外周细胞淋巴瘤诊疗进展.ppt

《外周细胞淋巴瘤诊疗进展.ppt》由会员分享，可在线阅读，更多相关《外周细胞淋巴瘤诊疗进展.ppt（49页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、外周细胞淋巴瘤诊疗进展现在学习的是第1页，共49页主要内容主要内容PTCLPTCL的分类的分类PTCLPTCL的流行病学的流行病学PTCLPTCL的预后因子的预后因子PTCLPTCL治疗新药物治疗新药物现在学习的是第2页，共49页外周外周T淋巴瘤的分类淋巴瘤的分类PTCLisaheterogeneousgroupofaggressivematureT-/NK-celllymphomasPTCLdoesnotrefertoanatomicsites,butrathertotheinvolvementofmoremature(postthymic)Tcellsvsprethymicorimmatu

2、reTcellsAdaptedfromSwerdlowSH,etal.WHOClassificationofTumoursofHaematopoieticandLymphoidTissues.2008.Non-Hodgkins lymphomaT-/NK-cell neoplasmsB-cell neoplasmsT-cell prolymphocytic LeukemiaPrecursor Lymphoid NeoplasmsCutaneousExtranodalLeukemicMature T-/NK-cell neoplasmsNodalNK/TCL nasal typeAdult T-

3、cell leukemia/lymphoma Subcutaneous panniculitis-like TCLEnteropathy-associated TCLHepatosplenic TCLAggressive NK-cell leukemiaTransformed MFPrimary cutaneous gamma/delta TCLPeripheral TCL-NOSAngioimmunoblastic TCLAnaplastic large-cell lymphoma(ALK+/-)AggressiveT-Lymphoblastic Leukemia/LymphomaPrima

4、ry cutaneous CD30+T-cell disordersMFT-cell large granular lymphocytic leukemiaSzary SyndromeIndolent现在学习的是第3页，共49页InternationalT-CellLymphomaProject.JClinOncol.2008;26:4124-4130.1314例例PTCL和和NKTCL的分布的分布25.9%18.5%10.4%9.6%6.6%5.5%4.7%12.2%2.5%0.9%1.4%1.7%PeripheralT-celllymphomaAngioimmunoblasticNatur

5、alkiller/T-celllymphomaAdultT-cellleukemia/lymphomaAnaplasticlarge-celllymphoma,ALK+Anaplasticlarge-celllymphoma,ALK-Enteropathy-typeTcellPrimarycutaneousALCLHepatosplenicTcellSubcutaneouspanniculitis-likeUnclassifiablePTCLOtherdisorders现在学习的是第4页，共49页四川省肿瘤医院淋巴瘤病区截止四川省肿瘤医院淋巴瘤病区截止20142014年年1010月月总数总数5

6、02例淋巴瘤患者例淋巴瘤患者T-NHL108例例现在学习的是第5页，共49页2012.4-2014.10四川省肿瘤医院淋巴瘤数据四川省肿瘤医院淋巴瘤病区截止四川省肿瘤医院淋巴瘤病区截止20142014年年1010月月现在学习的是第6页，共49页PTCL流行病学不同地域不同地域PTCL亚型相对发病率亚型相对发病率1,2总的发病率亚洲和加勒比地区更高总的发病率亚洲和加勒比地区更高1.SavageKJ.HematologyAmSocHematolEducProgram.2005;10:267-277.2.InternationalT-CellLymphomaProject.JClinOncol.20

7、08;26:4124-4130.SubtypePercentage2NorthAmericaEuropeAsiaPTCL-NOS34.434.322.4Angioimmunoblastic16.028.717.9ALCL,ALK+16.06.43.2ALCL,ALK-7.89.42.6NK/TCL5.14.322.4ATLL(HTLV-1+)2.01.025.0Enteropathy-type5.89.11.9Hepatosplenic3.02.30.2PrimarycutaneousALCL5.40.80.7Subcutaneouspanniculitis-like1.30.51.3Uncl

8、assifiableT-cell2.33.32.4现在学习的是第7页，共49页PTCL亚型及细胞来源亚型及细胞来源PTCL SubtypeImmune Cell of OriginNK-cell lymphomaNatural killer cells T-cell lymphoma T-cellsALCL and PTCL/NOST-helper and T-cytotoxic cellsAITL/Tth-PTCL/NOST-follicular helper cellsPiccalugaPP,etal.ExpertRevHematol.2011;4:415-425.现在学习的是第8页，共4

