霍奇金淋巴瘤治疗进展

《霍奇金淋巴瘤治疗进展》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、霍奇金淋巴瘤治疗进展1960’s1970’s1980’s1990’s10yJoeConnors不同预后组的治疗疗效:EuropeandNorth-AmericaEuropeStageCureRates(GSHGandEORTC)早期预后良好组CSI,IIA,Bnoriskfactors98%早期预后不良组CSI,IIA,Bwithriskfactors93%进展期CSIII–IV,SelectedCSIIBwithABVD(NorthAmerica)65-80%(intermediate)Caus

2、esofDeathamong2733PatientswithHodgkin’sDisease(1960-97)Hodgkin’sDisease38341.2%SecondaryCancers20021.5%MDS111.2%Cardiovascular14815.9%Pulmonary414.4%Infection353.8%Trauma/Suicide161.7%Other/Unknown9610.3%Total930100.%Stanford,R.HoppeDidwelearnfromourm

3、istakesover40years?个体化治疗！对于早期患者如何在保证疗效的情况下尽可能减少副作用？能否进一步减少化疗疗程？减小放疗剂量？晚期患者如何进一步提高治愈率？早期预后良好组:CSI/II无不良预后因素早期预后不良组:CSI/II有不良预后因素*进展期:CSIII/IV;CSIIB(LMM)*a)bulk;b)E-lesion;c)highESR;d)>=3involvedareasGHSG–临床预后分组预后不良(Unfavorable)早期HL年龄≥50岁≥4个淋巴结区域受侵单独ESR

4、≥50B症状和ESR≥30纵隔大肿块，或肿块直径大于10cm≥2个结外部位受累预后良好(Favorable)早期HL不符合预后不良组条件的其它临床I/II期HLHodgkinLymphoma:早期预后不良组Islessmore?寻找高效和低毒间的最佳平衡点CSI–IIwithoutriskfactorsABVDABVD30GyIFABVDABVDABVDABVDABVDABVDABVDABVDABVDABVD30GyIF20GyIF20GyIF2003:1375patientsrecruited.

5、Trialclosed1/2003.早期预后良好组:GHSG:HD10-TrialHD10,4thInterimAnalysis,August20061OS(CT-Comparison)5764xABVD561534454323208925762xABVD2.56152246433820097Pts.atRiskOverallSurvival[months]4xABVD2xABVDProbability0.00.10.20.30.40.50.60.70.80.91.0012243648607284

6、OSratesand95%CIat5years*:4xABVD:97%;[95%;98%]2xABVD:96%;[94%;98%]HD10,4thInterimAnalysis,August2006SurvivalcurvesareKaplan-Meierestimates.Medianobservationtimeis53months,N=1109OS(RT-Comparison)55330Gy54551343932520610055620Gy54351145331418680Pts.atRis

7、kOverallSurvival[months]30Gy20GyProbability0.00.10.20.30.40.50.60.70.80.91.0012243648607284OSratesand95%CIat5years:30Gy:97%;[95%;98%]20Gy:96%;[94%;98%]HD10结论2×ABVDisnon-inferiorto4×ABVD20GyIF-RTisnon-inferiorto30GyIF-RTHD13Trial:早期无不良预后问题减少化疗疗程的可能性?D

8、oweneedbleomycinanddacarbacininABVD?CSI/IIwithoutRF*ABVDABVDABVABVAVDAVDAVAV30GyIF30GyIF30GyIF30GyIF*Largemediastinalmass;extranodaldisease;highERS;3ormoreareasinvolvedHD13TrialforpatientswithearlyfavourablestageDesignFFTFat18months91%,95%CI[8