RituximabandDLBCL利妥昔单抗与弥漫大B细胞淋巴瘤—培训课件.ppt

309例可评估: 中位年龄44 岁(15-60); 178 男性，131女性; 根据 aa-IPI评分，10% 低~中危, 51% 中高危，39% 高危; PS 2 59%, 96(31%)例BM受累, 53% 巨块症, 84% LDH 正常, 34% 2以上结外累及，12/19/69% II/III/IV期 . CHOEP-14 ：CHOP + VP16 300 mg/m2 ，q2wks MegaCHOEP：CTX(第1周期1500 mg/m2 ; 第2，3周期4500 mg/m2; 第4周期6000 mg/m2),?多柔比星 (70 mg/m2), VP-16 (第1周期600mg/m2 ,第2，3周期 960 mg/m2 ,第4周期1480 mg/m2), 泼尼松 (500 mg).长春新碱(2 mg), 第1和2周期后，采集造血干细胞；第HDT2，3，4 周期后回输. R：375 mg/m2 Rituximab(利妥昔单抗) and DLBCL(弥漫大B细胞淋巴瘤) 报告人： 指导老师： Outline: Lymphoma Non Hodgkin’s lymphoma Diffuse large B cell lymphoma Rituximab --Mechnism --Clinical trial What is Lymphoma? 淋巴瘤（lymphoma）是起源于淋巴结和淋巴组织的免疫系统恶性肿瘤，其发生大多与免疫应答过程中淋巴细胞增殖分化产生的某种免疫细胞恶变有关。 淋巴瘤可发生在身体的任何部位，其中淋巴结、扁桃体、脾及骨髓是最易受到累及的部位。 按组织病理学可分为：霍奇金淋巴瘤和非霍奇金淋巴瘤 Aetiology of NHL Viruses EBV Human T-cell leukaemia virus type I Kaposi sarcoma-associated virus Immunosuppression Genetic and occupational factors Clinical manifestation Widespread painless lymphadenopathy(无痛性淋巴结肿大) is more common. Superior vena cava syndrome（上腔静脉压迫综合征） caused by a bulky mediastinal mass is also more frequent in. Hepatosplenomegaly（肝脾肿大） is frequent at diagnosis. B symptoms(unexplained fever of 38°C or higher, night sweats and loss of more than 10% of body weight in 6 months) Ann Arbor staging system What is DLBCL? 1.cells are larger 2.round nucleus 3.prominent nucleoli, some adjacent to the nuclear membrane What is Rituximab? Rituximab: chimeric murine/human anti-human CD20 (人鼠嵌合抗CD20) Rituximab destroys B cells, and is therefore used to treat diseases which are characterized by having too many B cells, overactive B cells or dysfunctional B cells. This includes lymphomas,? leukemias, transplant rejection?and some?autoimmune disorders. What is CD20? CD20 is a hydrophobic transmembrane protein with a molecular weight of approximately 35 kD located on pre-B and mature B lymphocytes The antigen is expressed on most B-cell non-Hodgkin’s lymphomas but is not found on stem cells, pro-B cells, norma