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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¿¡ À־ 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