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LYMPHOMES NON HODGKINIENS

1er manuel. Low grade -diffuse lymphocytic Stage Rating -nodular lymphocytic I class 3 = pp2yrs,std 7th yr -nodular histiocytic II class 2= pp3yrs,std 8th yr III class 1= pp5yrs,std 11th yr IV DEC to 100, cl1Intermediate-High grade Stage Rating -diffuse lymphocytic, poorly diff I 25

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LYMPHOMES NON HODGKINIENS

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    1. LYMPHOMES NON HODGKINIENS François Sestier, MD, PhD Abdelouahed Naslafkih, MD, PhD AQTV, Montréal, 14 Mai 2009 Programme de médecine d’assurance et expertise en sciences de la santé, Université de Montréal www.mae.umontreal.ca

    2. 1er manuel Low grade -diffuse lymphocytic Stage Rating -nodular lymphocytic I class 3 = pp2yrs,std 7th yr -nodular histiocytic II class 2= pp3yrs,std 8th yr III class 1= pp5yrs,std 11th yr IV DEC to +100, +cl1 Intermediate-High grade Stage Rating -diffuse lymphocytic, poorly diff I class 2 -diffuse lymphocytic-histiocytic II class 1 -Burkitt’s lymphoma III +100, + class 1 -Unclassified IV DEC to +200 + class 1

    3. 2ième manuel Low grade lymphomas: -Stage 1 : PP 3yrs , then +50 and 10$ x 7 yrs 11th yr : +50 -Stage II: PP 3 yrs , then +50 and $15 x 7 yrs 11th yr : + 50 -Other stages : PP 10 yrs, then 15$ x 5yrs 16th yr : std

    4. Les LNH sont-ils des risques standards s’ils survivent 7 à 16 ans ??

    5. OBJECTIFS Identifier la littérature médicale la plus récente concernant la mortalité des LNH Calculer la mortalité observée en utilisant une méthodologie actuarielle

    6. LNH: définition et épidémiologie Definition: malignant disease of the lymphoid system, highly heterogeneous, both histologically and clinically, with several classifications 2. Epidemiology: - annual incidence: 5-10 new cases per 100 000 persons, - age distribution: middle-age patients and the elderly, - males are affected more often than females (1.5:1.0).

    11. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) 1. Low grade 2. Intermediate grade 3. High grade

    12. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) Low grade A - Small lymphocytic cell. B - Follicular, predominantly small cleaved cell C - Follicular mixed, small cleaved and large cell.

    13. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) Intermediate grade D - Follicular, predominantly large cell. E - Diffuse small cleaved cell. F - Diffuse mixed, small and large cell. G - Diffuse large cell.

    14. Histologic classification of non-Hodgkin’s lymphomas - Working Formulation (WF) High grade H -Large cell immunoblastic. I -Lymphoblastic. J -Small noncleaved cell: Burkitt’s

    16. Staging: Ann Arbor I. 1 lymph node region or structure II. >1 lymph node region or structure, same side of diaphragm III. Both sides of diaphragm IV. Extranodal sites beyond “E” designation subscripts: A, B, E, S

    22. Follicular lymphoma and long term survival Gandhi, Blood Rewiews,2005,19:165-178

    29. Figure 2. Development of a Molecular Predictor of Survival in Follicular Lymphoma. Panel A shows overall survival among the patients with biopsy specimens in the test set, according to the quartile of the survival-predictor score (SPS). Panel B shows overall survival according to the International Prognostic Index (IPI) risk group for all the patients for whom these data were available. Panel C shows overall survival among the patients with specimens in the test set for the indicated IPI risk group, stratified according to the quartile of the SPS.Figure 2. Development of a Molecular Predictor of Survival in Follicular Lymphoma. Panel A shows overall survival among the patients with biopsy specimens in the test set, according to the quartile of the survival-predictor score (SPS). Panel B shows overall survival according to the International Prognostic Index (IPI) risk group for all the patients for whom these data were available. Panel C shows overall survival among the patients with specimens in the test set for the indicated IPI risk group, stratified according to the quartile of the SPS.

    30. LYMPHOMA SURVIVAL: a textbook approach

    31. Southwest Oncology Group lymphoma survival

    32. LNH Surviennent chez le jeune adulte et la personne agée Il faut dond tenir compte de l’âge dans le calcul de la mortalité

    36. Netherlands, 1981-89 1164 patients, age : 64 yrs, 50% women

    40. CCCW-NHL Registry Netherlands, 1981-89 1167 Patients, age : 64 yrs, 50% women Follow-up: 8 years

    45. Localized aggressive lymphoma Rey et al. NEJM 2005;352:1197 France, 1993-2000 647 patients (318 ACVBP, 329 CHOP+RX) Age : 46 years, 60% men Stage I : 66% Stage II : 32% Stage IV : 2% 95% IPI score= 0 Follow-up : 8 years Deaths = 115 Mortality Ratio* = 560%

    48. Follicular lymphoma Montoto et al. Ann Oncol 2002;13:523-530 Spain, 1977-1997 201 patients, 53% men Age : 54 years Stage I: 10%, II: 9%, III: 15%, IV: 66% Overall survival : 71% at 5 years, 48% at 10 years MR* = 973% at 5 years = 785% at 10 years

    50. Survival of 389 follicular lymphomas : std at 10 yrs????

    51. Diffuse large B-cell lymphoma ( aggressive lymphomas) US,1987-1998 128 Patients, (46% men) Age : 65 years 5-year overall survival: 43% Mortality Ratio* = 722%

    52. Indolent lymphoma Follicular vs. Non Follicular lymphoma Corradini et al. J Clin Oncol 2004;22:1460-1468 Italy,1990-99 70 patients,60% men Age: 47 years 87% stage IV Overall survival at 12 yrs Follicular subtype: 76%, MR = 514% Non-Follicular : 49%, MR = 1311%

    53. Relapsed Follicular Lymphoma Autologous Bone Marrow Transplantation Freedman et al. Blood 1999;94:3325-3333 USA, 1985-1995 153 Patients, 53% men Age: 43 years (66%: stage IV, 24% stage III, 7% stage II, 3% stage I) Survival : 69% at 12 years MR* = 1330%

    57. Localized Intermediate and high-grade Non-hodgkin's lymphoma Soutwest Oncology Group, 1988-1995 442 patients (CHOP: 201; CHOP+RX :200) Age : 59 years 5-year overall survival : CHOP : 72% CHOP+RX : 82%

    60. Intermediate or high-grade Non-Hodgkin lymphoma Italy, 1984-1998 186 patients, 52% men Age: 56 years Overall survival : 60.4% at 10 years Mortality ratio = 495%

    61. Intermediate or high-grade Non-Hodgkin lymphoma MR by stage Stage I-II = 431% Stage III-IV = 995% MR by IPI IPI 1 = 260% IPI 2 = 495% IPI 3 = 800% IPI 4 = 1170%

    66. The International Lymphoma Study Group Classification of Non-Hodgkin’s Lymphoma 1403 cases (untreated) from 8 countries, 1988-90 Omaha, NE: 200 Vancouver, Canada: 202 Cape Town, South Africa: 196 London, UK: 120 Locarno, Switzerland: 80 Lyon, France: 195 Wurzburg, Germany: 210 Hong Kong: 200

    71. Lymphomes indolents Sont incurables Invasion moelle osseuse Rémission spontanée dans 25 % des cas Rechutes 2-3 après et ensuite de plus en plus rapidement Sur-mortalité persist e après 10 ans Certains LNH chez les personnes agées peuvent être assurés avec surprime (?) Les LNH indolents doivent être refusés

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