Objective To analyze the potential causal relationship between sunscreen/ultraviolet protection and the risk of non-Hodgkin lymphoma using a two sample Mendelian randomization (MR) study method. Methods The summary data of genome-wide association study was used to select three types of non-Hodgkin lymphoma, namely diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, T/NK cell lymphoma, and sunscreen/ultraviolet protection highly correlated genetic loci, namely single nucleotide polymorphism (SNP), as instrumental variables. The reverse variance weighting method was used as the main method for MR analysis, MR Egger and MR-PRESO were used to detect level pleiotropy, and leave-one-out method was used for sensitivity analysis to ensure the robustness of the results. Results A total of 132 SNPs were included in the analysis. The results of the inverse variance weighted analysis showed that sunscreen/ultraviolet protection increased the incidence of DLBCL [odds ratio=2.439, 95% confidence interval (1.109, 5.362), P=0.027]. The heterogeneity test results showed that there was no heterogeneity in the causal relationship between sunscreen/ultraviolet protection and DLBCL (P>0.05). The results of the horizontal pleiotropy test showed that SNP did not exhibit horizontal pleiotropy (P>0.05). The leave-one-out method showed that no SNP with a significant impact on the results was found. There was no causal relationship between sunscreen/ultraviolet protection and follicular lymphoma and T/NK cell lymphoma. Conclusion There is a positive causal relationship between sunscreen/ultraviolet protection and the incidence of DLBCL.
Objective To investigate ultrasonography features of primary thyroid non-Hodgkin lymphoma (PT-NHL). Methods Ultrasonographic data of patients with PT-NHL(PT-NHL group) and non-Hodgkin lymphoma (control group) who were treated in our hospital from May. 2002 to Jul. 2014 were collected and analyzed. Results Compared with control group, enhancement of posterior echoes was more common in PT-NHL group (P=0.000), and difference values of transverse diameters, anteroposterior diameters, and sagittal diameters of more involved lobe to another lobe were bigger(P < 0.05), but echo pattern of gland, ultrasonographic classification of lesions, classification of vascularity, and condition of cervical lymph nodes were found no statistical difference(P > 0.05). In patients with nodular-type lesions(37 patients in PT-NHL group and 12 patients in control group), length of nodule lesions was larger in PT-NHL group (P=0.000), but there was no statistical difference in shape, boundary, orientation, and echoes of nodules between 2 groups(P > 0.05). In Pulsed-Wave(PW) Doppler between 2 groups(17 patients in PT-NHL group and 4 patients in control group), vascular resistance index(RI) was higher in PT-NHL group than those of control group (P=0.024). Conclusion The enhancement of posterior echoes was a feature in ultrasonography images of PT-NHL. Asymmetrical volume, high value of RI, and big nodule might link to PT-NHL, but diffuse heterogeneous echo with hypoechoic lesions might result in wrong diagnosis as PT-NHL.
Objective To investigate the clinical features of non-gastrointestinal mucosa-associated lymphoid tissue ( MALT) lymphoma.Methods Forty-eight pathologically proved cases of nongastrointestinal MALT lymphoma, admitted into Peking Union Medical College Hospital fromJanuary 2000 to July 2011, were retrospectively analyzed.Results There were 32 females and 16 males. The median age at diagnosis was 55. 4 years old ( range, 21-76 years) . The most commonly affected sites were lung, salivary glands, thyroid and ocular adnexa. In5 cases, the lymphoma presented at multiple mucosal sites. 27 patients were asymptomatic while 13 had non-specific symptoms. Blood test showed mild or moderate anemia in 8 cases, elevated erythrocyte sedimentation rate in 19 cases, and elevated lactate dehydrogenase in 6 patients.Imaging examinations revealed enlarged lymph nodes in 20 patients. 6 patients had a history of Sjoren’s syndrome, in whom3 cases were salivary gland diseases. In the patients with lung involvement, pathological diagnosis was obtained by bronchial biopsies in 3 cases, by CT-guided percutaneous lung biopsies in 11 cases, and by surgical biopsies in 9 cases. While in the patients without lung involvement, pathological diagnosis was obtained all by surgical biopsies. Of the 23 patients with lung involvement, 1 remain untreated,while 22 received various combinations of treatment ( surgery alone in 3 patients, surgery plus chemotherapy in 6 patients, and chemotherapy alone in 13 patients) . Of the 25 patients without lung involvement, 11 patients received surgery alone, 10 patients received surgery plus chemotherapy, 3 patients received chemotherapy alone, and 1 patient received surgery plus chemotherapy and radiotherapy. 46 patients remained alive during the median follow-up of 46. 7 months ( range, 4-133 months) . While 1 patient with lung involvement died from unknown causes, another 1 patient with lung involvement died from lung infection. Conclusions Non-gastrointestinal MALT lymphoma tends to occur in old-aged females, and commonly occurs in lung, salivary gland and thyroid sites. Most patients are asymptomatic or have only nonspecific symptoms. CT-guided percutaneous lung biopsies and surgical biopsies are helpful to the diagnosis.Prognosis for this lymphoma tends to be indolent.
