淋巴瘤自体造血干细胞移植的临床实践优化探索与未来展望

金正明

doi:10.19401/j.cnki.1007-3639.2022.02.008

您当前的位置：

首页 >

文章列表页 >

淋巴瘤自体造血干细胞移植的临床实践优化探索与未来展望

综述 | 更新时间：2025-12-31

- 淋巴瘤自体造血干细胞移植的临床实践优化探索与未来展望
- Clinical practice optimization exploration and future prospects of autologous hematopoietic stem cell transplantation for lymphoma
- 中国癌症杂志 2022年32卷第2期页码：161-171
- 作者机构：
  
  苏州大学附属第一医院,江苏省血液病研究所,国家血液系统疾病临床医学研究中心,江苏苏州215006
- 作者简介：
  
  金正明 E-mail：jinzhengming519519@163.com
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.02.008
  中图分类号： R733.4
- 收稿：2021-05-30，
  
  纸质出版：2022-02-28
- 稿件说明：
移动端阅览
金正明. 淋巴瘤自体造血干细胞移植的临床实践优化探索与未来展望[J]. 中国癌症杂志, 2022,32(2):161-171.

Zhengming JIN. Clinical practice optimization exploration and future prospects of autologous hematopoietic stem cell transplantation for lymphoma[J]. China Oncology, 2022, 32(2): 161-171.
金正明. 淋巴瘤自体造血干细胞移植的临床实践优化探索与未来展望[J]. 中国癌症杂志, 2022,32(2):161-171. DOI： 10.19401/j.cnki.1007-3639.2022.02.008.

Zhengming JIN. Clinical practice optimization exploration and future prospects of autologous hematopoietic stem cell transplantation for lymphoma[J]. China Oncology, 2022, 32(2): 161-171. DOI： 10.19401/j.cnki.1007-3639.2022.02.008.

摘要

自体造血干细胞移植（autologous hematopoietic stem cell transplantation

AHSCT）是高度侵袭性和复发/难治性淋巴瘤的有效治疗手段之一

可为患者带来生存获益。近年来

小分子靶向药物、单克隆抗体、细胞治疗和免疫治疗等新药给淋巴瘤患者提供了更多的选择

但AHSCT在淋巴瘤治疗中仍占据重要地位。对AHSCT适应证和治疗时机进行概述

进而详细介绍AHSCT治疗流程、移植后管理及注意事项。AHSCT的适应证和治疗时机与疾病亚型、危险分层及移植前疾病状态紧密相关。行AHSCT前

需对患者进行移植前诱导及疗效评估

诱导方案根据淋巴瘤亚型不同而有所差异

可参考相应指南推荐进行选择;目前临床中广泛使用的疗效评价标准为影像学缓解（CT/MRI评价）和代谢缓解（PET/CT评价）。AHSCT流程的每一个环节都与预后密切相关

