第二届NCCN亚洲学术会议恶性淋巴瘤.pptVIP

绝大多数MCL（套细胞淋巴瘤）可见t（11;14)染色体易位导致的细胞周期蛋白D1（cyclinD1）表达失调。也见于多发性骨髓瘤。诊断MCL要求cyclinD1表达。cyclinD1表达是鉴别CLL与MCL最可靠的标志。对于免疫表型不典型（CD23弱阳性或阴性）的CLL病例，应考虑应用免疫组化法检测cyclinD1或用荧光原位杂交（FISH)技术进行细胞遗传学分析检测t（11;14)。 cyclinD1表达分析也有助于确诊形态学考虑为MCL而免疫表型显示CD5-或CD23+的病例。 在90%的FL和约20%的DLBCL病例中可测到t（14；18）易位导致的BCL2过表达。但BCL2表达也常见于其他类型的淋巴瘤，因而不能作为诊断FL的可靠依据。 CD10表达有助于鉴别FL和MCL。 HCL毛细胞淋巴瘤（CD103+) MZL（边缘区B细胞淋巴瘤）包括：结外MZL（MALT淋巴瘤）、淋巴结MZL和脾MZL（累及脾和骨髓）。MALT又细分为胃的和非胃的淋巴瘤。 免疫表型有助于鉴别MZL与慢性淋巴细胞白血病（CD5+)、套细胞淋巴瘤（CD5+)、毛细胞白血病（annexin-1和CD103+)。 * * * * * 一些病例在停用利妥昔单抗后发生了病毒感染，最长间隔时间可达1年。 * * * * Hepatitis B prophylaxis in patients undergoing chemotherapy for lymphoma: A decision analysis model. AU Saab S; Dong MH; Joseph TA; Tong MJ SO Hepatology. 2007 Aug 6;46(4):1049-1056. ? ? Hepatitis B reactivation is a major cause of morbidity and mortality in patients undergoing chemotherapy for lymphomas. These patients may experience direct liver-related complications or reduced cancer survival because of interruptions in chemotherapy. Our aim was to compare the costs and outcomes of 2 different chronic hepatitis B management strategies. In hepatitis B carriers undergoing chemotherapy, we pursued a decision analysis model to compare the costs and clinical outcomes of using lamivudine prophylaxis versus initiating lamivudine only when clinically overt hepatitis occurred. Our results indicate that the use of lamivudine prophylaxis is cost-effective. Even though the use of lamivudine prophylaxis was associated with an incremental cost of $1530 per patient ($18,707 versus $17,177), both the number and severity of hepatitis B reactivations were reduced. None of the patients in the prophylaxis group had liver-related deaths versus 20 who died in the no-prophylaxis group. Cancer deaths were also reduced from 47-39 with lamivudine prophylaxis, presumably because of the increased need for cessation or modification of chemotherapy in patients who had severe hepatitis B virus flares. The incremental cost-effectiveness ratio of usin