A paper counts the treatment of N-lazy B cells for non-Hodgkin's lymphoma.

Author: Du Du Ma, this article is authorized by the author to release yimaitong. Please do not reprint without authorization.lymphoma can be divided into Hodgkin's lymphoma (HL) and non Hodgkin's lymphoma (NHL). NHL can be divided into B-NHL and T / nk-nhl according to cell origin. B-NHL can be divided into inert B-NHL and invasive B-NHL according to clinical characteristics.as we all know, aggressive B-NHL requires immediate treatment regardless of stage and prognosis. However, most inert B-NHL patients need to evaluate whether they have treatment indications after diagnosis. If there are no treatment indications, select "watch and wait" (i.e. observation and wait), and start treatment after patients have treatment indications.this article will review the treatment indications of common clinical inert B-NHL, in order to learn with you. If there are mistakes or incomplete points, we hope you will not hesitate to point out.indications for the treatment of chronic lymphoblastic leukemia (CLL), after the diagnosis of CLL, it is not the choice of treatment, but whether the patient needs treatment.both the Chinese CLL guidelines and the latest NCCN guidelines [1-2] emphasize that CLL patients should be treated with one of the following indications: evidence of progressive bone marrow failure, progressive reduction of hemoglobin and / or platelets; megaspleen (e.g., under the left costal margin & gt; The results showed that LDT could not be used as the treatment indication when the initial lymphocyte count was less than 30 × 109 / L; massive lymphadenopathy (such as the longest diameter > 10 cm) or progressive or symptomatic lymphadenopathy; progressive increase in the number of lymphocytes (e.g., 50% increase within 2 months) or lymphocyte doubling time (LDT) < 6 months; when the initial lymphocyte count was less than 30 × 109 / L, LDT could not be used as the treatment indication When the cell count is more than 200 × 109 / L, or there is white blood cell stasis; when autoimmune hemolytic anemia (AIHA) and / or immune thrombocytopenia (ITP) do not respond to corticosteroids or other standard treatment; there are at least one of the following disease-related symptoms, such as weight loss ≥ 10% without obvious cause within 6 months before diagnosis, severe fatigue and no evidence of infection Fever ＞ 38 ℃, ≥ 2 weeks, no evidence of infection, night sweats > 1 month.indications for the treatment of follicular lymphoma (FL), at present, the treatment of FL patients is first differentiated according to the pathological grade, among which the treatment of FL 3B patients refers to the treatment of diffuse large B-cell lymphoma (DLBCL); and FL At present, there are some controversies about the treatment of 3A patients. According to the clinical characteristics of patients, some guidelines recommend the treatment of DLBCL, some recommend the treatment of FL 1-2; and for FL, the treatment of DLBCL is recommended At present, the domestic and foreign guidelines for patients with grade 1-2 are mainly based on the clinical stage. For patients with stage III - IV FL, we should evaluate whether the patients have treatment indications [3-5].different guidelines for the treatment of advanced FL 1-2 patients vary slightly, as detailed below.at present, NCCN guidelines and ESMO guidelines recommend [3-4] to evaluate FL according to gelf (groupe d'etude des lymphomes folliculaires) standard Whether patients with advanced stage 1-2 have high tumor load: there are more than 3 different regions of involved lymph nodes, and the diameter of each involved lymph node is greater than or equal to 3cm; there are any lymph nodes or extranodal lesions with diameter greater than 7cm; presence of B symptom; splenomegaly; pleural and abdominal effusion due to organ compression; hematopenia caused by lymphoma (leucocyte < 1.0 × 109 / L and / or platelet < 100 × 1) The expression of leukemia (malignant cells > 5.0 × 109 / L).about FL in 2013 Chinese FL diagnosis and treatment guidelines [5] The treatment indications for advanced stage 1-2 patients are as follows: B symptom; splenomegaly, pleural effusion, ascites, etc.; lymphoma involving important organs and leading to organ function damage; hematological indicators such as leukopenia (leucocyte < 1.0 × 109 / L and / or platelet < 100 × 109 / L), leukemia (malignant cells > 5.0 × 109 / L), lactate dehydrogenase (LDH) > normal value, β 2 - microglobulin The results showed that there were more than 3 mg / dl globulin (β 2-mg) ≥ 3 mg / dl, hemoglobin (HB) < 12 g / dl; there were more than 3 masses with diameter ≥ 5 cm or 1 mass diameter ≥ 7 cm (Ann Arbor stage Ⅲ - Ⅳ patients); continuous tumor progression (mass increased by about 20% - 30% in 2-3 months, and increased by about 50% within 6 months); it met the requirements of clinical trial.in a phase 2 clinical study conducted by Professor Emanuele Zucca et al. [6], rituximab combined with lenalidomide was used as the