《国际咨询病例》如何最佳治疗弥漫大B细胞淋巴瘤，ABC亚型，有双重表达？
（原创）美国希望之光医疗中心，欢迎转载，请注明出处。
咨询日期：2016年8月29日
患者：xx
年龄：54岁
性别：女
诊断： DLBCL ABC subtype, with double expression, stage I-E, IPI = 0. 弥漫大B细胞淋巴瘤，ABC亚型，有双重表达，I-E期，IPI=0。
病史总结：
Patient is a 53 yo woman previous in excellent health. Found to have left kidney masses in May 2016, s/p nephrectomy. Patholgoy is consistent with DLBCL ABC subtype, double expressing, but not double hit (DHL), involving only left kidney. Normal LDH. No bone marrow involvement. IPI = 0.
Now s/p 3 cycles of DA-EPOCH-R, most recent escalated to level 2 of the regimen. Complicated by pneumonia requiring dose delay by 1 week. Performance status remains adequate per treating physician and husband.
Physical exam: N/A
患者于2016年5月发现左侧肾脏肿块，行左肾切除。病理报告显示弥漫大B细胞淋巴瘤，ABC亚型，有双重表达，但非双重打击，只涉及左肾。LDH正常。骨髓无浸润。IPI = 0。现经过三个疗程的DA-EPOCH-R治疗，最后升级到二级。期间因肺炎而推迟化疗一周。根据主治医生和患者先生介绍，病人身体状况保持良好。
身体检查：因为是远程医疗，没法做。
咨询建议：
1. Overall prognosis is good to excellent with the current regimen of DA-EPOCH-R. Probability of cure potential should be more than 60%.
2. Continue the current regimen for a total of 6 cycles if she tolerates it. She should get 10-14 days of Neupogen.
3. Will not recommend dose escalation at the cost of dose delays.
4. Will re-stage after c4 and c6 of chemo.
5. Optional collection of stem cells. May be prudent to do so.
6. Optional intrathecal therapy. May be prudent to do so.
7. Should consider sending samples for whole exome sequencing.
1. 用DA-EPOCH-R治疗总体预后良好，治愈可能性应该超过60%。
2. 如果患者可以耐受，继续目前的治疗方案，共六个疗程，用10-14天的Neupogen。
3.不建议继续计量升级以免治疗推迟。
4.四个和六个疗程后再做一次全身PET/CT。
5.建议收集干细胞。
6.可以考虑鞘内化疗。
7.建议做肿瘤全基因测序。
