B细胞淋巴瘤诊疗规范昆明.ppt

Inclusion criteria CD20+ follicular NHL; Ann Arbor stage III or IV (classes B, C and D) No previous systemic antilymphoma treatment WBC 25 x 109/L No CNS involvement Additional standard inclusion criteria 美罗华联合各种化疗一线治疗可延FL总生存：三个关键的临床试验 无论那种化疗方案，美罗华组的总生存和无病生存均能明显延长 98年随着美罗华问世后，FL患者的OS有了显著改善 * Actuarial survival curves for patients with low-grade NHL treated at Stanford University from 1960–1976, 1976–1987, and 1987–1996 are essentially indistinguishable, which shows that the widespread use of single-agent or multi-agent chemotherapy or combined modality therapy has not had a significant impact on the natural course of the disease.6 * A phase III intergroup collaborative study (EORTC 20981) is being conducted to evaluate the efficacy of both combination therapy with MabThera? + CHOP and maintenance therapy with MabThera? in patients with relapsed CD20+ follicular NHL. Patients are being randomized to receive either CHOP (750 mg/m2 cyclophosphamide on day 1, 50 mg/m2 doxorubicin on day 1, 1.4 mg/m2 vincristine on day 1, and 100 mg oral prednisolone on days 1–5, administered every 3 weeks for a maximum of 6 cycles) or MabThera? + CHOP (375 mg/m2 as a slow infusion on day 1). Patients are assessed after 3 cycles, and patients with no change or progressive disease are taken off the study. Patients who achieve a PR or CR are then randomized to receive MabThera? (375 mg/m2) administered as a slow IV infusion once every 3 months until relapse or for a maximum of 2 years. * * * Actuarial survival curves for patients with indolent NHL treated at Stanford University from 1960 to 1976, 1976 to 1987, and 1987 to 1996 are essentially indistinguishable, which shows that the widespread use of single-agent or multiagent chemotherapy or combined modality therapy has not had a significant impact on the natural course of the disease.54 * 二十世纪七十年代到八十年代已证实CHOP作为第一代联合化疗方案治疗淋巴瘤的疗效，患者达到较高有效率（45%~53%）和较高长期生存率（五年或五年以上为30%~37%）。 二十世纪八十年代中进行的单中心研究试验提示中高度非霍奇金淋巴瘤患者使用更复杂的第三代方案有55%~65%可能