淋巴瘤完全缓解后的维持治疗课件.ppt

RICOVER 60研究(DSHNHL1999-1) 无事件生存时间(EFS)(36月随访) 47% 53% p=0.125 100 80 60 40 20 0 0 5 10 15 20 25 30 35 40 45 月 8 x CHOP-14(n=305) 6 x CHOP-14(n=307) 8 CHOP-14 vs 6 CHOP-14 Failure-free survival (%) 66% 63% p=0.23 100 80 60 40 20 0 0 5 10 15 20 25 30 35 40 45 Failure-free survival (%) 8R+8CHOP-14 vs 8R+6CHOP-14 p=0.23 8 x R + 6 x CHOP-14(n=306) 8 x R + 8 x CHOP-14(n=304) Pfreundschuh M, et al. Blood 2006;Abstract205 增加缓解率 克服原发耐药 剂量强度/密度 新药 降低复发率 维持缓解状态 利妥昔单抗 新型药物 R-CHOP时代改善侵袭性NHL的策略 侵袭性NHL 利妥昔单抗维持治疗在非DLBCL 中的结果 美罗华维持 3 年85.1 % 观察 3 年77.1 % 0 1 2 3 4 5 6 0 10 20 30 40 50 60 70 80 90 100 Overall survival p=0.011 FL的启示-----EORTC 20981研究 CHOP±R后美罗华维持治疗复发FL: OS van Oers al.Blood 2005;106:Abs.353 年 SAKK study: MCL利妥昔单抗诱导治疗后 延长利妥昔单抗治疗结果 延长利妥昔单抗治疗的首个报道 初治或复发/难治 MCL 诱导缓解后Q2Mx４与观察组比较* 延长治疗组 (12 mo vs 6 mo)中位EFS无明显改善 但在复发/难治病例EFS 得到改善(11 mo vs 5 mo; p = 0.04) * 375mg/m2 rituximab q1wk x 4 Ghielmini M, et al. J Clin Oncol 2005; 23:705–711. GLSG 研究设计 R A N D O M I S E 4 x FCM Rituximabplus4 x FCM R A N D O M I S E Rituximab maintenance therapy* Observation only 晚期复发/难治 FL 或MCL * 4 x rituximab (375 mg/m2) at 3 and 9 months after induction CR/PR CR/PR Forstpointner R, et al. Blood 2006; 108:4003–4008. Rituximab maintenance therapy prolongs response duration in MCL Forstpointner R, et al. Blood 2006; 108:4003–4008. Rituximab maintenance (11/22) Observation (2/25) Probability Time (years after end of initial therapy) p = 0.0489 7 6 5 4 3 2 1 0 1.0 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 0.9 DLBCL的利妥昔单抗维持治疗 ECOG 4494: R-CHOP vs CHOP followed by maintenance vs observation Aggressive NHL PS 0–3 Stage I–IV Age ? 60 yrs No prior Rx 6–8 x CHOP R A N D O M I S E Rituximabmaintenance 4 x R/q6mo (for 2 years) Observation CR/PR R A N D O M I S E 4–5 x rituximab plus6–8 x CHOP Habermann T, et al. J Clin Oncol 2006; 24:3121–3127. ECOG 4494: Effect of rituximab maintenance on FFS according to induction regimen Time (years) R-CHOP induction CHOP induction 5 4 3 2 1 0 p =