文章：

通过评估细胞起源在弥漫性大B细胞淋巴瘤治疗计划中的整合精准医学

Integrating precision medicine through evaluation of cell of origin in treatment planning for diffuse large B-cell lymphoma

原文发布日期：2019-05-16

DOI: 10.1038/s41408-019-0208-6

类型: Review Article

开放获取: 是

英文摘要：

Precision medicine is modernizing strategies for clinical study design to help improve diagnoses guiding individualized treatment based on genetic or phenotypic characteristics that discriminate between patients with similar clinical presentations. Methodology to personalize treatment choices is being increasingly employed in clinical trials, yielding favorable correlations with improved response rates and survival. In patients with diffuse large B-cell lymphoma (DLBCL), disease characteristics and outcomes may vary widely, underscoring the importance of patient classification through identification of sensitive prognostic features. The discovery of distinct DLBCL molecular subtypes based on cell of origin (COO) is redefining the prognosis and treatment of this heterogeneous cancer. Owing to significant molecular and clinical differences between activated B-cell-like (ABC)- and germinal center B-cell-like (GCB)-DLBCL subtypes, COO identification offers opportunities to optimize treatment selection. Widespread adoption of COO classification would greatly improve treatment and prognosis; however, limitations in interlaboratory concordance between immunohistochemistry techniques, cost, and availability of gene expression profiling tools undermine universal integration in the clinical setting. With advanced methodology to determine COO in a real-world clinical setting, therapies targeted to specific subtypes are under development. The focus here is to review applications of precision medicine exemplified by COO determination in DLBCL patients.
 

摘要翻译： 

精准医学正在推动临床研究设计策略的现代化，有助于改进诊断，根据区分临床表现相似患者的遗传或表型特征来指导个体化治疗。这种个性化治疗选择的方法学正日益应用于临床试验，与改善缓解率和生存率呈现出良好的相关性。在弥漫性大B细胞淋巴瘤患者中，疾病特征和结局可能差异很大，这强调了通过识别敏感预后特征进行患者分类的重要性。基于细胞起源的不同DLBCL分子亚型的发现正在重新定义这种异质性癌症的预后和治疗。由于活化B细胞样与生发中心B细胞样DLBCL亚型之间存在显著的分子和临床差异，细胞起源鉴定为优化治疗选择提供了机会。细胞起源分类的广泛采用将极大改善治疗和预后，然而免疫组化技术实验室间一致性、成本及基因表达谱工具可用性方面的局限性阻碍了其在临床实践中的普及。随着在真实临床环境中确定细胞起源的先进方法出现，针对特定亚型的疗法正在开发中。本文重点综述以DLBCL患者细胞起源测定为例的精准医学应用。

原文链接：

Integrating precision medicine through evaluation of cell of origin in treatment planning for diffuse large B-cell lymphoma