Figure 6 . Macroscopic aspect of the cut surface of a human lymph node replaced by lymphoma . The node was about 6x4cm . The lymphoma is the nodules of pinkish tissue surrounded by yellowish fatty tissue . Upon histological examination , the node contained follicular lymphoma . |
Emmanuelm / CC BY / bit . ly / 3soRkH1 |
A B C D
Figure 7 . Stages and subtypes of cutaneous T-cell lymphoma . A , B and C . The three main stages of mycosis fungoides . D . A patient with Sézary syndrome .
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Maria Gluud , et al ; MicroRNAs in the pathogenesis , diagnosis , prognosis and targeted treatment of cutaneous T-cell lymphomas ; Cancers ; CC BY / bit . ly / 3FddDr4 |
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traditional chemotherapy . Many
of these targeted therapies aim at receptors on the surfaces of cells that drive their activation , or cellular pathways inside cells that are downstream mediators of these receptors .
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Melvil / CC BY / bit . ly / 3Sr88b2 |
Samir / bit . ly / 3gDGJWc |
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However , the majority of cancers |
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are driven by numerous mutations , |
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and simply targeting a single pathway |
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is not a cure ; the development of |
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clones that escape the suppression of |
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individual pathways mean that these |
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targeted agents generally need to be |
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taken continuously and may stop working after a period of time . 36 Most of the currently available targeted |
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therapies are taken orally and do not |
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have the same toxicities as chemotherapy |
, though they do have limitations and their own particular side effect profiles . |
B-CELL RECEPTOR SIGNALLING |
Figure 8 . Varicella-zoster . |
Figure 9 . Anteroposterior chest X-ray of patient with P . jirovecii pneumonia showing reticular interstitial markings in all lung fields . |
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INHIBITORS |
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The B-cell receptor is a key signalling |
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mechanism not just for normal |
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immune function , but for the growth |
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and survival of normal and neoplastic |
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B-cells . Agents that target the enzyme |
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Bruton ’ s tyrosine kinase , a key component |
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of this pathway , have become |
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standard treatments for certain B-cell |
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malignancies including CLL , mantle |
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cell lymphoma ( see figure 12 ) and |
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Waldenstrom ’ s macroglobulinaemia |
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. Bruton ’ s tyrosine kinase inhibitors |
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include ibrutinib , acalabrutinib and zanubrutinib . 37 They can produce remissions lasting sometimes years , |
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notably in patients who may respond poorly to chemotherapy because of their genomic profile .
Ibrutinib is generally well
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Figure 10 . T-cells can be harnessed in multiple ways to attack malignant cells : reprogrammed as CAR T-cells , or endogenous T-cells brought to the cancer with bispecific antibodies . |
Shutterstock |
A |
C |
Mariana Righetto de Ré , et al ; Blastoid mantle cell lymphoma : cutaneous infiltration ; An Bras Dermatol / CC BY / bit . ly / 3TOJ5jl |