霍奇金淋巴瘤课件

霍奇金淋巴瘤指南解读程淑琴病理CHL的特点是在炎性背景下存在R-S细胞，LPHL缺乏R-S细胞，但存在肿瘤性淋巴细胞，有时称为爆米花细胞LPHL表现为结节性或弥漫性形式结节性亚型：表现为大量B淋巴细胞中出现肿瘤性淋巴细胞弥漫性亚型：背景细胞主要为T细胞。免疫组化CHL：R-S细胞大多表达CD15和CD30，而CD3和CD45常常阴性40%以下的病人可检测到CD20

推荐CD3﹑CD15﹑CD20、CD30和CD45LPHL：CD45+和CD20+，不表达CD15，极少表达CD30指南推荐CD3、CD15﹑CD20﹑CD21、CD30和CD57染色经典的霍奇金淋巴瘤

在初始诊断和检查后，病人分为下列几组：I-II期III-IV期I-II期的病人，根据是否存在不利因素，进一步分为下列亚组：IA-IIA期（有利）I-II期（不利伴巨块型疾病）I-II期（不利伴非巨块型疾病）StagingandPrognosisEachstageissubdividedintoAandBcategories.“A”indicatesthatnosystemicsymptomsarepresentand“B”isassignedtopatientswithunexplainedweightlossof>10%oftheirbodyweight,unexplainedfevers,ordrenchingnightsweats.PatientswithHLareusuallyclassifiedinto3groups:early-stagefavorable(stageI-IIwithnounfavorablefactors);early-stageunfavorable(stageI-IIwithanyoftheunfavorablefactorssuchaslargemediastinaladenopathy;>2–3nodalsitesofdisease;Bsymptoms;extranodalinvolvement;orsignificantlyelevatederythrocytesedimentationrate[ESR]≥50)advanced-stagedisease(stageIII-IV).FOLLOW-UPAFTERCOMPLETIONOFTREATMENTANDMONITORINGFORLATEEFFECTSCRshouldbedocumentedincludingreversionofPETto"negative"within3monthsfollowingcompletionoftherapy.•Itisrecommendedthatthepatientbeprovidedwithatreatmentsummaryatthecompletionofhis/hertherapy,includingdetailsofradiationtherapy,organsatrisk,andcumulativeanthracyclinedosagegiven.•Follow-upwithanoncologistisrecommended,especiallyduringthefirst5yearsaftertreatmenttodetectrecurrence,andthenannuallyduetotheriskoflatecomplicationsincludingsecondcancersandcardiovasculardisease.kk,llLaterelapseortransformationtolargecelllymphomamayoccurinNLPHL.•Thefrequencyandtypesoftestsmayvarydependingonclinicalcircumstances:ageandstageatdiagnosis,socialhabits,treatmentmodality,etc.Therearefewdatatosupportspecificrecommendations;theserepresenttherangeofpracticeatNCCNMemberInstitutions.Follow-upandMonitoringAfter5YearskkInterimH&P:AnnuallyAnnualbloodpressure,aggressivemanagementofcardiovascularriskfactorsPneumococcal,meningococcal,andH-flurevaccinationafter5–7y,ifpatienttreatedwithsplenicRTorprevioussplenectomy(accordingtoCDCrecommendations)Annualinfluenzavaccine•Cardiovascularsymptomsmayemergeatayoungage.Considerstresstest/echocardiogramat10-yintervalsaftertreatmentiscompleted.Considercarotidultrasoundat10-yintervalsifneckirradiation.•Laboratorystudies:CBC,platelets,chemistryprofileannuallyTSHatleastannuallyifRTtoneckBiannuallipidsAnnualfastingglucoseFollow-upandMonitoringAfter5YearskkConsiderlow-dosechestCTforpatientsatincreasedriskforlungcancer.mm•Annualbreastscreening:Initiate8–10ypost-therapy,oratage40,whichevercomesfirst,ifchestoraxillaryradiation.TheNCCNHodgkinLymphomaGuidelinesPanelrecommendsbreastMRIinadditiontomammographyforwomenwhoreceivedirradiationtothechestbetweenages10–30y,whichisconsistentwiththeAmericanCancerSociety(ACS)Guidelines.Considerreferraltoabreastspecialist.•Colonoscopyevery10yearsforpatientsage≥50,ifhighriskbeginatage40,whichisconsistentwithACSGuidelines.•Counseling:Reproduction,healthhabits,psychosocial,cardiovascular,breastself-exam,andskincancerrisk.•TreatmentsummaryandconsiderationoftransfertoPCP.•Considerareferraltoasurvivorshipclinic.PRINCIPLESOFSYSTEMICTHERAPY(1of2)ClassicalHodgkinLymphoma•ThemostcommonvariantsofchemotherapyusedatNCCNMemberInstitutionsincludeABVDandStanfordV.•Routineuseofgrowthfactorsisnotrecommended.•Leukopeniaisnotafactorfordelayoftreatmentorreductionofdoseintensity(exceptforescalatedBEACOPP).RegimensABVD(doxorubicin,bleomycin,vinblastine,anddacarbazine)±ISRTStanfordV(doxorubicin,vinblastine,mechlorethamine,etoposide,vincristine,bleomycin,andprednisone)*EscalatedBEACOPP(bleomycin,etoposide,doxorubicin,cyclophosphamide,vincristine,procarbazine,andprednisone)EscalatedBEACOPPfollowedbyABVDwithISRTRegimensNodularLymphocyte-PredominantHodgkinLymphoma**•ThemostcommonchemotherapiesusedatNCCNMemberInstitutionsforNLPHLarelistedbelow.ABVD(doxorubicin,bleomycin,vinblastine,dacarbazine)±rituximabCHOP(cyclophosphamide,doxorubicin,vincristine,prednisone)±rituximabCVP(cyclophosphamide,vinblastine,prednisolone)±rituximabRituximabInvolved-siteRadiationTherapy(ISRT)Dose:•CombinedModalityTherapyNon-bulkydisease(stageI-II):20*–30Gy(iftreatedwithABVD),30Gy(iftreatedwithStanfordV)Non-bulkydisease(stageIB-IIB):30GyBulkydiseasesites(allstages):30–36GyPETscanDeauville3-4followingchemotherapy:30–45Gy•ISRTAlone(uncommon,exceptforNLPHL):Involvedregions:30–36Gy(thedoseof30GyismainlyusedforNLPHL)Uninvolvedregions:25–30GyPRINCIPLESOFSYSTEMICTHERAPYFORRELAPSEDORREFRACTORYDISEASE(1OF2)Regimens(listedinalphabeticalorder•Brentuximabvedotin(onlyforCHL)1•C-MOPP(cyclophosphamide,vincristine,procarbazine,prednisone)(category2B)•DHAP(dexamethasone,cisplatin,high-dosecytarabine)2,3•ESHAP(etoposide,methylprednisolone,high-dosecytarabineandci