1 Cutaneous T- cell lymphoma) 2)
2001 WHO - - - PS LDH soluble IL- B 38.5 C 10 International Prognostic Index IPI
International prognostic factor and index Prognostic factor >60 LDH > PS 2-4 Stage III or IV Prognostic index low risk 0-1 low intermediate 2 high intermediate high risk 4-5 >2
PS LDH, IL- 2 R, - microglobulin B International Prognostic Index
1962 Kaplan / 1969 MOPP ABVD 1980
nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) nodular sclerosis Hodgkin lymphoma (NSHL) mixed cellularity Hodgkin lymphoma (MCHL) lymphocyte-rich classical Hodgkin lymphoma (LRHL) lymphocyte depleted Hodgkin lymphoma (LDHL) classical Hodgkin lymphoma
Ann Arbor
Cotswolds
1 2
Non- lymphoma (NHL)
NHL
NHL
Involved- field radiotherapy
MALT
Marginal zone B cell lymphoma - - - 25-30Gy 30-36Gy non- bulky MALT lymphoma 25-45Gy
MALT MALT
grade 3 grade 4 BLM
10 gap TSH 6 13-18Gy ABVD 10 1 15 13
1
Mycosis fungoides) indolent malignancy of skin- homing CD4+ T- cells * early stage: limited to the skin *1806 MF 1938 Sezary leukemic variant
MF Blood 90:354, 1997
MF NCI SEER 2830
MF patch stage plaque stage tumor stage erythroderma
MF TNM
EORTC guidelines J Am Acad Dermatol 47:364, 2002
Geometry of dual field TSE
1 3
1) ) 2Gy / 12Gy 20 20-30Gy
t(9;22) BCR/ABL Imatinib abl
Chronic myeloid leukemia; CML) 4 5 6 6 9 3 6 20 10 3 / 15% 15 30% 30% 20% Ph Ph Ph
CML (Failure) T315I TKI IC50>3nM IC50>150nM / 51;1389, 2010
Total Cell Kill 1kg 10 12 10 9 10 8 10 6 10 3 FISH G- Real-time PCR 10 0 complete remission; CR JALSG 5% 0% 10
AML M3 APL APL acute promyelocytic leukemia t(15;17) PML-RARa DIC all-trans retinoic acid (ATRA CR 93% 6 OS 83.9% t 15; 17 p 1 1 q 1 2 p 1 q 3 2 1 3 2 5 4 1 2 3 4 5 6 15 1 2 1 2 1 2 3 4 5 A B 17 t(15;17) A B B A PML-RAR
/ HLA HLA HLA GVHD Graft-versus-host disease GVL Graft-versus-leukemia effect QOL QOL GVL QOL GVHD) GVHD
AML vs vs SWOG Risk status SWOG coding Favorable inv 16 / t 16;16 / del 16q, t 15;17 with/without secondary aberrations, t 8;21 lacking del 9q or complex karyotypes Intermediate Normal, +8, +6, -Y, del 12p Unfavorable Unknown del 5q / -5, -7/ del 7q, abn 3q, 9q, 11q, 20q, 17p, t 6;9, t 9;22 and complex karyotypes 3 unrelated abn All other abnormalities Slovak ML et al. Blood 96: 4075-4083, 2000
AML AML M3 CBF t(8:21) inv(16) core binding factor (CBF) t(8;21) AML1/ETO (AML1=CBF 2 inv(16), t(16;16) CBF /MYH11 CBF 2 CBF heterodimer MPO MPO 3q 11q 5 7 hypodiploid t(9;22) MPO JSHCT monograph Vol.6 2002 4
AML JALSG AML 97 CR JALSG Score HLA 3 Disease-free Survival Overall Survival AML Sakamaki H et al. Int J Hematol 91: 284-292, 2010
AML 11
AML NPM1 CEBPA c-kit FLT3-ITD BAALC ERG NM1 FOXO3a MLL-PTD NRAS TP53 WT1 IDH1 NPM1 CEBPA FLT3-ITD BAALC ERG NM1 FOXO MLL-PTD NRAS TP53 WT1 IDH1 Nucleophosmin 5q35 CCAAT/enhancer binding protein, alpha 19q13.1 Fms-related tyrosine kinase 3 13q12 internal tandem duplication brain and acute leukemia, cytoplasmic Ets-related gene 21q22 meningioma1 22q12 FOXO family 6q21 mixed-lineage leukemia partial tandem duplication neuroblastoma RAS viral oncogene homolog Wilms' tumor gene WT1 isocitrate dehydrogenase 1 gene 1
(Acute lymphoblastic leukemia; ALL) ALL 80% ALL 20 40
ALL JALSG ALL93 CR >4 MRD (t(9;22)/bcr-abl) t(4;11)/alli-af4 >35 >30,000(B-lineage) >100,000(T-lineage) Positive/High Hoelzer, Semin Oncol 27, 540-559, 2000 100 80 Probability 60 40 20 0 Low-risk (n=63) Intermediate-risk (n=97) High-risk (n=69) Age 30 WBC p<0.0001 (log-rank test) Low-risk Intermediate-risk High-risk 0 1 2 3 4 5 6 7 ( ) Takeuchi J et al. Leukemia 16: 1259-1266, 2002
Ph ALL German ALL study ALL Ph+ vs Ph- 1.0 OS 0.8 0.6 Ph- 0.4 Ph t(9;22)= del(9q)/t(9q) del(12q)/t(12q) t(4 11) AF4-MLL 14q11-q13 14q32 t(9 22) BCR-ABL Philadelphia 0.2 Ph+ 0.0 0 1 2 3 4 5 6 7 8 p=0.0001(log-rank) -1543, 2002 Philadelphia ALL
CPA 1,200mg/m 2 1 3 DNR 60mg/m 2 1 1 VCR 1.3mg/m 2 2 PSL 60mg/m 2 imatinib 600mg MTX 15mg Ara-C 40mg DEX 4mg day 1,2,3 8 15 22 29 63 21 2 56 Yanada M et al.: J. Clin Oncol. 24(3): 460, 2006
ALL ALL Ph ALL Burkitt ALL VCR/PSL/DNR (oradm)/l-asp CPA Hyper-CVAD (CPA, VCR, ADM, DEX) Ara-C/MTX 6-MP/VCR/PSL/MTX Ph ALL Imatinib ALL (15~25 ALL Burkitt ALL MTX CPA R-CODOX-M/R-IVAC, R-Hyper CVAD
ALL : AML
ALL
ALL
ALL 4 J Clin Oncol 14:20, 1996
AML French- American- British (FAB) system
International myeloma WG stage
5 3 12% 5-24
ABVD ABVd )
DHAP
DPHA
DPHA
EPOCH
EPOCH
EPOCH
AVBD
AVBD