弥漫大B细胞淋巴瘤幻灯片.pptVIP

* 两组患者的特征非常相似 * * * 为了证实美罗华联合CHOP治疗小于60岁的弥漫大B淋巴瘤同样有效,从2000年开始,824为初治患者被随机分入全球170个中心分别接受6疗程美罗华联合类似CHOP或单用类似CHOP的治疗,对于治疗前有大包块或结外受累的患者,完成免疫化疗或化疗后,再接受30-40Gy的放射治疗. * 2003年11月对326为患者开展首次中期分析,单用化疗组患者165人,免疫化疗组161人,两组患者特征具有相当的可比性 * CHOEP为CHOP和依托泊甙(Etoposide,VP-16), MACOP-B为甲氨蝶呤(MTX),阿霉素(ADM),环磷酰胺(CTX),长春新碱(VCR),强的松(Prednisone)和博莱霉素(BLM),PMitCEBO为强的松(Prednisone),米托蒽醌(MIT),环磷酰胺(CTX),依托泊甙(VP-16, Etoposide),博莱霉素(BLM)和长春新碱(VCR) * 美罗华+化疗组的疗效明显由于单用化疗 * 随访34月，R-Chemo组显著提高了总生存率：93％：84％，两组差异9％，有统计意义 * 随访34月的无事件生存率对比,美罗华+化疗：化疗为79%：59%，提高了33％。 * 安全性比较,3/4级不良反应化疗组为57%,免疫化疗组为53%,血液学毒性和感染发生率几无差异. * * * * There are 3 genetic profile subgroups (from DNA microarray analysis) in diffuse large B-cell lymphoma (DLBCL): Germinal-center B-cell–like, which accounts for 50% of cases t(14;18) bcl2 and c-rel amplification Activated B-cell–like, which accounts for 30% of cases Nuclear factor-kappaB (NF-kB) activation Type 3 DLBCL Germinal-center B-cell–like DLBCL has the highest 5-year survival. Genetic profiling can be used to predict survival after chemotherapy. The figure at left shows the levels of expression of 57 genes that distinguish 3 subgroups of DLBCL: Germinal-center B-cell–like (orange); activated B-cell–like (blue); and type 3 (purple). The Kaplan-Meier curve illustrates the differing survival among the subgroups after chemotherapy. Rosenwald A, Wright G, Chan WC, et al. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:1937-1947. Staudt LM. Molecular diagnosis of the hematologic cancers. N Engl J Med. 2003;348:1777-1785. * DLBCL CD20 * CHOP?利妥昔单抗: 初治侵袭性淋巴瘤 (GELA研究) 随 机 CHOP x 8 周期 (每3 周) R + CHOP x 8周期 (在CHOP疗程的第一天使用) 美罗华 375mg/m2 i.v. day 1 环磷酰胺 750mg/m2 i.v. day 1 长春新碱 1 .4mg/m2 i.v. day 1 阿霉素 50mg/m2 i.v. day 1 强的松 40mg/m2 p.o. days 1–5 侵袭性 NHL ( ?85%为DLBCL) II–IV期 60-80 岁 未接受过治疗 Coiffier et al. N Engl J Med. 2002;346:235 Feug