ObjectiveTo analyze the disease burden and development trend of non-Hodgkin lymphoma (NHL) in China from 1990 to 2019. MethodsThe changes of incidence, mortality, disability-adjusted life years (DALY) and their corresponding age-normalization rates for NHL were analyzed by using the 2019 Global Burden of Disease Database. Regression analysis was performed by Joinpoint software to calculate annual percentage change (APC) and average annual percentage change (AAPC) of standardized morbidity, standardized mortality, standardized DALY rate to reflect the change trend of disease burden. And the results were compared with global data. ResultsFrom 1990 to 2019, the disease burden of NHL in China showed an overall increasing trend. Compared with 2019, the standard incidence rate, standard mortality rate and standard DALY rate of NHL in China increased by 144.72%, 27.17% and 15.61%, respectively. The annual rates of change were 3.12%, 0.80% and 0.51%, respectively. There were gender and age differences in disease burden. The burden of disease increased with age, and the burden of disease was higher in males than in females. ConclusionThe disease burden of NHL in China shows an increasing trend from 1990 to 2019. With the development of diagnosis and treatment options, the disease burden has decreased in recent years, but it is still higher than the global level. There is still a need to strengthen research on its pathogenesis and treatment options, and to actively intervene in high-risk groups to reduce the disease burden of NHL.
目的 增加對治療相關性繼發白血病的認識。 方法 報道非霍奇金淋巴瘤治療后2年繼發急性髓細胞白血病M6型1例，結合文獻討論治療相關性白血病的發病機制、治療、預后。 結果 1例73歲非霍奇金淋巴瘤患者接受R（Rituxmab，利妥昔單抗）－CHOP環磷酰胺+多柔比星+長春新堿+潑尼松方案規律化學治療。治療結束24+個月后，經骨髓涂片及細胞免疫分型診斷為急性髓細胞白血病M6型，染色體檢查為：44～48，XY，del（5）（q12q33），-8，-10，der（12）t（4；12）（q11-q12；p13），其一般情況急劇惡化并死亡。 結論 治療相關性白血病的發生可能與烷化劑等化療藥物使用和免疫受損等有關，利妥昔單抗導致第二腫瘤的發生暫時不能除外。治療相關性白血病常伴有復雜染色體核型，其病情發展迅速，治療效果差，生存期明顯縮短。Objective To improve the understanding of secondary therapy-related leukemia. Methods The clinical data of one patient with non-Hodgkin lymphoma which transformed into acute myeloid leukemia M6 2 years after chemotherapy were studied. We discussed the pathogenesis, treatment and prognosis of therapy-related leukemia with literature review. Results A 73-year-old patient diagnosed to have non-Hodgkin’s lymphoma accepted R-CHOP chemotherapy.Two years after the treatment, the disease finally developed into acute myeloid leukemia M6 confirmed by cytogenetics, bone marrow morphology and flowcytometry analysis. The chromosome analysis demonstrated complex karyotypes as 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13). His general status deteriorated rapidly and soon after the patient died. Conclusions Occurrence of therapy-related leukemia may be due to the administration of alkylating agents, topoisomerase inhibitors and damage of immune function. Therapy-related leukemia often occurs with complex karyotypes and progresses rapidly with poor treatment response.
目的：分析口咽部B細胞來源非霍奇金淋巴瘤(NHL)的CT表現、特征，初步探討不同病理類型B細胞來源NHL的CT表現特點，為臨床診斷和治療提供更為準確的信息。方法：對18例經病理證實的口咽部B細胞來源非霍奇金淋巴瘤的CT表現進行回顧性分析。結果：18例中，彌漫大B細胞淋巴瘤13例，占72.2%(13/18)，濾泡性淋巴瘤3例，占16.7%(3/18)，套細胞淋巴瘤1例，占5.6%(1/18)，結外邊緣區淋巴瘤(MALT淋巴瘤)1例，占5.6%(1/18)。病變分布為：扁桃體NHL9例(彌漫大B細胞淋巴瘤8例、套細胞淋巴瘤1例)；舌根8例(彌漫大B細胞淋巴瘤5例、濾泡性淋巴瘤3例)；軟腭1例，為結外邊緣區淋巴瘤(MALT淋巴瘤)。18例病變均表現為腫塊型。同時有淋巴結受累者12例(66.7%)，其中雙側受累者3例。結論：口咽B細胞來源NHL多發生于扁桃體及舌根。病理類型以彌漫大B細胞淋巴瘤為主，主要表現為腫塊。 CT對于B細胞來源NHL的鑒別診斷和病變范圍的判斷具有重要作用。
Objective To systematically evaluate the pharmacoeconomic vaule of chemotherapy combined with rituximab for patients with non-Hodgkin’s lymphomas (NHL). Methods A systematic literature search of cost-effectiveness studies on rituximab treating NHL published from 1998 to 2012 was carried out in following databases: PubMed, ScienceDirect, Health Technology Assessment (HTA) and Cochrane Database of Systematic Reviews (CDSR). And the references of included studies were also retrieved manually. The studies were screened according to the pre-designed inclusion and exclusion criteria, and the incremental cost- effectiveness ratio (ICER) in comparison between chemotherapy plus rituximab and chemotherapy alone was systematically evaluated according to the literature evaluation index system. Results The average ICER of Rituximab treating NHL was 16 318/QALY, 17 688/QALY, and 22 461/QALY in the UK, Mainland Europe, and US, respectively. All the reported ICERs in the included studies were below the implemented country-specific thresholds. Conclusion Based on present foreign literature, the integrated therapy of chemotherapy and rituximab for NHL is supposed to be a better cost-effective therapy with ICER below the implemented country-specific thresholds.