Therapie maligner Lymphome

ZUSAMMENFASSUNG

Ziel Ziel dieses Artikels ist es, einen aktuellen Überblick über gegenwärtige Standards und aktuelle Entwicklungen in der Therapie maligner Lymphome zu geben.

Material und Methoden Nicht-systematische Übersicht über die Therapie wichtiger Lymphom-Entitäten unter Berücksichtigung aktueller Leitlinien.

Ergebnisse Patienten mit aggressiven B-Zell-Lymphomen sowie Hodgkin-Lymphomen werden mit kurativem Therapieziel behandelt. Therapiestandard des diffusen großzelligen B-Zell-Lymphoms sind 6–8 Zyklen R-CHOP. In Abhängigkeit vom internationalen Prognose-Index sind Modifikationen dieser Therapie möglich. Im Falle eines frühen Rezidivs wird der bisherige Standard einer Hochdosischemotherapie (HDCT) mit autologer Stammzelltransplantation (ASCT) zukünftig durch eine Therapie mit CAR-T-Zellen abgelöst werden. Eine Stadien-adaptierte Therapie des Hodgkin-Lymphoms führt zu sehr hohen Heilungsraten, die auch in fortgeschrittenen Stadien bei ca. 90% liegen. Jüngere Patienten mit Rezidiv erhalten eine HDCT mit ASCT. Die Verfügbarkeit des Antikörper-Wirkstoff-Konjugates Brentuximab Vedotin sowie der Anti-PD1-Antikörper Nivolumab und Pembrolizumab haben die Rezidivtherapie des Hodgkin-Lymphoms in den letzten Jahren erheblich bereichert. Indolente Lymphome sind durch langsames Wachstum, längere stabile Krankheitsphasen und meist lange Überlebenszeiten der Patienten charakterisiert. Die Therapie des häufigsten Vertreters der indolenten Lymphome, dem follikulären Lymphom, erfolgt mit einer Kombination aus einem gegen CD20-gerichteten Antikörper und mit z. B. CHOP oder Bendamustin, worunter lange progressionsfreie Zeiten erreicht werden.

Diskussion und Schlussfolgerung Die Therapie maligner Lymphome ist in stetem Wandel. Der Einsatz verschiedener Immuntherapien habt in den letzten Jahren zu einer Verbesserung der Therapieergebnisse geführt.

ABSTRACT

Objective The objective of this article is to provide an up-to-date overview of current standards and current state of development in the treatment of malignant lymphomas.

Materials and methods Non-systematic review of the therapy of important lymphoma entities with regard to current guidelines.

Results Patients with aggressive B-cell lymphomas and Hodgkin lymphomas are treated with curative intent. 6-8 cycles of R-CHOP are standard therapy for diffuse large B.-cell lymphoma. Treatment may also be adjusted to the international prognostic index (IPI). Recent data indicate improved outcomes with CAR T-cell therapy compared to high dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) in patients with early relapse or refractory DLBCL. A stage-adapted therapy of Hodgkin lymphoma results in high cure rates of around 90% even in advanced stages. In recent years, the availability of the antibody-drug conjugate brentuximab vedotin, and the anti-PD1 antibodies nivolumab and pembrolizumab, have opened up new treatment options in relapsed/refractory HL. Indolent lymphomas are characterized by slow growth, longer stable disease phases and usually long patient survival. The most common type of indolent lymphoma, follicular lymphoma, is treated with a combination of an antibody directed against CD20 and with e. g., CHOP or bendamustine, with which a long progression-free survival can be achieved.

Discussion and conclusion The therapy of malignant lymphomas is in continuous change. The use of various immunotherapies has led to an improvement in therapy outcomes in recent years.

Schlüsselwörter

Non-Hodgkin-Lymphome - Hodgkin-Lymphom - Burkitt-Lymphom - T-Zell-Lymphom - Follikuläres Lymphom

Key words

Non-Hodgkin lymphoma - Hodgkin lymphoma - Burkitt lymphoma - T cell lymphoma - follicular lymphoma

Publication History

Article published online:
29 June 2022

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