套细胞淋巴瘤临床诊疗体会.ppt

Twenty-six patients had low bulk (10 cm) stage IA (12 patients) or IIA (14 patients) MCL. Initial therapy was involved-field radiation therapy (RT) with or without chemotherapy (CT), 17 patients; CT alone or observation, nine patients. Fifteen patients are alive at a median follow-up of 72 months (range 14-194). Progression-free survival (PFS) at 2 and 5 years was 65% and 46%, and overall survival (OS) 86% and 70%, respectively. Five patients surviving beyond 8 years. Only age and initial use of RT significantly affected PFS. Five-year PFS for patients 60 years of age was 83%, compared with 39% for those aged /= 60 years, P = 0.04. Patients receiving RT with or without CT (n = 17), had a 5-year PFS of 68%, compared with 11% for those not receiving RT (n = 9, P = 0.002). Receiving RT eliminated the impact of age on PFS (with RT the 5-year PFS was 83% for those aged 60 years and 57% for those /= 60 years, P = 0.17). Although OS for the whole group was 53% at 6 years, it was 71% for those initially treated with RT, but only 25% for those not given RT (P = 0.13). CONCLUSION: In our experience, patients with limited-stage MCL had an improved PFS when treated with regimens including RT, with a trend towards improved OS. These results suggest a potentially important role for RT in limited-stage MCL * 2013年NCCN指南中，克拉屈滨+利妥 昔单抗是MCL非高强度诱导治疗的一线治 疗选择之一，也是复发患者的二线治疗选 择之一。 Of 22 patients, the overall response rate was 77% and the complete response rate was 64%. With a median follow-up time of 37 months in surviving patients, the median PFS was 37 months and the median OS was not reached. CC组的CR和ORR分别达47%和88%，而FC组为46%和82%（P =0.25和P =0.11）。CC组的中位PFS为2.34年，FC组为2.27年（P =0.51）。OS以及3～4度治疗相关的毒性反应两组相当。 药代动力学---优点：在细胞内的浓度远较血浆浓度高， 可达128～375倍；药物可以透过血脑屏障 * 中位随访21.5个月 * 个案报道 * 本品可以透过血脑屏障，脑脊液中的浓度约为血浆浓度的25%。血浆蛋白结合率约为20%。MTX血浆蛋白结合率约为50%,3.0-7.5g/m2 CSF浓度可达到1umol/l另一项研究中包括各种血液恶性病患者8名，克拉屈滨按0.12mg/kg的剂量作2小时的静滴。滴注完毕时的平均血浆浓度为48±19ng/ml。可用双相或三相消除模型解释克拉屈滨在其中5位患者体内的消除过程。肾功能正常患者的终末半衰期为5.4