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(2)鍏嶇柅绲勫寲锛欱L鏄捣婧愪簬鐢熺櫦(f膩)涓績鎴栫敓鐧�(f膩)涓績鍚嶣绱�(x矛)鑳炵殑渚佃ゲ鎬ф穻宸寸槫锛岃叓鐦ょ窗(x矛)鑳炶〃閬�(d谩)B绱�(x矛)鑳炵浉闂�(gu膩n)鎶楀師(濡侰Dl9銆丆D20銆丆D22)浠ュ強CD10銆乥cl-6銆丆D38銆丆D43鍜孋D77锛宐cl-2閫氬父闄版€ф垨寮遍櫧(y谩ng)鎬�锛宬i-67澧炲€兼寚鏁�(sh霉)闄�(y谩ng)鎬х巼鎺ヨ繎100%銆侴CB-DLBCL鐩搁棞(gu膩n)妯�(bi膩o)瑷橈細bcl-6琛ㄩ仈(d谩)浜庢垚鐔熺殑鐢熺櫦(f膩)涓績B绱�(x矛)鍜岄潨姝绱�(x矛)鑳�锛岄毃钁楃窗(x矛)鑳炵殑娲诲寲鑰岃〃閬�(d谩)闄嶄綆锛屽彲浣滅偤鐢熺櫦(f膩)涓績鐨勬(bi膩o)蹇楃墿銆�

CD10鍦ㄦ穻宸寸窗(x矛)鑳炵殑鍒嗗寲閬庣▼涓〃閬�(d谩)浜庡墠B绱�(x矛)鑳炲拰鐢熺櫦(f膩)涓績B绱�(x矛)鑳�銆侭cl-6鍜孋D10鑱�(li谩n)鍚堟噳(y墨ng)鐢ㄨ兘澶犵⒑DLBCL鐨凣CB鍨�銆俷on-GCB鐩搁棞(gu膩n)妯�(bi膩o)蹇楃墿锛氱磩50%锝�70%鐨凞LBCL绱�(x矛)鑳炶〃閬�(d谩)MUM1/IRF4銆侷RF4鐨勮〃閬�(d谩)鎻愮ず绱�(x矛)鑳炰締鑷簬GC鍒嗗寲鏈湡鐨凚绱�(x矛)鑳烇紝鎴栫敓鐧�(f膩)涓績鍚庣洿鑷冲垎鍖栫偤婕跨窗(x矛)鑳炵殑鍚勯殠娈礏绱�(x矛)鑳�銆�

MUML/IRF4鍙綔鐐虹敓鐧�(f膩)涓績鍚庝締婧愮窗(x矛)鑳炵殑妯�(bi膩o)蹇楃墿锛孧UM1鐨勮〃閬�(d谩)鑸嘇BC浜炵兢瀵嗗垏鐩搁棞(gu膩n)銆侾MBL鍙〃閬�(d谩)CD19銆丆D20銆丆D22銆丆D79a锛孊绱�(x矛)鑳炶綁(zhu菐n)閷勭浉闂�(gu膩n)鍥犲瓙PAX5銆丱CT2銆丅OB-1澶氱偤寮�(qi谩ng)闄�(y谩ng)鎬�锛屼絾涓嶈〃閬�(d谩)κ鍜�λ杓曢張銆�

(3)鍒嗗瓙鐢熺墿瀛�(xu茅)鍙婄窗(x矛)鑳為伜鍌冲(xu茅)锛氬咕涔庢墍鏈塀L鐥呬緥鍧囧瓨鍦╟-MYC鍩哄洜鐨勬槗浣�锛宑-MYC鏄竴绋綁(zhu菐n)閷勫洜瀛愶紝鍙互淇冮€�(j矛n)绱�(x矛)鑳炲娈栧拰绱�(x矛)鑳炶綁(zhu菐n)鍖�锛屽苟涓旀姂鍒剁窗(x矛)鑳炲垎鍖�锛屽湪绱�(x矛)鑳炲娈栧拰鍒嗗寲鐨勮(di脿o)鎺т腑璧烽棞(gu膩n)閸典綔鐢�銆俢-MYC鍩哄洜浣嶄簬鏌撹壊楂�8q24涓�锛屽鏁�(sh霉)c-MYC鏄撲綅鐐簍(8;14)(q24;q32)鐨勯噸鎺�锛岀磩鍗�80%銆�

姝ゅ锛岄倓瀛樺湪鍏╃ó鍏朵粬椤炲瀷鐨勬槗浣�锛屽垎鍒ョ偤t(8;22)(q24;q11)鍙妕(2;8)(q12;q24)銆傜洝绠′笂杩版槗浣嶉粸(di菐n)涓嶅悓锛屼絾鏄潎鏈奖闊縞-MYC鍩哄洜鐨勭法纰煎崁(q奴)锛屽叾绲�(ji茅)鏋滃潎灏�(d菐o)鑷碿-MYC铔嬬櫧鐨勬寔绾�(x霉)楂樿〃閬�(d谩)銆侭L鐨勭窗(x矛)鑳為伜鍌冲(xu茅)鐣板父杓冪偤寰�(f霉)闆�锛岄櫎c-MYC鏄撲綅澶栵紝閭勫瓨鍦ㄥ妯ｅ寲鐨勬煋鑹查珨鐣板父锛屽叾涓渶甯歌鐨勫寘鎷�13q鐨勭己澶�銆乴q閲嶅京(f霉)浠ュ強6q缂哄け锛屼笖閫欎簺涓嶅悓鐨勬煋鑹查珨绐佽畩鍙兘鑸囬爯(y霉)鍚庣浉闂�(gu膩n)銆�

鑰屽厭绔LBCL涓禃澶у鏁�(sh霉)鐒-MYC鍩哄洜琛ㄩ仈(d谩)銆傞櫎浜嗙梾鐞嗗厤鐤祫绻斿寲瀛�(xu茅)鏌撹壊鍑虹従(xi脿n)c-MYC铔嬬櫧楂樿〃閬�(d谩)澶�锛岄倓瑕佺稉(j墨ng)FISH妾㈡脯(c猫)鍒癱-MYC鍩哄洜浣嶉粸(di菐n)鐨勬柗瑁傛墠鍙互纰鸿ê銆侾MBL鏌撹壊楂旂暟甯稿寘鎷�9p24锛�2p15锛孹p11.4-21锛屽瓨鍦ㄧ殑鐣�?锛涱媰铏弸鈫桝K2锛孭DL锛孭DL2锛屽彲鑳藉瓨鍦ㄧ殑鑷寸梾閫氳矾鍖呮嫭NF-κB鍜孞AK-STAT淇¤櫉(h脿o)閫氳矾銆�

2.鍏朵粬

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鑵槫璨�(f霉)鑽峰ぇ鐨勬偅鑰呭彲鍑虹従(xi脿n)琛€灏块吀鍙婁钩閰歌劔姘叾鍚噺澧為珮锛岄浕瑙ｈ唱(zh矛)绱婁簜锛岃厧鍔熻兘鐣板父绛夎〃鐝�(xi脿n)锛岃嫢浼存湁鑳拌吅渚电姱鎴栬喗绺界鍙楀鑰�锛屽彲鏈夎儼閰跺楂�锛岃喗绱呯礌澧為珮绛夌辜鐧�(f膩)鏀硅畩銆傚嚌琛€鍔熻兘鍖呮嫭PT銆丄PTT銆丗IB銆丏-浜岃仛楂�锛屾湰鐥呭湪鐧�(f膩)鐥呮檪(sh铆)鎴栧寲鐧傛棭鏈熸湁鍙兘鍑虹従(xi脿n)鍑濊鍔熻兘鐣板父锛屽锛欶IB鍙奃-浜岃仛楂斿崌楂�锛孭T鍙夾PTT寤堕暦(zh菐ng)绛�銆傝€孌LBCL鐥呬汉锛屽鏁�(sh霉)琛€璞�銆佺敓鍖�銆佸嚌琛€鍔熻兘鏀硅畩涓嶈憲銆�

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楠ㄩ珦娴佸紡绱�(x矛)鑳炴鏌ュ彲琛ㄩ仈(d谩)CD10銆丆D19銆丆D20銆並appa/Lambda锛岄渶瑕佹敞鎰忚垏鎬ユ€娣嬪反绱�(x矛)鑳炵櫧琛€鐥呯浉閼掑垾銆傜暥(d膩ng)楠ㄩ珦鐒′镜鐘檪(sh铆)锛岄楂撳父瑕�(gu墨)鍚屾甯搁楂撹薄銆侱LBCL鎮ｅ厭楠ㄩ珦渚电姱鑰呮サ鐐哄皯瑕�銆傜敱浜庢穻宸寸槫楠ㄩ珦杞�(zhu菐n)绉荤櫦(f膩)鐢熼儴浣嶅彲鑳戒笉鍚�锛屽缓璀板悓鏅�(sh铆)鎳�(y墨ng)鑷冲皯鍋氳兏楠ㄥ強楂傞鍏╁€�(g猫)閮ㄤ綅鐨勯绌�锛屼互澧炲姞闄�(y谩ng)鎬х巼銆�

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15%鐨勯櫧(y谩ng)鎬ч儴浣嶇殑妾㈠嚭銆�

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(涓�)瑷烘柗

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2.楠ㄩ珦渚电姱鐨勮ê鏂�

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(2)楠ㄩ珦鍏嶇柅琛ㄥ瀷鏂规硶(鍏嶇柅绲勭箶鍖栧(xu茅)鎴栨祦寮忕窗(x矛)鑳炶(sh霉)鍒嗘瀽锛氱壒鎸囨穻宸寸槫绱�(x矛)鑳炵櫨鍒嗘瘮)闄�(y谩ng)鎬�銆�

(3)楠ㄩ珦绱�(x矛)鑳為伜鍌冲(xu茅)鎴朏ISH鍒嗘瀽闄�(y谩ng)鎬�銆�

(4)楠ㄩ珦娲绘鍙互瑕嬪埌鑵槫绱�(x矛)鑳炴蹈娼�(r霉n)銆�

3.涓绁炵稉(j墨ng)绯荤当(t菕ng)渚电姱鐨勮ê鏂�

(1)瑷烘柗:涓绁炵稉(j墨ng)绯荤当(t菕ng)渚电姱鍦˙L鐧�(f膩)鐥呮檪(sh铆)鍙〃鐝�(xi脿n)鐐洪牠鐥�銆佸様鍚愮瓑椤遍珮澹撶櫏鐙€浠ュ強鑴婃煴鍗犱綅(濡備笅鑲㈢劇鍔涳紝浜屼究澶辩鎴栨帓渚垮洶闆ｇ瓑琛ㄧ従(xi脿n))锛屾垨椤辩缍�(j墨ng)楹荤椆銆佽叇鐐庣櫏鐙€濡傚棞鐫＄敋鑷虫槒杩�銆傝叇鑴婃恫琛屽父瑕�(gu墨)妾㈡脯(c猫)鏅�(sh铆)鍙櫦(f膩)鐝�(xi脿n)鐣板父銆�

鈶犺叇鑴婃恫涓璚BC≥5鍊�(g猫)/μL锛屽悓鏅�(sh铆)鍦ㄨ叇鑴婃恫闆㈠績娑傜墖妯�(bi膩o)鏈腑浠ョ櫧琛€鐥呯窗(x矛)鑳炵偤涓�锛屾垨鐧借鐥呯窗(x矛)鑳炴墍鍗犳瘮渚嬮珮浜庡鍛ㄨ骞肩绱�(x矛)鑳炵櫨鍒嗘瘮銆�

鈶℃垨鏈夊奖鍍忓(xu茅)妾㈡煡(CT/MRI)椤ず鑵︽垨鑵﹁啘鐥呰畩鎴栨鍏�(n猫i)鍗犱綅銆�

鈶㈡祦寮忕窗(x矛)鑳炲剙鑵﹁剨娑叉娓�(c猫)鍛堥櫧(y谩ng)鎬�锛屽彲瑷烘柗CSFi(+)銆�

(2)鑵﹁剨娑茬殑鍒嗙礆(j铆):鏍规摎(j霉)鑵﹁剨娑茬窗(x矛)鑳炲(xu茅)(鍖呮嫭鑵﹁剨娑茬窗(x矛)鑳炶▓(j矛)鏁�(sh霉)鍙婄窗(x矛)鑳炲舰鎱�(t脿i)瀛�(xu茅)鍙婃祦寮忕窗(x矛)鑳炲(xu茅))銆佽嚚搴婅〃鐝�(xi脿n)鍜屽奖鍍忓(xu茅)妾㈡煡绲�(ji茅)鏋�锛屽皣CNS鍒嗙偤3绱�(j铆)锛�

鈶燙NS1锛氶渶瑕佸悓鏅�(sh铆)绗﹀悎浠ヤ笅3闋�(xi脿ng)锛氳叇鑴婃恫涓劇鐧借鐥呯窗(x矛)鑳�锛屾祦寮忕窗(x矛)鑳炲剙妾㈡脯(c猫)闄版€�;鐒NS鐣板父鐨勮嚚搴婅〃鐝�(xi脿n)锛屽嵆鐒℃槑椤殑鑸囩櫧琛€鐥呮湁闂�(gu膩n)鐨勯”绁炵稉(j墨ng)楹荤椆;鐒NS鐣板父鐨勫奖鍍忓(xu茅)渚濇摎(j霉)銆�

鈶NS2锛氱鍚堜互涓嬩换浣�1闋�(xi脿ng)锛歛.鑵扮┛鐒℃悕鍌峰嵆鑵﹁剨娑蹭笉娣疯锛孯BC:WBC≤100:1鏅�(sh铆)锛岃叇鑴婃恫涓璚BC≤5鍊�(g猫)/μL锛屽苟瑕嬪埌鏄庣⒑鐨勭櫧琛€鐥呯窗(x矛)鑳�;b.鑵扮┛鏈夋悕鍌峰嵆鑵﹁剨娑叉贩琛€(RBC:WBC>100:1)锛孋SF涓鍒版槑纰虹殑鐧借鐥呯窗(x矛)鑳�;c.鑵扮┛鏈夋悕鍌峰苟

鐐鸿鎬SF锛屽鍒濊êWBC>50×10⁹/L鍓囨鐐篊NS2銆�

鈶NS3锛欳SF涓璕BC:WBC≤100:1锛學BC>5鍊�(g猫)/μL锛屽苟浠ョ櫧琛€鐥呯窗(x矛)鑳炵偤涓�锛屾垨鐧借鐥呯窗(x矛)鑳炲崰姣斾緥楂樹簬澶栧懆琛€骞肩绱�(x矛)鑳炵櫨鍒嗘瘮锛岃叇鑴婃恫娴佸紡绱�(x矛)鑳炲(xu茅)妾㈡脯(c猫)闄�(y谩ng)鎬�;鎴栨湁鐒″叾浠栨槑纰虹梾鍥犵殑椤辩缍�(j墨ng)楹荤椆;鎴朇T/MRI椤ず鑵︽垨鑵﹁啘鐥呰畩锛屽苟闄ゅ鍏朵粬涓绁炵稉(j墨ng)绯荤当(t菕ng)鐤剧梾銆�

4.鐫父渚电姱鐨勮ê鏂�

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5.鑵槫绶╄В瑷烘柗妯�(bi膩o)婧�(zh菙n)

(1)瀹屽叏绶╄В(CR)锛氶€氶亷鏌ラ珨鍜屽奖鍍忓(xu茅)妾㈡煡璀夊(sh铆)鎵€鏈夌槫鐏跺叏閮ㄦ秷澶�銆侰T椤ず鍘熻叓澶х殑娣嬪反绲�(ji茅)鍜岃叓濉婂凡绺皬鑷虫甯歌寖鍦�(鏈€澶у緫绶�<1.5cm)锛屽悇鍣ㄥ畼褰卞儚瀛�(xu茅)鍙鍒扮殑鎵€鏈夌槫鐏跺潎宸叉秷澶�銆侾ET鎺冩弿宸茬劇闄�(y谩ng)鎬х櫦(f膩)鐝�(xi脿n)銆傞楂撴秱鐗�/娲绘姝ｅ父銆�

(2)閮ㄥ垎绶╄В(PR)锛氱槫鐏舵渶澶у緫绶氱府灏�≥50%锛屾矑鏈夋柊鐧�(f膩)鐦ょ伓銆�

(3)鐒″弽鎳�(y墨ng)(NR)(鐤剧梾绌�(w臎n)瀹�)锛氳⿻(p铆ng)浼伴’绀烘矑鏈夐仈(d谩)鍒癙R锛屼絾涔熸矑鏈夋柊鐧�(f膩)鐦ょ伓銆�

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(6)鍒嗗瓙鐢熺墿瀛�(xu茅)绶╄В锛氳嫢鐥呭垵瀛樺湪楠ㄩ珦渚电姱锛岄渶閫氶亷FISH鏂规硶鐩�(ji膩n)娓�(c猫)楠ㄩ珦铻嶅悎鍩哄洜c-MYC寰為櫧(y谩ng)鎬ц綁(zhu菐n)鐐洪櫚鎬�銆�

(7)鍒嗗瓙鐢熺墿瀛�(xu茅)寰�(f霉)鐧�(f膩)(鎴栭櫚杞�(zhu菐n)闄�(y谩ng))锛氭不鐧傚悗杞�(zhu菐n)鐐洪櫚鎬х殑c-MYC鍩哄洜鍐嶆妾㈡脯(c猫)鐐洪櫧(y谩ng)鎬�銆�

鍥�銆侀憭鍒ヨê鏂�

1.鑵硅厰鍏�(n猫i)鑵槫锛氬湪鎮ｆ湁鑵硅厰鍏�(n猫i)鑵槫鐨勫厭绔ヤ腑锛屾渶甯歌鐨勫(sh铆)楂旀槸鑵庢瘝绱�(x矛)鑳炵槫鍜岀缍�(j墨ng)姣嶇窗(x矛)鑳炵槫;鍏朵粬鍖呮嫭鍏锋湁寤ｆ硾楂撳鍙楃疮鐨勭櫧琛€鐥�銆佽倽鑵槫銆佸嵉宸㈣叓鐦ゅ拰杌熺祫绻旇倝鐦�銆俉ilm's鐨勮叓鐦ゅ拰绁炵稉(j墨ng)姣嶇窗(x矛)鑳炵槫鍦ㄥ鍏掍腑鏇村父瑕嬶紝鑰岃倽鑷�銆佽劸鑷熸垨鑵硅啘鍚庢穻宸寸祼(ji茅)鐨勭櫧琛€鐥呮垨娣嬪反鐦ゅ彈绱洿甯歌浜庡勾榻¤純澶х殑鍏掔銆傛垚浜虹殑閼掑垾瑷烘柗鍖呮嫭鑹€у拰鎯℃€у(sh铆)楂�锛屼緥濡傜祼(ji茅)鑵哥洿鑵哥檶鍜屽嵉宸㈢檶銆�

2.闈㈤儴鑵槫锛氶潰閮ㄨ叓鐦ょ殑閼掑垾瑷烘柗鍖呮嫭鑲夌槫銆佺檶銆佺缍�(j墨ng)闉樼槫銆侀粦鑹茬礌鐦�銆佸斁娑茶吅鑵槫鍜岃壇鎬у(sh铆)楂旂槫锛屽鍓缍�(j墨ng)绡€(ji茅)鐦�銆�

3.娣嬪反姣嶇窗(x矛)鑳炴穻宸寸槫锛氭槸鍙︿竴绋珮搴︿镜瑗叉€х殑娣嬪反鐦�锛屽湪绲勭箶瀛�(xu茅)涓婅垏BL琛ㄩ潰鐩镐技銆傜劧鑰�锛孊L绱�(x矛)鑳炲湪骞惧€�(g猫)鏂归潰鑸囨穻宸存瘝绱�(x矛)鑳炴穻宸寸槫绱�(x矛)鑳炰笉鍚�锛屽畠鍊戝叿鏈変腑绛夊ぇ灏忕殑姗㈠湏褰㈡垨鍦撳舰鏍�锛屾洿鍒嗘暎鐨勬煋鑹茶唱(zh矛)锛屽咕鍊�(g猫)涓嶅悓鐨勭窗(x矛)鑳炴牳鍜屾洿璞愬瘜鐨勭窗(x矛)璩�(zh矛)銆傛澶�锛屾穻宸存瘝绱�(x矛)鑳炴穻宸寸槫琛ㄩ仈(d谩)TdT锛孊娣嬪反姣嶇窗(x矛)鑳炴穻宸寸槫涓嶈兘琛ㄩ仈(d谩)鑶滆〃闈㈢殑鍏嶇柅鐞冭泲鐧�锛屾祦寮忕窗(x矛)鑳炶(sh霉)鎴栧厤鐤祫鍖栧彲浠ユ槑纰哄崁(q奴)鍒咮L鍜屾穻宸存瘝绱�(x矛)鑳炴穻宸寸槫銆�

浜�銆佹不鐧�

(涓€)绯荤当(t菕ng)鍖栫檪

1.鍖栫檪鍘熷墖

鐩墠鍦�(gu贸)闅涗笂鍏掔鎴愮啛B绱�(x矛)鑳炴穻宸寸槫澶氶噰鐢˙FM95銆丩MB89銆丩MB96绛夋柟妗堝寲鐧�锛屾柟妗堢殑鐗归粸(di菐n)鏄珮寮�(qi谩ng)搴�銆佺煭鐧傜▼銆�

2.鍖栫檪鍓嶆簴(zh菙n)鍌�

(1)纰鸿ê妾㈡煡锛氱洝鍙兘鍦ㄦ渶瀹规槗鍙栨潗鐨勯儴浣嶅彇寰楁(bi膩o)鏈皨鎵捐叓鐦ょ窗(x矛)鑳�锛屽寘鎷細楠ㄩ珦銆佽兏鑵规按銆佹泛琛ㄦ穻宸寸槫銆佺毊鑶氬彲鐤戠槫鐏�銆佹繁閮ㄦ穻宸寸祼(ji茅)绌垮埡鎴栨椿妾�銆佺槫鐏舵墜琛�(sh霉)鍙栨椿妾�銆傜劧鍚庡畬鍠勮叓鐦ょ窗(x矛)鑳炵殑MICM鍒嗗瀷锛屽畬鎴愪腑蹇冪梾鐞嗘渻(hu矛)瑷�(鑷冲皯2瀹朵笁鐢查啱(y墨)闄㈢梾鐞嗚€佸斧鏈�(hu矛)瑷�)銆�

(2)寤鸿鑳搁鍙婇珎楠ㄥ叐鍊�(g猫)閮ㄤ綅楠ㄩ珦绌垮埡鎴栨椿妾細鎳�(y墨ng)琛岄楂撶窗(x矛)鑳炲舰鎱�(t脿i)瀛�(xu茅)銆佹祦寮忕窗(x矛)鑳炲厤鐤〃鍨嬪垎鏋�銆佺窗(x矛)鑳為伜鍌冲(xu茅)鍜屽熀鍥犳鏌�銆�

(3)甯歌(gu墨)妾㈡煡锛氬寘鎷叏琛€绱�(x矛)鑳炲垎鏋�銆佺櫧绱�(x矛)鑳炲垎椤�銆佽倽鑵庡姛鑳�銆佽娓呬钩閰歌劔姘叾銆佽兏鑵规按鍙婂叾浠栭珨娑茬殑绱�(x矛)鑳炲(xu茅)妾㈡煡绛�銆�

(4)鑵﹁剨娑叉鏌ワ細绱�(x矛)鑳為洟蹇冩硶鎵剧槫绱�(x矛)鑳�銆佹祦寮忔柟娉曟娓�(c猫)寰噺绱�(x矛)鑳�銆�

(5)褰卞儚瀛�(xu茅)妾㈡煡閫�(j矛n)琛屽垎鏈燂細琛屽彲鐤戞穻宸寸祼(ji茅)鍙婅吂閮˙瓒�銆佸彲鐤戝彈渚甸儴浣嶇殑楠ㄩ鐗�銆丆T绛夊奖鍍忓(xu茅)妾㈡煡浠ヤ究浜嗚В鐥呰畩鑼冨湇銆傛嚪鐤戜腑妯炵缍�(j墨ng)绯荤当(t菕ng)鐥呰畩鏅�(sh铆)鍙鑵﹀強鑴婇珦MRI妾㈡煡銆傛湁姊濅欢鐨勮PET/CT妾㈡煡銆�

(6)鍖栫檪鍓嶆鏌ワ細浜嗚В鑷熷櫒鍔熻兘銆佸厤鐤媭娉�銆佺梾姣掓劅鏌�銆佸偝鏌撶梾绛夌媭娉�銆�

3.鎸夊嵄闅�(xi菐n)搴﹀垎绲�

A绲勶細鎵€鏈夊畬鍏ㄥ垏闄ょ殑I鏈熷強鑵归儴鐨勨叀鏈熻叓鐦�锛屾湭鍒囬櫎鐨勨厾鏈熷拰鈪℃湡婵炬场绱�(x矛)鑳炴穻宸寸槫(鏈夋不鐧傜悊鐢�);

B绲勶細鏈垏闄ょ殑鈪狅綖鈪℃湡鑵槫锛屸參锝炩叄鏈�(鐒NS娴告饯(r霉n)锛岄楂�<25%)锛孉绲勬棭鏈熷弽鎳�(y墨ng)涓嶅ソ锛屾烤娉＄窗(x矛)鑳炴穻宸寸槫鈪綖鈪ｆ湡;

C绲勶細鏈垏闄ょ殑鈪綖鈪ｆ湡浼存湁宸ㄥぇ鐦ゅ(鐩村緫>10cm鎴栧浜�4鍊�(g猫)鍣ㄥ畼渚电姱)锛屸叄鏈熶即CNS娴告饯(r霉n)(鍖呮嫭CNS2)锛屸叄鏈熶即鐫父鍙婂嵉宸镜鐘紝楠ㄩ珦骞肩绱�(x矛)鑳�>25%(Burkitt's鐧借鐥�)锛�

B绲勬棭鏈熸不鐧傚弽鎳�(y墨ng)涓嶅ソ锛屼腑鏈熸湁娈樼暀鐥呯伓銆�

4.鏂规娴佺▼

(1)涓€绶氭不鐧�

鈶燜AB/LMB96鏂规(閬╃敤浜嶣L锛孌LBCL锛孍BV闄�(y谩ng)鎬LBCL锛岄珮绱�(j铆)鍒绱�(x矛)鑳炴穻宸寸槫锛孎(xi脿n)L)

A绲勬柟妗圕OPAD—COPAD

B绲勬柟妗圕OP—COPADM31—鍒╁Ε鏄斿柈鎶�+COPADM32—鍒╁Ε鏄斿柈鎶�+CYM1—鍒╁Ε鏄斿柈鎶�+CYM²—鍒╁Ε鏄斿柈鎶�+COPDM33(鍒嗙董鎸佽垏涓嶇董鎸佺祫)

C1绲勬柟妗圕OP—COPADM51—鍒╁Ε鏄斿柈鎶�+COPADM52—鍒╁Ε鏄斿柈鎶�+CYVE1—MTX5—鍒╁Ε鏄斿柈鎶�+CYVE2—鍒╁Ε鏄斿柈鎶�+M51—M²—M3—M4

C2绲勬柟妗�(CNS+绲�)COP—COPADM51—鍒╁Ε鏄斿柈鎶�+COPADM82—鍒╁Ε鏄斿柈鎶�+CYVE1-MTX8—鍒╁Ε鏄斿柈鎶�+CYVE2—鍒╁Ε鏄斿柈鎶�+M81—M²—M3—M4

A绲勬柟妗�:COPAD—COPAD銆�

COPAD鍏烽珨濡備笅:

VCR2mg/m²(鏈€澶у姂閲�2mg)闈滆剤鎺ㄦ敞锛宒1锛宒6;Pred60mg/(m²·d)(鍒�2娆＄郸)d1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;CTX250mg/(m²·娆�)Q12h×3d锛�15鍒嗛悩杓稿叆锛宒1锝瀌3(棣栧姂鎳�(y墨ng)鍦―NR鍓嶇郸);鍚屾檪(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]锛屾寔绾�(x霉)姘村寲鑷虫渶鍚�1娆TX鍚�12灏忔檪(sh铆);

DNR30mg/m²×2d(d1锝瀌2)锛�6灏忔檪(sh铆)杓稿叆锛屽湪棣栧姂CTX鍚庣郸銆�

B绲勬柟妗�

B1绲勬柟妗堬細

COP—COPADM3—鍒╁Ε鏄斿柈鎶�+COPADM3—鍒╁Ε鏄斿柈鎶�+CYM1—鍒╁Ε鏄斿柈鎶�+CYM²—鍒╁Ε鏄斿柈鎶�+COPDM3

B2绲勬柟妗�

COP—COPADM3—鍒╁Ε鏄斿柈鎶�+COPADM3—鍒╁Ε鏄斿柈鎶�+CYM1—鍒╁Ε鏄斿柈鎶�+CYM²—鍒╁Ε鏄斿柈鎶�+COPDM3(3)—M²—M3COP鍏烽珨濡備笅:VCR1mg/m²(鏈€澶у姂閲�2mg)锛宒1;CTX300mg/m²(15鍒嗛悩鍏�(n猫i)婊村叆)锛宒1;Pred60mg/m²鍒嗗叐娆″彛鏈�锛宒1锝瀌7;浜岃伅(li谩n)闉樻敞d1鍔戦噺濡備笅:骞撮健(姝�)MTX(mg)Dex(mg)<1821锝�1022锝�122≥3154COPADM3

