胃MALT淋巴瘤的诊疗热点问题PMA.pptVIP

(1) 评估Hp相关MALT的抗生素治疗疗效;(2) 复发/难治患者二线治疗的结果 This was a retrospective, multicentre, Italian study involving 4 centres (1 Northern, 1 Central, and 2 Southern Italian locations). Patients with persistence or progression following H.pylori treatment, received either single agent chemotherapy with chlorambucil or fludarabine monophosphate, or multiagent chemotherapy with cyclophosphamide, doxorubicin,vincristine, and prednisolone (CHOP) or, more recently,therapy with the monoclonal anti-CD20 antibody rituximab(375 mg/mq on days 1–8 and 15–22), 研究背景：The aetiological association between MALT lymphomas and Helicobacter pylori is well established. The role of additional chemotherapy after H. pylori eradication in localised MALT lymphomas is unclear. The LY03 trial was designed to establish whether chlorambucil after treatment for H. pylori would help prevent recurrence 入组的患者是：成功清除HP并且没有淋巴瘤进展表现的患者 选择苯丁酸氮芥的原因：苯丁酸氮芥的单药治疗是目前欧洲治疗低等级淋巴瘤的标准方案 * Chlorambucil was chosen because, at the time the study was designed, single-agent chlorambucil was the accepted standard treatment for low-grade Non-Hodgkin lymphomas in most European countries 解释121个注册的患者没有进入随机分组的原因：Eleven patients were not randomised due to disease progression and 44 due to inadequate response to antibiotics. Other cases were not randomised despite being eligible – sometimes because of patient refusal, more often clinician reluctance (as initiation of the study preceded the recognition of the excellent prognosis of antibiotic-treated gastric MALT lymphoma). * 平均随访58m（4m-115m）There is no evidence that chlorambucil was more or less effective than observation in different responses to antibiotics at randomisation for either recurrence/progression or overall survival. * The 5-year overall survival rate from randomisation for all randomised patients was 93% 这是第一个胃MALT根除HP治疗后增加药物治疗以预防复发/进展随机对照研究，证实了HP清除后增加苯丁酸氮芥治疗并没有获益 来自加拿大的回故性研究，1989-2000入组了03例局限期MALT（I-II期)。胃及甲状腺的疗效最好。胃及甲状腺MALT各13例。13例胃MALT中有10例是单纯的放疗。甲状腺MALT有12例是单纯放疗。两者5年OS