整体流程包括干细胞动员及采集、移植前预处理、干细胞回输、合并症管理、植入情况评估。制定良好的动员策略以保证动员效果是最关键的一步

对于淋巴瘤患者

应根据诱导治疗后患者的疾病缓解状态来选择最佳的动员方案

以提高干细胞动员成功率。参考国外造血干细胞动员经验

在疾病稳定状态下

如达到CR1/CR2的患者

可优选稳态动员;针对活动复发的患者

建议优选疾病特异性的非稳态动员。针对干细胞采集目标

过往国内外临床经验多推荐外周血干细胞（peripheral blood stem cells

PBSC）的最佳目标采集量为5×10

个CD34

细胞/kg

近期新发表的研究结果提示

骨髓瘤患者PBSC为4.5×10

~8×10

个CD34

细胞/kg具有更好的生存获益

淋巴瘤患者PBSC最佳阈值还有待进一步研究。自体移植物质量评价也打破了传统仅评估CD34

细胞数量的模式

已有研究显示

可将自体移植绝对淋巴细胞计数（autograft absolute lymphocyte count

A-ALC）纳入到自体移植物评估中。AHSCT预处理应采用清髓性预处理方案

BEAM（卡莫司汀、依托泊苷、阿糖胞苷、马法兰）方案在淋巴瘤的AHSCT预处理中较为常用。在干细胞回输上

应提前做好准备以避免出现细胞聚集现象

输注过程中还需加强临床质量控制管理

出现不良事件时应及时进行对症处理。植入后定期监测全血细胞计数等指标直至移植后100 d

以评估植入情况。移植后部分淋巴瘤亚型需行维持治疗以减少复发和治疗失败风险

提高生存率;针对不同淋巴瘤亚型

可采取不同的维持治疗方案

对于移植后复发高危患者

现已有BTK抑制剂、免疫调节剂等多种不同作用机制的新药上市

目前针对新药开展的疗效和安全性研究也在进一步探索中。淋巴瘤患者接受AHSCT治疗后造血恢复需要一定的时间

移植后应采取措施避免并发症的发生

植入成功后也应定期进行疗效评价及随访。对于适合移植的淋巴瘤患者

建议尽早转诊到移植中心行AHSCT治疗

以免延误最佳治疗时机。

Abstract

Autologous hematopoietic stem cell transplantation (AHSCT) is one of the effective treatments for highly aggressive and relapsed/refractory lymphoma

which can bring survival benefits to patients. In recent years

with the advent of new drugs such as small molecule targeted drugs

monoclonal antibodies

cell therapy and immunotherapy

more choices are provided for lymphoma patients

however

AHSCT still occupies an important position in the treatment of lymphoma. This paper summarized the indications eligible for AHSCT and its timing

and introduced the treatment process

post transplantation management and precautions of AHSCT in detail. The indications and timing of AHSCT are closely related to disease subtypes

risk stratification and disease status before transplantation. Before AHSCT

patients need to undergo pre-transplant induction and efficacy evaluation. The induction scheme varies according to different lymphoma subtypes

which can be selected according to the recommendations of corresponding guidelines. Currently the widely used clinical efficacy evaluation standard is imaging remission (CT /MRI evaluation) and metabolic remission (PET/CT evaluation). Every step of the AHSCT process is closely related to posttransplant outcome and prognosis. The overall process includes stem cell mobilization and collection

pretreatment prior to transplantation

stem cell reinfusion

comorbidity management and implantation evaluation. Formulating a good mobilization strategy to ensure the smooth development of transplantation is the most critical step. It is reasonable to choose stem cell mobilization regimen according to disease status after induction therapy

which is beneficial to improve mobilization success rate. Referring to the experience of hematopoietic stem cell mobilization abroad

steady-state mobilization is preferred in patients with stable disease

such as patients with CR1/CR2; in terms of stem cell collection

previous clinical experiences domestically and abroad mostly recomm

end that the optimal target collection of peripheral blood stem cells (PBSC) is 5×10

CD34

cells/kg. A recently published study suggests that a PBSC of 4.5×10

-8×10

CD34

cells/kg in myeloma patients generates significantly better survival

and the optimal PBSC threshold for lymphoma patients needs further study. The evaluation of autograft is now evolving from only CD34

cells model

and studies have shown that autograft absolute lymphocyte count (A-ALC) can be introduced in autograft evaluation. Myeloablative pretreatment should be used before AHSCT

BEAM (carmustine

etoposide

cytarabine and melphalan) regimen is commonly used in AHSCT pretreatment of lymphoma. For stem cell reinfusion

preparations should be made in advance to avoid cell aggregation. Clinical quality control and management should be strengthened during infusion

and targeted treatment should be carried out in time in case of adverse events. After implantation

the complete blood count and other indicators were monitored regularly until 100 days after the transplantation to evaluate engraftment. After transplantation

patients with certain lymphoma subtypes need maintenance treatment to reduce the risk of recurrence and treatment failure

and to improve survival rate. Different maintenance treatment schemes can be adopted for different lymphoma subtypes. For patients at high risk of recurrence after transplantation

a variety of new drugs with different action mechanisms such as BTK inhibitors and immunomodulators have been launched into the market. At present

the research on the efficacy and safety of new drugs is also under further exploration. It takes a certain amount of time for lymphoma patients to get hematopoiesis recovery after AHSCT treatment. After transplantation

measures should be taken to avoid complications. After successful engraftment

curative effect evaluation and follow-up should be performed re

gularly. Lymphoma patients eligible for transplantion should be transferred to transplantion centers for AHSCT treatment at an early stage

to avoid missing the best AHSCT timing.

