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鍒濇瑷烘柗鏅�(sh铆)锛屾噳(y墨ng)棣栭伕鍒囬櫎鎴栧垏鍙栫梾璁婄祫绻�;灏�(du矛)浜庡京(f霉)鐧�(f膩)鎮h€�锛屽鏋滅劇(w煤)娉曠嵅寰楀垏闄ゆ垨鍒囧彇鐨勭梾璁婄祫绻旀(bi膩o)鏈�锛屽彲閫氶亷(gu貌)绌鸿姱閲濈┛鍒虹嵅鍙栫殑鐥呰畩绲勭箶閫�(j矛n)琛岀梾鐞嗚ê鏂�銆傜⒑瑷烘噳(y墨ng)鍙栬純澶х殑鏁村€�(g猫)娣嬪反绲�(ji茅)鎴栬€呰叓鐗╁仛鐥呯悊妾㈡煡銆傜梾鐞嗗舰鎱�(t脿i)瀛�(xu茅)鐗瑰緛鐐猴細鍏稿瀷鐨凥RS鑵槫绱�(x矛)鑳炪€佺█灏戠殑鑵槫绱�(x矛)鑳炰互鍙婂ぇ閲忕殑鐐庢€ц儗鏅窗(x矛)鑳�銆傛壘鍒癏RS绱�(x矛)鑳炴槸瑷烘柗鏈梾鐨勪緷鎿�(j霉)銆傝叓鐦ょ窗(x矛)鑳炲儏鍗犳暣鍊�(g猫)鐥呰畩鐨�0.1%锝�10%锛屽鏄撹瑷恒€�
2.鐥呯悊鍒嗛
鏍规摎(j霉)2017骞翠慨瑷傜増WHO娣嬪反鐦ゅ垎椤�锛孒L鍒嗙偤缍�(j墨ng)鍏稿瀷鍜岀祼(ji茅)绡€(ji茅)鎬ф穻宸寸窗(x矛)鑳炵偤涓诲瀷鍏╁ぇ椤炲瀷锛岀稉(j墨ng)鍏稿瀷HL(Classic Hodgkinlymphoma锛宑HL)鍙垎鐐�4绋祫绻斿(xu茅)浜炲瀷锛屽嵆绲�(ji茅)绡€(ji茅)纭寲鍨�銆佸瘜浜庢穻宸寸窗(x矛)鑳炲瀷銆佹贩鍚堢窗(x矛)鑳炲瀷鍜屾穻宸寸窗(x矛)鑳炴秷娓涘瀷;绲�(ji茅)绡€(ji茅)鎬ф穻宸寸窗(x矛)鑳炵偤涓诲瀷灏戣(ji脿n)锛岀磩鍗燞L鐨�10%銆傛穻宸寸窗(x矛)鑳炴秷娓涘瀷鍏掔缃曡(ji脿n)銆�
HL璧锋簮浜庣敓鐧�(f膩)涓績鐨凚娣嬪反绱�(x矛)鑳�锛屽舰鎱�(t脿i)瀛�(xu茅)鐗瑰緛琛ㄧ従(xi脿n)鐐烘甯哥祫绻旂祼(ji茅)妲�(g貌u)鐮村锛屽湪娣峰悎鎬х窗(x矛)鑳炶儗鏅腑鏁e湪鐣板瀷澶х窗(x矛)鑳�锛屽Reed–Sternberg(R-S)绱�(x矛)鑳炲強璁婄暟鍨婻-S绱�(x矛)鑳�銆傚吀鍨婻-S绱�(x矛)鑳炵偤闆欐牳鎴栧鏍稿法绱�(x矛)鑳烇紝鏍镐粊鍡滈吀鎬�锛屽ぇ鑰屾槑椤�锛岀窗(x矛)鑳炶唱(zh矛)璞愬瘜;鑻ョ窗(x矛)鑳炶〃鐝�(xi脿n)鐐哄皪(du矛)绋辩殑闆欐牳鏅�(sh铆)鍓囩ū鐐洪彙褰辩窗(x矛)鑳炪€傜祼(ji茅)绡€(ji茅)鎬ф穻宸寸窗(x矛)鑳炵偤涓诲瀷HL涓殑鑵槫绱�(x矛)鑳炵偤娣嬪反绱�(x矛)鑳炵偤涓诲瀷(lymphocytepredominant锛孡P)绱�(x矛)鑳�锛岄亷(gu貌)鍘荤ū鐐烘穻宸寸窗(x矛)鑳炲拰绲勭箶绱�(x矛)鑳�(lymphocytic-histocyticcell锛孡-H绱�(x矛)鑳�)锛岀窗(x矛)鑳炴牳澶с€佹姌鐤�锛屼技‘鐖嗙背鑺辨ǎ’锛屾晠鍙堢ū鐐虹垎绫宠姳(popcorn)绱�(x矛)鑳烇紝鍏舵牳浠佸皬銆佸鍊�(g猫)銆佸棞鍫挎€�銆�
LP琚玃D-1闄�(y谩ng)鎬х殑T绱�(x矛)鑳炵挵(hu谩n)绻炪€傝秺渚�(l谩i)瓒婂鐨勮瓑鎿�(j霉)鎻愮ず瀹屽叏鍛堝綄婕敓闀�(zh菐ng)鐨勭祼(ji茅)绡€(ji茅)鎬ф穻宸寸窗(x矛)鑳炵偤涓诲瀷闇嶅閲戞穻宸寸槫(Hodgkinlymphomanodular lymphocyticpredominancetype锛孨LPHL)鍜屽瘜浜嶵绱�(x矛)鑳�/绲勭箶绱�(x矛)鑳炵殑澶绱�(x矛)鑳炴穻宸寸槫閲嶇枈銆傝ê鏂稨L鎳�(y墨ng)甯歌(gu墨)妾㈡脯(c猫)鐨処HC妯�(bi膩o)瑷樼墿鍖呮嫭CD45(LCA)銆丆D20銆丆D15銆丆D30銆丳AX5銆丆D3銆丮UM1銆並i-67鍜孍BV-EBER銆俢HL甯歌〃鐝�(xi脿n)鐐篊D30(+)銆丆D15(+)鎴�(-)銆丳AX5寮�(+)銆丮UM1(+)銆丆D45(-)銆丆D20(-)鎴栧急(+)銆丆D3(-)锛孊OB1(-)銆丱CT2(-/+)銆侀儴鍒嗙梾渚婨BV-EBER(+)銆侼LPHL鐐篊D20(+)銆丆D79蓱(+)銆丅CL6(+)銆丆D45(+)銆丆D3(-)銆丆D15(-)銆丆D30(-)銆丅OB1(+)銆�)OCT2(+)銆丒BV-EBER(-)銆�
鍦ㄩ€�(j矛n)琛岄憭鍒ヨê鏂锋檪(sh铆)闇€澧炲姞鐩告噳(y墨ng)鐨勬(bi膩o)瑷樼墿锛屼互閼掑垾ALCL鎴朌LBCL绛夈€傛不鐧傚拰闋�(y霉)鍚庣浉闂�(gu膩n)鐨勬(bi膩o)蹇楃墿鍖呮嫭PD-1銆丳D-L1鍜孭53绛�銆傞楂撶窗(x矛)鑳炲(xu茅)妾㈡煡椤ず楠ㄩ珦鏈夋牳绱�(x矛)鑳炲鐢熸椿韬嶆垨鏄庨’韬�锛岄儴鍒嗙梾渚嬪棞閰哥矑绱�(x矛)鑳炲澶�銆傝嫢鑵槫绱�(x矛)鑳為楂撴蹈娼�(r霉n)锛屽彲鎵捐(ji脿n)鏈梾鐗瑰緛鎬х殑R-S绱�(x矛)鑳炪€傞楂撶┛鍒虹窗(x矛)鑳炲(xu茅)娑傜墖鎵惧埌R-S绱�(x矛)鑳為櫧(y谩ng)鎬х巼杓冧綆锛屽儏3%宸﹀彸;楠ㄩ珦娲绘鍙彁楂樺埌9%锝�22%銆傚鏈夋贩鍚堟€х窗(x矛)鑳炲鐢燂紝灏忔穻宸寸窗(x矛)鑳炴槑椤�锛屽憟娴佹按妯g祼(ji茅)妲�(g貌u)锛屾彁绀烘湁cHL鐨勫彲鑳�锛岃寮曡捣娉ㄦ剰銆�
(涓�)瑷烘柗妯�(bi膩o)婧�(zh菙n)銆�
1.瑷烘柗渚濇摎(j霉)锛歐HO2008/2016鍒嗗瀷瑷烘柗妯�(bi膩o)婧�(zh菙n)銆傚洜?y脿n)闀燣鐥呯悊瑾よê鐜囧緢楂橈紝闇€鑷冲皯鍏╁涓夌礆(j铆)鐢茬瓑閱�(y墨)闄㈢梾鐞嗘渻(hu矛)瑷�銆傚垵娌�18姝蹭互涓嬬稉(j墨ng)鍏稿瀷鍙婄祼(ji茅)绡€(ji茅)鎬ф穻宸寸窗(x矛)鑳炵偤涓诲瀷HL銆�
