FC and FCR in CLL and Indolent NHL: A descriptive retrospective institutional study Aftimos P, Chahine G Hotel-Dieu de France University Hospital Beirut,

Slides:

Advertisements

Similar presentations

What is the Optimal Approach to CLL, BR vs. FCR/FR?

Advertisements

An Intergroup Randomised Trial of Rituximab versus a Watch & Wait Approach in Patients with Advanced Stage, Asymptomatic, Non-bulky Follicular Lymphoma.

13th Annual Hematology & Breast Cancer Update Update in Lymphoma

Follicular Lymphoma Laurie H. Sehn, MDCM, MPH BC Cancer Agency Vancouver, Canada.

Follicular lymphoma Optimal primary therapy and consolidation ? Seminars in Hematological Oncology * Israel, April M. Dreyling, Dept. of Medicine.

Casulo C et al. Proc ASH 2013;Abstract 510.

Spotlight on Chronic Lymphocytic Leukemia and Indolent Non-Hodgkin's Lymphoma: European and US Perspectives on the Evolving Standard of Care Bruce Cheson,

Kovacs G et al. Proc ASH 2014;Abstract 23.

Agne Paner, MD Assistant professor of Medicine RUSH University Medical Center.

M. BENDARI, M. Rachid, S. Marouane, A. Quessar, S. Benchekroun Department of Hematology-Oncology pediatric Hospital 20 Aout, CHU Ibn Rochd Casablanca.

Jonathan W. Friedberg M.D., M.M.Sc. University of Rochester Medical Center Optimal frontline therapy for Follicular lymphoma: Do we need to start with.

Rituximab Maintenance: Stage III/IV Follicular Lymphoma (ECOG/CALGB E1496) Subset: 237 FL pts CVP x 6-8 → PR/CR (cyclophosphamide, vincristine, prednisone)

Eastern cooperative oncology group E1496: ECOG and CALGB Cyclophosphamide/Fludarabine (CF) with or without Maintenance Rituximab (MR) in Advanced Indolent.

HELIOS – Klinikum Erfurt

Experience and Outcomes with Hypofractionated Concurrent Chemoradiation for Stage III NSCLC at NCCC Gregory Webb Medical Student.

Alliance/CALGB 50803: A Phase 2 Trial of Lenalidomide plus Rituximab in Patients with Previously Untreated Follicular Lymphoma1 The ‘RELEVANCE’ Trial:

MANAGEMENT OF MANTLE CELL LYMPHOMA IN TUNISIA R BEN LAKHAL, L KAMMOUN, K ZAHRA, S KEFI Sousse 25 MAY 2012.

Background Diffuse large B-cell lymphoma (DLBCL) is the most commonly occurring lymphoma in the Western world. It’s account for about one-third of all.

Treatment of B Cell Malignancies: Current and Emerging Strategies Thomas A. Rado, MD, PhD.

Rituximab efficacy in other haematological malignancies Christian Buske.

NHL13: A Multicenter, Randomized Phase III Study of Rituximab as Maintenance Treatment versus Observation Alone in Patients with Aggressive B ‐ Cell Lymphoma.

Sequential Dose-Dense R-CHOP Followed by ICE Consolidation (MSKCC Protocol ) without Radiotherapy for Patients with Primary Mediastinal Large B Cell.

Consolidation treatment with Y 90 Ibritumomab Tiuxetan after R-CHOP induction in high-risk patients with Follicular Lymphoma (FL) (GOTEL-FL1LC): a multicentric,

Alternating Courses of CHOP and DHAP Plus Rituximab (R) Followed by a High-Dose Cytarabine Regimen and ASCT is Superior to Six Courses of CHOP Plus R Followed.

Rituximab maintenance for the treatment of indolent NHL Dr Christian Buske.

A phase III trial comparing R-CHOP 14 and R-CHOP 21 for the treatment of newly diagnosed diffuse large B cell lymphoma Results from a UK NCRI Lymphoma.

Rituximab Maintenance versus Wait and Watch After Four Courses of R-DHAP Followed by Autologous Stem Cell Transplantation in Previously Untreated Young.

Gray Zone Lymphoma (GZL) with Features Intermediate between Classical Hodgkin Lymphoma (cHL) and Diffuse Large B-Cell Lymphoma (DLBCL): A Large Retrospective.

Optimal use of rituximab in aggressive NHL

Corinne Haioun et al. Survival benefit of high dose therapy in poor risk aggressive non Hodgkin’s lymphoma: final analysis of the prospective LNH87-2 protcol-

Increased Incidence of Therapy- Related Myeloid Neoplasia (t-MN) After Initial Therapy for CLL with Fludarabine-Cyclophosphamide (FC) vs Fludarabine (F):

1 Flinn I et al. Proc ICML 2013;Abstract 084.

Frontline Chemoimmunotherapy with Fludarabine (F), Cyclophosphamide (C), and Rituximab (R) (FCR) Shows Superior Efficacy in Comparison to Bendamustine.

