Follicular

LymphomaContentsincidenceandepidemiologydiagnosisandmolecular

biologystagingandriskassessmenttreatmentfollow-upandlong-termimplicationsFLSitesandenrollmentbyregion.Follicularlymphomaisthesecondmostcommonsubtype

oflymphoma(althoughitsincidencemaybelowerinsome

partsoftheworldsuchasAsia)andrepresentsabout20%

to25%ofcasesofnon-HodgkinlymphomasintheU.S.

andEurope.IncidenceandEpidemiologyDiagnosisandMolecular

biology

HistologicalandpathologicalImmunohistologicfindingsGENETICABNORMALITIESGradingoffollicularlymphomaAnnalsofOncologyAdvanceAccessCD19+、CD20+、CD79a+、CD10+、Bcl6+BCL2rearrangement、t(14；18)、t(8；14)HistologicalandpathologicalGradingoffollicularlymphomaArchitecturalPatternsinFollicularSpectrumofFollicleMorphologyImmunoarchitecturalPatternsofFollicualrlymphoma1.DescribecontentsforaChart

-Descriptionofthecompany’ssubcontents-Descriptionofthecompany’ssubcontents2.DescribecontentsforaChart

-Descriptionofthecompany’ssubcontents-Descriptionofthecompany’ssubcontentsImmunohistologicfindingsIHCGENETICABNORMALITIESGENETICABNORMALITIESThemeGallery

isaDesignDigitalContent&ContentsmalldevelopedbyGuildDesignInc.GuildDesign

isoneofalignedcompanywithMicrosoftLtd,andwedevelopandprovidethedesigntemplatesforOffice97,2000,andXP.GENETICABNORMALITIESAmodeloftheFL

microenvironment.010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextGENETICABNORMALITIESBCL2mutationscorrelatewithtransformationriskanddisease-specificdeathinFL.010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextGENETICABNORMALITIESGraphicsummaryofcommongeneticlesionsinfollicularlymphoma010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextBCL2mutationsinFLcorrelatewithactivation-Inducedcytidine

deaminaseexpressionandfrequentlyaltertheaminoacidsequenceoftheprotein.MutationsintheBCL2codingsequenceatdiagnosisareassociatedwithshortenedtimetotransformationandEarlierdeathduetolymphoma.DescriptionofthecontentsDescriptionofthecontentsGENETICABNORMALITIES010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddText“ThemeGalleryisaDesignDigitalContent&ContentsmalldevelopedbyGuildDesignInc.”StagingandRiskAssessmentANewPrognosticIndexforFLDescriptionofthecompany’ssubcontentsDescriptionofthecompany’ssubcontentsDescriptionofthecompany’ssubcontentsContentTitleContentTitle010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextStagingandRiskAssessmentFLIPI-2betterthanFLIPI-1?010203StageI–IIStagesIII–IVInductiontherapyConsolidation/MaintenanceRelapseddiseaseTreatmentFirstlineStageI–IIStageI–IIInstageI–IIpatientswithlargetumourburdenoradverseprognosticfeatures,systemictherapyasindicatedforadvancedstagesshouldbeapplied;aradiationconsolidationmaybeconsidereddependingontumourlocationandexpectedside-effects.Inthesmallproportionofpatientswithlimitednon-bulkystagesI-II,radiotherapyisthepreferredtreatmenthavingacurativepotential,whereasthe2×2Gyscheduleisinferiorandismerelypalliative.Inselectedcases,watchfulwaitingorrituximabmonotherapymaybeconsideredtoavoidtheside-effectsofradiation.StagesIII–IV

TreatmentIndicationTREATbulkydiseaseBsymptomsascites,pleuraleffusionvitalorgancompressionhaematopoieticimpairmentrapidlymphomaprogressionCriteriafordelayingtreatmentinFLWatchfulwaitingradioimmunotherapyimmunotherapyImmuno-chemotherapyStagesIII–IVImmuno-chemotherapyR-CHOPR-CVPR-FCR-FMR-BImmunotherapyRituximabRadio-immunotherapy131I-tositumomabFirstlineWatchfulwaiting010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextDescriptionofthecontentsDescriptionofthecontentsDescriptionofthecontentsSimplifiedsummaryofcurrentandemergingtreatmentoptionsforfollicularlymphoma.Treatmentconsolidation/maintenanceRituximab

maintenance

for2yearsRadio-immunotherapyconsolidation......ASCT利妥昔單抗維持治療可作為高危和高腫瘤負荷患者選擇000102030405060750%70%160%230%100%150%380%300%YearClinicaltrialsexaminingrituximabmaintenancetherapy010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextCTXcytotoxicchemotherapy,ERGEvidenceReviewGroup,HRhazardratio,NEnotestimable,NSnotstated,PFSprogression-freesurvival,RTXrituximabKeyoutcomesofthePRIMAtrial010203ClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextClicktoaddTextTreatment-SummaryStep1Step2Step3Arepeatedbiopsyisstronglyrecommended.Observationisanacceptedapproach

inasymptomaticpatientswithlowtumourburden.SalvagetreatmentRelapsedDiseaseStep3Step4BetterOS50%70%160%YearEORTC2098170%160%230%100%150%300%YearEORTC20981YearGermanLowGradeLymphoma

StudyGroup(GLSG)YearASCTforRelapsedFLYearASCTforRelapsedFLYearRESORT(RituximabExtendedScheduleorRe-TreatmentTrial)Inlow–tumorburdenFL,are-treatmentstrategyuseslessrituximabwhileprovidingdisease

controlcomparabletothatachievedwithamaintenancestrategy.010203ClicktoaddTextClicktoaddTextCl