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晚期(Ⅲ/Ⅳ)滤泡淋巴瘤的初始治疗

Authors
Arnold S Freedman, MD
Jonathan W Friedberg, MD
Section Editor
Andrew Lister, MD, FRCP, FRCPath, FRCR
Deputy Editor
Rebecca F Connor, MD
Translators
刘尚勤, 主任医师，教授

引言

滤泡淋巴瘤(follicular lymphoma, FL，旧称滤泡中心淋巴瘤)是第二常见的非霍奇金淋巴瘤(non-Hodgkin lymphoma, NHL)类型。也是最常见的惰性NHL(惰性NHL是指：有这类淋巴瘤的患者在未经治疗的情况下可以生存数年)。 (参见“造血系统肿瘤的分类”)

FL的治疗取决于就诊时的疾病分期(表 1)。病变呈局限性(Ⅰ期)的患者适合放射治疗，该疗法可治愈部分患者。相比之下，晚期(Ⅲ/Ⅳ期)疾病的治疗不能治愈，主要关注通过联合或不联合放疗的化学免疫疗法来控制症状。即便如此，晚期FL患者的预后一般很好。

Ⅱ期FL患者的疗法较多变，一些临床医师采用类似Ⅰ期疾病的疗法，而其他医师则采取类似晚期病变患者的疗法。 (参见“局限期(Ⅰ/Ⅱ期)滤泡淋巴瘤的初始治疗”，关于‘巨块型Ⅱ期FL’一节)

本专题将讨论晚期(Ⅲ/Ⅳ)FL的初始治疗。局限期FL(Ⅰ/Ⅱ)的初始治疗、复发或难治性FL的治疗，以及FL的流行病学、临床表现、病理特征、诊断和病理生物学参见其他专题。需要强调的是，本专题所列出的推荐适用于组织学分级为1、2或3a级的FL患者；组织学3b级的FL患者按照侵袭性淋巴瘤(例如弥漫大B细胞淋巴瘤)进行治疗。 (参见“局限期(Ⅰ/Ⅱ期)滤泡淋巴瘤的初始治疗”和“复发性或难治性滤泡淋巴瘤的治疗”和“滤泡淋巴瘤的临床表现、病理特征、诊断和预后”和“Pathobiology of follicular lymphoma”, section on ‘Introduction’和“Pathobiology of follicular lymphoma”)

治疗前评估

针对NHL患者的初步评估必须确定其准确的组织学亚型、病变范围和部位以及患者的一般状况和日常生活活动能力。这些评估对明确治疗策略及通过滤泡淋巴瘤国际预后指数(Follicular Lymphoma International Prognostic Index, FLIPI)或其变型来预测结局非常重要。NHL的一般诊断性检查与分期方法参见其他专题(表 1)。晚期FL患者的治疗前评估与局限期FL患者的相同。对此将单独作更详细的讨论。 (参见“局限期(Ⅰ/Ⅱ期)滤泡淋巴瘤的初始治疗”，关于‘治疗前评估’一节和“非霍奇金淋巴瘤的临床表现与诊断”和“非霍奇金淋巴瘤的评估与分期”)

                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-29.
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