【讨论】美罗华在经典型霍奇金淋巴瘤

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结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）典型的免疫表型CD20+, 可以使用美罗华，但是 经典型霍奇金淋巴瘤（c HL）典型的免疫表型是CD20-，能否用美罗华呢？当时心怀疑虑，查了一些文献，确有cHL使用美罗华的，有学者认为，即使cHL中即使CD20-也可使用美罗华，理由是
1. depleting B cells in the microenvironment that may be necessary for survival of the Hodgkin Reed Sternberg (HRS) cell
2.direct killing of HRS cells in the 10–15% ofCD20+ cases of cHL,
3 the possibility that there is a CD20+ HRS stem cell在临床研究方面，美罗华多用于一些复发难治的cHL，多为个案报道，德国有一个14例的研究，Based on the premise that B-cells may play a pathogenic role in AITL, Joly and colleagues recently described their experience with rituximab as an adjunct to CHOP (R-CHOP) in 9 elderly (age >60 years) patients with AITL.Using R-CHOP given at standard doses, they noted CR in 8 of 9 patients, with 1 patient having progressive disease. At a median follow-up of 12 months, they reported 2 relapses at 13 and 14 months, with the 7 remaining patients in continued clinical remission. However, it is noteworthy that 5 of the 9 patients studied also harbored significant numbers of EBV-positive large B-cells and a serum M-protein, suggesting the presence of a B-cell clone that might be uniquely sensitive to rituximab. Their findings have been extended to an ongoing phase II study of the GELA group.
AITL的临床表现往往有比较浓重的免疫异常色彩，如溶血性贫血，多克隆的高γ球蛋白血症等等，在多数病例中(75%)可见EBV（＋）的细胞，但是EBV（＋）的细胞大部分为B细胞，有些研究发现EBV也存在T细胞。EBV的感染率很高，即使有EBV+的B细胞，似乎对还没有标准治疗方案，再有B细胞EBV+和T细胞淋巴瘤有多大直接关系呢？当然有很多做B细胞永生化的就是用EBV进行体外转染的。即使杀掉B细胞，对肿瘤本身有什么好处呢？
cHL使用美罗华？似乎理由不够充分，cHL的RS没有CD20的表达，用美罗华的借口在哪里呢？消灭掉B细胞，理论上切断了肿瘤的细胞来源，但是对于已经瘤变的细胞，有用么？能消除么？如果用R结合其他方案，干掉所有的B细胞，客观上来说，既消灭了来源，又消灭了瘤细胞本身，但是cHL大家戏称如同治感冒一样，需要用那么昂贵的R么？

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资料来源丁香园

qianqiandejia

我们是cd20阳性的经典霍奇金可以用美罗华吗？

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qianqiandejia 发表于 2017-7-27 23:05
我们是cd20阳性的经典霍奇金可以用美罗华吗？

abvd失败的话可以用美罗华