms." Blood, The Journal of the American Society of Hematology 127.20 (2016): 2375-2390.
Mansour, Nagat. "The Comparative analysis of PET/CT and Contrast CT in the Evaluation of Patients with Lymphoma." Egyptian Journal Nuclear Medicine 3.3 (2010): 8-17.
Landsburg, Daniel J., et al. "Outcomes of patients with double-hit lymphoma who achieve first complete remission." Journal of Clinical Oncology 35.20 (2017): 2260-2267.
Cheson, Bruce D., et al. "Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas." Journal of clinical oncology 17.4 (1999): 1244-1244.
Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 2007;25:571-578.
Cheson, Bruce D., et al. "Revised response criteria for malignant lymphoma." Journal of clinical oncology 25.5 (2007): 579-586.
Meignan M, Gallamini A, Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on Interim-PETScan in Lymphoma. Leuk Lymphoma 2009;50:1257-1260.
Mütevelizade GY. Lenfomalarda Tedavi Yanıtının Değerlendirilmesinde PET/BT. Nucl Med Semin. 2021 Jul;7(2):177-186. doi:10.4274/nts.galenos.2021.0017.
Younes, Anas, et al. "International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017)." Annals of Oncology 28.7 (2017): 1436-1447.
Berzaczy, Dominik, et al. "RECIL versus Lugano for treatment response assessment in FDG-avid non-Hodgkin lymphomas: a head-to-head comparison in 54 patients." Cancers 12.1 (2019): 9.
Rigacci L, Puccini B, Broccoli A, et al. Clinical characteristics of interim-PET negative patients with a positive end PET from the prospective HD08-01 FIL study. Ann Hematol 2020;99:283-291
Zaman MU, Fatima N, Zaman A, Zaman U, Zaman S, Tahseen R. Progression Free Survival and Predictor of Recurrence in DLBCL patients with Negative Interim 18FDG PET/CT Using Standardized Imaging and Reporting Protocols. Asian Pac J Cancer Prev 2020;21:2343-2348.
Tokola, Susanna, et al. "Interim and end‐of‐treatment PET‐CT suffers from high false‐positive rates in DLBCL: Biopsy is needed prior to treatment decisions." Cancer Medicine 10.9 (2021): 3035-3044.
Cheson, Bruce D., et al. "Revised response criteria for malignant lymphoma." Journal of clinical oncology 25.5 (2007): 579-586.
Zijlstra, Josée M., et al. "18F-fluoro-deoxyglucose positron emission tomography for post-treatment evaluation of malignant lymphoma: a systematic review." Haematologica 91.4 (2006): 522-529.
Terasawa, Teruhiko, et al. "18F-FDG PET for posttherapy assessment of Hodgkin's disease and aggressive Non-Hodgkin's lymphoma: a systematic review." Journal of Nuclear Medicine 49.1 (2008): 13-21.
Armitage, James O., et al. "Non-hodgkin lymphoma." The lancet 390.10091 (2017): 298-310.
Poulou, Loukia S., Loukas Thanos, and Panayiotis D. Ziakas. "Unifying the predictive value of pretransplant FDG PET in patients with lymphoma: a review and meta-analysis of published trials." European journal of nuclear medicine and molecular imaging 37 (2010): 156-162.
Schöder, Heiko, et al. "Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin’s lymphoma." Journal of Clinical Oncology 23.21 (2005): 4643-4651.
Meignan, Michel. "VI. FDG-PET as a biomarker in lymphoma: from qualitative to quantitative analysis." Hematological Oncology 33 (2015): 38-41.
Guo, Baoping, et al. "Prognostic value of baseline metabolic tumor volume and total lesion glycolysis in patients with lymphoma: a meta-analysis." PloS one 14.1 (2019): e0210224.
Davids, Matthew S., and D. C. Fisher. "Overview of care for adult survivors of non-Hodgkin lymphoma." 2012.