9、9页PTCLPTCL的诊断的诊断10%PTCL10%PTCL诊断不正确诊断不正确大多数病人是大多数病人是III/IVIII/IV期期结外受累常见结外受累常见:皮肤、肝脏、脾脏、骨髓、外周血皮肤、肝脏、脾脏、骨髓、外周血PTCLPTCL的诊断：的诊断：MIC MIC（形态学、免疫学和细胞遗传学）（形态学、免疫学和细胞遗传学）细针穿刺活检不能作为诊断依据，必须进行活检切除术细针穿刺活检不能作为诊断依据，必须进行活检切除术1.VoseJ,etal.JClinOncol.2008;26:4124-4130.2.WarnkeRA,etal.AmJClinPathol.2007;127:511-527.3

10、.SwerdlowSH,etal.WHOClassificationofTumoursofHaematopoieticandLymphoidTissues.2008.4.KocjanG.JClinPathol.2005;58:561-567.现在学习的是第9页，共49页主要的外周T细胞淋巴瘤的临床和病理学特征现在学习的是第10页，共49页ALCL,ALK+97%PTCL,unspecified75%ATLL 93%Panniculitis like75%Nasal NK/T cell 92%ALCL,ALK-74%Angioimmunoblastic 81%Hepatosplenic72%En

11、teropathy type 79%Cutaneous ALCL66%VoseJM,etal.JClinOncol.2008;26:4124-4130.专家诊断共识专家诊断共识现在学习的是第11页，共49页The aggressive peripheral T cell lymphomas:2012 update on diagnosis,risk stratification,and managementAmerican Journal of HematologyVolume 87,Issue 5,pages 511-519,17 APR 2012 现在学习的是第12页，共49页PTCL的治

12、疗的治疗现在学习的是第13页，共49页PTCL的临床预后指数的临床预后指数TheIPIforNHLiscommonlyusedinPTCL11.InternationalNon-HodgkinsLymphomaPrognosticFactorsProject.NEnglJMed.1993;329:987-994.2.GallaminiA,etal.Blood.2004;103:2474-2479.InternationalPrognosticIndexAllpatientsAge(60yrsvs60yrs)SerumLDH(1xULNvs1xULN)Performancescore(0or1v

13、s2-4)Stage(IorIIlocalizedvsIIIorIVadvanced)Extranodalinvolvement(1sitevs1site)Age-adjustedindex(age60yrs)Stage(IorIIvsIIIorIV)SerumLDH(1xULNvs1xULN)Performancescore(0or1vs2-4)ThePITisalsoinuse2PrognosticIndexforPTCL60yrsofageECOGperformancescore(score2)ElevatedLDHBonemarrowinvolvementTheIPIiscalcula

14、tedbasedonthesumofthenumberofriskfactorspresentatdiagnosis:0-1Low2Low/intermediate3High/intermediate4-5HighThePITisbasedonnumberofriskfactorspresentatdiagnosis:Group1:0riskfactor(62%5-yrOS)Group2:1riskfactor(53%5-yrOS)Group3:2riskfactors(33%5-yrOS)Group4:3-4riskfactors(18%5-yrOS)现在学习的是第14页，共49页PTCL的

15、生物预后因素的生物预后因素现在学习的是第15页，共49页PTCLSubtypesALK+ALCLALKALCLPTCL-NOSAITLNK/TCLATLL5-yrOSrate,%704932323214Majority of patients(85%)with most common disease subtypes received anthracycline-containing regimenInternational T-Cell Lymphoma Project.J Clin Oncol.2008;26:4124-4130.OS(%)Yrs0102030405060708090100

16、02468101214161820ALCL,ALK+ALCL,ALK-All NK/T-cell lymphomasPTCL-NOSAITLAdult T-cell leukemia/lymphoma含蒽环类方案治疗含蒽环类方案治疗PTCLPTCL的疗效有限的疗效有限现在学习的是第16页，共49页Treatment Guidelines for PTCL:Still CHOP BasedNCCN.Clinicalpracticeguidelinesinoncology:non-Hodgkinslymphoma.v.3.2012.First-line TherapyClinical trial(

