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Q1. Which of the following statement regarding the treatment of B-cell lymphoma is wrong?

  • (A) Polatuzumab vedotin is an antibody-drug conjugate targeting CD79b, and peripheral neuropathy is reported as an adverse event resulting from monomethyl auristatin E.
  • (B) Mantle cell lymphoma is characterized by t(14;18) translocation, which juxtaposes BCL2 with the IGH locus resulting in the deregulated expression of BCL2.
  • (C) The etiology of marginal zone lymphoma has been associated with chronic immune stimulation due to infectious agents or inflammation.
  • (D) Follicular lymphoma of the gastrointestinal tract is common in the small intestine, most patients have clinically indolent and localized disease and appear to be excellent even without treatment.
  • (E) CAR T-cell therapies, such as axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel, are approved for the treatment of relapsed/refractory DLBCL.
點此顯示正解

(B) Mantle cell lymphoma is characterized by t(14;18) translocation, which juxtaposes BCL2 with the IGH locus resulting in the deregulated expression of BCL2.

詳解

1. Why (B) is the WRONG statement

(B) is incorrect because mantle cell lymphoma is characterized by t(11;14) translocation, not t(14;18). The t(11;14)(q13;q32) translocation juxtaposes CCND1 (cyclin D1) at 11q13 with the immunoglobulin heavy-chain (IGH) locus at 14q32, resulting in cyclin D1 overexpression124. The t(14;18) translocation that juxtaposes BCL2 with IGH is the hallmark of follicular lymphoma, not mantle cell lymphoma5.

2. Why the other options are TRUE statements

(A) is correct. Polatuzumab vedotin is indeed an antibody-drug conjugate targeting CD79b, conjugated to monomethyl auristatin E (MMAE), a microtubule inhibitor8[^11]. Peripheral neuropathy is a recognized adverse event due to the anti-tubulin mechanism of action of MMAE, though most cases are grade 1-2 and manageable with dose modifications7[9][10].

(C) is correct. Marginal zone lymphoma etiology has been well-established to be associated with chronic immune stimulation from infectious agents (such as Helicobacter pylori in gastric MALT lymphoma, Chlamydia psittaci in ocular adnexal MALT, and Borrelia burgdorferi in cutaneous MALT) and chronic inflammatory conditions.

(D) is correct. Follicular lymphoma of the gastrointestinal tract, particularly primary intestinal follicular lymphoma, most commonly involves the duodenum (small intestine). These cases typically present as localized, indolent disease with excellent prognosis, and many patients can be managed with observation or local therapy without requiring systemic treatment.

(E) is correct. The three CAR T-cell therapies mentioned—axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel—are all FDA-approved for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) after at least two prior lines of therapy.

詳解 · 中文翻譯

1. 為什麼 (B) 是錯誤的敘述

(B) 不正確因為套細胞淋巴瘤特徵性為 t(11;14) 易位，而不是 t(14;18)。t(11;14)(q13;q32) 易位並置位於 11q13 的 CCND1（cyclin D1） 與位於 14q32 的免疫球蛋白重鏈 (IGH) 軌跡，導致 cyclin D1 過度表達124。將 BCL2 與 IGH 並置的 t(14;18) 易位是 濾泡淋巴瘤的標誌，而不是套細胞淋巴瘤5。

2. 為什麼其他選項是真實陳述

(A) 正確。 Polatuzumab vedotin 確實是靶向 CD79b 的抗體藥物偶聯物，與 monomethyl auristatin E (MMAE)，微管抑制劑結合8[^11]。周邊神經病變是由於 MMAE 的抗微管作用機制的已識別不利事件，儘管大多數病例為 1-2 級，可通過劑量修改進行管理7[9][10]。

(C) 正確。 邊緣區淋巴瘤的病因已充分確立與來自傳染性病原體的慢性免疫刺激相關（例如胃 MALT 淋巴瘤中的幽門螺桿菌、眼附屬 MALT 中的鸚鵡熱衣原體和皮膚 MALT 中的伯氏疏螺旋體）和慢性炎症狀況。

(D) 正確。 胃腸道濾泡淋巴瘤，特別是原發性腸濾泡淋巴瘤，最常涉及 十二指腸（小腸）。這些病例通常表現為侷局化、惰性病具有優越預後，許多患者可通過觀察或局部治療進行管理而不需要系統治療。

(E) 正確。 所述三種 CAR T 細胞療法——axicabtagene ciloleucel、tisagenlecleucel 和 lisocabtagene maraleucel——都被 FDA 批准用於復發/難治瀰漫性大 B 細胞淋巴瘤 (DLBCL) 在至少兩項先前治療線後。

參考文獻 (AMA)

  1. Silkenstedt E, Salles G, Campo E, Dreyling M. B-Cell Non-Hodgkin Lymphomas. Lancet (London, England). 2024;403(10438):1791-1807. doi:10.1016/S0140-6736(23)02705-8. PMID:38614113. ↩↩

  2. Armitage JO, Longo DL. Mantle-Cell Lymphoma. The New England Journal of Medicine. 2022;386(26):2495-2506. doi:10.1056/NEJMra2202672. PMID:35767440. ↩↩

  3. Yin CC, Luthra R. Molecular Detection of T(11;14)(q13;q32) in Mantle Cell Lymphoma. Methods in Molecular Biology (Clifton, N.J.). 2013;999:211-6. doi:10.1007/978-1-62703-357-2_14. PMID:23666700. ↩

  4. Barista I, Romaguera JE, Cabanillas F. Mantle-Cell Lymphoma. The Lancet. Oncology. 2001;2(3):141-8. doi:10.1016/S1470-2045(00)00255-2. PMID:11902564. ↩↩

  5. Tavakkoli M, Barta SK. 2024 Update: Advances in the Risk Stratification and Management of Large B-Cell Lymphoma. American Journal of Hematology. 2023;98(11):1791-1805. doi:10.1002/ajh.27075. PMID:37647158. ↩↩

  6. Tilly H, Morschhauser F, Sehn LH, et al. Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma. The New England Journal of Medicine. 2022;386(4):351-363. doi:10.1056/NEJMoa2115304. PMID:34904799. ↩

  7. Tilly H, Morschhauser F, Bartlett NL, et al. Polatuzumab Vedotin in Combination With Immunochemotherapy in Patients With Previously Untreated Diffuse Large B-Cell Lymphoma: An Open-Label, Non-Randomised, Phase 1b-2 Study. The Lancet. Oncology. 2019;20(7):998-1010. doi:10.1016/S1470-2045(19)30091-9. PMID:31101489. ↩↩

  8. Sehn LH, Herrera AF, Flowers CR, et al. Polatuzumab Vedotin in Relapsed or Refractory Diffuse Large B-Cell Lymphoma. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2020;38(2):155-165. doi:10.1200/JCO.19.00172. PMID:31693429. ↩↩

Slide correction

"Mantle cell lymphoma" corrected to "Follicular lymphoma".

Slide annotations

t(11;14)(q13;q32) --- IGH-CCND1

t(2;11)(p11;q13) --- IGK-CCND1 t(11;22)(q13;q11.2) --- IGL-CCND1 IGH/K/L-CCND2 IGK/L-CCND3 MCL Follicular lymphoma-duodenal type

Figures