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淋巴瘤患者的诊断与治疗路径:通过名义群体法和德尔菲法形成的专家共识

英文原题:Diagnostic and therapeutic pathways for lymphoma patients: expert consensus through Nominal Group Technique and Delphi methodology.

PubMed 2025/08/13(内容时间) Front Oncol Q2 · IF 3.4(JCR 2025)

研究概要

该项目强调,淋巴瘤诊疗需要一种结构化、共识驱动的方法,既与不断发展的国际指南保持一致,又能应对意大利特有的监管与医疗体系环境。

中文摘要

引言:淋巴瘤涵盖一组异质性B细胞和T细胞恶性肿瘤,需要复杂且精确的管理。为在意大利多个血液病中心建立标准化诊断和治疗路径,研究者设计了“Right Path 4 Lymphomas”项目,作为多学科专家平台,通过共识制定诊断与治疗路径。 方法:采用两阶段方法——先进行名义小组技术讨论,再开展Delphi程序;专家系统评估并排序五种主要淋巴瘤亚型的关键诊疗议题:经典型霍奇金淋巴瘤、弥漫大B细胞淋巴瘤、滤泡性淋巴瘤、套细胞淋巴瘤和外周T细胞淋巴瘤。 结果:Delphi程序对270项陈述中的264项达成高度共识(97.8%),进一步强调多学科合作对于制定循证建议的重要性。主要共识领域包括组织病理学和分子诊断标准、结合新型免疫疗法的风险适配治疗方案,以及结构化随访策略。对于微小残留病监测的临床价值、免疫疗法的最佳序贯方案,以及CAR-T疗法与双特异性抗体的选择,仍存在争议。 讨论:该项目强调,需要采用结构化、由共识驱动的淋巴瘤诊疗方法,在与不断演进的国际指南保持一致的同时,兼顾意大利独特的监管和医疗环境。研究结果为临床医生和政策制定者提供了有价值的框架,可在创新、资源配置和临床可行性之间取得平衡,优化淋巴瘤管理。

展开英文摘要原文

INTRODUCTION: Lymphomas encompass a heterogeneous group of B- and T-cell malignancies necessitating a complex and precise management. With the aim to define standardized diagnostic and therapeutic pathways across multiple hematology centers in Italy, the "Right Path 4 Lymphomas" project was designed as a multidisciplinary expert platform designed to establish consensus-driven diagnostic and therapeutic pathways. METHODS: Using a two-phase methodology - the Nominal Group Technique followed by a Delphi process - experts systematically evaluated and prioritized key diagnostic and therapeutic topics for five major lymphoma subtypes: classical Hodgkin lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and peripheral T-cell lymphomas. RESULTS: The Delphi process achieved a high level of consensus on 264 of 270 statements (97.8%), reinforcing the importance of multidisciplinary collaboration in shaping evidence-based recommendations. Key areas of agreement included histopathologic and molecular diagnostic standards, risk-adapted treatment approaches integrating novel immunotherapies, and structured follow-up strategies. However, areas of debate remained over the clinical utility of minimal residual disease monitoring, optimal sequencing of immunotherapies, and the potential of CAR-T therapy versus bispecific antibodies. DISCUSSION: This project highlights the need for a structured, consensus-driven approach to lymphoma care that aligns with evolving international guidelines while addressing the distinct regulatory and healthcare landscape in Italy. The findings provide a valuable framework for clinicians and policymakers to optimize lymphoma management, balancing innovation with the allocation of resources and clinical feasibility.

论文信息

作者
Guarini A、Bozzoli V、Ciavarella S、Cimminiello M、Donatelli F、Fama A、Fesce VF、Fraticelli V
第一作者单位
Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.Italy
通讯作者单位
UOC Ematologia e Trapianto di CSE azienda ospedaliera C.Panico Tricase, Lecce, Italy.Italy
期刊
Frontiers in oncology2025
原文标识
PubMed 40881873 · DOI 10.3389/fonc.2025.1627175