Transcript PowerPoint-presentatie

vervolg CASUS
september 2009
- inmiddels 6 kuren R-CVP ondergaan
- restadiering: PR
EN NU?
september 2009
- watch and wait
- onderhoud rituximab
- autologe SCT
onderhoud rituximab 1e lijn
onderhoud rituximab 1e lijn
Vidal et al. Rituximab tmaintenance for the treatment of patient with follicular lymphoma: systematic review and meta-analysis of randomized trials.
J Natl Cancer Inst 2009; 101: 248-255
onderhoud rituximab 1e lijn
Hochster et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednison prolongs progression-free survival in advanced indolent
lymphoma: results of the randomized phase III ECOG 1496 study. J Clin Oncol 2009; 27 (10): 1607-1614
onderhoud rituximab 1e lijn
3jaar 4.3 jr vs 1.3 jr (p<0.001)
Hochster et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednison prolongs progression-free survival in advanced indolent
lymphoma: results of the randomized phase III ECOG 1496 study. J Clin Oncol 2009; 27 (10): 1607-1614
onderhoud rituximab 1e lijn
3jaar 91% vs 86% (p = 0.08)
Hochster et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednison prolongs progression-free survival in advanced indolent
lymphoma: results of the randomized phase III ECOG 1496 study. J Clin Oncol 2009; 27 (10): 1607-1614
onderhoud rituximab 1e lijn
Vidal et al. Rituximab tmaintenance for the treatment of patient with follicular lymphoma: systematic review and meta-analysis of randomized trials.
J Natl Cancer Inst 2009; 101: 248-255
onderhoud rituximab 1e lijn
PRIMA study?????
autologe SCT in 1e lijn
autologe SCT in 1e lijn
Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients
with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood
autologe in 1e lijn
conditionering middels TBI
en cyclofosfamide
autologe SCT in 1e lijn
plateau na 7 jaar
64% vs 39% (p = 0.004)
Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients
with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood
autologe SCT in 1e lijn
76% vs 80% (NS)
Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients
with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood
autologe SCT in 1e lijn
Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients
with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood
januari 2009
verklaringen:
- better survival rates of relapsing patients in the
chemotherapy arm
- more secondary cancers in HDT arm
januari 2009
progressie….
C/ vroeg recidief (binnen 6 maanden)
EN NU?
allo SCT
autologe SCT
RCHOP plus onderhoud R
allo?
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 2003; 102: 3521
allo?
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 2003; 102: 3521
allo?
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 2003; 102: 3521
allo?
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 2003; 102: 3521
allo?
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 203; 102: 3521
allo?
51% vs 62% vs 55%
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 2003; 102: 3521
allo?
Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.
Blood 2003; 102: 3521
allo?
Khouri et al. Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning
with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111
allo?
Khouri et al. Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning
with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111
allo?
Khouri et al. Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning
with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111
rituximab onderhoud
rituximab onderhoud
- 1:1 open label trial fase III trial
- nov 1998 – april 2004
- graad 1-3 FL stadium 3-4
- relapse after or resistance to a maximum of 2
nonanthracycline-containing chemotherapy
rituximab onderhoud
- remissie-inductie:
* CHOP
* RCHOP
indien na 6 kuren PR of CR 2e randomisatie
* observatie
167
* onderhoud rituximab
167
(375 mg/m2 per 3 maanden)
remissie-inductie; response rates
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and
without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295
remissie-inductie; PFS
median PFS 20.2 vs 33.1 months
P < 0.001
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and
without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295
remissie-inductie; OS
3 jrn: 71.9% vs 82.5% (p = 0.096)
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and
without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295
rituximab onderhoud; PFS
median PFS 51.5 vs 14.9 months
P < 0.001
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and
without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295
rituximab onderhoud; OS
3 jaar; 77.1% vs 85.1% (p = 0.011)
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and
without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295
rituximab onderhoud; OS
5 jaar OS; 74% vs 64% (p = 0.07)
(veel R als salvage)
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma: Long-term outcome
of the EORTC 20981 phase III randomized intergroup study. Blood 2008; 112: 108: 3295
Overall survival
Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and
without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295
rituximab onderhoud
C/ R maintenance treatment results in a major
improvement in PFS (not OS) both after
chemotherapy and immunotherapy
rituximab onderhoud
Vidal et al. Rituximab tmaintenance for the treatment of patient with follicular lymphoma: systematic review and meta-analysis of randomized trials.
J Natl Cancer Inst 2009; 101: 248-255
autologe SCT
autologe SCT
autologe SCT
autologe SCT; PFS
autologe SCT; OS
discussiepunten:
- early closure (planned 250-89 evalueerbaar)
- pre rituximab tijdperk
Wat indien pt laat recidief had gehad?
- allo SCT
- autologe SCT
- RCHOP met onderhoud R
- opnieuw RCVP