first-line treatment for FL patients in need of treatment The efficacy of rituximab, FL patients included in this study were from the Swiss clinical cancer research group (SAKK) and the Nordic Lymphoma Group (NLG). The treatment indications of FL patients in need of treatment determined by the researchers in this clinical study were: 1) symptomatic lymphadenopathy; 2) splenomegaly or other lymphoma manifestations; 3) large mass (diameter ≥ 6cm); 4) in-service What disease has clinical significant progress in at least 6 months; 5) B symptoms; 6) HB < 100 g / L or platelets < 100 × 109 / L, or significant progressive reduction of hemoglobin or platelet count due to lymphoma.indications for the treatment of lymphoplasmacytic lymphoma / Fahrenheit macroglobulinemia (LPL / WM), as an inert and incurable disease, emphasizes that the treatment should be started only after the treatment indications appear; for the WM patients with no symptoms or mild symptoms, the observation and waiting strategy should be adopted, which needs to be followed up once in 3-6 months.according to the 2016 Chinese LPL / WM guidelines and NCCN WM / LPL group recommendations [7-8], patients diagnosed with LPL / WM should be treated only if there are treatment indications.The indications of LPL / WM treatment are as follows: B symptom; symptomatic hyperviscosity; peripheral neuropathy; giant lymph node and organ enlargement; amyloidosis; cold agglutinin disease; cryoglobulinemia; hemocytopenia associated with the disease (HB ≤ 100g / L, PLT < 100 × 109 / L) (pay attention to differentiate from hemocytopenia caused by autoimmune factors); extramedullary lesions, especially central nervous system diseases When there is evidence that the disease is transformed.the indications for the treatment of marginal zone lymphoma (MZL) can be divided into three subtypes according to the involved sites. Splenic marginal zone lymphoma (SMZL), lymph node marginal zone lymphoma (nmzl) and extranodal mucosa associated lymphoid tissue marginal zone lymphoma (MMZL) are further divided into gastric marginal zone lymphoma (gastric MALT) and non gastric marginal zone lymphoma (non gastric MALT).NCCN and ESMO guidelines [3,9] recommended treatment indications for newly diagnosed SMZL include: 1) progressive or painful splenomegaly; 2) symptomatic or progressive hemocytopenia, such as HB < 100g / L, PLT < 80 × 109 / L, and neutrophil absolute value (ANC) < 1.0 × 109 / L (attention should be paid to differentiate from hemocytopenia caused by autoimmune factors).the treatment indications of newly diagnosed stage III - IV nmzl are as follows: 1) there are more than 3 involved lymph nodes in different regions, and the diameter of each involved lymph node is greater than or equal to 3cm; 2) there is any lymph node or extranodal lesion with diameter greater than 7cm; 3) there is B symptom; 4) splenomegaly; 5) organ compression symptoms, pleural and peritoneal effusion; 6) blood caused by the disease The results showed that the number of cells decreased; 7) the disease progressed continuously or rapidly; 8) met the requirements of clinical trial. ESMO guidelines recommend gelf standard or blni standard, blni criteria [9] include: 1) rapid disease progression; 2) end organ damage; 3) kidney involvement; 4) bone involvement; 5) hematopenia caused by the disease. the indications for gastric MALT treatment in newly diagnosed stage II 2 or II e or IV (distant lymph node involvement and late stage) include: 1) meeting the requirements for clinical trial enrollment; 2) the presence of lymphoma related clinical symptoms; 3) gastrointestinal bleeding; 4) end organ damage; 5) large mass; 6) continuous or rapid disease progression; 7) patient's willingness. NCCN guidelines recommend that patients with newly diagnosed stage IV non gastric MALT should be observed only when the lesion is removed by diagnostic surgery or radiotherapy may cause serious complications. References: [1]. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia / small lymphocytic lymphoma in China (2018 Edition). [2]. NCCN guidelines version 4.2020. Chronic lymphocytic leukemia / small lymphocytic lymphama. [3]. NCCN guidelines version 1.2020. B-cell lymphamas. [4]. M dreyling, m ghielmini, s rule, et al. Newly diagnosed and relapsed follicular lymphoma:ESMO Clinical Practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016 Sep; 27 (supply 5): v83-v90. [5]. Chinese guidelines for diagnosis and treatment of follicular lymphoma (2013 Edition). [6]. Emanuele Zucca, Stephanie Rondeau, Anna vanazzi, et al. Short Regimen of Rituximab Plus Lenalidomide in Follicular Lymphoma Patients in Need of First-Line Therapy. Blood. 2019 Jul 25; [8]. NCCN guidelines version 1.2020. Waldenstr ó m macroglobulinmia / lymphamacytic lymphama. [9]. M dreyling 1, C thieblemont, a gallamini, et al. ESMO consensus conferences: guidelines on malignant lymphama. Part 2: marginal zone Lymphama, mantle cell, lymphama, peripheral T-cell, lymphama. Ann Oncol. 2013 Apr; 24 (4): 857-77