关键词

Keywords

references

JIANG M L , BENNANI N N , FELDMAN A L . Lymphoma classification update: T-cell lymphomas, Hodgkin lymphomas, and histiocytic/dendritic cell neoplasms [J ] . Expert Rev Hematol , 2017 , 10 ( 3 ): 239 - 249 .

SHANKLAND K R , ARMITAGE J O , HANCOCK B W . Non-Hodgkin lymphoma [J ] . Lancet , 2012 , 380 ( 9844 ): 848 - 857 .

石远凯 , 孙燕 . 中国恶性实体瘤自体造血干细胞移植25年回顾 [J ] . 中华医学杂志 , 2015 , 95 ( 10 ): 721 - 726 .

SHI Y K , SUN Y . Review of autologous hematopoietic stem cell transplantation for malignant solid tumors in China for 25 years [J ] . Natl Med J China , 2015 , 95 ( 10 ): 721 - 726 .

COLITA A , COLITA A , BUMBEA H , et al . LEAM vs BEAM vs CLV conditioning regimen for autologous stem cell transplantation in malignant lymphomas. Retrospective comparison of toxicity and efficacy on 222 patients in the first 100 days after transplant, on behalf of the Romanian Society for Bone Marrow Transplantation [J ] . Front Oncol , 2019 , 9 : 892 .

XU L P , LU P H , WU D P , et al . Hematopoietic stem cell transplantation activity in China 2019: a report from the Chinese Blood and Marrow Transplantation Registry Group [J ] . Bone Marrow Transplant , 2021 , 56 ( 12 ): 2940 - 2947 .

吴冠青 , 雷英衡 , 孙燕 , 等 . 大剂量放化疗合并自体骨髓移植治疗成人晚期高度恶性T细胞非何杰金淋巴瘤 [J ] . 中华肿瘤杂志 , 1993 , 15 ( 1 ): 47 - 51 .

WU G Q , LEI Y H , SUN Y , et al . High dose radiotherapy and chemotherapy combined with autologous bone marrow transplantation in the treatment of adult advanced highly malignant T-cell non-Hodgkin’s lymphoma [J ] . Chin J Oncol , 1993 , 15 ( 1 ): 47 - 51 .

KANATE A S , MAJHAIL N S , SAVANI B N , et al . Indications for hematopoietic cell transplantation and immune effector cell therapy: guidelines from the American Society for Transplantation and Cellular Therapy [J ] . Biol Blood Marrow Transplant , 2020 , 26 ( 7 ): 1247 - 1256 .

NCCN . NCCN Clinical Practice Guidelines in Oncology [M ] . B-cell lymphomas, version 5, September 22 , 2021 .

DUARTE R F , LABOPIN M , BADER P , et al . Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019 [J ] . Bone Marrow Transplant , 2019 , 54 ( 10 ): 1525 - 1552 .

中国临床肿瘤学会 . 淋巴瘤诊疗指南(2021) [M ] . 北京 : 人民卫生出版社: 1 - 292 .

Chinese Society of Clinical Oncology . Guidelines for diagnosis and treatment of lymphoma (2021) [M ] . Beijing , People’s Medical Publishing House: 1 - 292 .

MILPIED N , DECONINCK E , GAILLARD F , et al . Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support [J ] . N Engl J Med , 2004 , 350 ( 13 ): 1287 - 1295 .

GREB A , BOHLIUS J , TRELLE S , et al . High-dose chemotherapy with autologous stem cell support in first-line treatment of aggressive non-Hodgkin lymphoma - results of a comprehensive meta-analysis [J ] . Cancer Treat Rev , 2007 , 33 ( 4 ): 338 - 346 .

STIFF P J , UNGER J M , COOK J R , et al . Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma [J ] . N Engl J Med , 2013 , 369 ( 18 ): 1681 - 1690 .

