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LYMPHOMES NON HODGKINIENS

LYMPHOMES NON HODGKINIENS. François Sestier , MD, PhD Abdelouahed Naslafkih , MD, PhD AQTV, Montréal, 14 Mai 2009 Programme de médecine d’assurance et expertise en sciences de la santé, Université de Montréal www.mae.umontreal.ca. 1 er manuel. Low grade

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LYMPHOMES NON HODGKINIENS

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  1. LYMPHOMES NON HODGKINIENS François Sestier, MD, PhD AbdelouahedNaslafkih, MD, PhD AQTV, Montréal, 14 Mai 2009 Programme de médecine d’assurance et expertise en sciences de la santé, Université de Montréal www.mae.umontreal.ca

  2. 1er manuel • Low grade -diffuse lymphocytic Stage Rating -nodular lymphocytic I class 3 = pp2yrs,std 7th yr -nodular histiocytic II class 2= pp3yrs,std 8th yr III class 1= pp5yrs,std 11th yr IV DEC to +100, +cl1 • Intermediate-High grade Stage Rating -diffuse lymphocytic, poorly diff I class 2 -diffuse lymphocytic-histiocytic II class 1 -Burkitt’s lymphoma III +100, + class 1 -Unclassified IV DEC to +200 + class 1

  3. 2ième manuel • Low grade lymphomas: -Stage 1 : PP 3yrs , then +50 and 10$ x 7 yrs 11th yr : +50 -Stage II: PP 3 yrs , then +50 and $15 x 7 yrs 11th yr : + 50 -Other stages : PP 10 yrs, then 15$ x 5yrs 16th yr : std

  4. Les LNH sont-ils des risques standards s’ils survivent 7 à 16 ans ??

  5. OBJECTIFS • Identifier la littérature médicale la plus récente concernant la mortalité des LNH • Calculer la mortalité observée en utilisant une méthodologie actuarielle

  6. LNH: définition et épidémiologie • Definition: malignant disease of the lymphoid system, highly heterogeneous, both histologically and clinically, with several classifications 2. Epidemiology: - annual incidence: 5-10 new cases per 100 000 persons, - age distribution: middle-age patients and the elderly, - males are affected more often than females (1.5:1.0).

  7. Incidence selon l’âge au diagnostic Source : SEER-Cancer statistics Review 1995-2004 Increasing incidence with age. Differences between SEER registries 2002-2004 and 1975-1977.

  8. Non-Hodgkin lymphoma classification

  9. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) 1. Low grade 2. Intermediate grade 3. High grade

  10. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) Low grade A - Small lymphocytic cell. B - Follicular, predominantly small cleaved cell C - Follicular mixed, small cleaved and large cell.

  11. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) Intermediate grade D - Follicular, predominantly large cell. E - Diffuse small cleaved cell. F - Diffuse mixed, small and large cell. G - Diffuse large cell.

  12. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) High grade H -Large cell immunoblastic. I -Lymphoblastic. J -Small noncleaved cell: Burkitt’s

  13. Staging: Ann Arbor I. 1 lymph node region or structure II. >1 lymph node region or structure, same side of diaphragm III. Both sides of diaphragm IV. Extranodal sites beyond “E” designation subscripts: A, B, E, S

  14. ANN ARBOR and SEER classifications Fever (at least 38°C during 15 days without infection), night sweats or weight lost at least 10 % during the previous 6 months are indicated by the suffix letter A or B. Source : http://www.rapidesregional.com/CPM/CancerAnnualReport2002.htm

  15. Source: NCDB, Commission on Cancer, AcoS. Benchmark Reports v1.1 - November 1, 2002.Rapid City Regional Hospital Cancer Registry.

  16. Source: NCDB, Commission on Cancer, AcoS. Benchmark Reports v1.1 - November 1, 2002.Rapid City Regional Hospital Cancer Registry.

  17. Source: NCDB, Commission on Cancer, AcoS. Benchmark Reports v1.1 - November 1, 2002.Rapid City Regional Hospital Cancer Registry.