17、preferred)ALCL,ALK+histologyCHOP-21CHOEP-21Other histologies(ALCL,ALK-;PTCL-NOS;AITL;EATL),regimens that can be used include:CHOEPCHOP-14CHOP-21CHOP followed by ICECHOP followed by IVE,alternating with intermediate-dose methotrexate(Newcastle regimen)HyperCVAD,alternating with high-dose methotrexate

18、 and cytarabine First-line ConsolidationAll patients except low risk(aaIPI)should be considered for high-dose therapy and stem cell rescue;ALCL,ALK+is a subtype with good prognosis and does not need consolidative transplant if in remission现在学习的是第17页，共49页The International PTCL and NK/TCL Study:Analys

19、is of Treatments多数多数PTCL PTCL 或或 NK/TCL(NK/TCL(除外除外 ALK+ALCL)ALK+ALCL)用含蒽环类方案不能获得生存受益用含蒽环类方案不能获得生存受益International T-Cell Lymphoma Project.J Clin Oncol.2008;26:4124-4130.PTCLAILTYrs01824681012 14 16010080604020OS(%)Anthracycline as part of initial treatmentYesNoP=.11Yrs018246810121416010080604020OS(%

20、)Anthracycline as part of initial treatmentYesNoP=.48传统含阿霉素的方案对传统含阿霉素的方案对PTCLPTCL无效无效现在学习的是第18页，共49页PTCLPTCL治疗？治疗？采用新的诱导化疗方案采用新的诱导化疗方案CTOP，EPOCH,CEOP,CHOPEnoveldrugcombinationregimen?CONSOLIDATION?Autologoustransplant?Allogeneictransplant?MAINTENANCE?新药、靶向药物研发新药、靶向药物研发现在学习的是第19页，共49页Surface Antigens

21、/ReceptorsCD2CD4CD25CD30Chemokine receptors.Microenvironmental FactorsAngiogenesisImmunomodulation Viral pathogensCellular Survival MechanismsProteasome inhibitionHDAC inhibitionDeath receptors and ligandsCell-cycle arrestSignal transduction inhibitionPTCLPTCL治疗可能的靶点治疗可能的靶点现在学习的是第20页，共49页化疗方案的新尝试化疗方

22、案的新尝试改良改良CHOPCHOP方案（含蒽环类药物）方案（含蒽环类药物）-EPOCH-HyperCVAD-CHOP/ICE;CHOP/IVE-ACVBP新组合化疗方案新组合化疗方案 -门冬酰胺酶为主方案联合放疗（NK/T细胞淋巴瘤鼻型）-IFO/VP-16/铂类/吉西他滨/MTX/Ara-C等 新药的使用新药的使用-分子靶向药物-单克隆抗体、小分子TKI-信号传导-免疫调节剂VoseJM,etal.JCO,2008;26:4124-30;NCCNguideline(2012);2012ASCO,abs8050SchmitzN,etal.Blood,2010;116:3418-25;Deard

23、enCE,etal.Blood,2011;Sep26现在学习的是第21页，共49页年轻年轻PTCLPTCL患者：患者：GHGNHLSGGHGNHLSG的研究的研究SchmitzN,etal.Blood.2010;116:3418-3425.18-60yrsofage,LDHUNVOtherMajorSubtypesALCL,ALK+/-Months020010080604020EFS(%)p=0.0034060801006xCHOP-14/21(n=41)6xCHOEP-14/21(n=42)Months020010080604020EFS(%)p=0.012406080100nonEtopo

24、side(n=12)Etoposide(n=32)Months020010080604020EFS(%)p=0.004406080100nonEtoposide(n=41)Etoposide(n=103)Months020010080604020EFS(%)p=0.057406080100nonEtoposide(n=29)Etoposide(n=69)现在学习的是第22页，共49页PralatrexateisselectiveantifolatedesignedtopreferentiallyaccumulateincancercellsEntryPralatrexateisselectiv

25、eforcellsthatexpressRFC-1,whichisoverexpressedonsomecancercellsrelativetonormalcellsAccumulationOncetakenupbycancercells,pralatrexatebecomespolyglutamylated,resultinginhighintracellulardrugretentionInhibitionPralatrexateactsonfolatepathwaytointerferewithDNAsynthesisandelicitcancercelldeathSirotnakFM

