DLBCL诊治进展.pptxVIP

弥漫大B细胞淋巴瘤的诊治进展与规范化治疗;定 义;弥漫大B细胞，非特指型 形态学：常见型和罕见型 分子亚组：GCB和非GCB 弥漫大B细胞淋巴瘤亚型 T-细胞/组织细胞丰富的大B细胞淋巴瘤 原发中枢神经系统弥漫大B细胞淋巴瘤 原发皮肤的大B细胞淋巴瘤，腿型 老年人EBV阳性的弥漫大B细胞淋巴瘤 其他大B细胞淋巴瘤 交界型（borderline cases）;DLBCL,NOS分类;中心母细胞、免疫母细胞和间变变型;Blood 2004；103:275-286;IPI NEJM 1993；329:987-94;IPI NEJM 1993；329:987-94;Swiss Med Wkly. 2012;142:w13511;Blood 2007；109: 1857-1861;Blood 2007；109: 1857-1861;Blood 2007；109: 1857-1861;预后因素研究进展;BCL6 :over 30% of cases BCL2:approximately 20% of cases C-MYC:5–10% of cases Somatic point mutations in other genes: CARD11, A20 and TNFRSF11A leading to NF-κB pathway activation are also observed in 10 to 20% of case;C-MYC gene rearrangement, demonstrated by a “break-apart” FISH probe. Note free green and red signals corresponding to the rearranged allele as well as fused signals corresponding to the second non-rearranged allele.;J Clin Oncol 2012；30:3452-3459;Savage et al ： OS 5 years 33% vs 72% Barrans et al ： OS 2 years 35% vs 61%;A new diagnostic algorithm for Burkitt and diffuse large B-cell lymphomas based on the expression of CSE1L and STAT3 and on MYC rearrangement predicts outcome;PET/CT scanning in DLBCL has been shown to be most useful at the time of initial staging and at the end of primary treatment, whereas the value of interim PET scanning to monitor response and guide treatment decisions is much less clear. In the setting of relapsed disease, PET/CT scanning may be helpful in guiding treatment approaches; however, more data are needed in order to generate reliable treatment algorithms.;诊 断;个体化治疗的分层依据;个体化治疗策略;CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diff use large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group Pfreundschuh M, et al. Lancet Oncol 2011; 12: 1013–22;MInT研究;MInT研究设计;MInT研究证实R-CHOP样显著提高患者六年OS率至90.1%;MInT研究证实R-CHOP样显著提高患者六年EFS率至74.0%;Michael Pfreundschuh, Evelyn Kuhnt, Lorenz Trümper, et al. Lancet Oncol 2011; 12: 1013–22