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2020 | OriginalPaper | Hoofdstuk

33. Maligne aandoeningen van het lymfatische systeem

Auteurs : Prof. dr. D. de Jong, Prof. dr. M. J. Kersten, Dr. W. J. Plattel, Dr. B. M. P. Aleman

Uitgeverij: Bohn Stafleu van Loghum

Samenvatting

Maligne lymfomen vormen een heterogene groep van lymfatische aandoeningen, die zich klinisch zeer indolent, maar ook zeer agressief kunnen gedragen. Een van de meest karakteristieke vormen is het hodgkinlymfoom, dat vooral op jongere leeftijd voorkomt. De veel frequenter voorkomende overige vormen van maligne lymfoom (non-hodgkinlymfoom, NHL) presenteren zich meestal op oudere leeftijd. Met behulp van immunohistochemie, flowcytometrie, cytogenetisch onderzoek en moleculair-biologische bepalingen kunnen zo’n 40 aparte ziekte-entiteiten worden gediagnosticeerd met ieder hun eigen typerende kliniek, behandeling en prognose. De maligne lymfomen treden meestal als een pijnloze lymfeklierzwelling aan het licht. Stadiëringsonderzoek is noodzakelijk om de uitgebreidheid van de ziekte vast te leggen en de hierop gebaseerde behandeling in te stellen. Met de huidige combinaties van chemotherapie en radiotherapie is meer dan 85 % van de patiënten met het hodgkinlymfoom te genezen. Toevoeging van anti-CD20- (rituximab)therapie aan chemotherapieschema’s heeft de prognose van bijna alle typen B-cel NHL zeer sterk verbeterd en is een integraal onderdeel van de behandeling geworden. Voor patiënten met een indolent lymfoom zijn meerdere therapeutische opties beschikbaar, variërend van afwachtend beleid tot intensieve therapie. Bij agressievere lymfomen wordt intensieve chemotherapie toegepast (R-CHOP en varianten daarvan). Hiermee is ongeveer 60 % van de patiënten te genezen. Voor diverse lymfoomtypen worden nu gerichte behandelingen, die zijn toegesneden op specifieke moleculaire afwijkingen en ontstaansmechanismen, ontwikkeld en toegepast in het kader van fase II-trials en ook steeds meer in fase III-trials. Het is te verwachten dat deze strategie in de komende jaren steeds belangrijker wordt.

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Titel: Maligne aandoeningen van het lymfatische systeem
Auteurs: Prof. dr. D. de Jong
Prof. dr. M. J. Kersten
Dr. W. J. Plattel
Dr. B. M. P. Aleman
Uitgeverij: Bohn Stafleu van Loghum
Boek: Leerboek oncologie
Print ISBN: 978-90-368-2448-4

Elektronisch ISBN: 978-90-368-2449-1

Copyright: 2020
DOI: https://doi.org/10.1007/978-90-368-2449-1_33

Bohn Stafleu van Loghum

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