南开医学院讲课淋巴瘤课件.ppt

BRIGHT Study: Response Rate Flinn IW, et al. ASH 2012. Abstract 902. Response, % (95% CI)* BR (n = 213) R-CHOP or R-CVP (n = 206) CR Ratio P Value (Noninferior) P Value (Superior) CR 31 (25.3-38.2) 25 (19.5-31.7) 1.25 (0.93-1.73) .0225 .1269 PR 65 66 -- -- -- ORR (CR + PR) 97 (93.3-98.7) 91 (86.0-94.4) -- -- -- *Evaluable population determined by independent review committee. BRIGHT Study: Response Rate CR rates with bendamustine + rituximab vs R-CHOP or R-CVP similar among patients with indolent NHL CR rate with bendamustine + rituximab statistically superior to CR rates with R-CHOP or R-CVP among patients with MCL Flinn IW, et al. ASH 2012. Abstract 902. Patient Population CR Rate Ratio P Value (Noninferior) P Value (Superior) Indolent NHL 1.16 (27%VS23%) .129 -- MCL 1.95 (51%VS24%) .017 .018 AEs Most common for BR and R-CHOP/R-CVP, respectively, were nausea (139 vs 102 patients), fatigue (113 vs 107), neutropenia (76 vs 85), constipation (65 vs 90), and alopecia (8 vs 74). Laboratory grade 3/4 hematologic toxicities for BR and R-CHOP/R-CVP were lymphopenia (137 vs 64), neutropenia (98 vs 151), leukopenia (84 vs 116), thrombocytopenia (16 vs 15), and anemia (6 vs 9) Fatal AEs occurred in 6 BR patients (pneumonia, respiratory failure, and sepsis; acute respiratory failure; cardiac arrest; pneumonia; chronic obstructive pulmonary disease; lung cancer) and 1 R-CHOP/R-CVP patient (sepsis) 新 药 表型 疾病 CD5 CD10 CD23 CD43 ANXA1 CD103 Cyclin D1 Ig FL - + -/+ - - - - M/G MCL + - - + - - + MD/l CLL/SLL + - + + - - - MD LPL - - - +/- - - - M(c) MZL - - - +/- - - - M(c,s) SMZL - - - - - - - M/D HCL - - - - + + -/+ G/l “小”B细胞淋巴瘤的鉴别诊断 DLBCL 发病率最高的NHL： 截止09年12月份NHL-B亚型分类数量比例图 中国抗癌协会淋巴瘤病理协作组 弥漫大B细胞淋巴瘤 弥漫大B细胞淋巴瘤，非特殊类型T细胞/组织细胞丰富的大B细胞淋巴瘤老年人EBV阳性的弥漫大B细胞淋巴瘤慢性炎症相关的弥漫大B细胞淋巴瘤－脓胸相关淋巴瘤－慢性骨髓炎相关淋巴瘤－植入物相关淋巴瘤原发中枢神经弥漫大B细胞淋巴瘤－淋巴瘤样肉芽肿－原发纵膈（胸腺）大B细胞淋巴瘤－血管内大B细胞淋巴瘤－原发皮肤大B细胞淋巴瘤，腿型－浆母细胞性淋巴瘤－原发渗漏性淋巴瘤－ALK阳性弥漫大B细胞淋巴瘤－起源于HHV8阳性的多中心Castleman病的大B细胞淋巴瘤 CHOP标准方案的确立！/ ? CHOP对比各种方案治疗