滤泡性淋巴瘤.ppt

,FollicularLymphoma,Contents,incidenceandepidemiology,diagnosisandmolecularbiology,stagingandriskassessment,treatment,follow-upandlong-termimplications,Sitesandenrollmentbyregion.,Follicularlymphomaisthesecondmostcommonsubtypeoflymphoma(althoughitsincidencemaybelowerinsomepartsoftheworldsuchasAsia)andrepresentsabout20%to25%ofcasesofnon-HodgkinlymphomasintheU.S.andEurope.,IncidenceandEpidemiology,DiagnosisandMolecularbiology,Histologicalandpathological,Immunohistologicfindings,GENETICABNORMALITIES,Gradingoffollicularlymphoma,AnnalsofOncologyAdvanceAccess,CD19+、CD20+、CD79a+、CD10+、Bcl6+,BCL2rearrangement、t(14；18)、t(8；14),Histologicalandpathological,Gradingoffollicularlymphoma,ArchitecturalPatternsinFollicular,SpectrumofFollicleMorphology,ImmunoarchitecturalPatternsofFollicualrlymphoma,1.DescribecontentsforaChart-Descriptionofthecompanyssubcontents-Descriptionofthecompanyssubcontents2.DescribecontentsforaChart-Descriptionofthecompanyssubcontents-Descriptionofthecompanyssubcontents,Immunohistologicfindings,IHC,GENETICABNORMALITIES,GENETICABNORMALITIES,ThemeGalleryisaDesignDigitalContentaradiationconsolidationmaybeconsidereddependingontumourlocationandexpectedside-effects.,Inthesmallproportionofpatientswithlimitednon-bulkystagesI-II,radiotherapyisthepreferredtreatmenthavingacurativepotential,whereasthe22Gyscheduleisinferiorandismerelypalliative.Inselectedcases,watchfulwaitingorrituximabmonotherapymaybeconsideredtoavoidtheside-effectsofradiation.,StagesIIIIVTreatmentIndication,bulkydisease,Bsymptoms,ascites,pleuraleffusion,vitalorgancompression,haematopoieticimpairment,rapidlymphomaprogression,CriteriafordelayingtreatmentinFL,Watchfulwaiting,radioimmunotherapy,immunotherapy,Immuno-chemotherapy,StagesIIIIV,Immuno-chemotherapy,R-CHOPR-CVPR-FCR-FMR-B,Immunotherapy,Rituximab,Radio-immunotherapy,131I-tositumomab,Firstline,Watchfulwaiting,01,02,03,ClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,Descriptionofthecontents,Descriptionofthecontents,Descriptionofthecontents,Simplifiedsummaryofcurrentandemergingtreatmentoptionsforfollicularlymphoma.,Treatment,consolidation/maintenance,Rituximabmaintenancefor2years,Radio-immunotherapyconsolidation,.,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,0001020304050607,50%,70%,160%,230%,100%,150%,380%,300%,Year,Clinicaltrialsexaminingrituximabmaintenancetherapy,01,02,03,ClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,CTXcytotoxicchemotherapy,ERGEvidenceReviewGroup,HRhazardratio,NEnotestimable,NSnotstated,PFSprogression-freesurvival,RTXrituximab,KeyoutcomesofthePRIMAtrial,01,02,03,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,Treatment-Summary,Step1,Step2,Step3,Arepeatedbiopsyisstronglyrecommended.,Observationisanacceptedapproachinasymptomaticpatientswithlowtumourburden.,Salvagetreatment,RelapsedDisease,Step3,Step4,BetterOS,50%,70%,160%,Year,EORTC20981,70%,160%,230%,100%,150%,300%,Year,EORTC20981,Year,GermanLowGradeLymphomaStudyGroup(GLSG),Year,ASCTforRelapsedFL,Year,ASCTforRelapsedFL,Year,RESORT(RituximabExtendedScheduleorRe-TreatmentTrial),InlowtumorburdenFL,are-treatmentstrategyuseslessrituximabwhileprovidingdiseasecontrolcomparabletothatachievedwithamaintenancestrategy.,01,02,03,ClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,GENETICABNORMALITIES,Graphicsummaryofcommongeneticlesionsinfollicularlymphoma,01,02,03,ClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText,Descriptionofthecontents,Descriptionofthecontents,Descriptionofthec