1.5专题讲座5、DLBCL诊疗规范-qiansx推荐.pptVIP

* Because of the shortcomings of the Ann Arbor staging system, the International Prognostic Index (IPI) was developed to assess the prognosis of patients with aggressive lymphomas. In this system, 5 pretreatment characteristics are considered to be independently statistically significant predictors of clinical outcome: age (60 or ≥60 years), tumor stage (stage I or II versus stage III or IV), number of extranodal sites (≤1 versus 1), ECOG (Eastern Cooperative Oncology Group) performance status (PS; 0 or 1 versus 1), and serum lactate dehydrogenase (LDH) level (normal versus elevated). The total number of adverse risk factors are summated, stratifying patients into low-risk (0 or 1 risk factor), low/intermediate-risk (2 risk factors), high/intermediate-risk (3 risk factors), and high-risk (4 or 5 risk factors) groups. These risk groups correspond to various 5-year disease-free survival (DFS) and overall survival (OS) rates. An age-adjusted index also exists for patients or ?60 years. The IPI is widely used with aggressive lymphomas and has been demonstrated to be of prognostic value in other subtypes of lymphomas as well, including low-grade lymphomas. The International Non-Hodgkins Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkins lymphoma. N Engl J Med. 1993;329:987-994. 接下来我们介绍一下DLBCL患者的分层标准。 首先，=60岁的患者，占约60%，为预后不良。 对于小于60岁的患者，我们根据IPI评分和有无大包块的情况，进一步分层。 IPI=0且无大包块的患者，占9%，为预后良好。 IPI=1或者伴有大包块的患者，占13%，为预后欠佳。 IPI=2的患者，占18%，为高危且预后差的患者。根据不同预后的患者，我们会进行分层治疗。 * * * * 美罗华联合化疗一线治疗FL，所有的研究均显示能够改善总生存，使患者获益。 * * 以上美罗华维持治疗FL的研究都显示改善患者EFS或PFS，使患者获益。 * * * * 可以看到：美罗华维持组的中位PFS为3.7年,比观察组提高了2.4年 * * * * 随访5年的总生存情况，美罗华维持治疗组为74.3%，观察组为64.7%，虽然目前P值为0.07，但是可以看到两组生存曲线有继续分离的趋势，我们可以期待进一步随访的结果； * * * * * FL的治疗演进过程：单用化疗PFS为3年；美罗华联合化疗PFS为5－6年，复发后在用美罗华联合化疗仍然有效； 再到美罗华用于复发病人的维持治疗，能进一步提高PFS（PFS为5年）；那么对于一线美罗华诱导后再美罗华维持治疗，PFS 7－9年或更长呢，有待进一步随访结 果 美罗华为基础的诱导和维持治疗能延长PFS，为FL治疗提供临床治愈的可能。 * * * * * * * 弥漫大B