2.鍒嗘湡锛欰nnArbor鍒嗘湡鏄暥(d膩ng)鍓嶅厭绔L鎳�(y墨ng)鐢ㄦ渶寤f硾鍒嗘湡鏂规硶(瑕�(ji脿n)闄勮〃2)銆�
(鍏�)閼掑垾瑷烘柗
1.鐥呯悊閼掑垾
闁撹畩鎬уぇ绱�(x矛)鑳炴穻宸寸槫(ALCL)鑸嘋HL浜岃€呭舰鎱�(t脿i)瀛�(xu茅)鐗瑰緛鏈夎ū澶氱浉浼笺€傝ū澶欰LCL鍚湁HRS妯g窗(x矛)鑳�锛岄兘鏈塁D30鐨勫挤(qi谩ng)鐑堣〃閬�(d谩)銆備絾涔熸湁椤憲宸暟锛欳HL鐐轰竴绋瓸绱�(x矛)鑳炵柧鐥�锛岃€屽ぇ閮ㄥ垎ALCL浠嶇偤T(m茅n)绱�(x矛)鑳炰締(l谩i)婧�銆傚厭绔LK鍩哄洜闄�(y谩ng)鎬�銆乀绱�(x矛)鑳炴(bi膩o)瑷樻垨T绱�(x矛)鑳炲熀鍥犻噸鎺掓槸ALCL閼掑垾CHL鐨勬湁鍔涗緷鎿�(j霉)?锛焩闅�(鑳歌吅)澶绱�(x矛)鑳炴穻宸寸槫(MLBCL)鑷ㄥ簥鍙婄梾鐞嗘槸鑸嘋HL鐩镐技銆�
鍙互鍋剁埦鐧�(f膩)鐝�(xi脿n)HRS妯g窗(x矛)鑳炵瓑鐗归粸(di菐n)锛屼絾鑵槫绱�(x矛)鑳為€氬父寮�(qi谩ng)鐑堣〃閬�(d谩)CD20绛塀绱�(x矛)鑳炴(bi膩o)瑷樸€侰D30琛ㄩ仈(d谩)鍙偤闄�(y谩ng)鎬т絾骞朵笉璞HL閭fǎ寮�(qi谩ng)鐑�銆侷g鍩哄洜閲嶆帓閫氬父闄�(y谩ng)鎬�锛岃€屽湪CHL闄版€�銆�
2.鑷ㄥ簥閼掑垾
鏈梾娣鸿〃娣嬪反绲�(ji茅)鑵ぇ锛岃嚚搴婇渶鑸囧偝鏌撴€у柈鏍哥窗(x矛)鑳炲澶氱櫏銆佹穻宸寸祼(ji茅)鐐庛€佹穻宸寸祼(ji茅)鏍�銆佷互鍙婃儭鎬ц叓鐦ゆ穻宸寸祼(ji茅)杞�(zhu菐n)绉荤浉閼掑垾銆傚眬閮ㄦ參鎬х値鐧ラ€犳垚鐨勬穻宸村弽鎳�(y墨ng)鎬у鐢�锛屾湁鏅�(sh铆)寰堥洠鑸囨鐥呴憭鍒�銆�
闋搁儴宸ㄥぇ娣嬪反绲�(ji茅)閭勯渶鑸囧叾浠栨穻宸寸祼(ji茅)鐥�锛屽Castleman鐥呯瓑閼掑垾銆傞渶闈犳穻宸寸祼(ji茅)鐥呯悊瑷烘柗璀夊(sh铆)銆傜疮鍙婄副闅旂殑HL鐨勯憭鍒ヨê鏂峰寘鎷副闅擳娣嬪反姣嶇窗(x矛)鑳炴穻宸寸槫銆佽兏鑵虹檶鎴栬綁(zhu菐n)绉荤檶銆佺缍�(j墨ng)姣嶇窗(x矛)鑳炵槫銆佽兏鑵虹槫鍜岃儦绲勭箶鐦�(濡傝壇鎬у拰鎯℃€х暩鑳庣槫銆佺簿鍘熺窗(x矛)鑳炵槫鍜屾儭鎬ч潪绮惧師绱�(x矛)鑳炶儦绲勭箶鐦�)銆�
(涔�)鑷ㄥ簥娌荤檪鍙嶆噳(y墨ng)瑭�(p铆ng)浼�
1.娌荤檪鍙嶆噳(y墨ng)瑭�(p铆ng)浼�
(1)鎵€鏈夌梾浜�2鐧傜▼鍖栫檪鍚庢帴鍙楄⿻(p铆ng)鍍�(ji脿)銆傞渶閫�(j矛n)琛岋細闋搁儴MRI/CT;鑳搁儴浣庡姂閲廋T/MRI;鑵归儴MRI+瓒呰伈/CT;鐩嗚厰(鑵硅偂婧�)MRI/CT;
