2024-03-20 23:05:47
“Lymphocytes” are distributed throughout the human body, and lymphoma may occur in any organ in the body, with more than half of them originating from lymph nodes (Lymph nodes). There are over a hundred types of lymphoma, which are roughly divided into two categories: Hodgkin lymphoma and Non-Hodgkin lymphoma. The latter includes slow-growing cancer cells. “Low grade lymphoma” (Low grade lymphoma), such as “Follicular lymphoma” (Follicular lymphoma), or “High grade lymphoma” (High grade lymphoma) with rapidly growing cancer cells, such as “Diffuse Large B Cell Diffuse large B cell lymphoma.
60-year-old Mr. Wang found that his left cervical lymph node was swollen. A PET/CT scan showed swollen lymph nodes all over the body and rapid cell growth. A biopsy confirmed that he had diffuse large B-cell lymphadenitis. “Cancer”; “Bone marrow biopsy” showed no cancer cells, indicating it was in the third stage. The doctor prescribes the standard R-CHOP regimen, which includes the anti-B cell CD20 monoclonal antibody “Rituximab” and three chemotherapy drugs: “Adriamycin”, “Vincristine” and “Cyclophosphate” “Cyclophosphamide” (Cyclophosphamide), and adding steroids at the same time, the chance of cure is high. If lymphoma cells have c-myc, bcl-2, or bcl-6 gene mutations, the toxicity will be higher. You can consider switching to the DA-EPOCH-R regimen, which also includes “rituximab” and “doxorubicin” , “vincristine” and three chemotherapy drugs and steroids; the dose of chemotherapy was larger, and an extra chemotherapy drug “Etoposide” was added. Some chemotherapy drugs required 24-hour intravenous drip for four consecutive days. “Polatuzumab” targets the CD79b protein of B cells and can replace the chemotherapy drug “vincristine” in the R-CHOP or DA-EPOCH-R regimen.
The human body’s “Central nervous system” has a protective barrier (Blood brain barrier). The chemotherapy drugs in the R-CHOP and DA-EPOCH-R regimens cannot penetrate into the brain and spinal cord, so they cannot effectively remove the blood brain barrier. Lymphoma cells within the central nervous system. High-risk patients must receive intensive treatment, including intravenous injection of large doses of “Methotrexate”, which can penetrate into the brain and spinal cord, and then use “Folinic acid” as an antidote to reduce side effects. “Intrathecal methotrexate” is another option. It injects “methotrexate” directly into the “Cerebrospinal fluid” (Cerebrospinal fluid), with the goal of reducing the chance of lymphoma recurrence in the “central nervous system” .
(This column is published every other Thursday)
Written by: Dr. Liang Xiansu, Hematologist and Hematology Oncologist
Column name: Medical Qing’s medical sentiment
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Diffuse large B-cell lymphoma – Qingbao – Life Supplement – Column – D240321
Diffuse large B-cell lymphoma – Qingbao – Life Supplement – Column
“Lymphocytes” are distributed throughout the human body, and lymphoma may occur in any organ in the body, with more than half of them originating from lymph nodes (Lymph nodes). There are over a hundred types of lymphoma, which are broadly divided into Hodgkin’s lymphoma
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