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1、惰性淋巴瘤规范化治疗 08年NCCN治疗指南解读,黄 慧 强 中山大学附属肿瘤医院 淋巴瘤治疗研究中心,Hungary ,Budapest 2008,2008 Lugano ICML,International Conference Maglinant Lympphoma,WHO Lymphoma Classification,B cell B cell chronic lymphocytic Mantle cell Follicular lymphoma Marginal B cell lymphoma, MALT type Plasma cell myeloma/plasmocytoma
2、Diffuse large B cell lymphoma Burkitts lymphoma Precursor B lymphoblastic leukemia/lymphoma,T cell Mycosis fungoides Peripheral T cell lymphoma, unspecified Angioimmunoblastic T cell lymphoma Extranodal NK/T cell lymphoma Adult T cell leukemia/lymphoma (HTLV1+) Anaplastic large cell lymphoma, primar
3、y systemic Precursor T cell lymphoblastic leukemia/lymphoma,Distribution of NHL subtypes,In the UK (population 60m), there are 8,450 new NHL cases/year1Across the EU (population 490m) this equates to an incidence of 69,000 new NHL cases/year,ALBCL,Other,DLBCL,FL,MALT lymphoma,Mature T-cell lymphoma,
4、CLL/SLL,MCL,PMLBCL,Burkitts lymphoma,Liu Q, et al. Blood. 2003;102. Abstract 1446.,Regimen,生 存,Treatment Period,No. of Patients,5 yr (%),10 yr (%),15 yr (%),CHOP Bleo CHOP Bleo-IFN ATT-IFN ATT-IFN vs. FND-IFN FND-R vs. FND-R(+IFN),1977 1982 1982 1988 1988 1992 1992 1997 1997 2002,96 131 136 142 200,
5、64 75 82 82 90,37 52 60 - -,29 42 - - -,IFN: interferon; ATT: alternating triple therapy with CHOD-B/ESHAP/NOPP; FND: fludarabine, mitoxantrone, and dexamethasone; Bleo: bleomycin; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone,Yes, Survival Has Improved!,过去25年惰性淋巴瘤的生存是否有改善?,Years,%存活率
6、,0,5,10,15,20,25,0,20,40,60,80,100,CHOP-Bleo,CHOP-Bleo+IFN,ATTIFN,ATTIFN vs FNDIFN,R-FND+IFN vs FNDR+IFN,P .0001,IV期滤泡性淋巴瘤: 不同治疗方案的OS 1972-2002,Liu et al, JCO 2006; 24: 1582-1589,Years,%Alive,0,5,10,15,20,25,0,20,40,60,80,100,CHOP-Bleo,CHOP-Bleo+IFN,ATTIFN,ATTIFN vs FNDIFN,R-FND+IFN vs FNDR+IFN,P .0
7、1,IV期滤泡性淋巴瘤: 不同治疗方案的生存, FLIPI评分3,Liu et al, JCO 2006; 24: 1582-1589,Years,% Failure- Free,0,5,10,15,20,25,0,20,40,60,80,100,P Leukeran,一线 - 滤泡性淋巴瘤治疗: Randomized,Rituximab 维持治疗的进展,Indolent NHL: induction and Maintenance,d8 after ASCT,Rituximab before and after ASCT for relapsed aggressive B-NHL,Cyclo
8、phosphamide 47 g/m2 G-CSF 10 g/kg/d,BEAM / ASCT,Rituximab 375 mg/m2,d1,d7,d1 after ASCT,Khouri IF, et al. J Clin Oncol 2005; 23:22402247.,Historical comparison N = 67,Rituximab significantly improves outcomes when combined with HDT and ASCT,Khouri IF, et al. J Clin Oncol 2005; 23:22402247.,Overall s
9、urvival,Months post-transplant,0.0,1.0,6,3,0,9,12,15,18,21,24,27,30,p = 0.004,No rituximab (n = 30),Rituximab (n = 67),0.2,0.4,0.6,0.8,Months post-transplant,0.0,1.0,6,3,0,9,12,15,18,21,24,27,30,p = 0.002,0.2,0.4,0.6,0.8,Disease-free survival,No rituximab (n = 30),Rituximab (n = 67),Radio-Immuno-The
10、rapy 单用,有效率：RIT 单用治疗复发耐药NHL,Response Duration: RIT on relapsed or refractory NHL,CD20 -I 131:FL and Transformed NHL: Long term outcome,11 studies ,1177 pts M age 57 ( 21-90), stage 90%, tumor 5cm 47%,BM + 44%1st (141) 2rd (226) 3rd (228) 4th ( 540) Response R. 95 73 58 46 M.d. response - 35 16 12 CR (%) 78 46 32 23 M.d. CR - - 35 59 PFS1Y (%) 82 59 42 27 ASCO 2005,abstract 6561 USA multicenters,Zevalin巩固治疗FL,CUP trial: AHSCT欧洲多中心研究,Schouten H, et al. J Clin Oncol 2003;21:391827,Relapsed follicular NHL,Registration,3 cycles of chemotherapy,
