伯基特淋巴瘤四期 3疗中。医生建议加卡替 没有商业保险 不知道前路如何……

伯基特淋巴瘤4期

今年39岁，3月底确诊伯基特淋巴瘤四期，四月初开始治疗，目前治疗方案是CODOX-M及IVAC交替，其中阿糖胞苷取消，口服泽布替尼。
目前3疗中 ，由于中途高烧，第10天要打的甲氨蝶吟不能上了，化疗中断了4天，今天第14天继续上甲氨蝶呤，但是剂量减少一半。他第一疗低烧并感染新冠；第二疗又低烧并感染新冠，唉。
今天医生找我，问我有没有商业保险，他建议我在六次化疗+自体移植的基础上，再加一个卡替，说伯基特复发率很高，做了卡替能减低复发率，但是我们没有商业保险，要自费100多万。家里还有三个孩子上小学，如果要做卡替的话，我就要回去把房子给卖了，如果做了真的有用的话，钱没了就没了，但是我真的怕人财两空。我真的觉得很迷茫，不知道前路如何……求你们指点一下，拜托了。

来自安卓APP客户端

橙色雨丝

不知道目前缓解状态如何，原则上说，高危伯基特淋巴瘤的常用标准治疗方案是R-CODOX-M/IVAC交替四个周期，不知道你说的六疗是什么意思。另外，没有任何证据证明其中的阿糖胞苷可以用泽布替尼替代，也没有证据显示一线治疗完全缓解的患者需要自体造血干细胞移植或者CAR-T来巩固。

橙色雨丝

伯基特的治疗，最怕不及时和中断，目前不了解缓解情况，无法判断医生的建议是否合理，只能说如果已经耐药，依靠移植或CAR-T彻底解决问题的希望非常渺茫，儿童患者或者可以，成人患者几乎没有成功的，即使缓解，也很快复发。泽布替尼毫无必要，还增加感染风险，不知道有多大的脑洞才会想出这种风险很大但获益不明确的馊主意。

康复加油2916

北京博仁和武汉同济有同情cart。
10多万可以做

来自安卓APP客户端

gdxnkj

没听过有伯基特治疗用泽步替尼的，是估计让买外购药吗

来自安卓APP客户端

伯基特淋巴瘤4期

儿童外周T非特指 发表于 2023-07-06 22:36
多找专家问诊，多学习疾病的相关知识，医生顾不上你的

谢谢

来自安卓APP客户端

段段加油加油

伯基特淋巴瘤4期 发表于 2023-07-06 17:00
病理玻片？我们只病理报告呢

如果要去中肿治疗的话，还是要去原医院病理科把玻片借出来，送去中肿会诊，中肿病理科有了结果才会给你在中肿治，大医院都是这样的，只认可自己医院的病理。  如果你只去中肿问问建议应该带上报告就可以了

来自安卓APP客户端

伯基特淋巴瘤4期

康复加油2916 发表于 2023-07-06 16:05
北京博仁和武汉同济有同情cart。
10多万可以做

挂号就能过去做了吗？

来自安卓APP客户端

柒月、

@橙色雨丝 麻烦雨丝大神帮忙

来自苹果APP客户端

伯基特淋巴瘤4期

橙色雨丝 发表于 2023-07-06 16:07
不知道目前缓解状态如何，原则上说，高危伯基特淋巴瘤的常用标准治疗方案是R-CODOX-M/IVAC交替，没有任何证据证明其中的阿糖胞苷可以用泽布替尼替代，也没有证据显示完全缓解的患者需要自体造血干细胞移植或者CAR-T来巩固。

