Zusammenfassung
Klinisches Problem
Maligne Lymphome sind die häufigsten Krebserkrankungen des hämatopoetischen Systems.
Therapeutische Standardverfahren
Die Therapie besteht in der Regel aus einer Chemotherapie, die bei indolenten Lymphomen erst bei klinischen Symptomen, bei aggressiven Lymphomen sofort begonnen wird. Lokale Maßnahmen wie z. B. Strahlentherapie werden meist nur ergänzend eingesetzt.
Neue Therapieverfahren
Mit zielgerichteten Therapieverfahren kann die Prognose weiter verbessert werden. Ein Prototyp hierfür ist der monoklonale, gegen Lymphome gerichtete Antikörper Rituximab.
Diagnostik
Zur Diagnose ist immer eine Biopsie notwendig. Oft werden aus immunhistologischen und molekulargenetischen Untersuchungen prognostische Informationen gewonnen. Bildgebende Untersuchungen wie CT, PET oder Sonographie werden am Anfang, im Verlauf und in der Nachsorge eingesetzt. Eine PET-Untersuchung am Ende der Chemotherapie kann bei Morbus-Hodgkin-Patienten diejenigen identifizieren, die keine Nachbestrahlung benötigen.
Leistungsfähigkeit
Viele aggressive Lymphome sind heilbar. Bei Morbus Hodgkin liegen die Überlebensraten über 90%, bei diffus-großzelligen Lymphomen zwischen 60 und 90%. Indolente Lymphome gelten mit Standardverfahren als unheilbar, die Überlebenswahrscheinlichkeit ist aber dennoch hoch.
Bewertung
Durch Rituximab konnten die Überlebensraten bei indolenten wie aggressiven Lymphomen um mindestens 10% verbessert werden. Weitere Verbesserungen gibt es durch neuere zielgerichtete Therapien und den Einsatz der autologen und allogenen Transplantation.
Empfehlung für die Praxis
Aufgrund des raschen Wissenszuwachses ist es sinnvoll, Patienten mit malignen Lymphome in Zentren und nach Möglichkeit in Studien zu behandeln. Durch genaue molekulargenetische Untersuchungen, aber auch durch funktionelle Bildgebung ist eine zunehmende Individualisierung der Therapie möglich.
Abstract
Clinical issue
Malignant lymphomas are the most common cancers of the hematopoietic system.
Standard treatment
The treatment is usually cytotoxic chemotherapy after the appearance of symptoms in indolent lymphoma and immediately in aggressive lymphoma. Local therapy, such as radiotherapy is sometimes required in addition to systemic treatment.
Treatment innovations
By the introduction of targeted therapies the prognosis has improved. The monoclonal antilymphoma antibody rituximab is a prototype for many other cancers.
Diagnostic work-up
A biopsy is mandatory for diagnosis. Additional immunohistological and molecular genetic analyses may provide prognostic information. Imaging techniques, such as computed tomography (CT), ultrasound or positron emission tomography (PET) are used for staging, restaging and follow-up. Following chemotherapy for Hodgkin’s disease PET can be considered to identify patients who do not require additional radiotherapy.
Performance
Aggressive lymphomas are often curable. In Hodgkin’s disease the long-term survival rate is over 90% and in diffuse large cell lymphoma between 60–90%. Indolent lymphomas are not curable by standard therapy, however, the survival rate is also high.
Achievements
After introduction of rituximab, the survival chance has improved by at least 10% in both indolent and aggressive lymphomas. Other targeted therapies and autologous or allogeneic transplantation have made additional contributions.
Practical recommendations
Due to the rapid increase of knowledge patients should be treated in experienced centers and whenever possible, in clinical trials. Using molecular genetic analyses and functional imaging, the treatment can be individualized even more.
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Viardot, A. Maligne Lymphome: Klinik, Klassifikation, Therapie und Prognose. Radiologe 52, 321–329 (2012). https://doi.org/10.1007/s00117-011-2258-z
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DOI: https://doi.org/10.1007/s00117-011-2258-z