therapy for Waldenstrom macroglobulinemia对于常规治疗原发性巨球蛋白血症ppt课件.pptVIP

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therapy for Waldenstrom macroglobulinemia对于常规治疗原发性巨球蛋白血症ppt课件.ppt

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therapy for Waldenstrom macroglobulinemia对于常规治疗原发性巨球蛋白血症ppt课件

Waldenstr?m macroglobulinemia;Topics to be covered - ;What is Waldenstr?m macroglobulinemia?;Waldenstr?m macroglobulinemia“A disease with two problems”;Lymphoplasmacytic infiltrate (usually intertrabecular) Immunophenotype - surface IgM+, CD19+, CD20+, CD79a+ and PAX5+. CD5?, CD10?, CD23?. exclude CLL and mantle cell lymphoma del(6)(q21) is the most common genetic abnormality seen;Waldenstr?m macroglobulinemia Monoclonal IgM;MYD88 Mutations in Waldenstr?m macroglobulinemia;Waldenstr?m macroglobulinemia – presenting symptoms;Hyperviscosity due to Waldenstr?m macroglobulinemia;IgM deposition due to Waldenstr?m macroglobulinemia;Autoimmune hemolysis secondary to Waldenstr?m macroglobulinemia ;Diagnostic Criteria for Waldenstr?m macroglobulinemia ;Time to developing WM and Survival in patients with Indolent WM or IgM MGUS;Risk of progression from IgM MGUS to WM or another B-cell malignancy;Survival of 587 symptomatic patients with Waldenstr?m macroglobulinemia ;Who needs treatment?;Patient 1;Patient 2;Many treatment options;Does everyone need treatment at diagnosis?;García-Sanz et al. Brit J Haematol. 115: 575-582, 2001;What clinical findings suggest that treatment should be started?;Before starting therapy – Does the patient have hyperviscosity and do they need plasmapheresis?;Plasmapheresis for Waldenstr?ms patients with hyperviscosity;Before plasmapheresis - optic disc edema (arrowheads), central retinal hemorrhages (bold arrows), and venous “sausaging” (thin arrows). ;Initial treatment for untreated symptomatic WM patients;Common Treatments used as initial therapy for WM ;Purine analogue based combinations – FCR/FR;Leleu X et al. JCO 2009;27:250-255;Alkylating agent based combinations – R-CHOP;Alkylating agent based combinations – DRC;Comparative outcomes following CP-R, CVP-R, and CHOP-R in Waldenstr?ms macroglobulinemia. ;Alkylating agent based combinations – R-Bendamustine;Bendamustine plus rituximab compared with R-CHOP in WM patients;Bortezomib based