HAMADANI M , HARI P N , ZHANG Y , et al . Early failure of frontline rituximab-containing chemo-immunotherapy in diffuse large B cell lymphoma does not predict futility of autologous hematopoietic cell transplantation [J ] . Biol Blood Marrow Transplant , 2014 , 20 ( 11 ): 1729 - 1736 .

VILLA D , SEHN L H , SAVAGE K J , et al . Bendamustine and rituximab as induction therapy in both transplant-eligible and-ineligible patients with mantle cell lymphoma [J ] . Blood Adv , 2020 , 4 ( 15 ): 3486 - 3494 .

中国抗癌协会血液肿瘤专业委员会 , 中华医学会血液学分会白血病淋巴瘤学组 , 中国临床肿瘤学会抗淋巴瘤联盟 . 造血干细胞移植治疗淋巴瘤中国专家共识(2018版) [J ] . 中华肿瘤杂志 , 2018 , 40 ( 12 ): 927 - 934 .

Hematology Oncology Committee of China Anti-Cancer Association, Leukemia & Lymphoma Group ; Society of Hematology at Chinese Medical Association, Chinese Union of Lymphoma Research ; Chinese Society of Clinical Oncology . The Chinese expert consensus on hematopoietic stem cell transplantation for malignant lymphoma(2018) [J ] . Chin J Oncol , 2018 , 40 ( 12 ): 927 - 934 .

YAMASAKI S , CHIHARA D , KIM S W , et al . Risk factors and timing of autologous stem cell transplantation for patients with peripheral T-cell lymphoma [J ] . Int J Hematol , 2019 , 109 ( 2 ): 175 - 186 .

HAN X , ZHANG W , ZHOU D B , et al . Autologous stem cell transplantation as frontline strategy for peripheral T-cell lymphoma: a single-centre experience [J ] . J Int Med Res , 2017 , 45 ( 1 ): 290 - 302 .

CHESON B D , FISHER R I , BARRINGTON S F , et al . Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification [J ] . J Clin Oncol , 2014 , 32 ( 27 ): 3059 - 3068 .

DEVINE S M . Toward a more rational policy for autologous hematopoietic stem cell mobilization [J ] . Biol Blood Marrow Transplant , 2012 , 18 ( 10 ): 1468 - 1470 .

MOHTY M , HÜBEL K , KRÖGER N , et al . Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation [J ] . Bone Marrow Transplant , 2014 , 49 ( 7 ): 865 - 872 .

GIRALT S , COSTA L , SCHRIBER J , et al . Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations [J ] . Biol Blood Marrow Transplant , 2014 , 20 ( 3 ): 295 - 308 .

FRICKER S P , ANASTASSOV V , COX J , et al . Characterization of the molecular pharmacology of AMD3100: a specific antagonist of the G-protein coupled chemokine receptor, CXCR4 [J ] . Biochem Pharmacol , 2006 , 72 ( 5 ): 588 - 596 .

LUND T , GLASS T , TOLAR J , et al . A model system for visualization of whole-body sdf-1 expression during hematopoietic cell transplant [J ] . Blood , 2009 , 114 ( 22 ): 3623 .

DIPERSIO J F , MICALLEF I N , STIFF P J , et al . Phase Ⅲ prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin’s lymphoma [J ] . J Clin Oncol , 2009 , 27 ( 28 ): 4767 - 4773 .

ZHU J , HUANG H Q , CHEN H , et al . Plerixafor and granulocyte-colony-stimulating factor for mobilization of hematopoietic stem cells for autologous transplantation in Chinese patients with non-Hodgkin’s lymphoma: a randomized Phase 3 study [J ] . Transfusion , 2018 , 58 ( 1 ): 81 - 87 .

SHAUGHNESSY P , ISLAS-OHLMAYER M , MURPHY J , et al . Cost and clinical analysis of autologous hematopoietic stem cell mobilization with G-CSF and plerixafor compared to G-CSF and cyclophosphamide [J ] . Biol Blood Marrow Transplant , 2011 , 17 ( 5 ): 729 - 736 .

