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GRADO INTERMEDIO D follicolare, prevalenza di grandi cellule E diffuso, a piccole cellule clivate F diffuso, misto a pic

BASSO GRADO A piccoli linfociti B follicolare, prevalentemenete a piccole cellule clivate C follicolare misto, piccole cellule clivate e grandi cellule. GRADO INTERMEDIO D follicolare, prevalenza di grandi cellule E diffuso, a piccole cellule clivate

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GRADO INTERMEDIO D follicolare, prevalenza di grandi cellule E diffuso, a piccole cellule clivate F diffuso, misto a pic

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  1. BASSO GRADO A piccoli linfociti B follicolare, prevalentemenete a piccole cellule clivate C follicolare misto, piccole cellule clivate e grandi cellule GRADO INTERMEDIO D follicolare, prevalenza di grandi cellule E diffuso, a piccole cellule clivate F diffuso, misto a piccole e grandi cellule G diffuso a grandi cellule ALTO GRADO H immunoblastico I linfoblastico J piccole cellule non clivate (burkitt)

  2. Table 1. International Lymphoma Study Group Classification T/NK-Cell Lymphoma Precursor T-lymphoblastic T-cell chronic lymphocytic leukemia Large granular lymphocyte leukemia Mycosis fungoides Peripheral T cell, unspecified Medium-sized Mixed medium and large cell Large cell Lymphoepithelioid Hepatosplenic Subcutaneous panniculitic Angioimmunoblastic Angiocentric, nasal Intestinal Adult T-cell lymphoma/leukemia Anaplastic large cell (including null phenotype) Anaplastic large cell, Hodgkin’s-like Unclassifiable low grade Unclassifiable high grade B-Cell Lymphoma Precursor B-lymphoblastic Small lymphocytic (CLL) Lymphoplasmacytic Mantle cell Follicle center, follicular Grade 1* Grade 2* Grade 3* Follicle center diffuse, small cell Marginal zone B-cell, MALT type Marginal zone B-cell, nodal Marginal zone B-cell, splenic Hairy cell leukemia Plasmacytoma Diffuse large B-cell Diffuse mediastinal large B-cell Burkitt’s High grade B-cell, Burkitt-like Unclassifiable low grade Unclassifiable high grade Blood, Vol 89, No 11 (June 1), 1997: pp 3909-3918

  3. International Prognostic Index (I.P.I.) Fattore assente presente stadio I-II III-IV LDH normali elevate performance status 0-1 2 o > Categoria - rischio RC OS 5 anni basso 0 92% 83% int. basso 1 78% 69% int. alto 2 57% 46% alto 3 46% 32% Shipp et al., NEJM 329, 387-394. 1993

  4. Shipp N Engl J Med 329, 987, 1993 OS and IPI Age adjusted index, patients < 69 (n = 1274) 28-2-99 SONO TROPPPO BASSE

  5. Shipp N Engl J Med 329, 987, 1993 OS and IPI Age adjusted index, patients < 69 (n = 1274) SONO TROPPPO BASSE 28-2-99

  6. Fisher

  7. EFS Fisher RI, et al. New Engl J Med 328, 1002, 1993

  8. Overall survival Fisher RI, et al. New Engl J Med 328, 1002, 1993

  9. Dipartimento di Scienze Mediche, Oncologiche e Radiologiche - Università di Modena - Marzo 1998

  10. Gianni

  11. De vita, NEJM review Hodgkin

  12. Philip

  13. Philip T. et al. New Engl J Med 333, 1540, 1995

  14. Philip T. et al. New Engl J Med 333, 1540, 1995

  15. Haioun

  16. Survival benefit of High-Dose Therapy in Poor-Risk Aggressive Non-Hodgkin’s Lymphoma: Final Analysis of the Prospective LNH87-2 Protocol • A Groupe d’Etude des Lymphomes de l’Adulte Study • Haioun C, Lepage E, Gisselbrecht C et al. • J Clin Oncol 18, 3025, 2000

