However, there are still some nonstandard problems in the treatment of malignant lymphoma. This is not only because patients do not insist on taking drugs according to the doctor's advice, but also because some doctors have little experience in treating lymphoma, do not adopt standardized treatment methods, do not use enough drugs or doses, or have improper drug selection and course of treatment.
In recent years, the incidence of non-Hodgkin's lymphoma has increased significantly, while Hodgkin's disease has declined. Therefore, this issue focuses on the treatment of non-Hodgkin's lymphoma, and the treatment of Hodgkin's disease will continue to be introduced in September 12. Attention, please.
The age of onset, lactate dehydrogenase, general condition, clinical stage and the number of invasion of parenchymal organs other than lymph nodes are obviously related to the prognosis of patients with non-Hodgkin's lymphoma. The expected 5-year survival rate of patients in low-risk group is 73%, 565,438+0% in middle-low risk group, 43% in middle-high risk group and 26% in high-risk group.
Primary lymph node indolent non-Hodgkin's lymphoma, grade ⅰ and ⅱ follicular lymphoma progressed slowly, and the annual survival rate of 10 was 80%. Simple radiotherapy can achieve better results, but simple chemotherapy or combination of radiotherapy and chemotherapy has not seen better clinical results. The choice of treatment plan for patients with stage ⅲ and ⅳ should be cautious, and there is no unified model at present. If the condition is stable and the quality of life and the function of major organs are not affected, observation can be carried out, otherwise necessary treatment should be carried out. Chemotherapy regimen should not be too strong, and general COPP or CHOP regimen can be used.
Chemotherapy combined with interferon therapy can improve the curative effect. At present, there have been beneficial attempts to treat the disease by autologous and allogeneic hematopoietic stem cell transplantation in clinic, but whether it can improve the survival time is still inconclusive. In recent years, a new trend is the application of non-myeloablative allogeneic hematopoietic stem cell transplantation, and the preliminary results are satisfactory.
The treatment principle of grade ⅲ follicular lymphoma is similar to that of aggressive non-Hodgkin lymphoma.
30% ~ 85% of inert non-Hodgkin's lymphoma will turn into a more malignant histological type during its development, so once it recurs or the disease progresses, it should be biopsied again to find out whether the nature of the disease has changed, so as to choose the appropriate treatment plan.
Invasive non-Hodgkin's lymphoma is a systemic disease. Chemotherapy plays an important role in comprehensive treatment, while radiotherapy can effectively control local lesions. The organic combination of the two makes the curative effect of stage I and II patients better than any single treatment. Nevertheless, the best treatment for stage I and stage II aggressive non-Hodgkin's lymphoma is still controversial. The consensus is that if patients have less than three affected sites or no huge masses, they can only receive short-term CHOP chemotherapy and then radiotherapy for the affected sites. If the mass is larger than 10 cm in diameter or accompanied by other adverse prognostic factors, it should be treated as a stage ⅲ or ⅳ patient.
Stage Ⅲ and Ⅳ aggressive non-Hodgkin's lymphoma is mainly treated with chemotherapy, followed by local radiotherapy. At present, CHOP regimen is still the first choice for aggressive non-Hodgkin lymphoma. It should be pointed out that whether CHOP regimen is suitable for all pathological types of aggressive non-Hodgkin's lymphoma needs further study. CHOP regimen is not ideal for the treatment of aggressive non-Hodgkin's lymphoma, and stronger or longer-lasting chemotherapy drugs may be needed to form a new regimen. For newly treated patients with obvious adverse prognostic factors, autologous hematopoietic stem cell transplantation after induction chemotherapy has achieved complete remission can significantly improve the long-term disease-free survival rate and overall survival rate. However, for patients who have only achieved partial remission after induction chemotherapy, the choice of hematopoietic stem cell transplantation should be based on the specific conditions of patients. For patients who are close to complete remission, the curative effect after transplantation is similar to that of patients who have achieved complete remission before transplantation.
The efficacy and long-term survival of various rescue chemotherapy schemes for relapsed and drug-resistant invasive non-Hodgkin's lymphoma are basically similar. Autologous hematopoietic stem cell transplantation will achieve better results than simple routine rescue treatment. Recently, the efficacy of chemotherapy combined with anti-CD20 monoclonal antibody (rituximab) in the treatment of relapsed aggressive B-cell non-Hodgkin's lymphoma and other new drugs in the treatment of relapsed drug-resistant patients were studied.
The prognosis of highly aggressive non-Hodgkin's lymphoma is poor, and the effect of conventional chemotherapy is not good. At present, there is still a lack of systematic clinical research on the standard first-line treatment of lymphoblastic non-Hodgkin's lymphoma. Because of its high degree of malignancy, it can spread far away in the early stage and often invade bone marrow and central nervous system. Therefore, even very early patients should be treated as stage ⅳ, and these factors must be considered when choosing chemotherapy schemes. Autologous or allogeneic hematopoietic stem cell transplantation is a treatment method that people are exploring.
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