课件：滤泡性淋巴瘤一线治疗新策略.ppt

* * Inclusion criteria CD20+ follicular NHL; Ann Arbor stage III or IV (classes B, C and D) No previous systemic antilymphoma treatment WBC 25 x 109/L No CNS involvement Additional standard inclusion criteria * * * * * * * * The objective of rituximab maintenance therapy is to control remaining malignant cells after initial therapy and improve survival although cure is currently not possible in indolent NHL, it is important to delay the next therapy for as long as possible. Importantly, rituximab maintenance causes only minimal disruption of daily life long half-life allows infrequent therapy while maintaining long-term exposure (in contrast to chemotherapy) rituximab has minimal acute toxicity and there is no known cumulative toxicity rituximab maintenance therapy can be delivered in the out-patient setting, causing minimal disruption to daily life. * In this study, all patients received four infusions of rituximab 375mg/m2 as induction. Patients in arm A received no further rituximab while in arm B further rituximab infusions were given at week 12 and months 5, 7 and 9. Circulating B-cells were rapidly depleted on induction treatment with rituximab in both arms levels of T-helper, T-suppressor and NK cells remained approximately stable. When no further rituximab treatment was given, B-cell recovery started 2–3 months after treatment and continued. Rituximab maintenance therapy caused B-cells to remain depleted at further follow-up, B-cell recovery appeared to commence once maintenance therapy was stopped. * There is now a considerable body of evidence demonstrating a significant clinical benefit with rituximab maintenance therapy in follicular lymphoma (FL). These studies have demonstrated a benefit for rituximab maintenance in previously untreated, relapsed and refractory FL and after induction with rituximab monotherapy and rituximab-containing immunochemotherapy. * Actuarial survival curves for patients with indolent NHL treated at Stanford University from 196