(2)涓嵄绲�4鍊�(g猫)鐧傜▼鍚�锛岄珮鍗辩祫6鍊�(g猫)鐧傜▼鍚庣2娆″啀瑭�(p铆ng)浼�(鍋滃寲鐧傚墠)銆佸畾缇╁悗鏈熸不鐧傚弽鎳�(y墨ng)瑭�(p铆ng)鍍�(ji脿)銆傝寖鍦嶅寘鎷墍鏈夌梾浜哄垵瑷哄彈绱寖鍦�/绲�(ji茅)鍗€(q奴)銆侾ET鏅�(sh铆)闁�(瑕栧悇鍠綅鍏烽珨鎯呮硜鏈夌劇(w煤)姊濅欢)锛�4鍊�(g猫)鐧傜▼鍚庡強鍋滄不鐧�3鍊�(g猫)鏈堝悗銆�
(3)鍖栫檪鍚庯細鎿�(j霉)鏈鍖栫檪28澶╁乏鍙宠璞℃仮寰�(f霉)鍚庨€�(j矛n)琛岋紝鐥呭彶鍙婇珨妾㈤渶闂�(gu膩n)娉ㄦ湁鐒�(w煤)B绲勭櫏鐙€锛屽(sh铆)椹�(y脿n)瀹ゆ敞鎰忚娌�锛岃倽鑵庡姛锛屽績鑷熷強鑲哄姛鑳�锛屸參鏈熶互涓婃垨鏈塀绲勭櫏鐙€鎮e厭寰�(f霉)鏌ラ楂撹薄銆傚叏闈㈣⿻(p铆ng)浼板奖鍍忓(xu茅)銆傞牳銆佽兏鑵�(鍘熸湁鐦ょ伓閮ㄤ綅鐐哄寮�(qi谩ng))CT/MRI锛岃吂閮˙瓒�;鑳搁儴蹇呴爤琛孋T蹇冭嚐鍔熻兘瑭�(p铆ng)鍍�(ji脿);鑲哄姛鑳姐€�
(4)娌荤檪鍚庨毃瑷細鏈鍖栫檪鍚�3锛�6锛�9锛�12锛�18锛�24锛�36锛�48锛�60鍊�(g猫)鏈�(绗竴骞存瘡3鍊�(g猫)鏈�1娆�锛岀浜屽勾姣�6鍊�(g猫)鏈�1娆�锛岀涓夊勾姣忓勾1娆�)瑭�(p铆ng)鍍�(ji脿)鍏�(n猫i)瀹圭偤鐦ょ伓褰卞儚瀛�(xu茅)鍙婂績鑲哄姛鑳�锛岃倽鑵庡姛鑳戒互鍙婄敓闀�(zh菐ng)鐧�(f膩)鑲茬瓑銆�
2.娌荤檪鍙嶆噳(y墨ng)瀹氱京
(1)瀹屽叏鍙嶆噳(y墨ng)(Completeresponse,CR)锛氶珨妾互鍙奀T/X绶�/瓒呰伈/MRI绛夊奖鍍忓(xu茅)鍧囦笉鑳界櫦(f膩)鐝�(xi脿n)鐦ょ伓銆傚皪(du矛)浜庣副鑶堬紝褰卞儚瀛�(xu茅)鍥炵府澶т簬70%浠ヤ笂涓擯ET/CT闄版€�銆�
(2)閮ㄥ垎鍙嶆噳(y墨ng)(partialresponse,PR)锛氭穻宸寸祼(ji茅)(鍖呮嫭绺辫唸鍜岃吂閮ㄦ穻宸寸祼(ji茅))鍙楃疮鑰呭畾缇╁涓嬶細鈶犲洖绺笉瓒�70%浣嗗ぇ浜�50%;鎴栤憽PET/CT闄�(y谩ng)鎬ц€�锛岃嚚搴婃鏌ョ槫鐏跺洖绺�>70%銆傛敞锛氫换浣曚笉鑳芥槑纰鸿€呭潎寤鸿琛屾穻宸寸祼(ji茅)娲绘鍗�(xi茅)鍔╄ê鏂�銆侾R鑰呭皣鎺ュ彈浣庡姂閲忓彈绱噹鏀剧檪RT銆�
(3)鐤剧梾閫�(j矛n)灞曞強寰�(f霉)鐧�(f膩)锛氣憼鍘熷厛闈炲彈绱儴浣嶇殑鐥呯悊璀夊(sh铆);鈶″師鍏堝彈绱儴浣嶆穻宸寸祼(ji茅)楂旂⿳澧炲ぇ;鈶R鍚庣梾鐞嗕粛鑳借瓑瀵�(sh铆)瀛樺湪HL銆�
(4)鐒�(w煤)鍙嶆噳(y墨ng)锛氫笉鑳借瓑瀵�(sh铆)浠ヤ笂鍚勯爡(xi脿ng)銆�
鍥�銆佸嵄闅�(xi菐n)搴﹀垎灞�
(涓€)浣庡嵄绲�
鈪燗锛屸叀A涓旂劇(w煤)宸ㄥぇ鐦ょ伓銆�
(浜�)涓嵄绲�
鈪燘锛屸參A涓旂劇(w煤)宸ㄥぇ鐦ょ伓銆�
(涓�)楂樺嵄绲�
鈪锛屸參B锛屸叄鏈熸垨(鍚勬湡)浼村法澶х槫鐏惰€�;鍙楃疮澶т簬4鍊�(g猫)娣嬪反绲�(ji茅)鍗€(q奴)(鍗冲垎鏈�銆丅绲勭櫏鐙€銆佸法澶х槫鐏跺潎鐐哄嵄闅�(xi菐n)鍥犵礌)銆�
(鍥�)宸ㄥぇ鐦ょ伓瀹氱京
鍠€�(g猫)娣嬪反绲�(ji茅)鐩村緫澶т簬6cm鎴栬€呮垚鍦�(tu谩n)娣嬪反绲�(ji茅)澶т簬10cm?锛焩鑶堝法澶х槫鐏跺畾缇╋細鑳哥墖鎻愮ず绺辫唸鑵槫鐩村緫澶т簬6cm鎴栧ぇ浜庤兏寤撶殑0.33銆�
浜�銆佹不鐧�
(涓€)绯荤当(t菕ng)鍖栫檪
1.鍖栫檪鍘熷墖
MOPP鍙夾BVD绛夊寲鐧傛柟妗堜竴鐩存槸鎴愪汉鍙婃棦寰€鍏掔鏅亶鎳�(y墨ng)鐢ㄧ殑鍖栫檪鏂规銆備絾灏�(du矛)浜庡厭绔ヤ締(l谩i)璎涳紝ABVD鏂规鍙婃摯(ku貌)澶ч噹鐨勬斁鐧傛柟娉曡伅(li谩n)鍚堟不鐧傚悗锛屾偅鍏掗仩(yu菐n)鏈熺櫦(f膩)鐢熺敓闀�(zh菐ng)鐧�(f膩)鑲查殰绀欎互鍙婂収(n猫i)鍒嗘硨鐤剧梾鍙婄浜岃叓鐦ょ殑棰�(f膿ng)闅�(xi菐n)澶у銆�
2.鍖栫檪鍓嶆簴(zh菙n)鍌�
(1)纰鸿ê妾㈡煡锛氱洝鍙兘鍦ㄦ渶瀹规槗鍙栨潗鐨勯儴浣嶅彇寰楁(bi膩o)鏈皨鎵捐叓鐦ょ窗(x矛)鑳烇紝鍖呮嫭锛氶楂�銆佽兏鑵规按銆佹泛琛ㄦ穻宸寸祼(ji茅)銆佺毊鑶氬彲鐤戠槫鐏�銆佹繁閮ㄦ穻宸寸祼(ji茅)绌垮埡鎴栨椿妾€€佽兏鑵硅厰鐦ょ伓绌垮埡鎴栨墜琛�(sh霉)鍙栨椿妾�銆傜劧鍚庡畬鍠勮叓鐦ょ窗(x矛)鑳炵殑MICM鍒嗗瀷;瀹屾垚涓績鐥呯悊鏈�(hu矛)瑷�(鑷冲皯鍏╁涓夌敳閱�(y墨)闄㈢梾鐞嗚€佸斧鏈�(hu矛)瑷�)銆�
(2)寤鸿鑳搁鍙婇珎楠ㄥ叐鍊�(g猫)閮ㄤ綅楠ㄩ珦绌垮埡鎴栨椿妾細鎳�(y墨ng)琛岄楂撶窗(x矛)鑳炲舰鎱�(t脿i)瀛�(xu茅)銆佹祦寮忕窗(x矛)鑳炲厤鐤〃鍨嬪垎鏋愩€佺窗(x矛)鑳為伜鍌冲(xu茅)鍜屽熀鍥犳鏌�銆�
(3)甯歌(gu墨)妾㈡煡锛氬寘鎷叏琛€绱�(x矛)鑳炲垎鏋�銆佺櫧绱�(x矛)鑳炲垎椤�銆佽倽鑵庡姛鑳�銆佽娓呬钩閰歌劔姘叾銆佽兏鑵规按鍙婂叾浠栭珨娑茬殑绱�(x矛)鑳炲(xu茅)妾㈡煡绛�銆�
(4)褰卞儚瀛�(xu茅)妾㈡煡閫�(j矛n)琛屽垎鏈燂細琛屽彲鐤戞穻宸寸祼(ji茅)鍙婅吂閮˙瓒呭彲鐤戝彈渚甸儴浣嶇殑楠ㄩ鐗囥€丆T绛夊奖鍍忓(xu茅)妾㈡煡浠ヤ究浜嗚В鐥呰畩鑼冨湇銆傛嚪鐤戜腑妯炵缍�(j墨ng)绯荤当(t菕ng)鐥呰畩鏅�(sh铆)鍙鑵﹀強鑴婇珦MRI妾㈡煡銆傛湁姊濅欢鐨勮PET/CT妾㈡煡銆�
(5)鍖栫檪鍓嶆鏌ワ細浜嗚В鑷熷櫒鍔熻兘銆佸厤鐤媭娉�銆佺梾姣掓劅鏌�銆佸偝鏌撶梾绛夌媭娉併€�
3.甯歌(gu墨)鍖栫檪
鐩墠鍦�(gu贸)闅涗笂寤f硾鍦∕OPP鍙夾BVD鐐洪鏋剁殑鍩虹(ch菙)涓�锛岄噰鐢ㄨ繎鏈熷強閬�(yu菐n)鏈熸瘨鎬х浉灏�(du矛)灏忕殑钘ョ墿鏇挎彌姣掓€уぇ鐨勮棩鐗╂不鐧�锛屾紨鍖栧嚭寰堝鍖栫檪鏂规銆傝€屼笖锛屾不鐧傚墠瑭�(p铆ng)浼伴爯(y霉)鍚庝笉鑹洜绱犲皪(du矛)浜庝腑楂樺嵄HL闋�(y霉)鍚庨潪甯搁噸瑕�锛屾噳(y墨ng)瑭茶獚(r猫n)鐪熻⿻(p铆ng)浼伴€�(j矛n)琛屽嵄闅�(xi菐n)搴﹀垎灞ゆ不鐧�锛岄倓瑕侀噸瑕栨棭鏈熸不鐧傚弽鎳�(y墨ng)浠ユ焙瀹氶€�(j矛n)涓€姝ユ不鐧傛柟妗堬紝缍�(j墨ng)閬�(gu貌)瑕�(gu墨)鑼冩不鐧�锛屽ぇ閮ㄥ垎5骞碋FS鍙互閬�(d谩)鍒�80%锝�85%浠ヤ笂銆�
鐩墠鏅亶鏍规摎(j霉)涓嶅悓鍗遍毆(xi菐n)搴︽噳(y墨ng)鐢�2锝�6鍊�(g猫)鐧傜▼鍖栫檪浼存垨涓嶄即鍙楃疮閲庣殑鏀剧檪?锛涱嚖鐔傝兒鏆栫啂闄俫鎳�(y墨ng)鐢ㄥ京(f霉)鏂圭:鑳虹敳鍣佸攽闋�(y霉)闃插崱姘忚偤鍥婅煵(ch贸ng)瀛㈠瓙鐥呫€�
4.娌荤檪璺窔鍦�
(1)浣庡嵄绲勶細ABVE/PC-COPP/ABV-ABVEPC-COPP/ABV鍏�4鍊�(g猫)鐧傜▼銆�
(2)涓嵄绲勫強楂樺嵄绲勶細CycleA-COPP/ABV-CycleC-CycleA-COPP/ABV-CycleC(鍏烽珨鍔戦噺涓嶅悓)鍏�6鍊�(g猫)鐧傜▼-鏀剧檪銆�
(浜�)鍖栫檪鏂规
1.浣庡嵄绲勶細鈪燗锛屸叀A銆侫BVE/PC锛氱挵(hu谩n)纾烽叞鑳�600mg/(m²·d)锛岄潨鑴堟淮娉�锛宒1锛屾按鍖栧牽鍖�2d;闀�(zh菐ng)鏄ユ柊鍫�1.4mg/(m²·d)锛岄潨鑴堟帹娉紝姣忔鏈€澶ч噺涓嶈秴閬�(gu貌)2mg锛宒1銆乨8;澶氭煍姣旀槦25mg/(m²·d)锛岄潨鑴堟淮娉�锛宒1銆乨2;鍗氫締(l谩i)闇夌礌5IU/(m²·d)锛岄潨鑴堟淮娉�锛宒1;10IU/(m²·d)锛岄潨鑴堟淮娉�锛宒8;渚濇墭娉婅嫹75mg/(m²·d)锛岄潨鑴堟淮娉�锛宒1锝瀌5锛屽ぇ浜�1h鍏�;寮�(qi谩ng)鐨勬澗40mg/(m²·d)锛屽彛鏈嶏紝d1锝瀌8;G-CSF5μg/(kg·d)锛岀毊涓嬫敞灏勶紝Qd锛宒6闁�(k膩i)濮嬬洿鑷矨NC>1000/mm3銆侰OPP/ABV锛氱挵(hu谩n)纾烽叞鑳�600mg/(m²·d)锛岄潨鑴堟淮娉�锛宒1姘村寲鍫垮寲2澶�;闀�(zh菐ng)鏄ユ柊鍫�1.4mg/(m²·d)锛岄潨鑴堟帹娉�锛屾瘡娆℃渶澶ч噺涓嶈秴閬�(gu貌)2mg锛宒1;鐢插熀鑺愯偧100mg/(m²·d)锛屽彛鏈�锛宒1锝瀌7;寮�(qi谩ng)鐨勬澗40mg/(m²·d)鍒嗗叐娆″彛鏈�锛宒1锝瀌14;澶氭煍姣旀槦35mg/(m²·d)锛岄潨鑴堟淮娉�锛宒8;鍗氳悐闇夌礌10U/(m²·d)锛岄潨鑴堟帹娉紝澶т簬5min锛宒8;闀�(zh菐ng)鏄ヨ姳鍫�6mg/(m²·d)锛岄潨鑴堟帹娉�锛宒8銆�
