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Non-Hodgkin lymfoom

Non-Hodgkin lymfoom. Mark-David Levin. Hemato-poiese. Normaal. Kaushansky K. N Engl J Med 2006;354:2034-2045. Lymfomen. Non-Hodgkin lymfoom. 85%. Hodgkin lymfoom. 15%. Kaushansky K. N Engl J Med 2006;354:2034-2045. Lymfomen. Non-Hodgkin lymfoom. 85%.

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Non-Hodgkin lymfoom

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  1. Non-Hodgkin lymfoom Mark-David Levin

  2. Hemato-poiese • Normaal Kaushansky K. N Engl J Med 2006;354:2034-2045

  3. Lymfomen Non-Hodgkin lymfoom 85% Hodgkin lymfoom 15% Kaushansky K. N Engl J Med 2006;354:2034-2045

  4. Lymfomen Non-Hodgkin lymfoom 85% NOOIT DIAGNOSE OP PUNCTIE, ALTIJD BIOPT!! Hodgkin lymfoom 15% Kaushansky K. N Engl J Med 2006;354:2034-2045

  5. Hemato-poiese • Normale lymfklier

  6. Hemato-poiese • Normale lymfklier • Diffuus Grootcellig NHL

  7. BM-morfologie

  8. BM-immuno

  9. Non-Hodgkin lymfoom - biopt

  10. Cytogenetica (FISH)

  11. Intermediair NHL - IPI • IPI • Age adjusted IPI (aaIPI) Ship. A predictive model for aggressive Non-Hodgkin’s lymphoma NEJM 1993; 329: 987

  12. Intermediair NHL - Age adjusted IPI • Plateau!

  13. Intermediair NHL - therapie (1999) • 1e lijn: • 8 x CHOP elke 3 weken • genezingskans 50% • Bij recidief: • 3 x DHAP (klinisch 5 dagen) • Autologe stamceltransplantatie na BEAM • Genezingskans 25% (grote selectie!)

  14. Intermediar NHL - Rituximab • Antistof gericht tegen CD20 = antigeen op alle B-cellen • Monotherapie slechts tijdelijke respons • Kosten 5.000 - 10.000 Euro per kuur per patient • Bijwerking: • koorts / rilling tijdens infusie

  15. Rituximab bij jongeren met intermediar NHL • 823 patienten met DLBC-NHL < 65 jaar chemo +/- Rituximab Pfreundschuh M. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial ... Lancet Oncol. 2006 May;7(5):379-91

  16. Rituximab bij ouderenmet intermediar NHL • 399 patienten met DLBC-NHL > 65 jaar • Event-free survival Coiffier B. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002 Jan 24;346(4):235-42.

  17. Rituximab bij ouderenmet intermediar NHL • Overleving

  18. Microarray

  19. DLBC-NHL: Gen-expressie profiel Rosenwald A et al. N Engl J Med 2002;346:1937-1947

  20. Gen-expressie profiel DLBC-NHL Rosenwald A et al. N Engl J Med 2002;346:1937-1947

  21. Brutons kinase

  22. Brutons kinase • Ibrutinib

  23. Gen-expressie profiel DLBC-NHL R R-CHOP-21 R-CHOP-21 + Ibrutinib

  24. Intermediar NHL • Stadium 1: 3 x R-CHOP-21 + IN-RTX • Stadium 2-4 Germinal-center type: • R-CHOP intraveneus vs subcutaan (MabEase) • Stadium 2-4 non-Germinal center type: • R-CHOP-21 vs R-CHOP-21 + Ibrutinib

  25. Non-Hodgkin lymfoom • Vragen?

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