胃と腸41巻3号

2006年03月発行

今月の主題 腸管悪性リンパ腫―最近の知見

主題

腸管悪性リンパ腫の治療―内科的治療―化学療法を中心に

著者： 小椋美知則¹

所属機関： ¹名古屋第二赤十字病院血液内科

ページ範囲：P.338 - P.344

文献概要

要旨　節外性リンパ腫は，リンパ腫全体の24～48％を占め，その発生部位も多岐にわたるが腸管もその代表的部位であり，胃腸原発のリンパ腫は非Hodgkinリンパ腫の5～10％を占める．病型ではびまん性大細胞型B細胞性リンパ腫（DLBCL）を中心とするaggressive non-Hodgkin's lymphoma（NHL）が最も頻度が高い．腸管原発のaggressive NHLに対しては，局所病変部の出血，穿孔などのコントロールを兼ねた切除術後に，限局期であればCHOP（DLBCLならrituximabを併用したR-CHOP）療法の3～4コース後の放射線照射（区域照射）もしくはCHOP（DLBCLならR-CHOP）療法6コース，進行期であればCHOP（DLBCLならR-CHOP）療法8コースが標準的な治療戦略である．DLBCLの生存予後は良好であるがT細胞性aggressive NHLの予後は不良であり今後の新たな治療戦略の開発が望まれている．腸管原発の濾胞性リンパ腫はまれであり十二指腸を中心とする小腸に多く発生し女性に多い．生命予後は良好であり，局所制御には放射線もしくはrituximabが使用される．進行期の治療戦略は，通常の節性，濾胞性リンパ腫と同じでrituximabとCHOPなどの化療との併用療法が準標準的治療法である．

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