ADEL N G , DUCK E , COLLUM K , et al . Cost analysis of using plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for autologous stem cell mobilization in multiple myeloma patients treated at Memorial Sloan-Kettering Cancer Center (MSKCC) [J ] . Blood , 2011 , 118 ( 21 ): 4059 .

CAMPEN C J , ARMSTRONG E P , CHRISTIAN J A , et al . Comparative cost-effectiveness of plerixafor plus granulocyte-colony stimulating factor versus cyclophosphamide plus granulocyte-colony stimulating for autologous peripheral blood stem cell mobilization in patients with non-Hodgkin’s lymphoma [J ] . Biol Blood Marrow Transplant , 2010 , 16 ( 2 ): S206 .

DANYLESKO I , SARELI R , VARDA-BLOOM N , et al . Plerixafor (mozobil): a stem cell-mobilizing agent for transplantation in lymphoma patients predicted to be poor mobilizers-a pilot study [J ] . Acta Haematol , 2016 , 135 ( 1 ): 29 - 36 .

GERTZ M A . Current status of stem cell mobilization [J ] . Br J Haematol , 2010 , 150 ( 6 ): 647 - 662 .

CARRERAS E , DUFOUR C , MOHTY M , et al . The EBMT handbook: hematopoietic stem cell transplantation and cellular therapies [M ] . Cham: Springer , 2019 .

JANTUNEN E , VARMAVUO V , VALTOLA J . Plerixafor injection: a hematopoietic stem cell mobilizer in non-Hodgkin lymphoma and multiple myeloma [J ] . Expert Rev Hematol , 2016 , 9 ( 8 ): 723 - 732 .

HAN X H , MA L , ZHAO L D , et al . Predictive factors for inadequate stem cell mobilization in Chinese patients with NHL and HL: 14-year experience of a single-center study [J ] . J Clin Apher , 2012 , 27 ( 2 ): 64 - 74 .

CALANDRA G , MCCARTY J , MCGUIRK J , et al . AMD3100 plus G-CSF can successfully mobilize CD34 + cells from non-Hodgkin’s lymphoma, Hodgkin’s disease and multiple myeloma patients previously failing mobilization with chemotherapy and/or cytokine treatment: compassionate use data [J ] . Bone Marrow Transplant , 2008 , 41 ( 4 ): 331 - 338 .

VARMAVUO V , MÄNTYMAA P , KUITTINEN T , et al . Pre-emptive plerixafor injection increases blood neutrophil, lymphocyte and monocyte counts in addition to CD34 + counts in patients with non-Hodgkin lymphoma mobilizing poorly with chemotherapy plus G-CSF: potential implications for apheresis and graft composition [J ] . Transfus Apher Sci , 2012 , 46 ( 3 ): 257 - 262 .

SÁNCHEZ-ORTEGA I , QUEROL S , ENCUENTRA M , et al . Plerixafor in patients with lymphoma and multiple myeloma: effectiveness in cases with very low circulating CD34 + cell levels and preemptive intervention vs remobilization [J ] . Bone Marrow Transplant , 2015 , 50 ( 1 ): 34 - 39 .

DUONG H K , SAVANI B N , COPELAN E , et al . Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation [J ] . Biol Blood Marrow Transplant , 2014 , 20 ( 9 ): 1262 - 1273 .

LEBEL E , LAJKOSZ K , MASIH-KHAN E , et al . Supermobilizers with high CD34 + cell collection for autologous transplant and impact on survival outcomes in multiple myeloma [J ] . Blood , 2021 , 138 : 1837 .

PORRATA L F , BURGSTALER E A , WINTERS J L , et al . Immunologic autograft engineering and survival in non-Hodgkin lymphoma [J ] . Biol Blood Marrow Transplant , 2016 , 22 ( 6 ): 1017 - 1023 .

FURLONG E , JENSEN J , WOODARD M , et al . Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies [J ] . Pediatr Transplant , 2020 , 24 ( 1 ): e13602 .

LECCHI L , GIOVANELLI S , GAGLIARDI B , et al . An update on methods for cryopreservation and thawing of hemopoietic stem cells [J ] . Transfus Apher Sci , 2016 , 54 ( 3 ): 324 - 336 .

