淋巴瘤2015-09.ppt

预后如何？ 患者年龄小于60岁 体能状况评分（ECOG）为0分 LDH升高 临床分期：IIIA期 淋巴结外病灶：0个 IPI评分：2分（低中危／高中危） 5年OS：51％／46％ 国际预后指数 (IPI) 因素 不良指标 年龄 60岁 体力状态评分 ≥2 LDH 正常 结外受累部位 ≥2 分期 III-IV 危险度分组 存在的危险 因素的数目 5年DFS (%) 5年 OS (%) 低 0-1 70 73 低/中 2 50 51 高/中 3 49 43 高 4-5 40 26 The International Non-Hodgkins Lymphoma Prognostic Factors Project. N Engl J Med. 1993;329:987-994. 因素 不良指标 体力状态评分 ≥2 LDH 正常 分期 III-IV 危险度分组 存在的危险 因素的数目 5年OS 年龄60 (%) 5年OS 年龄≤60 (%) 低 0 56 83 低/中 1 44 69 高/中 2 37 46 高 3 21 32 经年龄校正的 复习思考题 淋巴瘤的2008年WHO分型特点 淋巴瘤的临床表现(注意HL与NHL异同点) 淋巴瘤的分期 淋巴瘤主要辅助诊断手段及其意义 淋巴瘤确诊手段 HL治疗方法选择 惰性NHL淋巴瘤的代表疾病及治疗原则 侵袭性NHL淋巴瘤的代表疾病及治疗原则 参考文献 沈志祥，朱雄增等主编.恶性淋巴瘤.第2版.北京：人民卫生出版社，2011.4 美国血液学协会网址( ASH) 谢 谢 * This slide shows the findings of various diagnostic methods. The initial evaluation of a patient with possible NHL should include a complete history and physical examination, blood counts and serum chemistries, imaging studies, and a bone marrow aspirate and biopsy. Diagnostic methods performed on the biopsy specimens include a routine histologic study, immunoperoxidase staining, flow cytometry, cytogenetics, and molecular biologic methods (Southern blotting, polymerase chain reaction [PCR]). Fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH) are newer techniques that are useful for identifying chromosomal abnormalities, including translocations. FISH is now widely used to identify aberrant DNA sequences in both intact cells, either in interphase or metaphase, and isolated chromosomes. The detection of chromosomal aberrations can be performed at the single-cell level among both dividing and nondividing cells, therefore eliminating the need of metaphase preparations. Compared with FISH, CGH has much greater multiplexing capabilities. This technology examines numerous regions of the genome simultaneously for changes in DNA copy number, identifying complex patterns of gains and losses within the genome. CGH quantifies relative DNA copy differences between hybridized tes