滤泡性淋巴瘤课件

,Follicular Lymphoma,Contents,incidence and epidemiology,diagnosis and molecular biology,staging and risk assessment,treatment,follow-up and long-term implications,Sites and enrollment by region.,Follicular lymphoma is the second most common subtype of lymphoma (although its incidence may be lower in some parts of the world such as Asia) and represents about 20% to 25% of cases of non-Hodgkin lymphomas in the U.S. and Europe.,Incidence and Epidemiology,Diagnosis and Molecular biology,Histological and pathological,Immunohistologic findings,GENETIC ABNORMALITIES,Grading of follicular lymphoma,Annals of Oncology Advance Access,CD19+ 、CD20+ 、CD79a+、CD10+、Bcl6+,BCL2 rearrangement、t( 14；18)、t( 8；14),Histological and pathological,Grading of follicular lymphoma,Architectural Patterns in Follicular,Spectrum of Follicle Morphology,Immunoarchitectural Patterns of Follicualr lymphoma,1.Describe contents for a Chart - Description of the companys sub contents - Description of the companys sub contents 2.Describe contents for a Chart - Description of the companys sub contents - Description of the companys sub contents,Immunohistologic findings,IHC,GENETIC ABNORMALITIES,GENETIC ABNORMALITIES,ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.,GENETIC ABNORMALITIES,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,GENETIC ABNORMALITIES,BCL2 mutations correlate with transformation risk and disease-specific death in FL.,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,GENETIC ABNORMALITIES,Graphic summary of common genetic lesions in follicular lymphoma,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,BCL2 mutations in FL correlate with activation-Induced cytidine deaminase expression and frequently alter the amino acid sequence of the protein. Mutations in the BCL2 coding sequence at diagnosis are associated with shortened time to transformation and Earlier death due to lymphoma.,Description of the contents,Description of the contents,GENETIC ABNORMALITIES,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text,“ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.”,Staging and Risk Assessment,A New Prognostic Index for FL,Description of the companys sub contents,Description of the companys sub contents,Description of the companys sub contents,Content Title,Content Title,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text,Staging and Risk Assessment,FLIPI-2 better than FLIPI-1?,01,02,03,Stage III Stages IIIIV,Induction therapy,Consolidation/Maintenance,Relapsed disease,Treatment,First line,Stage III,Stage III,In stage III patients with large tumour burden or adverse prognostic features, systemic therapy as indicated for advanced stages should be applied; a radiation consolidation may be considered depending on tumour location and expected side-effects.,In the small proportion of patients with limited non-bulky stages I-II, radiotherapy is the preferred treatment having acurative potential, whereas the 22 Gy schedule is inferior and is merely palliative. In selected cases, watchful waiting or rituximab monotherapy maybe considered to avoid the side-effects of radiation.,Stages IIIIV Treatment Indication,bulky disease,B symptoms,ascites, pleural effusion,vital organ compression,haematopoietic impairment,rapid lymphoma progression,Criteria for delaying treatment in FL,Watchful waiting,radioimmunotherapy,immunotherapy,Immuno-chemotherapy,Stages IIIIV,Immuno-chemotherapy,R-CHOP R-CVP R-FC R-FM R-B,Immunotherapy,Rituximab,Radio- immunotherapy,131I-tositumomab,First line,Watchful waiting,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text,Description of the contents,Description of the contents,Description of the contents,Simplified summary of current and emerging treatment options for follicular lymphoma.,Treatment,consolidation/maintenance,Rituximab maintenance for 2 years,Radio-immunotherapy consolidation,. .,ASCT,利妥昔单抗维持治疗可作为高危和高肿瘤负荷患者选择,00 01 02 03 04 05 06 07,50%,70%,160%,230%,100%,150%,380%,300%,Year,Clinical trials examining rituximab maintenance therapy,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text,Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text,CTX cytotoxic chemotherapy, ERG Evidence Review Group, HR hazard ratio, NE not estimable, NS not stated, PFS progression-free survival, RTX rituximab,Key outcomes of the PRIMA trial,01,02,03,Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text,Treatment-Summary,Step 1,Step 2,Step 3,A repeated biopsy is strongly recommended.,Observation is an accepted approach in asymptomatic patients with low tumour burden.,Salvage treatment,Relapsed Disease,Step 3,Step 4,Better OS,50%,70%,160%,Year,EORTC 20981,70%,160%,230%,100%,150%,300%,Year,EORTC 20981,Year,German Low Grade Lymphoma Study Group (GLSG),Year,ASCT for Relapsed FL,Year,ASCT for Relapsed FL,Year,RESORT (Rituximab Extended Schedule or Re-Treatment Trial),In lowtumor burden FL, a re-treatment strategy uses less rituximab while providing disease control comparable to that achieved with a maintenance strategy.,01,02,03,Click to add Text Click to add Text Click to add Text,Click to add Tex