Lymphatics

14 pages, 1510 KiB

Open AccessReview

Incorporating Immunotherapy with Radiotherapy for Lymphomas

by Paolo Strati and Michael T. Spiotto

Lymphatics 2023, 1(3), 273-286; https://doi.org/10.3390/lymphatics1030018 - 07 Dec 2023

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Radiotherapy and/or chemotherapy have been used for nearly 100 years to treat lymphoma. Recently, immunotherapy has been incorporated into the treatment of lymphomas. Here, we will review both the role of immunotherapy in lymphoma as well as the feasibility of incorporating immunotherapies with conventional lymphoma treatments, especially radiotherapy. Immunotherapy agents include checkpoint inhibitors that target the PD-1/PD-L1 axis, CTLA-4, or CD47. In addition, other immunotherapy agents such as bi-specific antibodies and CD19 CAR-T cell therapy are being implemented in various non-Hodgkin’s lymphomas. Extrapolating from observations in other disease sites and incorporating immunotherapy with conventional treatments of lymphoma, including radiotherapy, may have opposing effects. Radiotherapy may stimulate anti-tumor immune responses that synergize with immunotherapies. In contrast, radiotherapy, as well as chemotherapy, may also induce local and systemic immune dysfunction which reduces the efficacy of immunotherapies. With newer radiation treatment techniques and limited radiation fields, it is likely that the efficacy of immunotherapy can be maintained when included with conventional treatments. Therefore, there remains an unmet need to better understand the role of immunotherapy alone and in combination with current treatments in lymphoma patients. Full article

(This article belongs to the Collection Radiation Oncology)

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11 pages, 918 KiB

Open AccessPerspective

Evolution of Radiation Fields from Involved Field to Involved Site—A Summary of the Current Guidelines by the International Lymphoma Radiation Oncology Group

by Hans Theodor Eich, Niklas Benedikt Pepper and Michael Oertel

Lymphatics 2023, 1(3), 262-272; https://doi.org/10.3390/lymphatics1030017 - 08 Nov 2023

Viewed by 876

Abstract

Radiation therapy has been proven to be highly effective in the treatment of lymphoma. With increasing rates of long-term survival, the reduction in toxicity has gained importance. The evolving understanding of the diseases’ biology, as well as technical and conceptual advances, allows for a precise and individualized application of irradiation. Smaller treatment fields and safety margins make it possible to spare healthy neighbouring tissue (organs at risk). The International Lymphoma Radiation Oncology Group (ILROG) has developed several guidelines to optimize radiotherapy treatment in lymphoma patients. Since its introduction in 2013, involved site radiotherapy (ISRT) has been adopted as the standard of care in most treatment regimens in adult lymphoma. This article serves as a summary of the current ILROG guidelines, also considering contemporary developments and possible future directions. Full article

(This article belongs to the Collection Radiation Oncology)

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5 pages, 198 KiB

Open AccessCommentary

It Is Time to Curb the Dogma in Lymphedema Management

by Heather Barnhart

Lymphatics 2023, 1(3), 257-261; https://doi.org/10.3390/lymphatics1030016 - 12 Oct 2023

Viewed by 646

Abstract

Lymphedema is an under-recognized and underappreciated disease. Advances in imaging and a deeper understanding of the pathophysiology of lymphedema are shedding new light on this disease that affects millions of people worldwide. As new evidence continues to emerge about the microcirculation and revised Starling Principle, etiological factors, related conditions, specific genes, and surgical innovations, the traditional approach to management must also evolve. This evolution is vital to maximize outcomes and improve quality of life. This commentary is a call to action to embrace innovation to better manage lymphedema and expand educational opportunities by leveraging technology to properly train healthcare providers to manage this disease. Full article

13 pages, 2629 KiB

Open AccessReview

Understanding the Role of Bispecific Antibodies in the Management of B-Cell Non-Hodgkin Lymphoma: A New Immunotherapy That Is Here to Stay

by Stanislav Ivanov, Meri Muminovic and Jose Sandoval-Sus

Lymphatics 2023, 1(3), 244-256; https://doi.org/10.3390/lymphatics1030015 - 06 Oct 2023

Viewed by 1212

Abstract

Non-Hodgkin lymphomas (NHLs) represent a diverse group of hematologic malignancies derived from various cells. B-cell NHLs represent the largest fraction of lymphomas diagnosed and treated in the United States. Standard chemo-immunotherapies with rituximab and multiagent cytotoxic regimens have proven to be effective in the management of these lymphoproliferative neoplasms; nonetheless, a considerable fraction of patients still experience relapse or have treatment-refractory disease. Therapeutic advances using novel immunotherapeutic agents as well as cell-based treatments, such as chimeric antigen receptor (CAR) T-cell therapies, have improved the outcomes of relapsed/refractory (R/R) B-cell NHL. Most of these new treatment strategies are not curative and most patients succumb to R/R disease, leaving this population with an unmet need for effective and well-tolerated therapeutic options. One of these up-and-coming options are bispecific antibodies (BsAb), either as single agent or in combination with other medications. Conclusion: BsAbs offer a novel “off the shelf” chemotherapy-free approach in the management of R/R B-cell NHL. Advancements in antibody construct design along with improved safety profile and clinical effectiveness of the most recent BsAbs suggest that these agents are a promising new option in the management of R/R B-cell NHL. Full article

(This article belongs to the Collection Lymphomas)

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7 pages, 1958 KiB

Open AccessCommunication

Scanning Electron Microscopy Analysis of Lymphatic Regeneration in a Secondary Lymphedema Mouse Model: A Preliminary Study

by Kenji Hayashida, Ryohei Ogino, Shota Suda and Sho Yamakawa

Lymphatics 2023, 1(3), 237-243; https://doi.org/10.3390/lymphatics1030014 - 26 Sep 2023

Viewed by 821

Abstract

Under inflammatory conditions including lymphatic disorders, bone marrow-derived myeloid cells often express lymphatic endothelial cell (LEC) markers, and these cells are then called LEC progenitor cells, which extend lymphatic vessels by fusing with existing lymphatic vessels. However, studies on the mechanism of lymphatic regeneration using three-dimensional images of lymphatic structures are limited. In this study, scanning electron microscopy (SEM) was used to observe the three-dimensional structure of lymphangiogenesis in a mouse model of secondary lymphedema. The model was established in C57BL/6J mice via circumferential incision in the inguinal region of the left hind limb. Skin samples were obtained from the lymphedema region on days 2, 5, and 8 after surgery. To determine lymphatic vessel positions using SEM analysis, we detected anti-lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1) immunoreactivity in serial sections and overlaid them during SEM observation. On days 2 and 5, spherical cells, probably myeloid cells, were attached and fused to the LYVE-1-positive lymphatic vessel walls. On day 8, spherical cells were converted to string-shaped cells, forming a new lymphatic vessel wall resembling an intraluminal pillar. Our results showed the newly formed lymphatic vessel wall extended into the lumen, suggesting intussusceptive lymphangiogenesis. Full article

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Lymphatics, Volume 1, Issue 3 (December 2023) – 5 articles

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