AKKÖK C A , LISETH K , MELVE G K , et al . Is there a scientific basis for a recommended standardization of collection and cryopreservation of peripheral blood stem cell grafts? [J ] . Cytotherapy , 2011 , 13 ( 8 ): 1013 - 1024 .

俞立权 . 造血干细胞移植标准实践手册 [M ] . 北京 : 人民卫生出版社 , 2007 .

YU L Q . Standard practice manual for hematopoietic stem cell transplantation [M ] . Beijing : People’s Medical Publishing House Co., LTD , 2007 .

SHI Y W , LIU P , ZHOU S Y , et al . Comparison of CBV, BEAM and BEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation in non-Hodgkin lymphoma: efficacy and toxicity [J ] . Asia Pac J Clin Oncol , 2017 , 13 ( 5 ): e423 - e429 .

VELA-OJEDA J , GARCÍA-RUIZ-ESPARZA M A , PADILLA-GONZÁLEZ Y , et al . Autologous peripheral blood stem cell transplantation in multiple myeloma using oral versus I.V. melphalan [J ] . Ann Hematol , 2007 , 86 ( 4 ): 277 - 282 .

HUANG H W , ZHANG L H , JIANG Y B , et al . Modified BuCy is an alternative conditioning regimen for lymphoma patients undergoing autologous stem cell transplantation [J ] . Ann Hematol , 2019 , 98 ( 5 ): 1259 - 1266 .

何旭 , 季杰 , 马春蓉 , 等 . 氟达拉滨联合BEAM预处理自体外周血干细胞移植治疗非霍奇金淋巴瘤的效果 [J ] . 国际移植与血液净化杂志 , 2017 , 15 ( 5 ): 24 - 27 .

HE X , JI J , MA C R , et al . Effect of fludarabine combined with beam pretreatment autologous peripheral blood stem cell transplantation in the treatment of non-Hodgkin’s lymphoma [J ] . Int J Transplant Blood Purification , 2017 , 15 ( 5 ): 24 - 27 .

ELEMARY M , SEGHATCHIAN J , STAKIW J , et al . Transfusion challenges in hematology oncology and hematopoietic stem cell transplant - literature review and local experience [J ] . Transfus Apher Sci , 2017 , 56 ( 3 ): 317 - 321 .

TOMBLYN M , CHILLER T , EINSELE H , et al . Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective [J ] . Bone Marrow Transplant , 2009 , 44 ( 8 ): 453 - 455 .

HAMADANI M . Autologous hematopoietic cell transplantation: an update for clinicians [J ] . Ann Med , 2014 , 46 ( 8 ): 619 - 632 .

HIJAZI Z , OLDGREN J , ANDERSSON U , et al . Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a randomized evaluation of long-term anticoagulation therapy (RE-LY) substudy [J ] . Circulation , 2012 , 125 ( 13 ): 1605 - 1616 .

KANATE A S , KUMAR A , DREGER P , et al . Maintenance therapies for Hodgkin and non-Hodgkin lymphomas after autologous transplantation: a consensus project of ASBMT, CIBMTR, and the lymphoma working party of EBMT [J ] . JAMA Oncol , 2019 , 5 ( 5 ): 715 - 722 .

MADDOCKS K , BLUM K A . Treatment strategies in mantle cell lymphoma [J ] . Cancer Treat Res , 2015 , 165 : 251 - 270 .

MAJHAIL N S , RIZZO J D , LEE S J , et al . Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation [J ] . Biol Blood Marrow Transplant , 2012 , 18 ( 3 ): 348 - 371 .

浏览量

4150

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

¹⁷⁷Lu-PSMA放射性配体疗法治疗前列腺癌的临床实践专家共识（2024年版）

淋巴瘤CD30免疫组织化学检测及结果判读规范

CD30在淋巴瘤中的表达及检测：现状与挑战

中国癌症相关性疲乏临床实践诊疗指南（2021年版）

头颈区黏膜淋巴瘤的WHO分类更新及诊断方法