霍奇金淋巴瘤治疗进展.pptVIP

霍奇金淋巴瘤治疗进展 Did we learn from our mistakesover 40 years? 个体化治疗！ 对于早期患者 如何在保证疗效的情况下尽可能减少副作用？ 能否进一步减少化疗疗程？减小放疗剂量？ 晚期患者 如何进一步提高治愈率？ 预后不良 (Unfavorable) 早期HL 年龄≥50岁 ≥4个淋巴结区域受侵 单独ESR≥50 B症状和ESR≥30 纵隔大肿块，或肿块直径大于10cm ≥2个结外部位受累 Hodgkin Lymphoma: 早期预后不良组 Is less more? 寻找高效和低毒间的最佳平衡点 早期预后良好组 :  GHSG: HD10- Trial  HD10结论 2×ABVD is non-inferior to 4×ABVD 20Gy IF-RT is non-inferior to 30Gy IF-RT 早期患者联合治疗VS 单化疗 早期预后良好患者 2ABVD+ 20 Gy IF-RT是标准治疗！ 单化疗、减药化疗+放疗尚待随机研究结果 Hodgkin LymphomaIntermediate Stages Fact: Combined chemo- and radiotherapy is largely considered as standard: 4 ABVD+ 30 Gy IF-RT Result: 90% tumorfree survival after 5 years 93% overall survival after 5 years EORTC Trials: H10 + H11 Standard Arm : 3 ABVD+ 30Gy IF-RT Hodgkin LymphomaEarly and Intermediate Stages Summary The GHSG experience Standard outside clinical trials: Early favorable: 2ABVD + 20 Gy IF-RT Early unfavorable: 4 ABVD + 20-30 Gy IF-RT (intermediate) Hodgkin Lymphoma Advanced Stages Current Practice Intensive Chemotherapy ?CR: no RT ? PR: 30 Gy IF-RT Chemotherapy: IF-RT 6-8 ABVD (45%RT) Or 6-8 BEACOPP (15% RT) Advanced Stages:-ABVD-the Gold Standard??No!It is not!At least not for all risk groups! Fourth Generation Regimens:are they superior to ABVD?? 1.Stanford V 2.ClVP/EVA 3.MEC (Gobbi: 10 drug regimen!) (JCO 2005) 4.BEACOPP ABVD vs Stanford V vs MEC Italian StudyAdvanced Hodgkin Lymphoma ABVD vs 4 BEACOPP- esc + 4 BEACOPP- base vs MEC (Italian 10 drug regimen) Open Questions: 1. How to identify the good and bad risk groups at diagnosis? 2.