娉細姣�21澶╀竴鍊�(g猫)鐧傜▼锛岀劇(w煤)鍤�(y谩n)閲嶆劅鏌擄紝鑲濊厧鍔熷強蹇冭嚐鍔熻兘姝e父锛屼腑鎬х矑绱�(x矛)鑳炵禃灏�(du矛)鍊煎ぇ浜�750/mm3绻肩簩(x霉)浜堜笅涓€鍊�(g猫)鐧傜▼鍖栫檪銆侫BVE/PC-COPP/ABV浜ゆ浛鍏�4鍊�(g猫)鐧傜▼銆傚叐鍊�(g猫)鐧傜▼绲�(ji茅)鏉熷悗瑭�(p铆ng)浼版不鐧傚弽鎳�(y墨ng)銆�4鍊�(g猫)鐧傜▼鏈€绲傝⿻(p铆ng)浼版湁娈樼暀灞€閮ㄦ斁鐧�锛岀劇(w煤)娈樼暀鍋滆棩銆�
2.涓嵄绲勶細鈪燘锛屸參A銆侰ycleA-COPP/ABV-CycleC-CycleA-COPP/ABV-CycleC
(1)CycleA锛氶樋绯栬優鑻�2g/(m²·d)锛屼緷鎵樻硦鑻�150mg/(m²·d)銆傚嵆锛氶樋绯栬優鑻�2g/(m²·d)锛岄潨鑴堟淮娉�3灏忔檪(sh铆)锛孮12h锛屽叡4娆�锛宒1銆乨2;渚濇墭娉婅嫹150mg/(m²·d)锛岄潨鑴堟敞锛屽ぇ浜�1灏忔檪(sh铆)锛孮12h锛屽叡4娆�锛宒1銆乨2(渚濇墭娉婅嫹鍦ㄩ潨鑴堟淮娉ㄥ畬闃跨硸鑳炶嫹鍚庣郸浜�)銆侴-CSF5μg/(kg·d)锛岀毊涓嬫敞灏�锛孮d锛宒3闁�(k膩i)濮嬬洿鑷矨NC>1000/ mm³銆�
(2)COPP/ABV鍔戦噺鍚屼綆鍗�锛�21澶╀竴鍊�(g猫)鐧傜▼銆�
(3)CycleC锛氱挵(hu谩n)纾烽叞鑳�1000mg/(m²·d)锛岄潨鑴堟淮娉紝20鍒嗛悩锛宒1銆乨2;缇庡徃閳�400mg/(m²·d)锛屼簬CTX鐨�0h銆�4h銆�8h鎳�(y墨ng)鐢紝姘村寲鍫垮寲4澶�;闀�(zh菐ng)鏄ユ柊鍫�1.4mg/(m²·d)锛岄潨鑴堟帹娉�(娌�(m茅i)鏈夋渶澶ч噺)锛宒1;澶氭煍姣旀槦25mg/(m²·d)锛岄潨鑴堟淮娉�锛宒1锛宒2锛宒3;鐢插熀寮�(qi谩ng)鐨勬澗榫�250mg/(m²·d)锛岄潨鑴堟淮娉�锛孮6h×4娆�锛宒1;寮�(qi谩ng)鐨勬澗60mg/(m²·d)锛屽彛鏈�锛孴ID锛宒2锝瀌4;G-CSF5μg/(kg·d)锛岀毊涓嬫敞灏勶紝Qd锛宒4锛岄枊(k膩i)濮嬬洿鑷矨NC>1000/ mm³銆傛敞锛氭瘡21澶╀竴鍊�(g猫)鐧傜▼锛岀劇(w煤)鍤�(y谩n)閲嶆劅鏌�锛岃倽鑵庡姛鍙婂績鑷熷姛鑳芥甯�锛屼腑鎬х矑绱�(x矛)鑳炵禃灏�(du矛)鍊煎ぇ浜�750/ mm³绻肩簩(x霉)浜堜笅涓€鍊�(g猫)鐧傜▼鍖栫檪銆傚叡6鍊�(g猫)鐧傜▼銆傜浜�銆佸洓鐧傜▼绲�(ji茅)鏉熷悗(绗笁銆佷簲鐧傜▼鍓�)瑭�(p铆ng)浼版不鐧傚弽鎳�(y墨ng)銆�
