课件：霍奇金淋巴瘤.pptx

霍奇金淋巴瘤指南解读程淑琴（WHO）HL 分为两种类型淋巴细胞为主型霍奇金淋巴瘤（LPHL）经典的霍奇金淋巴瘤（CHL）CHL 分为4 种亚型：结节硬化型CHL（NSCHL ）混合细胞型CHL（MCCHL）淋巴细胞消减型CHL（LDCHL）富淋巴细胞型CHL（LRCHL）。LPHL 占HL 病例的5%，CHL 占95%。病 理CHL 的特点是在炎性背景下存在R-S 细胞，LPHL 缺乏R-S 细胞，但存在肿瘤性淋巴细胞，有时称为爆米花细胞LPHL 表现为结节性或弥漫性形式结节性亚型：表现为大量B 淋巴细胞中出现肿瘤性淋巴细胞弥漫性亚型：背景细胞主要为T 细胞。免疫组化CHL：R-S 细胞大多表达CD15和CD30，而CD3 和CD45 常常阴性 40%以下的病人可检测到CD20 推荐CD3﹑CD15﹑CD20、CD30 和CD45LPHL ：CD45+和CD20+，不表达CD15，极少表达CD30 指南推荐CD3、CD15﹑CD20﹑CD21、CD30 和CD57 染色经典的霍奇金淋巴瘤在初始诊断和检查后，病人分为下列几组：? I-II 期? III-IV 期I-II 期的病人，根据是否存在不利因素，进一步分为下列亚组：? IA-IIA 期（有利）? I-II 期（不利伴巨块型疾病）? I-II 期（不利伴非巨块型疾病）Staging and PrognosisEach stageis subdivided into A and B categories.“A” indicates that no systemic symptoms are present and “B” is assigned to patients with unexplained weight loss of 10% of their body weight, unexplained fevers, ordrenching night sweats.Patients with HL are usually classified into 3groups:early-stage favorable (stage I-II with no unfavorable factors);early-stage unfavorable (stage I-II with any of the unfavorable factors such as largemediastinal adenopathy; 2–3 nodal sites of disease; B symptoms; extranodal involvement; or significantly elevated erythrocyte sedimentation rate [ESR] ≥ 50)advanced-stage disease (stageIII-IV).FOLLOW-UP AFTER COMPLETION OF TREATMENT AND MONITORING FOR LATE EFFECTSCR should be documented including reversion of PET to negative within 3 months following completion of therapy.? It is recommended that the patient be provided with a treatment summary at the completion of his/her therapy, including details of radiation therapy, organsat risk, and cumulative anthracycline dosage given.? Follow-up with an oncologist is recommended, especially during the first 5 years after treatment to detect recurrence, and then annually due to the risk oflate complications including second cancers and cardiovascular disease.kk,ll Late relapse or transformation to large cell lymphoma may occur in NLPHL.? The frequency and types of tests may vary depending on clinical circumstan