1. FC and FCR in CLL and Indolent NHL: A descriptive retrospective institutional study Aftimos P, Chahine G Hotel-Dieu de France University Hospital Beirut, Lebanon LSMO 7: National Forum Le Royal, Dbaye 11/14/2008

2. Indolent NHL: Standard Approaches Watch and Wait (worry) Alkylating agents ± steroids CVP CHOP Fludara Fludara combination chemo “New and improved” biological therapies

3. OBJECTIVE The purpose of this study is to evaluate the results of treatment of indolent NHL and CLL by FC and FCR.

4. MATERIAL AND METHODS Descriptive, retrospective study Patients with CLL or indolent lymphomas treated by FC or FCR between 1998 and 2004 Overall survival (OS) and disease-free interval (DFI) have been calculated, and response to treatment registered

5. RESULTS 43 patients, 33 treated by FC and 10 by FCR 26 (60%) ♀ ; 17 (40%) ♂ Mean age = 62.07 years old Median age = 61 years old 53.5% treated first line 23.3% received Rituximab

7. Type and Stage FollicularN = 23 (53.5%) SLL/CLLN = 19 (44.2%) MantleN = 1 (2.3%) Stage IN = 1 ( 2.3%) Stage IIN = 8 (18.6%) Stage IIIN = 10 (23.3%) Stage IVN = 24 (55.8%)

8. FLIPI index Solal-Celigny et al. Blood 2004

9. Prognostic Factors B signs: 79% of patients Bone marrow infiltration: 70% of patients Bulky disease: 18.6% of patients Mean LDH = 775 (Nl: 313-618). 40% elevated 57% above 60 years old 79.1% stage III or IV

11. Survival Relapse rate = 51.2% DFI = 20 months Overall survival:  85% at 1 year  68% at 3 years  55% at 5 years

12. Hematological Toxicities AnemiaNeutropeniaThrombocytopenia Gr 0 N = 23 (53.5%) N = 10 (23.3%) N = 22 (51.2%) Gr 1 N = 6 (14.0%) N = 6 (14.0%) N=10 (23.3%) Gr 2 N = 10 (23.3%) N = 15 (34.9%) N = 7 (16.3%) Gr 3 N = 4 (9.3%) N = 11 (25.6%) N = 4 (9.3%) Gr 4 N = 0N = 1 (2.3%) N = 0

13. Survival Confounding Factors

14. Best Response (DFI) P = 0.003

15. Best Response (OS) P = 0.000

16. Bulky Disease (DFI) P = 0.002

17. CONCLUSION Epidemiology, patient and disease characteristics from our series concur with the published data The first FCR paper published by MD Anderson* showed a RR of 95% (CR = 70%). All patients received Rituximab and were treated upfront. They were younger and had less advanced disease Update of our series is expected in 2009 with almost 100 patients and uniform administration of Rituximab * J Clin Oncol 2005;23(18):4079-88