26、,etal.CancerChemotherPharmacol.1998;42:313-318.KrugLM,etal.ClinCancerRes.2000;6:3493-3498.WangES,etal.LeukLymphoma.2003;44:1027-1035.新药新药Pralatrexate的作用机制的作用机制现在学习的是第23页，共49页PROPEL研究研究:PhaseIIPralatrexateinRelapsed/RefractoryPTCL111patientswithrelapsed/refractoryPTCLPralatrexate30mg/m2weeklyfor6wksi

27、n7-wkcyclesVitaminB12andfolicacidgiventodecreasemucositisORR:32/109(29%);CR:11%;PR:18%MedianPFS:3.5mosMedianOS:14.5mosGrade3/4toxicityThrombocytopenia:32%OConnorOA,etal.JClinOncol.2011;29:1182-1189.现在学习的是第24页，共49页PROPELPROPEL研究研究:肿瘤体积、有效时间和生存肿瘤体积、有效时间和生存OConnor OA,et al.J Clin Oncol.2011;29:1182-118

28、9.Patients-1001007550-25-75Change in Tumor Volumne From Baseline(%)Months0301.00.80.60.40.2Progression-Free Survival(probability)9121821Pralatrexate 30 mg/m2(6/7 weeks)n=109;70 eventsMedian(months)3.5;95%CI,1.7 to 4.8Months03010080604020Duration of Response(probability)9121824Months0301.00.80.60.40.

29、2Overall survival(probability)9151824-5002515246Pralatrexate 30 mg/m2(6/7 weeks)n=109;62 eventsMedian(months)14.5;95%CI,10.6 to 22.56-month,75%;95%CI,65.7%to 82.1%Pralatrexate 30 mg/m2(6/7 weeks)n=32;16 eventsMedian(months)10.1;95%CI,3.4 to NE6152121126现在学习的是第25页，共49页Romidepsin:A Novel,Potent Bicycl

30、ic HDACiGene regulation1Histone acetylation/transcription induction2Protein acetylation3Activation of apoptosis4Antiangiogenesis5Cell-cycle arrest41.Peart MJ,et al.Proc Nat Acad Sci U S A.2005;102:3697-3702.2.Bolden JE,et al.Nat Rev Drug Discov.2006;5:769-784.3.Wang Y,et al.Biochem Biophys Res Commu

31、n.2007;356:998-1003.4.Sato N,et al.Int J Oncol.2004;24:679-685.5.Kwon HJ,et al.Int J Cancer.2002;97:290-296.现在学习的是第26页，共49页Wk 4Wk 2Wk 31221581Wk 1Cycle 1Wk 1Cycle 2Schedule:4-hr infusion 14 mg/m2 on Days 1,8,and 15 every 28 daysCoiffier B,et al.J Clin Oncol.2012;30:631-636.RomidepsininRelapsed/Refra

32、ctoryPTCL:TreatmentScheduleRomidepsinRomidepsinRomidepsinRomidepsinAPhaseII,Multicenter,Open-LabelTrial现在学习的是第27页，共49页RomidepsininRel/RefPTCL:ORRsBest Response Category,n(%)IRC(N=130)Investigators(N=130)Objective response(CR/CRu+PR)33(25)38(29)Complete response(CR/CRu)19(15)21(16)CR13(10)19(15)CRu6(

33、5)2(2)PR14(11)17(13)SD33(25)22(17)PD/not evaluable*64(49)70(54)Coiffier B,et al.J Clin Oncol.2012;30:631-636.*Insufficient efficacy data to determine response due to early termination.现在学习的是第28页，共49页RomidepsininRel/RefPTCL:DORandSafetyMedian DOR:17 mosOf 19 patients in CR/Cru,17(89%)had not progress

34、ed at a median follow-up of 13.4 mosGrade 3 toxicitiesThrombocytopenia:24%Neutropenia:20%Coiffier B,et al.J Clin Oncol.2012;30:631-636.现在学习的是第29页，共49页Romidepsin for the treatment of relapsed/refractory Romidepsin for the treatment of relapsed/refractory peripheral T-cell lymphoma:peripheral T-cell l

35、ymphoma:(APhaseII,Multicenter,Open-LabelTrial)Coiffier B,et al.J Clin Oncol.2012;30:631-636.现在学习的是第30页，共49页Anti-CD30ADC:BrentuximabVedotin(SGN-35)ADC:3partsChimericantibodySGN-30Syntheticanalogue(MMAE)oftheantitubulinagentdolastatin10StabledruglinkerProposedmechanismofactionBindstoCD30Internalizedin

