滤泡性淋巴瘤ppt课件

1、LOGOFollicular LymphomaContentsincidence and epidemiologydiagnosis and molecular biologystaging and risk assessmenttreatmentfollow-up and long-term implicationsFLSites and enrollment by region.Follicular lymphoma is the second most common subtype of lymphoma (although its incidence may be lower in s

2、ome 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 EpidemiologyDiagnosis and Molecular biologyHistological and pathologicalImmunohistologic findingsGENETIC ABNORMALITIESGrading of follicular lymphomaAnnals of On

3、cology Advance AccessCD19+ 、CD20+ 、CD79a+、CD10+、Bcl6+BCL2 rearrangement、t( 14；18)、t( 8；14)Histological and pathologicalGrading of follicular lymphomaArchitectural Patterns in FollicularSpectrum of Follicle MorphologyImmunoarchitectural Patterns of Follicualr lymphoma 1.Describe contents for a Chart

4、- Description of the companys sub contents - Description of the companys sub contents2.Describe contents for a Chart - Description of the companys sub contents - Description of the companys sub contentsImmunohistologic findingsIHCGENETIC ABNORMALITIESGENETIC ABNORMALITIESThemeGallery is a Design Dig

5、ital Content & Contents mall developed by Guild Design Inc.Guild Design is one of aligned company with Microsoft Ltd, and we develop and provide the design templates for Office 97, 2000, and XP.GENETIC ABNORMALITIESA model of the FL microenvironment.010203 Click to add Text Click to add Text Cli

6、ck to add Text Click to add Text Click to add Text Click to add Text Click to add TextGENETIC ABNORMALITIESBCL2 mutations correlate with transformation risk and disease-specific death in FL.010203 Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add

7、Text Click to add TextGENETIC ABNORMALITIESGraphic summary of common genetic lesions in follicular lymphoma010203 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 TextBCL2 mutations in FL correlate with activation-Induced cytidi

8、ne 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 andEarlier death due to lymphoma.Description of the contentsDescription of the contentsGENETIC ABNORMALITIES0102

9、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 TextStaging and Risk AssessmentA New Prognostic Index for FLDescript

10、ion of the companys sub contentsDescription of the companys sub contentsDescription of the companys sub contents010203 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 C

11、lick to add Text Click to add Text Click to add TextStaging and Risk AssessmentFLIPI-2 better than FLIPI-1?010203Stage IIIStages IIIIVInduction therapyConsolidation/MaintenanceRelapsed diseaseTreatmentFirst lineStage IIIStage IIIIn stage III patients with large tumour burden or adverseprognostic fea

12、tures, systemic therapy as indicated for advancedstages 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 acurati

13、ve 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 IndicationTREATbulky diseaseB symptomsascites, pleural effusionvital organ compre

14、ssionhaematopoietic impairmentrapid lymphoma progressionCriteria for delaying treatment in FLWatchful waitingStages IIIIVImmuno-chemotherapyR-CHOPR-CVPR-FCR-FMR-BImmunotherapyRituximabRadio-immunotherapy131I-tositumomabFirst lineWatchful waiting010203 Click to add Text Click to add Text Click to add

15、 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 TextDescription of the contentsDescription of the contentsDescription of the contentsTreatmentconsolidation/maintenance

16、Rituximab maintenance for 2 yearsRadio-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利妥昔单抗维持治疗可作为高危和高肿瘤负荷患者选择50%70%160%230%100%150%380%300%YearClinical trials examining rituximab maintenance therapy010203 Click to add Text Click to add Text Click to add Text Click to add Text Click to ad

17、d 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 TextKey outcomes of the PRIMA trial010203 Click to add Text Click to add Text Click to add Text Click to add Text Click to add Text Click to add TextTreat

18、ment-SummaryStep 1Step 2Step 3A repeated biopsy is strongly recommended.Observation is an accepted approach in asymptomatic patients with low tumour burden.Salvage treatmentRelapsed DiseaseStep 3Step 4Better OS50%70%160%YearEORTC 2098170%160%230%100%150%300%YearEORTC 20981YearGerman Low Grade Lymphoma Study Group (GLSG)YearASCT for Relapsed FLYearASCT for Relapsed FLYearRESORT (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.010203 Clic