NCCN弥漫性大B细胞淋巴瘤指南2017.2版（2）
好消息：
目前《指南解读》已经完成43个癌种NCCN临床实践指南及7个支持治疗指南（合计50个）的编译，后续我们将陆续再编译筛查、预防、降低风险指南以及老年肿瘤、青少年及年轻成人肿瘤指南并更新！有意获取中文指南电子版的同行，可加黄医生个人微信号30842121，我们将以PDF格式通过电子邮箱发送。考虑编译者团队在工作之余付出的大量辛苦工作，我们将向每位订制者收取360元（50个指南），敬请大家理解和支持！
目录
国际预后指数a（BCEL-A）
a.The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive non-hodgkin’s lymphoma. N Engl J Med1993; 329:987-994.
b.Miller TP, Dahlberg S, Cassady JR. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and highgrade non-Hodgkin's lymphoma. N Engl J Med 1998;339:21-26.
c.This research was originally published in Blood. Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood 2014;123:837-842. © the American Society of Hematology
a.Schmitz N, Zeynalova S, Nickelsen M, et al. A new prognostic model to assess the risk of CNS disease in patients with aggressive B-cell lymphoma [abstract]. Hematol Oncol 2013;31 (Suppl. 1):96-150; Abstract 047.
b.Savage K, et al Validation of a prognostic model to assess the risk of CNS disease in patients with aggressive B-cell lymphoma [abstract]. Blood 2014;124:Abstract 394.
BCEL-B
原发性纵隔大B细胞淋巴瘤
（BCEL-B,4-1 ）
a.Dunleavy K, Pittaluga S, Maeda LS, et al. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med 2013;368:1408-1416.
b.Moskowitz C, Hamlin PA, Jr., Maragulia J, et al. Sequential dose-dense RCHOP followed by ICE consolidation (MSKCC protocol 01-142) without radiotherapy for patients with primary mediastinal large B-cell lymphoma [abstract]. Blood 2010;116:Abstract 420.
灰区淋巴瘤a,b,c（介于DLBCL与经典HL之间）（BCEL-B,4-2）
a.Dunleavy K, Pittaluga S, Tay K, et al. Comparative clinical and biological features of primary mediastinal B-cell lymphoma (PMBL) and mediastinal grey zone lymphoma (MGZL) [abstract]. Blood 2009;114:Abstract 106.
b.Jaffe ES, Stein H, Swerdlow SH, et al. B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma. In: Swerdlow SH, Campo E, Harris NL, et al., eds. WHO classification of tumours of haematopoietic and lymphoid tissues (ed 4th). Lyon: IARC; 2008:267-268.
c.Quintanilla-Martinez L, de Jong D, de Mascarel A, et al. Gray zones around diffuse large B cell lymphoma. Conclusions based on the workshop of the XIV meeting of the European Association for Hematopathology and the Society of Hematopathology in Bordeaux, France. J Hematop 2009;2:211-236.
d.Evens AM, Kanakry JA, Sehn LH, et al. Gray zone lymphoma with features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma: Characteristics, outcomes, and prognostication among a large multicenter cohort. Am J Hematol 2015;90:778-783.
双打击淋巴瘤（BCEL-B,4-3）
Petrich A, Gandhi M, Jovanovic B, et al. Impact of induction regimen and stem cell transplantation on outcomes in double-hit lymphoma: a multicenter retrospective analysis. Blood 2014;124:2354-2361.
Dunleavy K, Fanale M, LaCasce A, et al. Preliminary report of a multicenter prospective phase II study of DA-EPOCH-R in MYC-rearranged aggressive B-cell lymphoma [abstract]. Blood 2014: Abstract 395.
Johnson NA, Slack GW, Savage KJ et al. Concurrent expression of MYC and BCL2 in diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol 2012;30:3452-3459.
Green TM, Young KH, Visco C, et al. Immunohistochemical double-hit score is a strong predictor of outcome in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol 2012;30:3460-3467.
原发皮肤的弥漫大B细胞淋巴瘤，腿型（BCEL-B,4-4）
a.见皮下淋巴瘤TNM分类，不是MF/SS（见T细胞淋巴瘤和皮下B细胞淋巴瘤的NCCN指南 ）。
b.不能耐受蒽环类的患者，参见左室心功能不全患者方案BCEL-C。
c.不能耐受化疗的患者。
d.治疗结束时强烈推荐PET/CT或C/A/P增强CT评估疗效。如果临床怀疑疾病进展，也可重复影像学检查。
建议治疗方案a(BCEL-C)
按字母顺序排序
BCEL-C,4-1
a.方案的参考文献见BCEL-C 4-3和BCEL-C 4-4。
b.在R-CHOP-14和R-CHOP-21方案中，>60岁的患者，可考虑增加利妥昔单抗到500mg/m2。
c.含有任何蒽环类或蒽二酮类药物的方案治疗心功能受损的患者时，应更密切地监测心功能。
d.目前关于使用这些方案的已发表文献有限，但NCCN各成员机构将其用于左室功能不全的DLBCL患者的一线治疗。
e.目前有限的数据提示用这些方案治疗早期阶段的疾病，然而在NCCN各成员机构对于I-II期多用短疗程的化疗+放疗。
f.若需要提高剂量，应当维持阿霉素的基础剂量，不得提高。
BCEL-C,4-2
a.方案的参考文献见BCEL-C 4-3和BCEL-C 4-4。
c.含有任何蒽环类或蒽二酮类药物的方案治疗心功能受损的患者时，应更密切地监测心功能。
g.如果全程治疗后加用蒽环类药物，应当密切监测心功能。可加用右雷佐生做为心脏保护剂。
h.对经明显缓解（>6个月）后复发的患者，将利妥昔单抗列入二线治疗。但是，对于原发难治患者治疗常可不加利妥昔单抗。
BCEL-C,4-3/4-4
欢迎订购“肿瘤管家咨询服务”
（转载请联系公众号"指南解读"黄医生个人微信号：30842121）
长按二维码，关注我们