Der Onkologe

, Volume 12, Issue 7, pp 619–627 | Cite as

Fortschritte in der Behandlung der diffus-großzelligen Lymphome

Leitthema

Zusammenfassung

Der Internationale Prognose-Index (IPI) erlaubt eine prognostische Einteilung von Patienten mit aggressiven Lymphomen. Die besten Ergebnisse bei jungen Patienten mit diffus-großzelligen Lymphomen (DLBCL) und guter Prognose (niedriges und intermediär-niedriges Risiko bzw. altersadaptierter IPI=aaIPI=0,1) wurden mit 6 Zyklen CHOP-21 plus Rituximab erzielt. Damit erreichen Patienten mit einer sehr günstigen Prognose (IPI=0, kein Bulk) ereignisfreie Überlebensraten von >90% und Dreijahresüberlebensraten von 98%, während Patienten in der weniger günstigen Subgruppe (IPI=1, IPI=0 mit Bulk) ein ereignisfreies Überleben von unter 80% haben; dies bedarf einer weiteren Verbesserung. Junge Patienten mit schlechter Prognose (intermediär-hohes und hohes Risiko bzw. aaIPI=2,3) haben eine Fünfjahresüberlebensrate von nur ca. 50%. Da es bei diesen Patienten weder einen allgemein anerkannten Standard noch überzeugende Fortschritte gibt, sollten sie nur innerhalb von klinischen Studien behandelt werden. Bei älteren Patienten wurden die besten Ergebnisse mit 6 Zyklen CHOP-14 und 8 Applikationen Rituximab erreicht, sodass diese Therapie für ältere Patienten derzeit als Standard gelten kann.

Schlüsselwörter

Aggressive Lymphome Diffus-großzellige B-Zell-Lymphome Prognostische Gruppen Dosisdichte Chemotherapie Immuntherapie 

Progress in the treatment of diffuse large B-cell lymphomas

Abstract

The International Prognostic Index (IPI) distinguishes different prognostic groups of patients with aggressive lymphoma. Good prognosis patients (the low and low–intermediate risk groups or age-adjusted (aa)IPI=0, 1) with diffuse large B-cell lymphomas are best treated with six cycles of CHOP-21 plus rituximab. With this approach, event-free survival rates of >90% and overall survival of 98% can be achieved in a very favorable subgroup (aaIPI=0, no bulky disease), while further improvement is possible for the less favorable subgroups (aaIPI=1 or aaIPI=0 with bulk). For young, poor-prognosis patients, 5-year survival is around 50%. Because there has been no accepted standard and no convincing improvement in outcome in recent years, these patients should only be treated within prospective clinical studies. In elderly patients, six cycles of CHOP-14 with eight applications of rituximab have achieved the best results to date (78% overall survival after 2.5 years), and should therefore be considered standard for these patients.

Keywords

Aggressive lymphomas Diffuse large B-cell lymphomas Prognostic groups Dose-dense chemotherapy Immunotherapy 

Notes

Interessenkonflikt

Keine Angaben

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • G. Held
    • 1
  • J. Schubert
    • 1
  • C. Rübe
    • 1
  • M. Pfreundschuh
    • 1
  1. 1.Innere Medizin I, Universität des SaarlandesHomburg/Saar

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