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弥漫性大B细胞淋巴瘤(diffuse large B cell lymphema,DLBCL)在形态学、临床表现及其治疗反应上都表现出异质性,明确DLBCL的预后影响因素有利于实施个体化治疗。根据免疫表型分组,DLBCL分为GCB组和非GCB组,GCB组患者预后明显优于非GCB组,其分组的准确性甚至优于基因检测;相关免疫表型如bcl-2、bcl-6对于不同组的预后影响不同,利妥昔单抗的应用减少了细胞来源和相关免疫表型对于预后的不良影响。特定转录因子可以作为预后预测因子,如FOXP1阴性组预后好于阳性组、LMO2高表达的患者具有较高生存率等。抑制PI3K/AKT通路可使淋巴瘤细胞发生凋亡,且p-AKT阴性组预后较阳性组好。谷胱甘肽过氧化物酶1(GXP1)低表达组预后较好;而在GXP1低表达组中,ABC转运体MDR1低表达组预后明显好于高表达组。此外,EB病毒感染、骨髓浸润的一致性、肿瘤大小、肿瘤血管形成均同预后有关,都有可能作为预后预测因子。
Diffuse large B cell lymphema (DLBCL) showed heterogeneity in morphology, clinical manifestations and response to treatment. It is clear that DLBCL prognostic factors are conducive to the implementation of individualized treatment. According to the immunophenotyping group, DLBCL was divided into GCB group and non-GCB group. The prognosis of GCB group was significantly better than that of non-GCB group, and its accuracy was better than that of gene detection. The related immunophenotypes such as bcl-2, bcl-6 The effect of different rituximab groups on prognosis is different, and rituximab reduces the adverse prognostic impact of cellular sources and associated immunophenotypes. Specific transcription factor can be used as a predictor of prognosis, such as FOXP1 negative group prognosis is better than the positive group, high expression of LMO2 patients with high survival rate. Inhibition of PI3K / AKT pathway can induce apoptosis of lymphoma cells, and prognosis of p-AKT negative group is better than that of positive group. Glutathione peroxidase 1 (GXP1) low expression group has a good prognosis; while in GXP1 low expression group, ABC transporter MDR1 low expression group prognosis was significantly better than the high expression group. In addition, Epstein-Barr virus infection, the consistency of bone marrow infiltration, tumor size, and tumor angiogenesis are all associated with prognosis, all of which may serve as predictors of prognosis.