2012年DLBCL的争议

WorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012ThisprogramissupportedbyeducationalgrantsfromInterdisciplinaryManagementofDiffuseLargeB-CellLymphomaclinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012AboutTheseSlidesUsersareencouragedtousetheseslidesintheirownnoncommercialpresentations,butweaskthatcontentandattributionnotbechanged.UsersareaskedtohonorthisintentTheseslidesmaynotbepublishedorpostedonlinewithoutpermissionfromClinicalCareOptions([e-mail])DisclaimerThematerialspublishedontheClinicalCareOptionsWebsitereflecttheviewsoftheauthorsoftheCCOmaterial,notthoseofClinicalCareOptions,LLC,theCMEproviders,orthecompaniesprovidingeducationalgrants.ThematerialsmaydiscussusesanddosagesfortherapeuticproductsthathavenotbeenapprovedbytheUnitedStatesFoodandDrugAdministration.Aqualifiedhealthcareprofessionalshouldbeconsultedbeforeusinganytherapeuticproductdiscussed.Readersshouldverifyallinformationanddatabeforetreatingpatientsorusinganytherapiesdescribedinthesematerials.clinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012ProgramFacultyProgramDirectorMaryJoLechowicz,MDAssociateProfessor,Hematology/OncologyWinshipCancerInstituteatEmoryUniversityAtlanta,GeorgiaCoreFacultyJamesO.Armitage,MDProfessor,DepartmentofInternalMedicineJoeShapiroDistinguishedChairofOncologyUniversityofNebraskaMedicalCenterOmaha,NebraskaChristopherR.Flowers,MDDirector,LymphomaProgramMedicalDirector,OncologyDataCenterAssociateProfessorBoneMarrowandStemCellTransplantationDepartmentofHematologyandOncologyEmoryUniversityAtlanta,GeorgiaHillardM.Lazarus,MDProfessorofMedicineDepartmentofMedicineCaseWesternReserveUniversityDirector,NovelCellTherapyDepartmentofMedicineUniversityHospitalsCaseMedicalCenterCleveland,Ohioclinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012FacultyDisclosuresJamesO.Armitage,MD,hasdisclosedthathehasreceivedconsultingfeesfromAllos,Genentech,Roche,SeattleGenetics,andZiopharm.ChristopherR.Flowers,MD,hasdisclosedthathehasreceivedconsultingfeesfromAllos,Celgene,OptumRx,SeattleGeneticsandSpectrum,speakerfeesfromGenentech/Roche,andresearchsupportfromMillennium/Takeda,Novartis,andSpectrum.HillardM.Lazarus,MD,hasnosignificantfinancialrelationshipstodisclose.MaryJoLechowicz,MD,hasdisclosedthatshehasreceivedconsultingfeesfromAllosandCelgene.clinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012OldNamesforDiffuseLargeB-CellLymphomaReticulumcellsarcomaDiffusehistiocyticlymphomaCentroblasticlymphomaImmunoblasticlymphomaDiffuselarge-celllymphomaclinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012DiffuseLargeB-CellLymphoma:MostCommonSubtypeofNHLFollicular(25%)Smalllymphocytic(7%)MALTtypemarginalzoneBcell(7.5%)NodaltypemarginalzoneBcell(2%)Lymphoplasmacytic(2%)DiffuselargeBcell(30%)TandNKcell(12%)Othersubtypes(9%)Burkitt(2.5%)Mantlecell(6%)Lichtman.WilliamsHematology,7thEd.2006;1408.clinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012DiffuseLargeB-CellLymphomaMostcommonNHL:31%–PeakincidenceinsixthdecadeClinicaloutcomesandmolecularfeatureshighlyheterogeneousLargecellswithlossoffolliculararchitecture–30%to40%presentwithrapidlyenlarging,symptomaticmasswithBsymptoms–Maypresentasextranodaldisease(stomach,CNS,testis,skin)Curablein50%ormoreofcasesMediansurvival:wkstomosifnottreatedMichalletAS,etal.BloodRev.2009;23:11-23.Aswelearnmoreaboutthebiologyoflymphomas,itisclearthatdiffuselargeB-celllymphomaisnotjust1diseaseclinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012MicroarrayAnalysisandDiffuseLargeB-CellLymphomaHeterogeneityAlizadehAA,etal.Nature.2000;403:503-511.GCB-DLBCLABC-DLBCLProbability1.00.500610OS(Yrs)42812AllPatientsGCBlikeP=.0119patients,6deathsActivatedBlike21patients,16deathsclinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012NewWHOClassificationofDLBCLCentroblasticImmunoblasticAnaplasticPlasmablasticT-cellrichALKpositiveCD5positiveGCBNon-GCBPrimaryCNSPrimarycutaneous,legtypeMediastinalIntravascularPrimaryeffusionEBVpositiveinelderlyWithchronicinflammationLymphomatoidgranulomatosisInHHV-8–associatedCastleman’sdiseaseCampoE,etal.Blood.2011;117:5019-5032.JaffeES,etal.HematologyAmSocHematolEducProgram.2011;2011:506-514.clinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012OtherVariantsofDLBCLInterfaceDLBCL/BurkittInterfacemediastinalDLBCL/nodularsclerosingHodgkin’sdiseaseGeneticsubtypes—doublehit(MYCandBCL2)LeukemicDLBCLAswelearnmoreaboutthese“subtypes”ofdiffuselargeB-celllymphoma,wemightnottreatthemallwiththesameregimenclinicaloptions.com/oncologyWorkshopWiththeExperts:Non-Hodgkin’sLymphomaSeries2012FactorsAssociatedWiththeDevelopmentofDiffuseLargeB-CellLymphomaInheritedimmunedeficiencyHIVinfectionPostorgantransplantationRheumatoidarthritisandotherautoimmunedisordersEBVHerbicidesTransformedsmallB-cellmaligna