弥漫大B细胞淋巴瘤..pptVIP

GCB VS NONGCB Green等的研究发现了类似的结果，MYC/Bcl-2共表达的比例在ABC和GCB来源亚型中分别为41%和19%。 与此相反，Perry等的研究却发现MYC/Bcl-2共表达的比例在2种亚型中较为接近(GCB型为46%，ABC型为42%)，而且MYC/Bcl-2共表达只有在GCB亚型中成为独立的不良预后因素。 GCB VS NONGCB GCB DLBCL预后好, 首选R-CHOP The LySA group conducted a randomized trial demonstrating superiority of the aggressive ACVBP regimen over R-CHOP in younger patients with low-risk DLBCL; a correlative study demonstrated equivalent outcomes in GCB and nonGCB subsets indicating a potential bene?t of the aggressive regimen in the nonGCB subgroup. GCB VS NONGCB Two recently published studies have combined lenalidomide with R-CHOP. suggesting a bene?t in the nonGCB, as that group normally has inferior outcome. These promising results have led to an intergroup NCTN randomized trial led by ECOG comparing R-CHOP to R-CHOP with lenalidomide, which is powered to demonstrate bene?t in the nonGCB subgroup of patients, de?ned at diagnosis by immunohistochemistry. GCB VS NONGCB A phase 2 study has demonstrated safety of R-CHOP with bortezomib combination in de novo DLBCL, and suggested that nongerminal center subtype had similar outcome as GCB subtype. Two large randomized trials comparing R-CHOP with R-CHOP and bortezomib are ongoing powered to show improvement in outcome in the nongerminal subset of patients. 自体移植在初次缓解 The US/Canadian Phase III intergroup led by SWOG (S9704) sought to answer the question in the rituximab era S9704 study showed a PFS advantage for transplant There was no survival advantage for up-front transplant. 新药 Ibrutinib is an inhibitor of Bruton’s tyrosine kinase ABT-199, a speci?c and safe bcl-2 inhibitor The small molecule JQ1 suppresses c-myc expression Brentuximab vedotin (anti-CD30 ADC) has demonstrated activity in DLBCL with a response rate of 40% in one study Other targetable cell-surface molecules include CD19, CD22, CD70, and CD79b. 总结 GCB：RCHOP是标准方案 nonGCB：R ACVBP？临床试验？ 原发纵隔大 B 细胞淋巴瘤： DA-R-EPOCH是目前标准选择 双重打击淋巴瘤： DA-R-EPOCH？临床试验？ 高危DLBCL：初次缓解自体移植。 CNS预防：大剂量MTX