Safety and Efficacy of Abbreviated Induction with Oral Fludarabine (F) and Cyclophosphamide (C) Combined with Dose-Dense IV Rituximab (R) in Previously.

A Phase 1 Study of the Selective Phosphatidylinositol 3-Kinase-Delta (PI3Kδ) Inhibitor, Idelalisib (GS- 1101) in Combination with Rituximab and/or Bendamustine.

An Open-Label, Randomized Study of Bendamustine and Rituximab (BR) Compared with Rituximab, Cyclophosphamide, Vincristine, and Prednisone (R-CVP) or Rituximab,

Who can benefit from chemotherapy holidays after first-line therapy for advanced colorectal cancer ? N. Perez-Staub, B. Chibaudel, A. Figer, A. Cervantes,

Ibrutinib in Combination with Rituximab (iR) Is Well Tolerated and Induces a High Rate of Durable Remissions in Patients with High- Risk Chronic Lymphocytic.

Chemoimmunotherapy with Fludarabine (F), Cyclophosphamide (C), and Rituximab (R) (FCR) versus Bendamustine and Rituximab (BR) in Previously Untreated and.

Phase II Trial of R-CHOP plus Bortezomib Induction Therapy Followed by Bortezomib Maintenance for Previously Untreated Mantle Cell Lymphoma: SWOG 0601.

Christian Buske Attending Physician and Assistant Professor, University Hospital Grosshadern, Munich, Germany Prior posts at the University Hospital Göttingen,

R-CHOP with Iodine-131 Tositumomab Consolidation for Advanced Stage Diffuse Large B-Cell Lymphoma (DLBCL): Southwest Oncology Group Protocol S0433 Friedberg.

Nabhan C et al. Proc ICML 2013;Abstract 102.

A European Collaborative Study of 230 Patients to Assess the Role of Cyclophosphamide, Bortezomib and Dexamethasone in Upfront Treatment of Patients with.

BENEFIT OF CONSOLIDATIVE RADIATION THERAPY IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA TREATED WITH R-CHOP CHEMOTHERAPY JACK PHAN, ALI MAZLOOM, L. JEFFREY.

GALLIUM: Obinutuzumab- vs Rituximab-Based Immunochemotherapy in Patients With Untreated Follicular Lymphoma New Findings in Hematology: Independent Conference.

Phase II SAKK 35/10 Trial: Rituximab Plus Lenalidomide Shows Durable Activity in Untreated Follicular Lymphoma New Findings in Hematology: Independent.

Summary Author: Dr. C. Tom Kouroukis, MD MSc FRCPC

Geisler C et al. Proc ASH 2011;Abstract 290.

Campos M et al. Proc EHA 2013;Abstract B2009.

Campos M et al. Proc EHA 2013;Abstract B2009.

A Phase III Randomized Intergroup Trial (SWOG S0016) of CHOP Chemotherapy plus Rituximab vs CHOP Chemotherapy plus Iodine-131-Tositumomab for the Treatment.

Figure #1 Overall survival Figure #2 Disease free survival

New Findings in Hematology: Independent Conference Coverage

What do we do after FOLFIRINOX? Gemcitabine-Based Therapy is Standard

WHAT IS THE BEST Front-Line REGIMEN for Patients With CLL

Fowler NH et al. Proc ASCO 2010;Abstract 8036.

Stephen Ansell, MD, PhD Mayo Clinic

R-CHOP Stem Cell Transplantation for Follicular Lymphoma

Jonathan W. Friedberg M.D., M.M.Sc.

Badoux X et al. Proc ASCO 2010;Abstract 6508.

Vitolo U et al. Proc ASH 2011;Abstract 777.

What is the optimal management of an asymptomatic 62 year old with low tumor burden, stage IV, grade 1-2 FL? Answer: R-chemotherapy Peter Martin,

CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma by Robert Marcus, Kevin Imrie, Andrew Belch,

What is the optimal management of a 43-year-old man with high-risk FL not in CR after R-chemo? Answer: Radioimmunotherapy Peter Martin, M.D. The Charles,

Stephen Ansell, MD, PhD Mayo Clinic

Fowler NH et al. Proc ASH 2011;Abstract 99.

Follicular lymphoma Every patient should be treated at diagnosis

What is the best frontline regimen for CLL patients

Role for XRT in treatment of early stage Follicular lymphoma?

Presentation transcript:

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

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

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

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

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

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%)

FLIPI index Solal-Celigny et al. Blood 2004

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

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

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

Survival Confounding Factors

Best Response (DFI) P = 0.003

Best Response (OS) P = 0.000

Bulky Disease (DFI) P = 0.002

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):