  17. LNH87-2 median follow-up of 8 years final analysis: randomized study - consolidative sequential CHT (ifosfamide, etoposide, asparaginase, and cytarabine) vs - HDT using cyclophosphamide, carmustine, and etoposide (CBV regimen) followed by stem-ceIl transplantation Haioun C., et al. J Clin Oncol 18, 3025, 2000

  18. in patients with • aggressive NHL • in first complete remission after induction • higk/intermediate and high-risk patients identified by the age-ad justed internationai prognostic index. Haioun C., et al. J Clin Oncol 18, 3025, 2000

  19. 916 eligible patients • 451 with two or three risk factors. • 277 (61%) reached complete remission • 236 randomized • 125 patients HDT 111 sequential CHT Haioun C., et al. J Clin Oncol 18, 3025, 2000

  20. 8 year OS ABMT 64% (95% CI 55%-73%) CHT 49% (95% CI 39%-59%) Haioun C., et al. J Clin Oncol 18, 3025, 2000

  21. 8 year DFS ABMT 55% (95% CI 46%-64%) CHT 39% (95% CI 30%-48%) ABMT CHT Haioun C., et al. J Clin Oncol 18, 3025, 2000

  22. Conclusion: On the basis of the final analysis of this prospectively treated series of patients, retrospectively analyzed on the basis of the International Prognostic Index, we hypotesize that HDT benefits patients at higher risk who achieve complete remission after induction treatment Haioun C., et al. J Clin Oncol 18, 3025, 2000

  23. T - cell

  24. Peripheral T-CeII Lymphoma- - JAMES O. ARMITAGE: MD, JOHN P GREER. MD.t ALEXANDRA M. LEViNE. MDDENNIS D. WEISENBURGER. MD.§ SILVIA C. FORMENTI, MD.* MAWT1N BAST. BS, SUE CONLEY, BA.’ JENE PIERSON. BS, JAMES UNDER. MD,§ JOHN B. COUSAR. MD AND BHARAT N. NATHWANI, MD Cancer 63:158-163, 1989. Clinical data were reviewed from 134 cases of peripheral T-cell lymphoma diagnosed in three centers. The median age of the patients was 57 years (range, 4-97 yasrs), 59% were male, and 36 patients (27%) had a history of a preceeding disorder of the immune system. The tumors were grooped histologically into large cell (43%), mixed large and small cell (40%), sud small cell (17%). The stage at diagnosis was I(7%), II (21%), III (22%), and IV (50%). B symptoms were present in 57%. The most frequent sites of extranodal involvement were bone marrow (35%), skin (13%), and lung (11%). Eighty patients were treated with a multiagent chemotherapy regimen with proven curative potential in aggressive non-Hodgkin’s lymphomas and the remainder of the patients received less intensive chemotherapy (36 patients), radiotherapy (9 patients), or no treatment (9 patients). Fifty percent of the Intensively treated patients achieved complete remission and the actuarial 4-years survival was 45%. However, the 4-year disease free survival in patients with Stage IV disease was only 10%. Although peripheral T-cell lymphomas appeared similar in many ways to their B-cell counterpart, disease-free survival by stage was low and patients with Stage IV disease had an especially poor outlook.

  25. Armitage, Cancer 63:158-163, 1989.

  26. Table 3. Distribution of NHL Cases by the Consensus Diagnosis % Diffuse large B-cell 422 30.6 Follicular 304 22.1 Marginal zone B-cell, MALT 105 7.6 Peripheral T-cell 96 7.0 Small B-lymphocytic (CLL) 93 6.7 Mantle cell 83 6.0 Primary mediastinal large B-cell 33 2.4 Anaplastic large T/null-cell 33 2.4 High grade B-cell, Burkitt-like 29 2.1 Marginal zone B-cell, nodal 25 1.8 Precursor T-lymphoblastic 23 1.7 Lymphoplasmacytoid 16 1.2 Marginal zone B-cell, splenic 11 <1 Mycosis fungoides 11 <1 Burkitt’s 10 <1 Blood, Vol 89, No 11 (June 1), 1997: pp 3909-3918

