37 Treatment of B-Cell Lymphoma |
561 |
37.4Conclusions
SS-associated lymphomas are a heterogeneous group of malignancies. The most common subtype, accounting for up to 60% of lymphomas, is MZ lymphoma of MALT type. Recently, significant advances in our understanding of the morphology, phenotype, etiology, pathogenesis, and natural history, as well as the use of WHO classification of lymphoid neoplasms, have begun to elucidate the differences between MALT lymphoma and other lymphoproliferative disorders, enabling the identification of prognostic tissue markers. Beyond chemotherapy, a variety of new treatment options have emerged in the management of patients with SS MALT lymphoma, with B-cell depletion with monoclonal antibody therapy being the most significant. Nevertheless, the lack of large multicenter studies and the rarity of the disease prevent the proposal of a definite treatment approach.
Patients with low-grade lymphoma types, especially MALT lymphomas, including those with disseminated extranodal disease, should be managed conservatively with an anti-CD20 monoclonal antibody or other mild chemotherapeutic agents. In contrast, disease features that indicate high-grade disease are markers for poor prognosis. In patients who are otherwise young and fit, aggressive, multi-agent approaches to treatment may be indicated.
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Chapter 38
Classic Immunosuppressive
and Immunomodulatory Drugs
Clio P. Mavragani and Stuart S. Kassan
Contents |
|
|
38.1 |
Introduction................................................................................................................... |
565 |
38.2 |
Antimalarials ................................................................................................................. |
566 |
38.3 |
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) .................................................... |
567 |
38.4 |
Glucocorticoids.............................................................................................................. |
567 |
38.5 |
Azathioprine .................................................................................................................. |
567 |
38.6 |
Cyclophosphamide........................................................................................................ |
567 |
38.7 |
Methotrexate.................................................................................................................. |
568 |
38.8 |
Cyclosporine .................................................................................................................. |
568 |
38.9 |
Conclusion ..................................................................................................................... |
568 |
References................................................................................................................................. |
569 |
|
38.1Introduction
Symptoms of Sjögren’s syndrome (SS) are chronic and can sometimes be devastating, compromising patients’ quality of life to a major degree. Despite the advances in our understanding of the pathogenesis of SS, its therapy remains largely empiric, symptomatic, and focused on alleviating sicca symptoms. Eye lubricants, saliva substitutes, and stimulators of the glandular secretion are the cornerstones of therapy in SS. Despite the autoimmune nature of the disorder, evidence for the use of immunosuppressive agents, the mainstay of therapy of diseases of autoimmune origin, is scarce. In an attempt to alleviate the symptoms of SS by altering the natural disease process, a number of immunosuppressive agents have been tested in clinical studies, mostly with unsatisfactory or questionable results (Table 38.1).
C.P. Mavragani (*)
Department of Experimental Physiology, School of Medicine, University of Athens,
Athens, Greece
S.S. Kassan
University of Colorado Health Sciences Center, Denver, CO, USA
M. Ramos-Casals et al. (eds.), Sjögren’s Syndrome, |
565 |
DOI 10.1007/978-0-85729-947-5_38, © Springer-Verlag London Limited 2012 |
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