36、tothetumorcellMMAEisreleasedTumorcellundergoesG2/Mphasecell-cyclearrestandapoptosisPreclinicalactivityobservedbothininvitroandinvivoFrancisco JA,et al.Blood.2003;102:1458-1465.现在学习的是第31页，共49页BrentuximabVedotin+化疗一线治疗化疗一线治疗ALCLI期临床试验:39pts高危ALCL(IPI2)orCD30+成熟T-cell/NK-细胞淋巴瘤随机分为3组1.8mg/kgbrentuximabv

37、edotinq3wX2cycles,thenCHOPx6cycles1.8mg/kgbrentuximabvedotin+CHPq3wforupto6cyclesDetermineoptimaldoseofbrentuximabvedotintobeusedincombinationwithCHPinthirdarmRespondersreceiveadditionalcyclesofbrentuximabvedotinmonotherapyORR:100%(26/26);CR:88%(23/26)BrentuximabvedotinMTDnotexceededat1.8mg/kg1DLT:g

38、rade3rashin6pts治疗相关并发症:恶心(58%),疲乏(50%),腹泻(50%),周围神经病变(38%),脱发(38%)Fanale MA,et al.ASH 2012.Abstract 60.现在学习的是第32页，共49页Pro B,et al.J Clin Oncol.2012;30:2190-2196.BrentuximabVedotininRel/RefSystemicALCL:MaximumTumorReduction(IRC)Tumor Size(%changefrom baseline)-100-50 050 100Individual Patients(n=57)B

39、est clinical responseComplete remissionPartial remissionStable diseaseProgressive diseaseHistologically ineligible现在学习的是第33页，共49页Dueck G,et al.Cancer.2010;116:4541-4548.来啦度胺来啦度胺II 期临床试验：24 PTCL Pts.（N=24）ORR:30%(7/23)All PRs所有亚型都有效Median PFS:96 days Median OS:241 days AEs:中性粒细胞减少、疼痛、血小板减少、皮疹中性粒细胞减少、

40、疼痛、血小板减少、皮疹现在学习的是第34页，共49页Interimreportofaphase2clinicaltrialoflenalidomideforT-cellnon-HodgkinlymphomaRelapsed/refractory PTCLECOG PS 0-2(N=24)Lenalidomide25mg PO qd on Days 1-21 of a 28day cycleTheprimaryendpoint；ORRThesecondaryendpoints:OS,PFS,andsafety.open-label,single-arm,multicenterCanadianph

41、ase2clinicaltrialSeptember2006toNovember2008,CancerVolume116.Issue19.pages45414548,1October2010PD or Intolerable 现在学习的是第35页，共49页Interimreportofaphase2clinicaltrialoflenalidomideforT-cellnon-HodgkinlymphomaCancerVolume116.Issue19.pages45414548,1October2010现在学习的是第36页，共49页Alisertib:InvestigationalAuror

42、aAKinaseInhibitorResults in mitotic defectsAbnormal spindlesUnseparated centrosomesDelayed mitotic progressionApoptosis or senescence UntreatedTreatedTreatedNCIOFNNHNOOHOFriedberg J,et al.ASH 2011.Abstract 95.现在学习的是第37页，共49页FriedbergJ,etal.ASH2011.Abstract95.Alisertib(MLN8237):AnAuroraAKinaseInhibit

43、orII期进展期期进展期B-cell和和T-cellNHLN=48ORR:32%CR:12%病理学诊断病理学诊断PTCL:57%DLBCL:20%;MCL:23%;转化转化FL:40%副作用副作用:中性粒细胞减少中性粒细胞减少,血小板减少血小板减少,胃炎胃炎现在学习的是第38页，共49页AlisertibAlisertib的随机临床开放的随机临床开放III III 期临床试验：复发难期临床试验：复发难治治 PTCLPTCLPrimaryendpoint:ORR,PFSSecondaryendpoints:safety,CR,OS,TTPRelapsed/refractory PTCLECOG

