Current Issues in Histology, Biology and Prognosis of Hodgkin Lymphoma - - - Aktuelne teme u histologiji i biologiji i prognoza Hočkinovog Limfoma
Journal Title: Acta Facultatis Medicae Naissensis - Year 2017, Vol 34, Issue 2
Abstract
High risk Hodgkin lymphoma patients may occasionally have borderline characteristics similar to gray zone lymphomas and T-cell/histiocyte rich B cell lymphomas. These entities require different and more aggressive treatment modalities. Aggressive behavior is often associated with disturbances caused by Epstein Barr virus, or immune evasion caused by overexpression of check point inhibitors PDL-1 and PDL-2 coupled with the lack of expression of Class I and II MHC molecules. Galectin-1, TARC, sCD163 and other surrogate markers of immunosuppression in Hodgkin lymphoma may be useful for the assess-ment of treatment response. The improvements in lymphoma management diminished the importance of prognostic factors unified in the International Prognostic Scoring system, reducing them from 7 to 3 factors that remained relevant. Interim PET analysis is the only method able to identify resistant patients while chemotherapy is ongoing, thus enabling adjustment of treatment according to the treatment response. Efforts for stratification of patients according to disease histology, biology, microenvironment, clinical scoring systems and PET scan are ongoing. Current breakthroughs have set strong background for novel therapies with monoclonal antibodies and check point inhibitors that will result in improvement of management of high risk patients. - - - Oboleli od Hočkinovog limfoma sa visokim rizikom neretko imaju patohistološke karakteristike entiteta sa graničnim osobinama kao što su limfomi sive zone, ili nehočkinski B ćelijski limfom bogat T ćelijama i histiocitima. Ovi entiteti zahtevaju agresivniji terapijski pristup. Agresivan tok je često posledica infekcije Epštajn-Barovim virusom ili imunskim poremećajem usled hiperekspresije kontrolnih inhibitornih molekula PDL-1 i PDL-2 udruženim sa odsustvom ekspresije MHC molekula I i II klase. Surogat markeri imunosu-presije, kao što su galektin-1, TARC, sCD163 mogu biti korisni za procenu odgovora na terapiju. Napredak u terapiji limfoma je smanjio značaj prognostičkih faktora revidirajući Internacionalni prognostički skoring sistem smanjenjem sa 7 na tri faktora koji su zadržali prediktivnu sposobnost. Istovremena PET analiza tokom terapije je jedina metoda koja može da identifikuje rezistentne bolesnike u toku lečenja, čime je omogućena izmena tretmana u skaldu sa terapijskim odgovorom. Nastojanja za stratifikovanje bolesnika na osnovu histologije, biologije, sastava mikrookoline, kliničkih skoring sistema i PET sken analize i dalje traju. Savremena dostignuća u ovim oblastima postavila su izvanrednu osnovu za primenu novih terapija monoklonskim antitelima i inhibitorima kontrolnih tačaka imunog odgovora, čime su se stekli uslovi za poboljšanje rezultata lečenja visokorizičnih bolesnika.
Authors and Affiliations
Goran Marjanović, Olivera Simonović
Keywords
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- EP ID EP347644
- DOI 10.1515/afmnai-2017-0010
- Views 77
- Downloads 0
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