淋巴瘤的规范治疗演示幻灯片.pptVIP

2年随访,无失败生存率比较,美罗华联合CHOP超过80%,而CHOP仅70% 美罗华显著提高了缓解率,延长了无病生存时间 目前并无所谓治疗晚期惰性淋巴瘤的一线方案,CVP和CHOP是较为常用的方案. 从 2000年4月至2002年3月, 322位患者入组了这个3期试验. 患者随机进入R+CVP组或CVP组 90%为滤泡小细胞或混合型,9%为滤泡大细胞型 先予各4周期治疗,SD和PD患者退出,缓解的患者继续各4周期治疗 两组患者的基本情况,临床和病理特征无明显差异 CR quadruple 4 groups were identified with a relatively even distribution of patients in the mIPI. The outcomes for 3 y FFS and OS were different in the L and LI risk groups and the HI and High risk groups . These differences were statistically different This is also seen for OS where there was a clear cut distinction in the mIPI in the L versus LI compared to the std IPI. In the mIPI, the 3y OS was 86% for the L risk group vs 74% for the LI group. Again, both the standard IPI and mIPI discriminate HI from H risk pts and identify pts with 50% 3 y OS CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) plus radiotherapy (RT) is the strategy of choice for localized diffuse large B-cell lymphoma (DLBCL), based on several randomized trials described on this slide: ECOG (Eastern Cooperative Oncology Group) trial: Stage II, bulky disease was treated with CHOP (6-8 cycles), followed by RT vs CHOP alone in patients who achieved complete response (CR) to CHOP. At 10 years, disease-free survival (DFS) and time to progression (TTP) favored CHOP-RT, but overall survival (OS) was similar. (Glick J et al). SWOG (Southwest Oncology Group) trial: Stage I and II, nonbulky disease was treated with CHOP (3 cycles) plus RT versus CHOP (8 cycles). At 9 years, DFS and TTP favored CHOP-RT, but OS was similar. (Miller TP et al; Horning S et al). GELA (Groupe d’Etude des Lymphomes de l’Adult) trial: Elderly, International Prognostic Index (IPI) = 0. Treatment was CHOP (4 cycles) plus RT vs CHOP. No improvement was seen in complete response (CR), 5-year event-free survival (EFS), or 5-year OS. (Fillet G et al). It has been recommended that 3 cycles of CHOP with involved field RT be used for stage I and nonbulky stage II disease based on s