(1)鍏烽珨濡備笅:VCR2mg/m²(鏈€澶у姂閲�2mg)锛岄潨鑴堟帹娉�锛宒1;Pred60mg/(m²·d)(鍒�2娆℃湇)锛宒1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;MTX3g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�3灏忔檪(sh铆)锛宒1;FH4Ca15mg/m²MTX鍚�24灏忔檪(sh铆)闁嬪鍙ｆ湇锛屾瘡6灏忔檪(sh铆)1娆�锛屽叡12娆�(鍏堟湇8娆★紝浠ュ悗渚濇摎(j霉)MTX婵冨害瀹�);CTX250mg/(m²·娆�)Q12h×3澶�锛岄潨鑴堟淮娉�15鍒嗛悩鍏�锛宒2锝瀌4;

棣栧姂鎳�(y墨ng)鍦ㄧ2澶╃殑DNR鍓嶈几鍏�锛屽悓鏅�(sh铆)姘村寲3000mL/(m²·d)[125mL/(m².h)]锛岀洿鑷矯TX鐢ㄥ畬鍚�12灏忔檪(sh铆);DNR30mg/m²×2d锛�6灏忔檪(sh铆)杓稿叆锛宒2锝瀌3锛屽湪棣栧姂CTX鍚庣郸闉樻敞锛氬叐鑱�(li谩n)闉樻敞(MTX+Dex)d2锛宒6銆�

绗簩鐧傜▼COPADM3(2)鍏烽珨濡備笅:VCR2mg/(m²·d)(鏈€澶у姂閲�2mg)闈滆剤鎺ㄦ敞锛宒1;Pred60mg/(m²·d)(鍒�2娆℃湇)锛宒1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;CTX500mg/(m²·娆�)Q12h锛岄潨鑴堟淮娉�15鍒嗛悩鍏�锛宒2锝瀌4[鍗虫瘡澶�1000mg/m²锛岀編鍙搁垑200mg/m²(CTX鐨�0h銆�4h銆�8h绲�)]棣栧姂鎳�(y墨ng)鍦ㄧ2澶╃殑DNR鍓嶈几鍏ュ悓鏅�(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]鎸佺簩(x霉)杓告恫鑷虫渶鍚�1娆＄敤钘ュ悗12灏忔檪(sh铆);DNR30mg/m²×2d锛�6灏忔檪(sh铆)杓稿叆锛宒2锝瀌3锛屽湪棣栧姂CTX鍚庣郸;MTX3g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�3灏忔檪(sh铆)閫�(j矛n)鍏ワ紝d1锛屽悓鏅�(sh铆)姘村寲3000锝�4000mL/(m²·d)[125mL/(m²·h)],鐩磋嚦MTX婵冨害浣庝簬0.15μmol/L;鍥涙矮钁夐吀閳�:15mg/m²锛屽彛鏈�锛孧TX闈滆剤婊存敞闁嬪鍚�24灏忔檪(sh铆)闁嬪锛屾瘡6灏忔檪(sh铆)1娆�锛屽叡12娆�(鍏堟湇8娆�锛屼互鍚庝緷鎿�(j霉)MTX婵冨害瀹�锛岃В鏁戣嚦婵冨害灏忎簬0.15μmol/L鍋滄瑙ｆ晳)銆傞灅娉細鍏╄伅(li谩n)闉樻敞(MTX+Dex)d2锛宒6銆�

CYM1—CYM²CYM1闁嬪姊濅欢锛氬湪COPADM32鍚嶢NC>1.0×10⁹/L锛孭LT>100×10⁹/L;Ara-c100mg/m²婧跺叆500锝�1000mL/m²婧舵恫锛屾寔绾�(x霉)杓告敞24灏忔檪(sh铆)锛宒2锝瀌6(鍏�5澶�);MTX3g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉紝>3h鍏�銆傚悓鏅�(sh铆)姘村寲3000mL/(m²·d)[鍫垮寲125mL/(m²·h)]銆傛寔绾�(x霉)杓告恫鑷虫績搴﹀皬浜�0.15μmol/L;FH4Ca15mg/m²;闉樻敞MTX+Dex绗�2澶�(鍔戦噺鍚屽墠)Ara-c+Dex绗�7澶�;CYM²鐢ㄨ棩鍚孋YM1锛屾噳(y墨ng)鍦–YM1鍚嶢NC>1.0×10⁹/L锛孭LT>100×10⁹/L闁嬪鎳�(y墨ng)鐢�銆侰OPADM3(3)鍏烽珨濡備笅VCR2mg/m²(鏈€澶у姂閲�2mg)锛岄潨鑴堟淮娉�锛宒1;Pred60mg/(m²·d)(鍒�2娆℃湇)锛宒1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;CTX500mg/(m²·娆�)Q12h锛岄潨鑴堟淮娉�30鍒嗛悩鍏�锛宒2锝瀌4[鍗虫瘡澶�1000mg/m²锛岀編鍙搁垑200mg/m²锛孋TX0h銆�4h銆�8h绲棣栧姂鎳�(y墨ng)鍦―NR鍓嶈几鍏�锛屽悓鏅�(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]鎸佺簩(x霉)杓告恫鑷虫渶鍚�1娆＄敤钘ュ悗12灏忔檪(sh铆);E-ADR30mg/m²×2d锛�6灏忔檪(sh铆)杓稿叆锛宒2锝瀌3锛屽湪CTX鍚庣郸;MTX3g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�>3h鍏�锛宒1;FH4Ca15mg/2

24灏忔檪(sh铆)鍚庨枊濮�锛屽彛鏈�锛屾瘡6灏忔檪(sh铆)1娆�锛屽叡12娆�(鍏堟湇8娆�锛屼互鍚庝緷鎿�(j霉)MTX婵冨害瀹�);闉樻敞锛歁TX+Dex鍏╄伅(li谩n)闉樻敞锛宒2銆傛敞锛欱2绲勫湪COP绗�8澶╃槫鐏剁府灏�>25%浣�<75%;涓湡鐤戞畼鐣欑殑闈炴烤娉＄窗(x矛)鑳炲瀷B绱�(x矛)鑳炴穻宸寸槫锛屽彲绻肩簩(x霉)瀹屾垚缍寔娌荤檪M²-M3銆�

M²鍏烽珨濡備笅锛欰ra-c50mg/m²闈滆剤婊存敞Q12h锛宒1锝瀌5;VP16150mg/m²闈滆剤婊存敞90鍒嗛悩锛宒1锝瀌3;M3鍏烽珨濡備笅锛歏CR2mg/m²(鏈€澶у姂閲�2mg)锛宒1;Pred60mg/(m²·d)鍒�2娆″彛鏈�锛宒1锝瀌5锛�3澶╁収(n猫i)娓涘仠;CTX500mg/m²30鍒嗛悩鍏�(n猫i)杓稿叆锛孮d锛宒1锝瀌2锛岄鍔戝湪DNR鍓嶇郸锛岀董鎸佹恫閲忓湪3000mL/m²鑷矯TX鍚�12灏忔檪(sh铆);E-ADR30mg/m²锛宒1锛宒2锛岄潨鑴堟淮娉�6灏忔檪(sh铆)鍏�(鍦–TX鍚庣郸)銆傛敞锛欱绲勬垚鐔烞绱�(x矛)鑳炴穻宸寸槫鍦ㄥ寲鐧傛湡闁撳彲鑱�(li谩n)鍚�4鍔戝埄鏄斿柈鎶楁不鐧傦紝鍧囧湪鍖栫檪鍓�1澶�锛屽姂閲�375mg/(m²·娆�)銆�

C绲勬柟妗�

C1绲�

COP—COPADM5—鍒╁Ε鏄斿柈鎶�(2鍔�)+COPADM5—鍒╁Ε鏄斿柈鎶�(2鍔�)+CYVE1—MTX5-鍒╁Ε鏄斿柈鎶�(1鍔�)+CYVE2—鍒╁Ε鏄斿柈鎶�(1鍔�)+M51—M²—M3—M4

C2绲�

COP—COPADM5—鍒╁Ε鏄斿柈鎶�(2鍔�)+COPADM8—鍒╁Ε鏄斿柈鎶�(2鍔�)+CYVE1-MTX8—鍒╁Ε鏄斿柈鎶�(1鍔�)+CYVE2—鍒╁Ε鏄斿柈鎶�(1鍔�)+M81—M²—M3-M4

C1鏂规闋�(y霉)娌荤檪锛欳OPVCR1mg/m²(鏈€澶у姂閲�2mg)锛宒1;CTX300mg/m²(15鍒嗛悩鍏�(n猫i)婊村叆)锛宒1;Pred60mg/m²鍒嗗叐娆″彛鏈�锛宒1锝瀌7;涓夎伅(li谩n)闉樻敞d1锛宒3锛宒5;FH4Ca5mg/m²鍙ｆ湇Q6h×2娆�锛岄灅娉ㄥ悗24灏忔檪(sh铆)闁嬪;COPADM51鍏烽珨濡備笅锛歏CR2mg/m²(鏈€澶у姂閲�2mg)闈滆剤鎺ㄦ敞锛宒1;Pred60mg/(m²·d)(鍒�2娆℃湇)锛宒1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;

