Mantle lymphoma
The lymphomas of the mantle cells are a form of non-Hodgkin's lymphoma. They are caused by B lymphocytes from the mantle of the lymph gland follicles.
This lymphoma affects more frequently caucasian, male and female subjects after 50 years. Diagnosis is often done at an advanced stage as painless and often not detectable on a blood test. But whatever the stage, a treatment will reduce the adenopathies in an efficient way throughout the body. The median life expectancy after diagnosis is 54 months.
In virtually all cases of lymphoma called "mantle cells", B lymphocytes strongly express cyclin D1 as a result of translocation between chromosomes 11 and 14 [1].
The current treatments are based on 6 chemotherapy 3 R-CHOP and 3 R-DHA (optional P) alternated, followed by a bone marrow autograft, and allograft in case of recurrence, when the patient's condition allows (age and fitness). In fact both types of graft are preceded by total body irradiation in 4 sessions of about 20 minutes, to subdue the body to 10 Grays and through masking on 2 sessions to 8 Grays for the lungs. Intensive chemotherapy also precedes the graft, with Cytarabine and Melphalan. The autograft consists of reintroducing the stem cells that have previously been taken by Cytaphérèse.
The prognosis remains dark with many relapses
Cytaphérèse
The generic term cytaphérèse indicates the collection by apheresis of cells, whatever their nature, platelets, white blood cells including hematopoietic stem cells. The latter are taken from blood and are a graft used in the transplantation of hematopoietic stem cells or bone marrow transplant. Another way to have a graft is the removal of bone marrow.
Hematopoietic stem cells may be taken from a patient for subsequent administration in a self-graft. They may also be taken from a patient-compatible donor for allograft (Administration of donor cells to the patient). The donor may be related or not (voluntary donor) to the patient. Hematopoietic stem cells are located in the bone marrow. Injections of a hematopoietic growth factor drug or G-CSF Granulocyte Colony Stimulating factor, such as filgrastim or lenograstim molecules, lead to the passage of hematopoietic stem cells from the bone marrow to the blood . During this process called mobilization, they can be taken by apheresis by means of a cell separator. They are collected in a collection pocket, the other constituents of the blood are returned to the subject, donor or patient
This technique that lasts on average 3 hours is an alternative to the removal of bone marrow. It can be performed in ambulatory, while the removal of bone marrow is performed under general anesthesia and requires hospitalization. To obtain a graft, several consecutive days of apheresis may be necessary. In a voluntary donor of hematopoietic stem cells, two cytaphérèses are allowed to the maximum. The mobilization of hematopoietic stem cells from the bone marrow to the blood may be insufficient. When this occurs in a donor, a bone marrow collection in the operating room is organized in an emergency, the patient is already conditioned to receive the graft [1], [2]
0 komentar:
Posting Komentar