Non-Hodgkin's lymphoma ´ëÀå°æ Á¤¸®
1. B cell lineage
follicular center lymphoma
mantle cell lymphoma
hairy cell leukemia
Burkitt's lymphoma
2. low grade lymphoma
°ñ¼öħ¹üÀº ÈçÇϳª CNS, kidney, testisħ¹üÀº µå¹°´Ù.
3. follicular lymphoma t(14;18) bcl-2
mantle cell lympoma t(11;14) bcl-1, cyclin D1
diffuse large B cell lymphoma t(14;18) 25% bcl-2
t(8;14) myc
3q bcl-6
Burkitt's lymphoma t(8;14), t(2;8), t(8;22)
B cell CLL/SLL trisomy 12(30%) bcl-1
4. lymphoblastic lymphoma = precursor T cell/B cell lymphoblastic lymphoma
: high grade lymphoma
20-30´ë ÀþÀº ³²ÀÚ
Áø´Ü´ç½Ã 90%À̻󿡼 stage III or IVÀÌ°í ¹Ý¼ö¿¡¼ B symptomÀÌ ÀÖ´Ù.
´ë°³ T cell type(80%)
CSF tapping & CNS prophylaxis°¡ ÇÊ¿äÇÏ´Ù(ALL¿¡ ÁØÇÑ Ä¡·á).
5. lymphoma staging¿¡ ÀÖ¾î¼ CSF study°¡ ÇÊ¿äÇÑ °æ¿ì
i) PNS, BM, testis, bone involvement°¡ ÀÖ´Â aggressive lymphoma
ii) Burkitt's lymphoma, lymphoblastic lymphoma
iii) malignant histiocytosis
6. International prognostic index(risk factor)
old age >60
LDH > normal
performance status(ECOG) ¡Ã2
Ann Arbor stage III or IV
extranodal involvement > 1 site
=> 0-1 : low risk group
2 : low-intermediate
3 : high-intermediate
4 : high risk group
7. lymphoma¿¡¼ ¿¹ÈÄ ¹× Àç¹ßÀ» ÃßÀûÇϴµ¥ À¯¿ëÇÑ °Ë»ç: LDH
8. malignant lymphoma¿¡¼ Ãʱ⿡ BM involvement´Â 10-20%¿¡¼ ³ªÅ¸³´Ù.
9. Follicular lymphoma t(14;18) bcl-2 gene°ú ¿¬°ü
small cleaved cell type(mc)
mixed cell type
large cell type => aggressive
´ë°³ widely disseminated disease·Î liver, spleen, BMħ¹üÀÌ ÈçÇÏ´Ù.
±×·¯³ª PB, CNSħ¹üÀº µå¹°´Ù.
40-60%¿¡¼ diffuse large B cell lymphoma·Î ÁøÇàÇÑ´Ù.
<Ä¡·á> localized ds(stage 1,2) RT´Üµ¶
advanced ds(stage 3,4)
10. ÃÖ±Ù follicular lymphomaÀÇ »õ·Î¿î Ä¡·á¹æ¹ýÀ¸·Î monoclonal Ab¸¦ ÀÌ¿ëÇÑ ¹æ¹ýµéÀÌ
Á¦½ÃµÇ°í ÀÖ´Ù. ±× target? CD 20
Anti-B cell(anti-CD20) monoclonal antibodies conjugated to 131-I have shown promising
results with limited follow-up.
11. Mantle cell lymphoma: LN, spleen, liver, GIT & BM
Áø´Ü´ç½Ã 25%¿¡¼ PB ¹ß°ß
GITħ¹ü: multiple intestinal polyposis·Î ¹ßÇöµÇ´Â °æ¿ì°¡ ¸¹´Ù.
1/3¿¡¼ systemic sxÀÌ ³ªÅ¸³´Ù.
Æò±Õ »ýÁ¸Àº 3³â
12. MALToms : marginal zone B cell lymphoma
stomach(H. pylori), thyroid(Hashimoto's thyroiditis), salivary gland(Sjogren's
syndrome), lung, orbitµî¿¡¼ ¹ß»ýÇÒ¼ö ÀÖ´Ù.
13. primary CNS lymphoma
HIV-1 infection, high-dose immunosuppressive therapyÀÇ Áõ°¡·Î ºóµµ°¡ Áõ°¡ÇÔ
¿¹ÈÄ´Â ¸Å¿ì ³ªºü¼ Æò±Õ 12-18°³¿ù, AIDSÀÇ °æ¿ì¿£ 3°³¿ù
RT + preradiation CTx
steroid¿¡ ÀϽÃÀûÀ¸·Î dramatic response¸¦ º¸À̱⵵ ÇÑ´Ù.
14. B-cell CLL/SLL CD23(+)
mantle cell lymphoma CD23(-)
15. nasal T cell lymphoma
CSF studyÇÊ¿äÇϸç Ä¡·á´Â CTx + RTx