老年血液病诊疗策略PPT课件.pptx

老年恶性血液病整体治疗策略,目录,DIRECTORY,老年恶性血液病发病与治疗现状,01,老年恶性血液病的特点,02,CGA参与的整体治疗策略,03,总结和展望,04,老年恶性血液病发病与治疗现状,01,恶性血液病发病老龄化明显,-,老年恶性血液病发病与治疗现状-发病老龄化,数据显示血液病发病率与年龄呈正相关：无论是白血病还是淋巴瘤，60岁以上发病率均较60岁以下提高，特别是70岁以上，发病率提高了6-7倍，提示血液病老龄化明显。,TheAmericanCancerSocietyestimatesthenumbersofnewcancercasesanddeathsthatwilloccurintheUnitedStatesinthecurrentyearandcompilesthemostrecentdataoncancerincidence,mortality,andsurvival.,成人ALL发病率与年龄呈正相关，与总生存呈负相关,-,老年恶性血液病发病与治疗现状-预后差,Blood.2010;116(6):1011-1015.,55岁以下5年生存率30%以上，特别是小于30岁组，5年生存率60%以上，55-64岁组5年生存率下降为25%，65岁以上5年生存率不足10%，特别是85岁以上，不足5%。,TheSwedishAcuteLeukemiaRegistryisatruepopulation-basedregistrythatcontainsdataon3899patientsdiagnosedin1997through2006,therewere472adultpatientswithALL,AML发病率与年龄呈正相关，与总生存呈负相关,-,老年恶性血液病发病与治疗现状预后差,Blood.2009;113:4179-4187.,TheSwedishAcuteLeukemiaRegistry(1997through2005),therewere2767adultpatientswithAML.,小于50岁组5年生存率大于50%，55-64岁组，5年生存率22%左右，65-70岁组5年生存率下降为12%，70岁以上5年生存率不足5%,-,老年恶性血液病发病与治疗现状-治疗是否可以获益？,AnnHematol.2015;94(7):11271138.,部分老年白血病患者可以从治疗中受益，但接受治疗者不足50%,(66Yr),A.PatientswerediagnosedbetweenJanuary1,2000andDecember31,2009,66years,andcontinuouslyenrolledinMedicarePartAandBintheyearpriortodiagnosis.Therewere3327(40%)patientswhoreceivedchemotherapywithin3monthsofdiagnosis.,B.Themedianunadjustedoverallsurvivalwaslongerforpatientstreatedwithintensivetherapy(18.9months)comparedtothatwithHMAtherapy(6.6months)andnottreated(1.5months;logrankp70years)patientswithDLBCL.,Resultsofcomprehensivegeriatricassessmenteffectsurvivalinpatientswithmalignantlymphoma,受试人群：NewlydiagnosedpatientswithDLBCLaged70.,CGA:activitiesofdailyliving(ADL),instrumentalactivitiesofdailyliving(IADL)comorbidities(CIRS-G),TheOncologist.2012;17:838846.,-,CGA参与治疗实例分析,severecardiopathy：NYHAclassIIIorclassIVorCIRS-Ggrade3orgrade4,-,CGA参与治疗实例分析,PrognosticFactors,TheOncologist.2012;17:838846.,-,CGA参与治疗实例分析,TheOncologist.2012;17:838846.,-,CGA参与治疗实例分析,The5-yearOS,DFS,andEFS、CSSrateswere60%、80%、52%、74%,TheOncologist.2012;17:838846.,OS,DFS,EFS,CSS,-,CGA参与治疗实例分析,PatientsAged80Years,TheOncologist.2012;17:838846.,-,CGA参与治疗实例分析,TheOncologist.2012;17:838846.,结论：1.ChemoimmunotherapyadjustmentsbasedonaCGAareassociatedwithmanageabletoxicityandexcellentoutcomesinelderlypatientswithDLBCL.2.WideuseofthisCGA-driventreatmentmayresultinbettercurerates,especiallyinfitandunfitpatients.,Resultsofcomprehensivegeriatricassessmenteffectsurviva