CTX250mg/(m²·娆�)Q12h锛岄潨鑴堟淮娉�15鍒嗛悩鍏�锛宒2锝瀌4;棣栧姂鎳�(y墨ng)鍦ㄧ2澶╃殑DNR鍓嶈几鍏ワ紝鍚屾檪(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矯TX鐢ㄥ畬鍚�12灏忔檪(sh铆);DNR30mg/m²×2d锛�6灏忔檪(sh铆)杓稿叆锛宒2锝瀌3銆傚湪棣栧姂CTX鍚庣郸;MTX5g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�4h閫�(j矛n)鍏1锛屽悓鏅�(sh铆)姘村寲3000锝�4000mL/(m²·d)棣栧姂鎳�(y墨ng)鍦ㄧ2澶╃殑DNR鍓嶈几鍏�锛屽悓鏅�(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矯TX鐢ㄥ畬鍚�12灏忔檪(sh铆);DNR30mg/m²×2d锛�6灏忔檪(sh铆)杓稿叆锛宒2锝瀌3銆�

鍦ㄩ鍔慍TX鍚庣郸;MTX5g/m缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�4h閫�(j矛n)鍏1锛屽悓鏅�(sh铆)姘村寲3000锝�4000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矼TX婵冨害浣庝簬0.15μmol/L;125mL/(m²·h)锛岀洿鑷矼TX

婵冨害浣庝簬0.15μmol/L;FH4Ca15mg/m²24灏忔檪(sh铆)鍚庨枊濮�锛屽彛鏈�锛屾瘡6灏忔檪(sh铆)1娆�锛屽叡12娆�(鍏堟湇8娆�锛屼互鍚庝緷鎿�(j霉)MTX婵冨害瀹�)銆傞灅娉細涓夎伅(li谩n)闉樻敞(MTX+Dex+Ara-c)d2锛宒4锛宒6COPADM52鍏烽珨濡備笅锛歏CR2mg/m²(鏈€澶у姂閲�2mg)闈滆剤鎺ㄦ敞锛宒1;Pred60mg/(m²·d)(鍒�2娆℃湇)锛宒1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;

CTX500mg/(m²·娆�)Q12h锛岄潨鑴堟淮娉�锛�15鍒嗛悩鍏2锝瀌4(鍗虫瘡澶�1000mg/m²锛岀編鍙搁垑200mg/m²锛孋TX0h銆�4h銆�8h绲�)棣栧姂鎳�(y墨ng)鍦ㄧ2澶╃殑DNR鍓嶈几鍏�锛屽悓鏅�(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]鎸佺簩(x霉)杓告恫鑷虫渶鍚�1娆＄敤钘ュ悗12灏忔檪(sh铆);DNR30mg/m²×2d锛�6灏忔檪(sh铆)杓稿叆锛宒2锝瀌3鍦ㄩ鍔慍TX鍚庣郸;MTX5g/m²缃簬500mL娑�(5%绯栭菇閴€)涓潨鑴堟淮娉�4灏忔檪(sh铆)鍏�锛宒1锛屽悓鏅�(sh铆)姘村寲3000锝�4000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矼TX婵冨害浣庝簬0.15μmol/L;鍥涙矮钁夐吀閳�:15mg/m²锛孧TX闈滆剤婊存敞闁嬪鍚�24灏忔檪(sh铆)锛岄枊濮嬪彛鏈�锛屾瘡6灏忔檪(sh铆)1娆�锛屽叡12娆�(鍏堟湇8娆�锛屼互鍚庝緷鎿�(j霉)MTX婵冨害瀹�)銆傞灅娉細涓夎伅(li谩n)闉樻敞(MTX+Dex+Ara-c)d2锛宒4锛宒6銆�

C1绲�—CNS闄版€х殑闉忓浐娌荤檪:CYVE1-MTX5鍜孋YVE2

CYVE1—MTX5鍏烽珨濡備笅锛�

灏忓姂閲廇ra-c50mg/m²鎸佺簩(x霉)闈滆剤婊存敞12灏忔檪(sh铆)(寰炴櫄20榛�(di菐n)鑷虫鏃ユ櫒8榛�(di菐n))鍏辩敤5澶�;澶у姂閲廇ra-c3000mg/m²鍔犲叆375mL/m²娑查珨闈滆剤婊存敞灏忔檪(sh铆)锛屽湪灏忓姂閲忛枊濮嬪悗12灏忔檪(sh铆)绲�锛屽叡4娆�锛宒2锝瀌5(8榛�(di菐n)鑷�11榛�(di菐n));鍙殑鏉炬淮鐪兼恫榛�(di菐n)鐪煎叡5澶�锛屾瘡2灏忔檪(sh铆)涓€娆�;VP16200mg/m²鍔犲叆500mL/m²娑查珨涓潨鑴堟淮娉�4灏忔檪(sh铆)锛孮d锛宒2锝瀌5(14榛�(di菐n)鑷�18榛�(di菐n));

MTX5g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�4灏忔檪(sh铆)鍏�锛屽悓鏅�(sh铆)姘村寲3000锝�4000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矼TX婵冨害浣庝簬0.15μmol/L鏈檪绋婱TX蹇呴爤鍦–YVE1鍚�18d锝�25d锛岀暥(d膩ng)ANC>0.5×10⁹/L鍜孭LT>50×10⁹/L;G-CSF(濡傛灉鐢�)绲�(ji茅)鏉熷悗绗�48灏忔檪(sh铆);杞�(zhu菐n)姘ㄩ叾<10鍊嶆甯稿€�锛屾墠鑳戒娇鐢�;FH4Ca15mg/m²锛孧TX闈滆剤婊存敞闁嬪鍚�24灏忔檪(sh铆)锛岄枊濮嬪彛鏈�锛屾瘡6灏忔檪(sh铆)1娆�锛屽叡12娆�(鍏堟湇8娆�锛屼互鍚庝緷鎿�(j霉)MTX婵冨害瀹�)銆備笁鑱�(li谩n)闉樻敞锛歁TX+Dex+Ara-c锛孌19锛屽湪鍥涙矮钁夐吀閳ｈВ鏁戝墠绲︺€侰YVE2鍔戦噺鍚孋YVE1

C1绲勭董鎸佹不鐧侻51—M²—M3—M4锛氭湰鐧傜▼鎳�(y墨ng)鍦–YEV2鍚庤璞℃仮寰�(f霉)ANC>1.0×10⁹/L鍜孭LT>100×10⁹/L;

M51鍏烽珨濡備笅锛歏CR2mg/m²(鏈€澶у姂閲�2mg)闈滆剤鎺ㄦ敞锛宒1;Pred60mg/(m²·d)鍒�2娆℃湇锛宒1锝瀌5锛屼互鍚�3澶╁収(n猫i)娓涘仠;MTX5g/m²缃簬500mL娑查珨(5%绯栭菇閴€)涓潨鑴堟淮娉�4灏忔檪(sh铆)锛宒1锛屽悓鏅�(sh铆)姘村寲3000锝�4000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矼TX婵冨害浣庝簬0.15μmol/L;FH4Ca15mg/m²鍦∕TX鍚�24灏忔檪(sh铆)闁嬪鍙ｆ湇锛孮6h×12(鎸夎钘ユ績搴﹀畾娆℃暩(sh霉));CTX500mg/(m²·娆�)锛屾瘡澶�1娆�锛岄潨鑴堟淮娉�15鍒嗛悩鍏�锛宒2锝瀌3;

棣栧姂鎳�(y墨ng)鍦ㄧ2澶╃殑E-ADR鍓嶈几鍏�锛屽悓鏅�(sh铆)姘村寲3000mL/(m²·d)[125mL/(m²·h)]锛岀洿鑷矯TX鐢ㄥ畬鍚�12灏忔檪(sh铆);E-ADR30mg/m²Qd×2澶╅潨鑴堟淮娉�6灏忔檪(sh铆)锛屽湪棣栧姂CTX鍚庣郸锛宒2锝瀌3銆傞灅娉細涓夎伅(li谩n)闉樻敞(Ara-c+MTX+Dex)d2銆侻²-M4鍧囨噳(y墨ng)鍦∕1鍚庤璞℃仮寰�(f霉)ANC>1.0×10⁹/L鍜孭LT>100×10⁹/L銆�

M²鍏烽珨濡備笅锛欰ra-c50mg/m²闈滆剤婊存敞锛孮12h锛宒1锝瀌5;VP16150mg/m²闈滆剤婊存敞锛�90鍒嗛悩锛宒1锝瀌3;M3鍏烽珨濡備笅锛歏CR2mg/m²(鏈€澶у姂閲�2mg)锛宒1;Pred60mg/(m²·d)鍒�2娆″彛鏈�锛宒1锝瀌5锛�3澶╁収(n猫i)娓涘仠;CTX500mg/m²30鍒嗛悩鍏�(n猫i)杓稿叆锛宒1锝瀌2棣栧姂鍦―NR鍓嶇郸锛岀董鎸佹恫閲忓湪3000mL/m²鑷矯TX鍚�12灏忔檪(sh铆);E-ADR30mg/md1锛宒2闈滆剤婊存敞6灏忔檪(sh铆)(鍦–TX鍚庣郸)銆�

M4鍏烽珨濡備笅锛欰ra-c50mg/m²闈滆剤婊存敞锛孮12h锛宒1锝瀌5;VP16150mg/m²锛岄潨鑴堟淮娉�90鍒嗛悩锛宒1锝瀌3;

C2绲�

COP鏂规鍙婇枊濮嬫浠跺悓C1绲�;COPADM51鏂规鍚孋1绲�;COPADM82鏂规鍚孋1绲�(MTX鏀圭偤8g/m²);C2—CNS+鐨勯瀼鍥烘不鐧�:CYVE1-MTX8鍜孋YVE2(鏈祫鐢ㄨ棩闄TX鍔戦噺鏈夎畩鍖栧锛屽叾瀹冪敤钘ュ姂閲忓悓C1绲�锛孧TX鐐�5g/m²)銆�

C2绲勭董鎸佹不鐧侻81—M²—M3—M4(闄1涓璏TX鏀圭偤8g/m²锛屼綑鍧囧悓C1绲�)娉細C绲勬垚鐔烞绱�(x矛)鑳炴穻宸寸槫鍦ㄥ寲鐧傛湡闁撳彲鑱�(li谩n)鍚�6鍔戝埄濡ユ様鍠姉娌荤檪锛屽潎鍦ㄥ寲鐧傚墠1锝�2澶�锛屽姂閲�375mg/(m²·娆�)銆�

鈶HL-BFM90鏂规(閬╃敤浜嶣L锛孌LBCL锛孍B鐥呮瘨闄�(y谩ng)鎬LBCL锛岄珮绱�(j铆)鍒绱�(x矛)鑳炴穻宸寸槫锛屾烤娉℃穻宸寸槫)

娌荤檪鍒嗙祫锛�

R1:瀹氱京鐐鸿叓鐦ゅ畬鍏ㄥ垏闄�銆傞爯(y霉)娌荤檪V-A-B

R2锛氳叓鐦ゆ湭瀹屽叏鍒囬櫎锛孡DH<500U/L鎴栬€呰叓鐦ょ梾鐏朵笉渚电姱鑵归儴闋�(y霉)娌荤檪V-AA-BB-瑭�(p铆ng)浼板畬鍏ㄧ珐瑙�-AA-BB闋�(y霉)娌荤檪V-AA-BB-瑭�(p铆ng)浼版湭瀹屽叏绶╄В-铏曠悊鍚孯3绲�

R3锛氳吂鑵旂槫鐏朵笖LDH>500U/L锛屾垨楠ㄩ珦渚电姱锛屾垨涓渚电姱锛屾垨澶氱櫦(f膩)楠ㄩ渚电姱銆傞爯(y霉)娌荤檪锛�

鈶燰-AA-BB-瑭�(p铆ng)浼板畬鍏ㄧ珐瑙�-AA-BB-AA-BB

鈶-AA-BB-瑭�(p铆ng)浼版湭瀹屽叏绶╄В-CC-鍐嶈⿻(p铆ng)浼板畬鍏ㄧ珐瑙�-AA-BB-CC

鈶-AA-BB-瑭�(p铆ng)浼版湭瀹屽叏绶╄В-CC-鍐嶈⿻(p铆ng)浼版湁娈樼暀鐥呯伓-浜屾娲绘锛岃嫢(-)-AA-BB-CC

鈶-AA-BB-瑭�(p铆ng)浼版湭瀹屽叏绶╄В-CC-鍐嶈⿻(p铆ng)浼版湁娈樼暀鐥呯伓-浜屾娲绘锛岃嫢(+)-鑷珨閫犺骞茬窗(x矛)鑳炵Щ妞嶅叿楂旀柟妗堝涓嬶細

R1锛氶爯(y霉)娌荤檪V-A-B闋�(y霉)娌荤檪锛歅red30mg/m²锛宒1锝瀌5;CTX200mg/m²锛宒1锝瀌5;MTX+Dex+Arac(闉樻敞)d1銆侰ourseA:Dex10mg/m²锛宒1锝瀌5;IFO800mg/m²锛宒1锝瀌5;MTX(24h杓告敞)500mg/m²锛宒1;Ara-c150mg/(m²·娆�)锛孮12h锛宒4锝瀌5;VP-16100mg/(m²·娆�)锛宒4d5;MTX+Dex+Arac(闉樻敞)d1銆侰ourseB:Dex10mg/m²锛宒1锝瀌5;CTX200mg/m²锛宒1锝瀌5;MTX(24h杓告敞)1000mg/m²锛宒1;Ara-c150mg/(m²·娆�)锛孮12h锛宒4锝瀌5;Adr25mg/(m²·娆�)锛宒4锝瀌5;MTX+Dex+Arac(闉樻敞)d1銆�

R2锛氶爯(y霉)娌荤檪V-AA-BB---閬�(d谩)CR-AA-BBCourseAA:Dex10mg/m²锛宒1锝瀌5;IFO800mg/m²锛宒1锝瀌5;MTX(24灏忔檪(sh铆)杓告敞)5000mg/m²锛宒1;VCR1.5mg/m²锛宒1;Ara-c150mg/(m²·娆�)锛孮12h锛宒4锝瀌5;VP-16100mg/(m²·娆�)锛宒4锝瀌5;MTX+Dex+Arac(闉樻敞)d1銆侰ourseBB:Dex10mg/m²锛宒1锝瀌5;CTX200mg/m²锛宒1锝瀌5;MTX(24灏忔檪(sh铆)杓告敞)5000mg/m²锛宒1;Ara-c150mg/(m²·娆�)锛孮12h锛宒4锝瀌5;Adr25mg/(m²·娆�)锛宒4锝瀌5;MTX+Dex+Arac(闉樻敞)d1;

R3锛氶爯(y霉)娌荤檪V-AA-BB---CR-AA-BB-AA-BB,鏈仈(d谩)CR-CC--閬�(d谩)CR-AA-BB-CC銆侰ourseAA:Dex10mg/m²锛宒1锝瀌5;IFO800mg/m²锛宒1锝瀌5;MTX(24h杓告敞)5000mg/m²锛宒1;VCR1.5mg/m²锛宒1;Ara-c150mg/(m²·娆�)锛孮12h锛宒4锝瀌5;VP-16100mg/(m²·娆�)锛宒4锝瀌5;MTX+Dex+Arac(闉樻敞)d1銆侰ourseBB:Dex10mg/m²锛宒1锝瀌5;CTX200mg/m²锛宒1锝瀌5;MTX(24灏忔檪(sh铆)杓告敞)5000mg/m²锛宒1;Ara-c150mg/(m²·娆�)锛孮12h锛宒4锝瀌5;Adr25mg/(m²·娆�)锛宒4锝瀌5;MTX+Dex+Arac(闉樻敞)d1銆侰ourseCC锛欴ex10mg/m²锛宒1锝瀌5;VDS3mg/m²锛宒1;CTX200mg/m²锛宒1锝瀌5;Ara-c2000mg/(m²·娆�)锛孮12h锛宒1锝瀌2;VP-160150mg/(m²·娆�)锛宒3锝瀌5;MTX+Dex+Arac(闉樻敞)d1銆�

鈶A-EPOCH+R鏈柟妗堝儏閬╃敤浜嶱MBL锛屾湰鐥呭湅(gu贸)闅涗笂鍏獚(r猫n)鐨勬柟妗堢偤DA-EPOCH-R锛�3骞寸殑OS閬�(d谩)90%浠ヤ笂锛岃€岄噰鐢‵AB/LMB96鍙奛HL-BFM95鏂规鐢熷瓨鐜囧儏60%宸﹀彸銆傛敞锛氭湰鏂规闈滆剤婊存敞鍒╁Ε鏄斿柈鎶楀悗闁嬪鎸佺簩(x霉)涓夊€�(g猫)钘ョ墿(VP-16+ADR+VCR)娣峰悎闈滆剤婊存敞锛屾瘡鐧傜▼鍖栫檪闋嗗簭R-VP16+ADR+VCR娣峰悎-CTX锛屾瘡涓夊懆涓€鍊�(g猫)寰挵(hu谩n)锛屽叡6寰挵(hu谩n)锛屾瘡涓€寰挵(hu谩n)鏍规摎(j霉)鍓嶄竴寰挵(hu谩n)琛€璞℃儏娉侊細

a.鏈€浣嶢NC>0.5×10⁹/L锛屽墖鍔戦噺澧炲姞20%(VP16锛孉DR锛孋TX);

b.鑻ュ墠涓€鐧傜▼鏈€浣嶢NC<0.5×10⁹/L锛屽墖鍔戦噺涓嶈畩;c.鑻ヨ灏忔澘<25×10⁹/L锛屽墖闄嶄綆20%IT锛歁TX12mg锛岀1锝�2寰挵(hu谩n)锛岀5锝�6寰挵(hu谩n)鍚勪竴娆�锛宒1锛岀3锝�4寰挵(hu谩n)鍚�2娆�锛宒1锛宒5EPOCH

鏂规鍏烽珨濡備笅锛歏P-1650mg/(m²·d)锛宒1锝瀌4;VCR0.4mg/(m²·d)锛宒1锝瀌4;ADR10mg/(m²·d)锛宒1锝瀌4;Pred120mg/(m²·d)锛宒1锝瀌5;CTX750mg/(m²·d)锛宒5;缇庣緟鑿�375mg/(m²·娆�)锛宒1銆�

(2)鍒嗗瓙闈跺悜钘ョ墿娌荤檪锛欳D20琚獚(r猫n)鐐烘槸鍏嶇柅瀛�(xu茅)娌荤檪NHL鐨勭悊鎯抽澏榛�(di菐n)锛孋D20鏃笉鏁ｅ竷鍦ㄧ窗(x矛)鑳炶〃闈�锛屼篃涓嶉尐瀹氬湪鎶楅珨涓�锛屽洜姝ゅ湪娣嬪反鐦ょ殑娌荤檪涓�锛屾噳(y墨ng)鐢ㄦ姉CD20鍠厠闅嗘姉楂�(鍒╁Ε鏄斿柈鎶�)娌荤檪鎴愮偤鐩墠鏈€閲嶈鐨勪竴绋墜娈�锛屽叾娌荤檪NHL鐨勪富瑕佹(j墨)鍒跺寘鎷姉楂斾緷璩存€х窗(x矛)鑳炴瘨浣滅敤(ADCC)鍜岃(b菙)楂斾緷璩存€х窗(x矛)鑳炴瘨浣滅敤(CDC)锛屽苟鍦ㄨ繎20骞翠腑鍙栧緱閲嶅ぇ閫�(j矛n)灞�銆�

鍒╁Ε鏄斿柈鎶楄绋辩偤绗竴浠ｆ姉楂�锛屾槸浜洪紶宓屽悎鎶楅珨锛屾姉楂斾腑鐨勯紶婧愮祼(ji茅)妲�(g貌u)鏈�(hu矛)灏�(d菐o)鑷磋純闀�(zh菐ng)鏅�(sh铆)闁撶殑鐏屾敞鍜屽毚(y谩n)閲嶇殑姣掑壇浣滅敤銆傜2浠ｆ姉CD20鍠厠闅嗘姉楂旇垏浜虹殑鍚屾簮鎬ч珮閬�(d谩)90%锝�100%锛屾槸浜烘簮鍖栨姉楂旀垨鍏ㄤ汉婧愭姉楂�銆侭linatumomab锛欳D19銆丆D3闆欐(bi膩o)鎶楅珨锛屽叾浣滅敤姗�(j墨)鍒剁偤T娣嬪反绱�(x矛)鑳炴墍浠嬪皫(d菐o)鐨勫厤鐤洠(ji膩n)瑕栦綔鐢ㄥ湪鑵槫鐨勭櫦(f膩)鐢�銆佺櫦(f膩)灞曞強鐧傛晥涓櫦(f膩)鎻憲閲嶈浣滅敤銆�

鐮旂┒琛ㄦ槑锛屽皪(du矛)浜嶯HL銆丄LL鍙婁竴浜涘(sh铆)楂旂槫鎮ｈ€�锛孋D8+T绱�(x矛)鑳炵殑鏁�(sh霉)閲忚垏鎮ｈ€呯殑闋�(y霉)鍚庡憟姝ｇ浉闂�(gu膩n)銆俆绱�(x矛)鑳炵偤鍩虹(ch菙)鐨勬不鐧備富瑕佸寘鎷細鐤嫍銆侀珨澶朤绱�(x矛)鑳炵殑鎿�(ku貌)澧炲拰涓€浜涙椿鍖朤绱�(x矛)鑳炵殑钘ョ墿銆備絾鏄敱浜庤叓鐦ら€冮€告(j墨)鍒剁殑瀛樺湪锛屼娇寰椾笂杩版不鐧傛柟娉曞湪鑷ㄥ簥鎳�(y墨ng)鐢ㄩ亷绋嬩腑鐧傛晥娆犱匠銆�

(3)绱�(x矛)鑳炲厤鐤不鐧傦細CAR-T绱�(x矛)鑳炴槸鎸囧祵鍚堟姉鍘熷彈楂�(chimericantigenreceptor锛孋AR)鐨凾绱�(x矛)鑳�锛岄€氶亷鍩哄洜杞�(zhu菐n)灏�(d菐o)浣縏娣嬪反绱�(x矛)鑳炶〃閬�(d谩)鐗瑰畾鐨勬姉鍘熷彈楂�锛岄€氶亷瑭插彈楂旂壒鐣版€ц瓨(sh铆)鍒ラ澏鎶楀師锛岄€�(j矛n)鑰岄仈(d谩)鍒癟绱�(x矛)鑳炴鍌烽澏绱�(x矛)鑳�(鑵槫绱�(x矛)鑳�)鐨勭洰鐨�銆�

鑳炲収(n猫i)娈电偤淇¤櫉(h脿o)杞�(zhu菐n)灏�(d菐o)娈�锛岄€氶亷CD3(绗�1浠AR-T)浣滅偤鑳炲収(n猫i)淇¤櫉(h脿o)杞�(zhu菐n)灏�(d菐o)鍩熸縺娲诲厤鐤彈楂旈叒姘ㄩ吀娲诲寲鍩哄簭妯￠珨鎴朏ceRly;鎴栬€呴€ｆ帴1鍊�(g猫)(绗�2浠AR-T)鎴�2鍊�(g猫)鍙婁互涓�(绗�3浠AR-T)鍏卞埡婵€淇¤櫉(h脿o)锛屼緥濡侰D28锛岃獦灏�(d菐o)鎬у叡鍒烘縺鍒嗗瓙銆傜2浠ｆ垨绗�3浠AR-T鍙績閫�(j矛n)T娣嬪反绱�(x矛)鑳炲娈�锛屽寮�(qi谩ng)鍏舵鍌锋晥鎳�(y墨ng)锛屽欢闀�(zh菐ng)T娣嬪反绱�(x矛)鑳炲湪NHL鎮ｈ€呴珨鍏�(n猫i)浣滅敤鐨勬寔绾�(x霉)鏅�(sh铆)闁�銆�

CAR閫氶亷杓夐珨绯荤当(t菕ng)琛ㄩ仈(d谩)浜嶵娣嬪反绱�(x矛)鑳炶〃闈紝缍�(j墨ng)OKT3銆丆D3/CD8纾佺彔绛夋縺娲绘墜娈典娇T娣嬪反绱�(x矛)鑳炲湪楂斿澶ч噺澧炴畺銆佹椿鍖�锛岄€�(j矛n)鑰屽彲浠ヨ几娉ㄨ嚦NHL鎮ｈ€呴珨鍏�(n猫i)鐧�(f膩)鎻姉鑵槫鏁堟噳(y墨ng)銆傜洰鍓嶅凡鏈塁D19銆丆D20銆丆D22鐨凜AR-T鐢ㄤ簬娌荤檪闆ｆ不寰�(f霉)鐧�(f膩)鎴愮啛B绱�(x矛)鑳炴穻宸寸槫鐨勮嚚搴婅│椹�(y脿n)鍦ㄩ€�(j矛n)琛屼腑锛屽苟涓旂檪鏁堝崄鍒嗚偗瀹�銆�

鍏�銆佸苟鐧�(f膩)鐧ュ強杓斿姪娌荤檪

(涓€)鎬ユ€ц叓鐦ゆ憾瑙ｇ稖鍚堝緛

灏�(du矛)鍖栫檪鏁忔劅鐨勮叓鐦ゅ湪鍒濆娌荤檪鏅�(sh铆)锛屽ぇ閲忚叓鐦ょ窗(x矛)鑳炴憾瑙ｅ姝�锛屽紩璧烽珮灏块吀琛€鐧�銆侀珮纾疯鐧�銆佷綆閳ｈ鐧ャ€佷綆閹傝鐧ュ強灏块吀绲�(ji茅)鏅跺牭濉炶厧灏忕锛屽毚(y谩n)閲嶆檪(sh铆)灏�(d菐o)鑷存€ユ€ц厧鍔熻兘琛扮銆傛穻宸寸郴鑵槫灏�(du矛)鍖栫檪鏁忔劅锛屽湪鑵槫楂樿矤(f霉)鑽锋檪(sh铆)鏇村鏄撳悎骞惰叓鐦ょ窗(x矛)鑳炴憾瑙ｇ稖鍚堝緛銆傞渶绌嶆サ闋�(y霉)闃插拰铏曠悊銆�

1.鑵槫婧惰В缍滃悎寰侀爯(y霉)闃�

(1)鍒ュ槍鍛ら唶:50-100mg/(m²·娆�)锛�2锝�3娆�/鏃�锛岀洿鍒扮⒑瑾�(r猫n)鑵槫璨�(f霉)鑽锋槑椤笅闄�;

(2)姘村寲:2000锝�3000mL/m²鎸佺簩(x霉)闈滆剤鍧囧嫽婊存敞锛屾厧鐢ㄥ惈閴€娑�;

(3)涓嶄富寮靛父瑕�(gu墨)鍫垮寲琛€娑插強灏挎恫锛屼互閬垮厤鍫挎€ф浠朵笅鑵庡皬绠￠垼楣芥矇绌�锛屽湪楂樺翱閰�銆侀珮閴€鏅�(sh铆)閬╃暥(d膩ng)鎳�(y墨ng)鐢�;

(4)涓嶄富寮靛父瑕�(gu墨)闈滆剤瑁�(b菙)鍏呴垼鍔�锛屽儏鍦ㄤ綆閳ｅ苟鏈夎嚚搴婄櫏鐙€鏅�(sh铆)瑁�(b菙)閳�锛屼互閬垮厤澧炲姞鑵庡皬绠￠垼楣芥矇绌�;

(5)灏�(du矛)楂樿叓鐦よ矤(f霉)鑽疯€呮湁姊濅欢鑰呮噳(y墨ng)鑰冩叜鎳�(y墨ng)鐢ㄥ翱閰告哀鍖栭叾锛�0.15mg/(kg·娆�)+鐢熺悊楣芥按50mL锛岄潨鑴堟淮娉�30鍒嗛悩銆備絾闇€娉ㄦ剰妾㈡煡G6PD锛屽鏋滄湁閰剁己闄�锛屼笉鑳界敤灏块吀姘у寲閰�;涓嶈兘鍚屾檪(sh铆)浣跨敤鍒ュ槍鍛ら唶銆佺７閰歌倢閰镐繚蹇冭棩鐗�(闃叉纾烽吀楣界祼(ji茅)鏅�);灏块吀姘у寲閰跺彲浠ユ湁鏁堢殑闄嶄綆琛€灏块吀锛屾笡灏戣厧琛�锛屼絾鏄苟涓嶈兘娓涘皯鍤�(y谩n)閲嶈叓鐦ょ窗(x矛)鑳炴憾瑙ｇ稖鍚堝緛鐨勭櫦(f膩)鐢燂紝涓嶈兘浠ｆ浛閫ｇ簩(x霉)琛€娑插噲鍖�銆�

2.鑵槫婧惰В缍滃悎寰佹不鐧�

闄や簡闋�(y霉)闃叉€ф帾鏂藉锛岀暥(d膩ng)鐧�(f膩)鐢熸憾瑙ｇ稖鍚堝緛鏅�(sh铆)锛屾噳(y墨ng)鏍规摎(j霉)鑷ㄥ簥瀵�(sh铆)闅涙儏娉佽檿鐞嗭細