  18. Follicular lymphoma and long term survival Gandhi, Blood Rewiews,2005,19:165-178

  19. Prognostic Index Adapted from: Perea et al. Prognostic indexes in follicular lymphoma: a comparison of different prognostic systems. Ann Oncol 2005; 16:1508-1513

  20. The International Non-Hodgkin's Lymphoma Prognostic Factors Project NEJM 1993;329:987-994 A Predictive Model for Aggressive Non-Hodgkin's Lymphoma USA, Europe, Canada, 1982-1987 3273 patients (1274  60 years)

  21. NEJM 1993;329:987-994

  22. Factors Independently Prognostic of Overall Survival NEJM 1993;329:987-994

  23. Development of a Molecular Predictor of Survival in Follicular Lymphoma Dave, S. S. et al. N Engl J Med 2004;351:2159-2169

  24. LYMPHOMA SURVIVAL: a textbook approach

  25. Southwest Oncology Group lymphoma survival

  26. LNH • Surviennent chez le jeune adulte et la personne agée • Il faut dond tenir compte de l’âge dans le calcul de la mortalité

  27. NHL: Mortality ratio by age groups, SEER 9 Registries for 1988-2003

  28. LNH: MR at 5 years by stages SEER data (1988-2001)

  29. NHL: Mortality ratio by follow-up period SEER 9 Registries , 1988-2003

  30. CCCW-NHL Registry Netherlands, 1981-89 1164 patients, age : 64 yrs, 50% women Kroll et al. Ann Oncol 2003;14:131-139

  31. NHL: Mortality ratio (MR) at 2, 5, 10, and 15 years DLCB: diffuse large B-cell lymphomas Adapted from: Krol et al. Leukemia&Lymphoma 2003

  32. CCCW (The Comprehensive Cancer Center West) 1168 patients diagnosed with NHL between1981 and 1989. Median age at diagnosis: 66 years, 49% males , Follow-up 15 years Survival of patients with NHL vs. Dutch population Source: Krol et al. Leukemia&Lymphoma 2003

  33. NHL-Diffuse The Comprehensive Cancer Center West, 1981-89 470 patients with diffuse large B cells lymphomas , 49% males, median age: 66 years After 15 years  all patients died From: Krol et al. Leukemia & Lymphoma 2003; 44(3):451-458.

  34. CCCW-NHL Registry Indolent and agressive NHL Netherlands, 1981-89 1167 Patients, age : 64 yrs, 50% women Follow-up: 8 years Maartense et al. Cancer 2000; 89(12):2667-2676

  35. CCCW-NHL Registry. Maartense et al. Cancer 2000; 89(12):2667-2676 Effect of age

  36. NHL: MR at 5 and 8 years by type and age Adapted from : Maartense et al. Cancer 2000; 89 :2667-2676

  37. CCCW-NHL Registry. Maartense et al. Cancer 2000; 89(12):2667-2676 Effect of age on MR

  38. Maartense et al. Cancer 2000; 89(12):2667-2676

  39. Localized aggressive lymphomaRey et al. NEJM 2005;352:1197 France, 1993-2000 647 patients (318 ACVBP, 329 CHOP+RX) Age : 46 years, 60% men Stage I : 66% Stage II : 32% Stage IV : 2% 95% IPI score= 0 Follow-up : 8 years Deaths = 115 Mortality Ratio* = 560%

  40. Côte d'Or registry,France, 451 patients diagnosed with NHL between 1980-92 NHL: Mortality ratio (MR) at 5 years by different variables Source : Rolland-Portal et al. Int J Epidemiol 1997; 26 :945-952

  41. NHL: MR at 5 and 10 years by grade (Register Côte d’Or)

  42. Follicular lymphomaMontoto et al. Ann Oncol 2002;13:523-530 Spain, 1977-1997 201 patients, 53% men Age : 54 years Stage I: 10%, II: 9%, III: 15%, IV: 66% Overall survival : 71% at 5 years, 48% at 10 years MR* = 973% at 5 years = 785% at 10 years *Life table Spain, Total population 1980-89

  43. Time to treatment failure (TTF) and overall survival (OS) in 201 patients with follicular lymphoma MR = 785% (10yrs) Montoto, S. et al. Ann Oncol 2002 13:523-530

  44. Survival of 389 follicular lymphomas : std at 10 yrs????

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