R + Leukeran > Leukeran
2020/12/8
2020/12/8
2020/12/8
Indolent NHL: induction and Maintenance
2020/12/8
Rituximab before and after ASCT for relapsed aggressive B-NHL
ASCT
Overall survival Disease-free survival
1.0
Rituximab (n = 67)
1.0
0.8
0.8
Rituximab (n = 67)
0.6
0.6
0.4
No rituximab (n = 30)
0.4
No rituximab (n = 30)
0.2
p = 0.004 0.0
Rituximab 1 g/m2
d8 after ASCT
2020/12/8
Khouri IF, et al. J Clin Oncol 2005; 23:2240–2247.
Rituximab significantly improves outcomes when combined with HDT and
P < .0001
20
0
0
5
2020/12/8
10
15
Years
20
25
Liu et al, JCO 2006; 24: 1582-1589
100
80
60 % Alive
40
IV期滤泡性淋巴瘤: 不同治疗方案的生存, FLIPI评分3
R-FND+IFN vs FNDR+IFN ATTIFN vs FNDIFN ATTIFN CHOP-Bleo+IFN CHOP-Bleo
惰性淋巴瘤规范化治疗－08年NCCN 治疗指南解读
Hungary ,Budapest 2008
2008 Lugano ICML,International Conference Maglinant Lympphoma
2020/12/8
2020/12/8
2020/12/8
过去25年惰性淋巴瘤的生存是否有改善?
生存
Regimen
Treatment Period
CHOP – Bleo
1977 – 1982
CHOP – Bleo->IFN
1982 – 1988
ATT->IFN
1988 – 1992
ATT->IFN vs. FND->IFN 1992 – 1997
FND-R vs. FND->R(+IFN) 1997 – 2002
No. of Patients
96 131 136 142 200
5 yr 10 yr 15 yr (%) (%) (%)
64 37 29
75 52 42
82 60
--
82
--
--
90
--
--
IFN: interferon; ATT: alternating triple therapy with CHOD-B/ESHAP/NOPP; FND: fludarabine, mitoxantrone, and dexamethasone; Bleo: bleomycin; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone
P < .01
20
0
0
5
2020/12/8
10
15
Years
20
25
Liu et al, JCO 2006; 24: 1582-1589
IV期滤泡性淋巴瘤: 不同治疗方案的FFS 1972-2002
100
80
60 % FailureFree 40
R-FND+IFN vs FNDR+IFN ATTIFN vs FNDIFN ATTIFN CHOP-Bleo+IFN CHOP-Bleo
Cyclophosphamide 4–7 g/m2 G-CSF 10 μg/kg/d
BEAM / ASCT
Historical comparison N = 67
Rituximab 375 mg/m2
d–1
Rituximab 1 g/m2
dter ASCT
2020/12/8
Liu Q, et al. Blood. 2003;102. Abstract 1446.
Yes, Survival Has Improved!
100
80
60 % 存活率
40
IV期滤泡性淋巴瘤: 不同治疗方案的OS 1972-2002
R-FND+IFN vs FNDR+IFN ATTIFN vs FNDIFN ATTIFN CHOP-Bleo+IFN CHOP-Bleo
2020/12/8
Radio-Immuno-Therapy 单用
有效率： RIT 单用治疗复发耐药NHL
2020/12/8
Response Duration: RIT on relapsed or refractory NHL
CD20 -I 131:FL and Transformed NHL: Long term outcome
0 3 6 9 12 15 18 21 24 27 30
Months post-transplant
0.2
p = 0.002 0.0
0 3 6 9 12 15 18 21 24 27 30
Months post-transplant
2020/12/8
Khouri IF, et al. J Clin Oncol 2005; 23:2240–2247.
P < .0001
20
0
0
5
2020/12/8
10
15
Years
20
25
Liu et al, JCO 2006; 24: 1582-1589
惰性淋巴瘤治疗效果提高
• 常规化疗的改进 • Rituximab，CD 20 • RIT, Radio-immuno-therapy • AHSCT/ Allo-HSCT
2020/12/8
Rituximab:惰性 NHL(FL)
单药治疗结论
单药：复发和难治的低度恶性NHL (RR 48%)
单药：初发的低度恶性NHL
( RR 73%)
联合化疗结论 (Ⅲ期临床研究) R-CVP 疗效明显优于CVP 方案 R-CHOP明显优于CHOP方案(TTF PFS OS) CVP 后 + R维持治疗进一步增加疗效(PFS) FCM+R 明显优于FCM 方案(RR CR PFS OS)