5.年轻高危弥漫大B淋巴瘤诊治进展-王晓东重点.ppt

年轻高危弥漫大B细胞淋巴瘤治疗策略;内 容;DLBCL流行病学;DLBCL是一组异质性很强的疾病;年轻高危患者治疗方案尚未达成共识;内 容;;根据临床特征的危险度分层仍是临床实践主流DLBCL国际预后指数（IPI）;IPI与预后;LLBC研究;IPI仍然是目前适用的预后评估体系;LLBC研究结果;LLBC研究结果;;分子生物学因素-细胞起源;DLBCL中的MYC改变;DLBCL中的MYC基因重排;Double-hit B-cell lymphomas;IHC Double-Hit Score判断DLBCL预后;DLBCL中MYC蛋白过度表达比基因变异更为常见 ;NCCN指南关于MYC检测的更新;CD30+ DLBCL亚型预后良好 --the International DLBCL R-CHOP Consortium Program Study ;Blood. 2013;121(14):2715-2724;Blood?(ASH Annual Meeting Abstracts) 2010 116: Abstract 4166 ;TP53在DLBCL中的预后意义;;仅供内部使用;内 容;R之前缩短化疗间歇期、VP16的引入改善了中低危患者疗效;美罗华上市后，丹麦的回顾性分析显示RCHOEP改善了年轻中高危患者的预后; RCHOEP14 vs.R-MegaCHOEP14治疗年轻高危侵袭性B-NHL：DSHNHL 2002-1;R-MegaCHOEP耐受性差，非血液学毒性强;亚组分析显示：aaIPI 2-3患者的3年EFS，R-MegaCHOEP不优于RCHOEP;亚组分析显示：RCHOEP延长aaIPI2患者3年OS；但aaIPI3患者的OS相似;DSHNHL 2002-1: 结论; Results:?71 patients were evaluated. Median age was 60 years. ?57(80%) was DLBCL. 89% had advanced?(III-IV) CS, and 58% presented B symptoms. 59 (83%) achieved a CR or CRu, 6 (8%) a PR, 2 early deaths: ?one due to septic shock, and one due to non-related cause (traumatism).? With a median follow-up of 40 months, the EFS and OS is 60% and 61% respectively at?5 years. DFS is 72% at 5 years for patients?who achieved a CR or CRu. A grade 3-4 mucositis occurred in 9 occasions,?and neutropenic fever or infections in 66 cycles (16%). Conclusion:?DA-EPOCH-R is a regimen with clinically?significant activity and very acceptable toxicity profile?in patients with poor prognosis aggressive B-cell lymphomas?and could somehow overcome IPI risk factors. ;ESMO临床指南;DLBCL新的靶向药物及作用靶点和获益患者亚群;自体干细胞移植在年轻高危DLBCL中的地位;High Intermediate Risk;荟萃分析显示：ASCT在中高危患者中的地位仍存争议;SWOG-9704 研究设计;SWOG-9704 显示：移植提高2年PFS，但OS无差别;SWOG-9704亚组分析显示：移植组明显提高aaIPI3患者??PFS;SWOG-9704亚组分析显示：移植组明显延长aaIPI3患者的OS;SWOG9704研究提示：aaIPI 为3分的患者更适合接受ASCT作为巩固治疗; aaIPI不足够，需结合病变部位及更多免疫学或遗传学/分子学等特征，比如CD30、CD5、EBV、c-myc、Ki-67等;谢谢！