3.楂樺嵄绲勶細鈪锛屸參B锛屸叄鏈熸垨浼寸副鑶堝法澶х槫鐏惰€�锛屽ぇ浜�4鍊�(g猫)娣嬪反绲�(ji茅)鍗€(q奴)鍙楃疮鑰�銆侰ycleA-COPP/ABV-灏忚⿻(p铆ng)浼癈ycleC-CycleA-涓湡瑭�(p铆ng)浼�-COPP/ABV-CycleC鍌欐敞锛欱绲勭櫏鐙€(涓昏鏄櫦(f膩)鐔�)绐佸嚭鑰呭彲浠ュ厛鐢–ycleC鏂规锛岃(di脿o)鏁村寲鐧傞爢搴�?y脿n)闀儁cleC-CycleA-COPP/ABV-CycleC-CycleA-COPP/ABV
(1)CycleA(Ara-C/VP16)锛氶樋绯栬優鑻�3g/(m²·d)锛岄潨鑴堟淮娉紝3灏忔檪(sh铆)锛孮12h锛屽叡4娆�锛宒1銆乨2;渚濇墭娉婅嫹200mg/(m²·d)锛岄潨鑴堟淮娉紝1灏忔檪(sh铆)锛孮12h锛屽叡4娆�锛宒1銆乨2(渚濇墭娉婅嫹鍦ㄩ潨鑴堟淮娉ㄥ畬闃跨硸鑳炶嫹鍚庣郸浜�);G-CSF5μg/(kg·d)锛岀毊涓嬫敞灏�锛孮d锛宒3闁�(k膩i)濮嬬洿鑷矨NC>1000/ mm³銆�
(2)COPP/ABV鍔戦噺鍚屽墠锛屾瘡21澶╀竴鍊�(g猫)鐧傜▼锛岀劇(w煤)鍤�(y谩n)閲嶆劅鏌擄紝鑲濊厧鍔熷強蹇冭嚐鍔熻兘姝e父锛屼腑鎬х矑绱�(x矛)鑳炵禃灏�(du矛)鍊煎ぇ浜�750/ mm³绻肩簩(x霉)浜堜笅涓€鍊�(g猫)鐧傜▼鍖栫檪銆�
(3)CycleC(CHOP)锛氱挵(hu谩n)纾烽叞鑳�1200mg/(m²·d)锛岄潨鑴堟淮娉�锛�20鍒嗛悩锛孮d锛宒1銆乨2锛屾按鍖栧牽鍖�4澶�;缇庡徃閳�400mg/(m²·d)锛孋TX鐨�0h銆�4h銆�8h;闀�(zh菐ng)鏄ユ柊鍫�1.4mg/(m²·d)锛岄潨鑴堟帹娉�(娌�(m茅i)鏈夋渶澶ч噺)锛宒1;澶氭煍姣旀槦25mg/(m²·d)锛岄潨鑴堟淮娉紝Qd锛宒1銆乨2銆乨3;鐢插熀寮�(qi谩ng)鐨勬澗榫�250mg/(m²·d)闈滆剤婊存敞锛孮6h×4娆�锛宒1;寮�(qi谩ng)鐨勬澗60mg/(m²·d)锛屽彛鏈�锛孴ID锛宒2锝瀌4;G-CSF5μg/(kg·d)锛岀毊涓嬫敞灏�锛孮d锛宒4闁�(k膩i)濮嬬洿鑷矨NC>1000/mm³銆傛敞锛氭瘡21澶╀竴鍊�(g猫)鐧傜▼锛岀劇(w煤)鍤�(y谩n)閲嶆劅鏌�锛岃倽鑵庡姛鍙婂績鑷熷姛鑳芥甯�锛屼腑鎬х矑绱�(x矛)鑳炵禃灏�(du矛)鍊煎ぇ浜�750/ mm³绻肩簩(x霉)浜堜笅涓€鍊�(g猫)鐧傜▼鍖栫檪銆�
(涓�)鏀剧檪
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