  27. Table 6. Patient Characteristics by Histologic Type % Median %Stage % Marr % PI % PI % 5-yr % 5-yr Diagnosis Male Age 1 or 2 Pos 0/1 4/5 OAS FFS Follicular, all grades 42 59 33 42 39 6 72 40 Mantle cell 74 63 19 63 19 19 27 11 Marginal zone B-cell, MALT 45 61 66 14 38 5 74 60 Marginal zone B-cell, nodal 41 58 18 41 36 9 57 29 Small lymphocytic 53 65 6 73 17 10 51 25 Lymphoplasmacytoid 53 63 20 73 20 13 59 25 Diffuse large B-cell 55 64 51 17 31 16 46 41 Primary mediastinal large B-cell 34 37 66 3 44 9 50 48 Burkitt’s 89 31 56 33 44 22 44 44 Burkitt-like 59 55 50 21 25 18 47 43 T-lymphoblastic 74 25 13 43 35 22 26 24 Peripheral T-cell, all types 56 61 18 37 14 27 25 18 Anaplastic large T/ null-cell 69 33 50 12 50 19 77 58 Blood, Vol 89, No 11 (June 1), 1997: pp 3909-3918

  28. Table 7. Survival by Histologic Type and the International Prognostic Index immunologic data. For other types, such as the lymphoplas-macytoid, nodal marginal zone B-cell, and high-grade B-cell % 5-yr OAS % 5-yr FFS Burkitt-like lymphomas, imprecise histologic criteria and the Index Index Index Index lack of specific immunologic markers led to a diagnostic Consensus Diagnosis 0/1 4/5 0/1 4/5 accuracy of only 53% to 65%. Further definition of these Follicular, all grades 84 17 55 6 entities is clearly needed. Because the need for immunophe- Mantle cell 57 0 27 0 notyping cannot be predicted before biopsy, it is vital that Marginal zone B-cell, MALT 89 40 83 0 each patient have tissue available for immunophenotyping Marginal zone B-cell, nodal 76 50 30 0 and other special studies to facilitate proper patient care. In Small lymphocytic (CLL) 76 38 35 13 many cases, this will require communication between the Diffuse large B-cell 73 22 63 19 oncologist, the surgeon, and the pathologist. Primary mediastinal large B-cell 77 0 69 0 The 13 major types of NHL shown in Fig 1 made up over High grade B-cell, Burkitt-like 71 0 71 0 Precursor T-lymphoblastic 29 40 29 40 90% of the cases in our study, with diffuse large B-cell Peripheral T-cell, all types 36 15 27 10 lymphoma and follicular lymphoma comprising over 50% Anaplastic large T/null-cell 81 83 49 83 of the cases and the newly recognized entities comprising 21% of the cases (Table 3). The clinical features of the Abbreviations: PI, International Prognostic Index; OAS, overall sur-vival; FFS, failure-free survival; CLL, chronic lymphocytic leukemia. various lymphoma types were remarkably different, as were Blood, Vol 89, No 11 (June 1), 1997: pp 3909-3918

  29. MACOP-B vs ProMACE-MOPP in the treatment of advanced diffuse NHL: results of a prospective randomized trial by the non-Hodgkin's Lymphoma Cooperative Study Group. ProMACE-MOPP MACOP-B CR 49.1% 52.3% 3-year OS 45.2% 52.3% 3-yearPFS 36.4% 36.1% CONCLUSION: No significant differences in terms of efficacy and/or toxicity between ProMACE-MOPP and MACOP-B are evident. These results are consistent with recent randomized trials showing that the new-generation aggressive regimens are no better than previous ones. Sertoli-MR; et-al J-Clin-Oncol. 1994 12(7): 1366

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