霍奇金淋巴瘤治疗进展kklargir.ppt

6 IPFP produced widely recognized prognostic index for advanced stages. Already employed for describing, defining and stratifying patient cohorts CONFIDENTIAL Advanced Stages:-ABVD-the Gold Standard??No!It is not!At least not for all risk groups! Long-Term Follow-up Advanced HL: only stages IIB-LMM, III, IV !! Failure-free survival Overall survival Years after study entry Canellos et al. NEJM, 2002 Fourth Generation Regimens:are they superior to ABVD?? 1.Stanford V 2.ClVP/EVA 3.MEC (Gobbi: 10 drug regimen!) (JCO 2005) 4.BEACOPP Gobbi PG, et al. J Clin Oncol. 2005;23(36):9198-9207. Epub 2005 September 19. MOPP-EBV-CAD: Meclorethamine, CCNU, Vindesine, Alkeran, Prednisone, Epidoxorubicin, Vincristine, Procarbazine, Vinblastine, Bleomycin 355 patients, RT bulk + residual disease. ABVD vs Stanford V vs MEC Log rank 27.48 P0.0001 Log rank 3.05 P=0.22 FFS (%) OS (%) FFS (%) Time, Months Time, Months MEC ABVD Stanford V Italian StudyAdvanced Hodgkin Lymphoma ABVD vs 4 BEACOPP- esc + 4 BEACOPP- base vs MEC (Italian 10 drug regimen) Chemotherapy Radiotherapy CT-Intensity ABVD BEAesc StanfordV Advanced HL (5-10%) (45%) (90%) RT Intensity Need for RT: B Bleomycin E Etoposide A Adriamycin C Cyclophos. O Vincristin P Procarbazin P Prednison Basis [mg/m2] 10 100 25 650 1,4 100 40 The BEACOPP - schedule Escalated [mg/m2] 10 200 35 1250 1,4 100 40 G-CSF sc 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 22 restart CS IIB-IIIA with risk factors CS IIIB-IV Arm A 4 × COPP+ABVD ? RT Arm B 8 × BEACOPP baseline ? RT Arm C 8 × BEACOPP escalated* ? RT RT to initial bulk and residual tumor GHSG: HD9 Trial Design (1992- 96) * with G-CSF Randomisation Diehl et al, NEJM, 2003 HD9- 10 ys FFTF by treatment arm Log-rank tests: A v B v C p0.0001 A v B p=0.040 B v C p0.0001 A v C