文档介绍:惰性淋巴瘤规范化治疗-治疗指南解读Hungary,Budapest20082008LuganoICML,InternationalConferenceMaglinantLympphomaWHOLymphomaClassificationBcellBcellchroniclymphocyticMantlecellFollicularlymphomaMarginalBcelllymphoma,MALTtypePlasmacellmyeloma/plasmocytomaDiffuselargeBcelllymphomaBurkitt’slymphomaPrecursorBlymphoblasticleukemia/lymphomaTcellMycosisfungoidesPeripheralTcelllymphoma,unspecifiedAngioimmunoblasticTcelllymphomaExtranodalNK/TcelllymphomaAdultTcellleukemia/lymphoma(HTLV1+)Anaplasticlargecelllymphoma,primarysystemicPrecursorTcelllymphoblasticleukemia/lymphomaDistributionofNHLsubtypesIntheUK(population~60m),thereare8,450newNHLcases/year1AcrosstheEU(population~490m)thisequatestoanincidenceof69,000newNHLcases/yearALBCLOtherDLBCLFLMALTlymphomaMatureT-celllymphomaCLL/SLLMCLPMLBCLBurkitt’slymphomaLiuQ,;(%)10yr(%)15yr(%)CHOP–BleoCHOP–Bleo->IFNATT->IFNATT->->IFNFND-->R(+IFN)1977–19821982–19881988–19921992–19971997–2002961311361422006475828290375260----2942------IFN:interferon;ATT:alternatingtripletherapywithCHOD-B/ESHAP/NOPP;FND:fludarabine,mitoxantrone,anddexamethasone;Bleo:bleomycin;CHOP:cyclophosphamide,doxorubicin,vincristine,prednisoneYes,SurvivalHasImproved!过去25年惰性淋巴瘤的生存是否有改善?Years%存活率0510152025020406080100CHOP-BleoCHOP-Bleo+IFNATTIFNATTIFNvsFNDIFNR-FND+IFNvsFNDR+IFNP<.0001IV期滤泡性淋巴瘤:不同治疗方案的OS1972-2002Liuetal,JCO2006;24:1582-1589Years%Alive0510152025020406080100CHOP-BleoCHOP-Bleo+IFNATTIFNATTIFNvsFNDIFNR-FND+IFNvsFNDR+IFNP<.01IV期滤泡性淋巴瘤:不同治疗方案的生存,FLIPI评分3Liuetal,JCO2006;24:1582-1589Years%Failure-Free0510152025020406080100CHOP-BleoCHOP-Bleo+IFNATTIFNATTIFNvsFNDIFNR-FND+IFNvsFNDR+IFNP<.0001IV期滤泡性淋巴瘤:不同治疗方案的FFS1972-2002Liuetal,JCO2006;24:1582-1589惰性淋巴瘤治疗效果提高常规化疗的改进Rituximab,CD20RIT,Radio-immuno-therapyAHSCT/Allo-HSCTRituximab:惰性NHL(FL)单药治疗结论单药:复发和难治的低度恶性NHL(RR48%)单药:初发的低度恶性NHL(RR73%)联合化疗结论(Ⅲ期临床研究)R-CVP疗效明显优于CVP方案R-CHOP明显优于CHOP方案(TTFPFSOS)CVP后+R维持治疗进一步增加疗效(PFS)FCM+R明显优于FCM方案(RRCRPFSOS