你好，请问缓解状态是怎么知道的？做PET-CT吗？

来自安卓APP客户端

伯基特淋巴瘤4期

战斗先生 发表于 2023-07-06 16:06
泽布替尼用在伯基特淋巴瘤中是干嘛的？

不知道呢，从入院就开始服用了

来自安卓APP客户端

再来一次

建议换医院问一下如果cr后应该是不需要cart，博仁和同济可以直接挂号问

来自安卓APP客户端

伯基特淋巴瘤4期

柒月、 发表于 2023-07-06 15:51
@橙色雨丝 麻烦雨丝大神帮忙

感谢

来自安卓APP客户端

再来一次

只有化疗中出现进展无法cr的伯基特才需要去cart

来自安卓APP客户端

伯基特淋巴瘤4期

再来一次 发表于 2023-07-06 16:15
建议换医院问一下如果cr后应该是不需要cart，博仁和同济可以直接挂号问

cr是移植吗？

来自安卓APP客户端

再来一次

伯基特淋巴瘤4期 发表于 2023-07-06 16:23
cr是移植吗？

cr是完全缓解

来自安卓APP客户端

橙色雨丝

在NCCN指南2023版中，关于伯基特淋巴瘤的治疗是这么说的：

CODOX-M/IVAC (originally published in 1998) is a highly effective regimen with a 1-year event-free survival (EFS) rate of 85% in pediatric and adult patients with previously untreated BL or Burkitt-like lymphoma. Patients with high-risk disease received 4 alternating treatments (ABAB) of CODOX-M(A) and IVAC(B), and those with low-risk disease received 3 cycles of CODOX-M. Both cycles included intrathecal chemotherapy (cytarabine or methotrexate) for CNS prophylaxis in addition to high-dose systemic cytarabine and methotrexate.
Subsequent phase II and retrospective studies have confirmed the efficacy of this regimen, and a “modified” regimen (inclusion of rituximab and dose-modified to decrease toxicity).
The efficacy of modified CODOX-M/IVAC regimen (modified slightly with vincristine dose capped at 2 mg) in adult patients with BL was confirmed in an international phase II study (n =52; 12 patients had low-risk disease; patients had high-risk disease). The overall 2-year EFS and OS rates were 65% and 73%, respectively.

CODOX-M/IVAC在儿童和成年患者中1年的无进展生存率是85%。高危患者接受4个周期的ABAB交替治疗。改良的CODOX-M/IVAC方案（加入利妥昔单抗，降低化疗剂量）在II期临床研究中2年无事件生存率是65%，总生存率是73%。

关于一线治疗后CR患者，是这么说的：

Patients with CR to induction therapy should be followed up every 2 to 3 months for 1 year then every 3 months for the next 1 year, and then every 6 months thereafter. Disease relapse after 2 years is rare following CR to induction therapy, and follow-up should be individualized according to patient characteristics. Consolidation therapy in the context of a clinical trial may be considered for high-risk patients with CR to induction therapy. Patients with less than CR to induction therapy should be treated in the context of a clinical trial.

诱导治疗后CR的患者第一年每两三个月复查一次，第二年每三个月复查一次，之后每六个月复查一次。两年后复发的患者非常罕见。CR的高危患者可以在临床试验的前提下考虑巩固治疗。未能CR的患者应该参加临床试验。

伯基特淋巴瘤4期

再来一次 发表于 2023-07-06 16:25
cr是完全缓解

感谢

来自安卓APP客户端

伯基特淋巴瘤4期

橙色雨丝 发表于 2023-07-06 16:28
在NCCN指南2023版中，关于伯基特淋巴瘤的治疗是这么说的：

CODOX-M/IVAC (originally published in 1998) is a highly effective regimen with a 1-year event-free survival (EFS) rate of 85% in pediatric and adult patients with previously untreated BL or Burkitt-like lymphoma. Patients with high-risk disease received 4 alternating treatments (ABAB) of CODOX-M(A) and IVAC(B), and those with low-risk disease received 3 cycles of CODOX-M. Both cycles included intrathecal chemotherapy (cytarabine or methotrexate) for CNS prophylaxis in addition to high-dose systemic cytarabine and methotrexate.
Subsequent phase II and retrospective studies have confirmed the efficacy of this regimen, and a “modified” regimen (inclusion of rituximab and dose-modified to decrease toxicity).
The efficacy of modified CODOX-M/IVAC regimen (modified slightly with vincristine dose capped at 2 mg) in adult patients with BL was confirmed in an international phase II study (n =52; 12 patients had low-risk disease; patients had high-risk disease). The overall 2-year EFS and OS rates were 65% and 73%, respectively.