(1)绻肩簩(x霉)闋�(y霉)闃叉€ф不鐧�銆�

(2)楂橀墍琛€鐧ワ細

鈶犻潨鑴堟敞灏勮憽钀勭硸閰搁垼锛屽儏鑳藉皪(du矛)鎶楅珮閴€寮曡捣鐨勫績鑷熸瘨鎬�锛岃€屼笖浣滅敤鏅�(sh铆)闁撶煭鏆儏鏁�(sh霉)鍒嗛悩銆傚皪(du矛)浜庢湁鏄庨’蹇冭嚐姣掓€х殑鎮ｅ厭鎳�(y墨ng)闈滆剤绶╂參鎺ㄦ敞10%鐨勮憽钀勭硸閰搁垼1mL/(kg·娆�)锛屽姞绛夐噺5%鎴�10%钁¤悇绯栫█閲�锛屾帹娉ㄦ檪(sh铆)闁撳ぇ浜�20鍒嗛悩;

鈶￠潨鑴堟敞灏勭⒊閰告矮閳夛細灏�(du矛)浜庨吀涓瘨鎮ｅ厭鏁堟灉杓冨ソ锛屼絾鐧傛晥鎸佺簩(x霉)1灏忔檪(sh铆)宸﹀彸锛屽彧鑳戒綔鐐烘噳(y墨ng)鎬ヤ娇鐢�锛屼笖涓嶅疁鐢ㄤ簬琛€瀹归噺閬庡鐨勬偅鍏�銆傚姂閲忕偤1锝�2mmol/kg锛�5%鐨勭⒊閰告矮閳夌敤5%钁¤悇绯栫█閲�2鍊�锛�20锝�30鍒嗛悩杓稿叆銆�

鈶㈤潨鑴堢郸浜堣憽钀勭硸鍜岃儼宄剁礌锛�10%钁¤悇绯�5锝�10mL/kg锛屾瘡4锝�5g绯栧彲鍔犲叆1U鑳板扯绱�锛岄潨鑴堟淮娉�30閻�锛屽咕灏忔檪(sh铆)鍏�(n猫i)鍙娇琛€閴€闄嶄綆1锝�2mmol/L銆傜檪鏁堟寔绾�(x霉)鏁�(sh霉)灏忔檪(sh铆)銆�

鈶ｉ洟瀛愪氦鎻涙ü鑴傦細鍙檷浣庨墍闆㈠瓙鐨勫惛鏀�锛�1g/kg(鏈€澶ч噺50g)锛屽父鐢ㄧ殑鏄仛纾鸿嫰涔欑儻鎴栬仛鑻箼鐑：閰搁垑鑸囩敓鐞嗛菇姘�1mL/g娣峰悎鍚庝繚鐣欑亴鑵�?锛�?q奴)鈶�?5%鐨勫北姊ㄩ唶娣峰悎鍙ｆ湇銆傝┎鏂规硶骞惧皬鏅�(sh铆)鍏�(n猫i)鍙檷琛€閴€0.5锝�2mmol/L銆�

鈶ら€忔瀽:閫氶亷涓婅堪鏂规硶娌荤檪琛€閴€浠嶉€�(j矛n)琛屾€у崌楂樻垨闋�(y霉)鏈熶笉鑳介€氶亷涓婅堪杈︽硶绯炬鐨勯珮琛€閴€鎳�(y墨ng)鑰冩叜閫忔瀽娌荤檪銆�

(3)浣庨垼銆侀珮纾疯鐧ワ細鍥犻垼楣藉彲澧炲姞鑵庡皬绠￠垼楣芥矇绌�锛岃嚚搴婄劇鐧ョ媭鏅�(sh铆)涓嶆噳(y墨ng)甯歌(gu墨)浣跨敤闈滆剤閳ｅ姂?锛熸ⅱ閽ヨ瘻顠撳寰晑鍙互闃绘纾烽吀楣藉惛鏀�锛岄檷浣庤纾锋彁楂樻父闆㈤垼銆備竴鏃︾櫦(f膩)鐢熶綆閳ｆ€ф墜瓒虫娊鎼愭噳(y墨ng)10%钁¤悇绯栭吀閳�1锝�2mL/(kg·娆�)锛屽姞绛夐噺5%钁¤悇绯栨敞灏勬恫闈滆剤鎺ㄦ敞銆�

(4)鑵庡姛鑳戒笉鍏細杓曞害鑵庡姛鑳戒笉鍏ㄥ彲閫氶亷姘村寲銆佸埄灏跨瓑铏曠悊锛岄毃钁楄叓鐦よ矤(f霉)鑽锋笡杓�銆佽厧鑷熸蹈娼�(r霉n)绶╄В鑰岄€愭濂借綁(zhu菐n)銆備笉鎳�(y墨ng)鍥犺厧鍔熻兘涓嶅叏鑰岄檺鍒惰几娑查噺锛屽毚(y谩n)閲嶈厧鍔熻兘涓嶅叏浼村皯灏裤€佺劇灏�銆佹按鑵檪(sh铆)鎳�(y墨ng)鑰冩叜鍙婃檪(sh铆)鍋氶€忔瀽娌荤檪銆�

(浜�)蹇冭嚐姣掓€�

涓昏鎸囪捊鐠�(hu谩n)椤炶棩鐗╃殑蹇冭嚐姣掓€�锛屽寘鎷€ユ€у績鑲屾悕鍌峰拰鎱㈡€у績鍔熻兘鎼嶅銆傚墠鑰呯偤鐭毇鑰屽彲閫嗙殑蹇冭倢灞€閮ㄧ己琛€锛屽彲琛ㄧ従(xi脿n)鐐哄績鎱�銆佹埃鐭�銆佽兏鎮�銆佸績鍓嶅崁(q奴)涓嶉仼绛�;鍚庤€呯偤涓嶅彲閫嗙殑鍏呰鎬у績鍔涜“绔�锛岃垏钘ョ墿绱⿳鍔戦噺鐩搁棞(gu膩n)銆�

涓€鏃﹀績鍔熻兘妾㈡脯(c猫)鎻愮ず蹇冭嚐灏勮鍒�?j菒n)?sh霉)<55%鎴栬桓绺煭鍒�?j菒n)?sh霉)<28%锛岃嫢鑳借瓑鏄庡乏蹇冨姛鑳界暟甯稿拰绱�(x矛)鑿屾劅鏌撴湁闂�(gu膩n)锛屽彲浠ョ辜绾�(x霉)浣跨敤钂界挵(hu谩n)椤炴姉鐢熺礌锛屽惁鍓囨噳(y墨ng)瑭叉毇鍋滐紝鐩村埌灏勮鍒�?j菒n)?sh霉)≥55%鎴栬桓绺煭鍒�?j菒n)?sh霉)≥28%銆傛牴鎿�(j霉)钂界挵(hu谩n)椤炶棩鐗╀娇鐢ㄥ姂閲忔垨蹇冭倢鎼嶅偡绋嬪害閬告搰鍙充笝浜炶兒(Zinecard)锛屽乏鏃嬭倝鍫�銆佽兘閲忓悎鍔戠瓑钘ョ墿銆�

(涓�)鑵庤嚐姣掓€�

HD-MTX锛氳厧姣掓€ц棩鐗�(濡傞樋鏄旀礇闊�)鍙皫(d菐o)鑷磋娓呰倢閰愭甯窯FR闄嶄綆鐨勪簽鑷ㄥ簥鎬ц厧鍔熻兘鐣板父锛屽鏈夊彲鑳介€欓钘ョ墿鎳�(y墨ng)瑭插欢閬插埌HD-MTX鍚�20灏忔檪(sh铆)浠ュ悗鎴朚TX宸茬稉(j墨ng)鍏呭垎鎺掓硠鍚庣郸浜�銆傚鏋滆倢閰愬€兼彁绀鸿厧鍔熻兘鐣板父锛孧TX鐢ㄩ噺闇€瑕佽(di脿o)鏁�锛孧TX琛€钘ユ績搴﹀強鍥涙矮钁夐吀閳ｈВ鏁�(瑭宠闄勮〃3)銆�

(鍥�)涓€х矑绱�(x矛)鑳炵己涔忎即鐧�(f膩)鐔�

绮掔窗(x矛)鑳炵己涔忓悎骞舵劅鏌�锛屼締鍕�(sh矛)鍏囩寷锛岄€�(j矛n)灞曡繀閫�锛屽洜姝ゅ強鏅�(sh铆)灏�(du矛)鎰熸煋閫�(j矛n)琛屾伆鐣�(d膩ng)铏曠悊鑷抽棞(gu膩n)閲嶈銆傚湪鍙栭€佸悇绋煿椁�(y菐ng)鍚�锛岄爤绔嬪嵆绲︿簣鍒濆缍�(j墨ng)椹�(y脿n)鎬ф不鐧�锛屽緟鐥呭師楂旀槑纰哄悗锛屽啀閫�(j矛n)琛岄嚌灏�(du矛)鎬ф不鐧�銆�

(浜�)SMZco闋�(y霉)闃插崱姘忚偤鍥婅煵鎰熸煋

寤鸿闀�(zh菐ng)鏈熸湇鐢⊿MZco闋�(y霉)闃插崱姘忚偤鍥婅煵鎰熸煋锛�25mg/(kg·澶�)锛屽垎鍏╂锛屾渶澶у姂閲忔瘡娆�0.5g锛孊id锛屾瘡鍛�3澶�锛岀洿鑷冲寲鐧傜祼(ji茅)鏉熷悗3鏈�銆侶D-MTX鐢ㄥ墠24灏忔檪(sh铆)鍒扮敤MTX鍚庤嚦灏�72灏忔檪(sh铆)鍋滅敤寰�(f霉)鏂圭：鑳虹暟鍣佸攽銆�

涓�銆佽嚚搴婃不鐧傚弽鎳�(y墨ng)瑭�(p铆ng)浼版檪(sh铆)闁撻粸(di菐n)鍙婃柟娉�

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