恶性淋巴瘤医 ppt课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * Slide 7: More than 9,000 of the 10,500 autotransplants performed in North America in 2002 were for multiple myeloma or lymphoma. Of the 7,200 allotransplants performed in 2002, more than 5,000 were for leukemia or myeloproliferative diseases. * Slide 8: About one-third of allogeneic transplants are from unrelated donors. Indications are similar for related and unrelated donor transplantation. * * * * * * * * * * * 胃粘膜相关淋巴组织淋巴瘤 IE 或Ⅱ期 、 HP 阳性者 给予抗HP治疗，3月后确定疗效。 有 t（11，18）易位者 应予放疗。 抗 HP 治疗后 HP 转阴、肿瘤消失者，定期复查 HP 转阴而内窥镜下仍有肿瘤，给予放疗 HP 阳性而肿瘤缩小或稳定，更换抗 HP 治疗方案 HP 阳性而肿瘤进展，应予放疗，无效者手术切除。 Ⅲ～Ⅳ期 无症状、无治疗指征者可随诊、观察；需治疗者，参照惰性淋巴瘤治疗方案 非胃粘膜相关淋巴组织淋巴瘤 IE 或Ⅱ期 放疗、或手术切除 Ⅲ、Ⅳ期 治疗方案参考惰性淋巴瘤 组织学伴有大细胞者，按照 DLBCL 治疗 Burkitt 淋巴瘤 原则上给予高剂量联合化疗 可选用 CODOX-M 方案或 Hoelzer 方案 由于 NHL 亚型的多样性，治疗方案应当有所不同。 “规范化治疗”或“治疗指南”并没有要求每一位病人必须接受某一种治疗方案，而是根据不同情况提出一组经过研究、确实有效的治疗建议，具体的实施则一定要考虑患者的个体情况。 小结 淋巴瘤是异质性很强的一组疾病，临床表现多样。 诊断依赖病理检查，合理的取材很重要。 明确诊断后，需进行分期。 目前，国际上将淋巴瘤各个亚型看做独立的疾病，在治疗上也各有不同。 新药层出不穷，疗效在近些年有明显进步。 谢谢 * * * * * Slide 5: Frequency of NHL Subtypes in Adults The clinical utility of the REAL classification system was demonstrated in a retrospective evaluation involving more than 1400 cases of NHL. (NHL Classification Project, 1997) Data from nine institutions in eight countries were reviewed by pathologists, and the frequency of the occurrence of various subtypes of NHL were described. (Armitage and Weisenburger, 1998) Indolent NHL was the most frequent type of NHL and included the following subtypes (Armitage and Weisenburger, 1998) : Follicular lymphoma Small lymphocytic lymphoma Marginal zone B-cell lymphoma/MALT type Marginal zone B-cell lymphoma/nodal type Lymphoplasmacytic lymphomas Armitage JO, Weisenburger DD. New approach to classifying non-Hodgkin’s lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin’s Lymphoma Classification Project. J Clin Oncol. 1998;16:2780