CODOX-M/IVAC在儿童和成年患者中1年的无进展生存率是85%。高危患者接受4个周期的ABAB交替治疗。改良的CODOX-M/IVAC方案（加入利妥昔单抗，降低化疗剂量）在II期临床研究中2年无事件生存率是65%，总生存率是73%。

关于一线治疗后CR患者，是这么说的：

Patients with CR to induction therapy should be followed up every 2 to 3 months for 1 year then every 3 months for the next 1 year, and then every 6 months thereafter. Disease relapse after 2 years is rare following CR to induction therapy, and follow-up should be individualized according to patient characteristics. Consolidation therapy in the context of a clinical trial may be considered for high-risk patients with CR to induction therapy. Patients with less than CR to induction therapy should be treated in the context of a clinical trial.

诱导治疗后CR的患者第一年每两三个月复查一次，第二年每三个月复查一次，之后每六个月复查一次。两年后复发的患者非常罕见。CR的高危患者可以在临床试验的前提下考虑巩固治疗。未能CR的患者应该参加临床试验。

感谢感谢

来自安卓APP客户端

段段加油加油

在哪里治疗，是中肿吗

来自安卓APP客户端

伯基特淋巴瘤4期

橙色雨丝 发表于 2023-07-06 16:28
在NCCN指南2023版中，关于伯基特淋巴瘤的治疗是这么说的：

CODOX-M/IVAC (originally published in 1998) is a highly effective regimen with a 1-year event-free survival (EFS) rate of 85% in pediatric and adult patients with previously untreated BL or Burkitt-like lymphoma. Patients with high-risk disease received 4 alternating treatments (ABAB) of CODOX-M(A) and IVAC(B), and those with low-risk disease received 3 cycles of CODOX-M. Both cycles included intrathecal chemotherapy (cytarabine or methotrexate) for CNS prophylaxis in addition to high-dose systemic cytarabine and methotrexate.
Subsequent phase II and retrospective studies have confirmed the efficacy of this regimen, and a “modified” regimen (inclusion of rituximab and dose-modified to decrease toxicity).
The efficacy of modified CODOX-M/IVAC regimen (modified slightly with vincristine dose capped at 2 mg) in adult patients with BL was confirmed in an international phase II study (n =52; 12 patients had low-risk disease; patients had high-risk disease). The overall 2-year EFS and OS rates were 65% and 73%, respectively.

CODOX-M/IVAC在儿童和成年患者中1年的无进展生存率是85%。高危患者接受4个周期的ABAB交替治疗。改良的CODOX-M/IVAC方案（加入利妥昔单抗，降低化疗剂量）在II期临床研究中2年无事件生存率是65%，总生存率是73%。

关于一线治疗后CR患者，是这么说的：

Patients with CR to induction therapy should be followed up every 2 to 3 months for 1 year then every 3 months for the next 1 year, and then every 6 months thereafter. Disease relapse after 2 years is rare following CR to induction therapy, and follow-up should be individualized according to patient characteristics. Consolidation therapy in the context of a clinical trial may be considered for high-risk patients with CR to induction therapy. Patients with less than CR to induction therapy should be treated in the context of a clinical trial.

诱导治疗后CR的患者第一年每两三个月复查一次，第二年每三个月复查一次，之后每六个月复查一次。两年后复发的患者非常罕见。CR的高危患者可以在临床试验的前提下考虑巩固治疗。未能CR的患者应该参加临床试验。

我们是成人高危患者，医生建议先接受4个周期的ABAB交替治疗。CODOX-M/IVAC方案（加入利妥昔单抗，但大剂量化疗）。4期完成后，做一个pet-ct评估。

来自安卓APP客户端

伯基特淋巴瘤4期

段段加油加油 发表于 2023-07-06 16:37
在哪里治疗，是中肿吗

不是，在广州医科大学

来自安卓APP客户端

段段加油加油

伯基特淋巴瘤4期 发表于 2023-07-06 16:40
不是，在广州医科大学

离得近的话，考虑可以去中肿问诊看看

来自安卓APP客户端