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Other
ALBCL
12%
PMLBCL 2% Burkitt’s lymphoma 2%
3%
MCL 6%
CLL/SLL 7%
Mature T-cell 8%
lymphoma
8%
MALT lymphoma
31% DLBCL
22%
FL
过去25年惰性淋巴瘤的生存是否有改善?
生存
Regimen
Treatment Period
CHOP – Bleo
1977 – 1982
CHOP – Bleo->IFN
1982 – 1988
ATT->IFN
1988 – 1992
ATT->IFN vs. FND->IFN 1992 – 1997
FND-R vs. FND->R(+IFN) 1997 – 2002
No. of Patients
leukemia/lymphoma
T cell
• Mycosis fungoides
• Peripheral T cell lymphoma, unspecified
• Angioimmunoblastic T cell lymphoma
• Extranodal NK/T cell lymphoma
96 131 136 142 200
5 yr 10 yr 15 yr (%) (%) (%)
64 37 29
75 52 42
82 60
--
82
--
--
90
--
--
IFN: interferon; ATT: alternating triple therapy with CHOD-B/ESHAP/NOPP; FND: fludarabine, mitoxantrone, and dexamethasone; Bleo: bleomycin; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone
单药治疗结论
单药：复发和难治的低度恶性NHL (RR 48%)
单药：初发的低度恶性NHL
( RR 73%)
联合化疗结论 (Ⅲ期临床研究) R-CVP 疗效明显优于CVP 方案 R-CHOP明显优于CHOP方案(TTF PFS OS)
CVP 后 + R维持治疗进一步增加疗效(PFS) FCM+R 明显优于FCM 方案(RR CR PFS OS)
• Adult T cell leukemia/lymphoma (HTLV1+)
• Anaplastic large cell lymphoma, primary systemic
• Precursor T cell lymphoblastic leukemia/lymphoma
Байду номын сангаасistribution of NHL subtypes
B cell • B cell chronic lymphocytic • Mantle cell • Follicular lymphoma • Marginal B cell lymphoma,
MALT type • Plasma cell
myeloma/plasmocytoma • Diffuse large B cell lymphoma • Burkitt’s lymphoma • Precursor B lymphoblastic
P < .0001
20
0
0
5
10
15
20
25
Years
Liu et al, JCO 2006; 24: 1582-1589
惰性淋巴瘤治疗效果提高
• 常规化疗的改进 • Rituximab，CD 20 • RIT, Radio-immuno-therapy • AHSCT/ Allo-HSCT
Rituximab:惰性 NHL(FL)
P < .01
20
0
0
5
10
15
20
25
Years
Liu et al, JCO 2006; 24: 1582-1589
IV期滤泡性淋巴瘤: 不同治疗方案的FFS 1972-2002
100
80
60 % FailureFree 40
R-FND+IFN vs FNDR+IFN ATTIFN vs FNDIFN ATTIFN CHOP-Bleo+IFN CHOP-Bleo
Liu Q, et al. Blood. 2003;102. Abstract 1446.
Yes, Survival Has Improved!
100
80
60 % 存活率
40
IV期滤泡性淋巴瘤: 不同治疗方案的OS 1972-2002
R-FND+IFN vs FNDR+IFN ATTIFN vs FNDIFN ATTIFN CHOP-Bleo+IFN CHOP-Bleo
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
R + Leukeran > Leukeran
一线 - 滤泡性淋巴瘤治疗: Randomized
Hiddemann et al. 可评估患者 反应率
TTF OS (estimated 2-y OS) Marcus et al. 可评估患者 反应率
PFS OS ( 随访 53 m) Herold et al. 可评估患者 反应率
• In the UK (population ~ 60m), there are 8,450 new NHL cases/year1
• Across the EU (population ~ 490m) this equates to an incidence of 69,000 new NHL cases/year
P < .0001
20
0
0
5
10
15
20
25
Years
Liu et al, JCO 2006; 24: 1582-1589
100
80
60 % Alive
40
IV期滤泡性淋巴瘤: 不同治疗方案的生存, FLIPI评分3
R-FND+IFN vs FNDR+IFN ATTIFN vs FNDIFN ATTIFN CHOP-Bleo+IFN CHOP-Bleo
