悪性リンパ腫 （低悪性度） - harasanshin.or.jp

1 Version 2016 1 13 .. Malignant Lymphoma .. Pro-B Pre-B Immature B Mature B Activated B . B .. T . Pro-T Pre-T.. 10 . 38 .. ML . HL NHL . B . T . NK .. B T/NK . FL . Indolent lymphoma MALT T / . ATL . B-CLL/SLL . B T T . aggressive lymphoma DLBCL PTCL,NOS . ( ) B T . B AITL . T . MCL ALCL ALK .. NK/T . BL LBL . high aggressive lymphoma LBL T / . ATL .. DLBCL 30% . HTLV-1 ATLL NK/T.. B) B-cell lymphoma (n=471) T/NK-cell lymphoma (n=396). 1 Diffuse large cell 281 (60%) 1 ATLL 191 (48%). 2 Peripheral T, unspecified 83 (21%). A) Malignant lymphoma (n=933) 2 MALT 82 (17%). 1 B cell lymphoma 471 (50%) 3 AILD 38 (10%).

2 3 Follicular 52 (11%) 4 ALCL 22 (6%). 2 T/NK cell lymphoma 396 (42%). 3 Hodgkin's diseae 41 (4%) 4 Mantle cell 24 (5%) 5 Lymphoblastic 17 (4%). 4 B/T/NK undefined 20 (2%) 5 Burkitt 9 (2%) 6 Nasal and nasal type NK/T 17 (4%). 5 Histiocytic neoplasm 5 ( ) 6 Lymphoblastic 5 (1%) 7 Mycosis fungoides 9 (2%). 7 Other 21 (4%) 8 Other 8 (2%). 1. 1. 2. 2 1. 3. 3 2 4. 4 3 5. 5 4 6. 7. 5. 8. 6. 7. Ohshima K, et al. Ohshima K, et al. Ohshima K, et al. Pathol. Int. 2000, 50:696 Cancer Letter 1999,135:73 Br. J. Haematol. 1998, 101:703.. follicular lymphoma: FL . FL . FL NHL 7 15 .. 75 90 .. B .. HE . Copyright (C) 2009 Japanese Society of Pathology all rights reserved.

3 FL . histoligical transformation:HT .. t 14;18 q32 q21 . BCL2 H .. BCL2 germinal center cell FL . BCL2 apotosis .. Ann Arbor Cotswolds . ( ). ( E). 2 ( ).. ( E). ( , 3). ( ) . E ( S) ( SE) . 1 .. A B : A B . 38 . 6 10% .. Cotswolds . X: bulky disease). X . 10cm . 5/6 1/3 . Lister TA, et al. J Clin Oncol 1987; 7:1630-6 .. Ann Arbor Cotswolds .. FLIPI . FLIPI FLIPI2 . FLIPI FLIPI2 . 61 61 . LDH 2 . 12g/dL 12g/dL . 5 6 .. FLIPI FLIPI2 .. FLIPI 0 1 2 3 . FLIPI 0 1 2 3 . FLIPI .. 5 OS . 10 OS . NHL .. IPI FL .. FL . FLIPI . Tilly H et al:Blood 84: 1043, 1994. FLIPI2 . FLIPI . FLIPI2 .. 3 PFS 91 69 51 . 3 OS 99 96 84.

4 PFS OS . Massiomo F, et al: Journal of Clinical Oncology 2009. FL . RT Radiotherapy R Rituximab CMT Combined modality therapy 2013 . FL . 10% . RT Radiotherapy R Rituximab CMT Combined modality therapy 2013 .. 30 35Gy . 1 . B LDH .. OS . Pugh TJ, et al. Cancer 2010. FL .. GELF. BNLI. GLSG. RT Radiotherapy R Rituximab CMT Combined modality therapy 2013 .. GELF Groupe d'Etude des Lymphomes Folliculaires . 7 . 3 3 . B .. 109/L . Hb 10g/dL WBC 109/L 100 109/L . LDH 2 .. BNLI British National Lymphoma Investigation . B .. Hb 10g/dL 3000/ L 10 / L .. GLSG German Low Grade Lymphoma Study Group . B . Bulky cm 5 cm.

5 FL . RT Radiotherapy R Rituximab CMT Combined modality therapy 2013 .. Watchful Wait .. chlorambucil .. 10 . 19 . 70 40 . 70 .. Ardeshna KM, et 2003.. RCT R R + .. OS R .. Ardeshna K, et al. ASH 2010. Abstract 6. FL . RT Radiotherapy R Rituximab CMT Combined modality therapy 2013 .. R-CHOP R, CPA, DXR, VCR, PSL R-CVP R, CPA, VCR, PSL . Time to treatment failure Hiddemann W, et al. Blood 2005 Marcus R et al: Blood 105: 1417, 2005.. R-CHOP vs R-CVP vs R-FM . 3 . R-CHOP . R-FM R-CVP . 2 R-FM . R-CHOP R-CVP . R-CHOP .. Federico M, et al. J Clin Oncol 2013.. GELF .. OS .. R .. Van Oers MH et al: Blood 2006.

6 CD20 CD20 .. 2013 . 3% 10 30 15 45 B DLBCL .. FL .. R . R R . R .. R-CHOP . R .. Radioimmunotherapy RIT 90Y . 20 .. StiL . R-B R-CHOP .. CR R-B 40 R-CHOP 31 P= PFS . R-B R-CHOP P= R- B . R-B . FL . Rummel MJ, et al. ASH 2009 Abstract 405.. AHSCT . upfront AHSCT . PFS AML/MDS . OS . AHSCT . Lenz G et al. Blood 2004 104: 2667-74. AHSCT . AHSCT PFS OS . Schouten HC et al. J Clin Oncol 2003; 21:3918-27.. IBMTR . 40 3 . OS DFS 16 49 49 .. 5 . 21 43 58 . 5 . 30 14 8 . 5 OS. 51 62 55 .. Van Besien K et 2003; 102:3521-9.. MALT . follicular lymphoma: FL . MALT . extranodal marginal zone B-cell lymphoma of mucosa- associated lymphoid tissue(MALT).

7 MALT marginal zone B . MALT .. MALT B . MALT .. MALT . 10 . 85 .. Helicobacter pyloli .. MALT 90 .. lymphoepithelial lesion(LEL) . LEL.. Lugano . 1 .. E .. Lister TA, et al. J Clin Oncol 1987; 7:1630-6 . MALT .. 2013 . MALT .. 3 .. 30 1 2 200 400 750 1 2 7 . 1 2 . 20 1 2 .. 10 1 2 .. 20 1 2 . 1 90 . 2 . 81 96 . MALT .. MALT 50 80 . 3 . Wundisch T, et al. J Colin Oncol 2005; 23: 8018-24. 4 . 1 .. 90 . 95 . Nakamura S, et al. Gut 2012; 61: 507-13.. 10 .. MALT .. 2013 . MALT . 2013.