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惰性淋巴瘤规范化治疗－08年NCCN治疗指南解读课件
Hungary ,Budapest 2008 WHO Lymphoma Classification B cell B cell chronic lymphocytic Mantle cell Follicular lymphoma Marginal B cell lymphoma, MALT type Plasma cell myeloma/plasmocytoma Diffuse large B cell lymphoma Burkitt’s lymphoma Precursor B lymphoblastic leukemia/lymphoma T cell Mycosis fungoides Peripheral T cell lymphoma, unspecified Angioimmunoblastic T cell lymphoma Extranodal NK/T cell lymphoma Adult T cell leukemia/lymphoma (HTLV1+) Anaplastic large cell lymphoma, primary systemic Precursor T cell lymphoblastic leukemia/lymphoma Distribution of NHL subtypes In the UK (population ~ 60m), there are 8,450 new NHL cases/year1 Across the EU (population ~ 490m) this equates to an incidence of 69,000 new NHL cases/year 惰性淋巴瘤治疗效果提高 常规化疗的改进 Rituximab，CD 20 RIT, Radio-immuno-therapy AHSCT/ Allo-HSCT 一线 - 滤泡性淋巴瘤治疗: Randomized Rituximab 维持治疗的进展 Indolent NHL: induction and Maintenance Rituximab before and after ASCT for relapsed aggressive B-NHL Rituximab significantly improves outcomes when combined with HDT and ASCT CD20 -I 131:FL and Transformed NHL: Long term outcome 11 studies ,1177 pts M age 57 ( 21-90), stage ? 90%, tumor 5cm 47%,BM + 44% 1st (141) 2rd (226) 3rd (228) 4th ( 540) Response R. 95 73 58 46 M.d. response - 35 16 12 CR (%) 78 46 32 23 M.d. CR - - 35 59 PFS1Y (%) 82 59 42 27 ASCO 2005,abstract 6561 USA multicenters Zevalin巩固治疗FL CUP trial: AHSCT欧洲多中心研究 CUP trial: progression-free survival AutoPBSCT in 1st Remission FL AHSCT 1st-line :follicular lymphoma 540 pts, randomized trial 5-y estimated PFS 27% CHOP - IFN-alpha maintenance, 65% CHOP - ASCT, 68% R-CHOP - I
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