44、PS 0-2(N=354)*Choices:PralatrexateRomidepsinGemcitabineAlisertib5 x 10 mg PO BID on Days 1-7 of a 21-day cycleInvestigators choice*ClinicalTrials.gov.NCT01482962.现在学习的是第39页，共49页PohlmanB,etal.ASH2009.Abstract920.Belinostat(PXD101):APan-HistoneDeacetylaseInhibitorPhaseIItrialinPTCLN=20ORR:25%CR:2PR:3D

45、OR:5mosAEs:pruritus,edema,rash现在学习的是第40页，共49页DamajG,etal.JClinOncol.2012;Epubaheadofprint.苯达莫司丁苯达莫司丁复发耐药复发耐药PTCL的多中心的多中心II期临床试验期临床试验(BENTLY)：N=60(23ptsPTCL-U)方案方案:120mg/m2D1、2q3wORR:50%28%CR/CRuMedianPFS:3.6mosMedianOS:6.2mos最常见最常见3/4AEs:中性粒细胞减少、感染、血小板减少中性粒细胞减少、感染、血小板减少现在学习的是第41页，共49页Ishida T,et al.

46、J Clin Oncol.2012;30:837-842.Mogamulizumab(KW-0761):Mogamulizumab(KW-0761):抗抗-CCR4-CCR4（趋化因子受体（趋化因子受体4 4）单克隆抗体）单克隆抗体II II 期临床试验：入组期临床试验：入组ATLLATLL患者患者N=28N=28ORR:50%(13/26)ORR:50%(13/26)CR:8/26CR:8/26Median PFS:5.2 mosMedian PFS:5.2 mosMedian OS:13.7 mosMedian OS:13.7 mosAEs:AEs:输注反应输注反应 (89%),(89%)

47、,皮疹皮疹 (63%)(63%)现在学习的是第42页，共49页SelectOngoingClinicalTrialsofFirst-lineTherapyforPTCLPhase IIICHOP alemtuzumabCHOP followed by pralatrexatePhaseIICEOP/pralatrexateCHOP+everolimusCHOPvsGEM-PCHOP+romidepsinCHOP+lenalidomideCHOP+alemtuzumabCHOP+denileukindiftitoxCHP+brentuximabvedotinClinicalTrials.gov.

48、NCT00725231.NCT01420679.NCT01336933.NCT01198665.NCT01719835.NCT01280526NCT00453427.现在学习的是第43页，共49页目前已批准和正在进行的临床试验目前已批准和正在进行的临床试验现在学习的是第44页，共49页造血干细胞移植在造血干细胞移植在PTCLPTCL的疗效的疗效现在学习的是第45页，共49页目前造血干细胞的共识目前造血干细胞的共识首次复发、化疗有效患者行首次复发、化疗有效患者行ASCT：Yes！结论肯定，EFS提高15-40%存在问题：如何提高CR率；是否维持治疗？首次首次CR后行后行ASCT作为巩固治疗：作为

49、巩固治疗：Maybe！NCCN推荐部分争议！低危患者；ALK+的高危间变大T细胞淋巴瘤 鼻咽局部NK/T细胞淋巴瘤；血管免疫母T细胞淋巴瘤MakV,etal.Blood,2011;118:abstract96现在学习的是第46页，共49页目前造血干细胞的共识目前造血干细胞的共识异基因造血干细胞移植（异基因造血干细胞移植（Allo-SCT）：不休的争论！）：不休的争论！有限的回顾性研究数据，无前瞻性研究数据有限的回顾性研究数据，无前瞻性研究数据 何时做？何时做？PR，Auto-SCT的效果极差的效果极差 PR，Allo-SCT的效果极差的效果极差 如何做？如何做？清髓（清髓（MAC）vs.非清髓

50、非清髓(RIC)移植相关死亡率移植相关死亡率 vs.复发率复发率MakV,etal.Blood,2011;118:abstract96现在学习的是第47页，共49页总结总结必须有血液病理学专家参与必须有血液病理学专家参与需要仔细评估临床病史、预后资料、危险因素需要仔细评估临床病史、预后资料、危险因素预后不良的类型需要考虑临床试验或新药的使用预后不良的类型需要考虑临床试验或新药的使用基因表达谱可能会为我们确定新的靶点基因表达谱可能会为我们确定新的靶点治疗应当包括诱导、巩固和维持治疗治疗应当包括诱导、巩固和维持治疗临床试验对临床试验对PTCLPTCL治疗非常重要治疗非常重要干细胞移植在特定的病人有