1 / 28

MANAGEMENT OF MANTLE CELL LYMPHOMA IN TUNISIA

MANAGEMENT OF MANTLE CELL LYMPHOMA IN TUNISIA. R BEN LAKHAL , L KAMMOUN , K ZAHRA , S KEFI. Sousse 25 MAY 2012. MCL uncommon lymphoma. T lymphoblastic: 2%. Other: 9%. Marginal zone, nodal: 2%. Burkitt: 2%. Anaplastic large cell: 2 %. Diffuse large B cell: 31%.

odina
Download Presentation

MANAGEMENT OF MANTLE CELL LYMPHOMA IN TUNISIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


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

  2. MCL uncommon lymphoma T lymphoblastic: 2% Other: 9% Marginal zone, nodal: 2% Burkitt: 2% Anaplastic large cell: 2% Diffuse large B cell: 31% Mediastinal large B cell: 2% Mantle cell: 6% Small lymphocytic/CLL: 7% Peripheral T cell: 7% Follicular: 22% Marginal zone, extranodal: 8% Armitage JO, et al. J Clin Oncol. 1998;16:2780-2795.

  3. Introduction Mantel Cell Lymphoma (MCL) : Aggressive B-cell Malignancy. Complex pathophysiology : t(11, 14)  aberrant expression of cylcin D1. Advanced non-bulky disease. Diagnosed at age 60 to 65 years. Short median survival (3 years) despite intensive therapy.

  4. OBJECTIVE • Retrospective Tunisian multicenter study : • Analyze epidemiological,clinical and biological features of tunisian MCL patients. • Evaluate the response to treatement according to classical prognostic factors. • Analyze the event free survival (EFS) and the overal survival (OS) according to prognostic factors

  5. 32 patients : 2000-2011 3 centers : Tunis : 20 patients Sousse : 7 patients Sfax : 5 patients PATIENTS

  6. Epidémiologic Features Annual incidence of MCL

  7. Epidémiologic Features Median age : 62 years ( 30-84 years) 23 males ( 72%) Sex-ratio : 2.55

  8. Clinical and biological features

  9. Prognosis of patients

  10. Methods STATISTIC STUDY 1- Predictives response factors : ( Chi-square test, p < 0.05 ) 2 - The EFS «event free survival» and the OS «overall survival» : (Kaplan-Meier method and Log-Rank test) - Univariate study - Multivariate study

  11. Treatment Features • 30 patients treated (1death, 1 lost to follow-up) • 25/30 patients received Rituximab (83%) • 2 patients treated on 2001 • 3 patients > 75 years (Mini-CEOP) • Chemotherapy : • CHOP/DHAP = 12 patients ( 40%) • CHOP = 13 patients ( 43.3%) • Velcade – CHP = 2 patients (6.6%) • Mini-CEOP = 3 patients ( 10%) • Autologous stem cell transplantation = 5 patients (13pts<60 years) Allogeneic stem cell transplantation : 1 patient

  12. Response of Treatment 30 patients treated 4 lost to follow-up (13 %) 26 evaluables patients CR 11 patients (42%) Failure/progression 08 patients (31%) PR 07 patients (27%) ORR = 69% 6 Deaths (4 toxic deaths)

  13. Response according to prognostic factors

  14. Response according to prognostic factors

  15. OVERALL SURVIVAL (OS) OS : 60% (5years)

  16. OS according to prognostic factors • One significant adverse prognostic factor : failure to treatement OR Failure

  17. Event free survival (EFS) EFS(5years) : 52%

  18. DEATHS : 8 patients • 1 death before treatement • 5 toxic deaths • 2 deaths progression RELAPSES • One relapse • Late relapse (5 years) • Post ASCT

  19. DISCUSSION • Epidemiological , clinical and biological characteristics of Tunisian patients are comparables to littérature data. • annual incidence increasing ? or improvement of diagnosis tools ?

  20. DISCUSSION PROGNOSIS • There is no generally established prognostic index for patients with MCL. • For our patients : IPI>2 (High risk patients) : 20 (62%) MIPI evaluated in 16 patients High risk patients : 8 (50%)

  21. MIPI > FLIPI > IPI

  22. Biologic MIPI = MIPI + proliferation marker Ki-67

  23. DISCUSSION TREATMENT • Aggressive therapies including chemo-immunotherapy or high dose chemotherapy followed by autologous stem cell transplant have been shown to improve outcome BUT no standard therapy offers the potential for cure. • Our patients : Immunotherapy : all younger patients RCHOP/RDHAP : 12 patients ASCT : only 5 patients (13 pts < 60 yrs) ORR : 69% (DHAP : ORR at 80%) OS : 60% EFS : 52%

  24. Role of cytarabine (Ara-C)

  25. Role of ASCT

  26. CONCLUSION • Epidemiological , clinical and biological characteristics of Tunisian patients are comparables to littérature data. • Therapeutic results must be improved +++ Younger patients (< 60 yrs) : HD Arac + ASCT Patients <40yrs : allogeneic transplantation Older patients : RCHOP +/- Rituximab maintenance • Salvage therapy +++ • Better management of toxicity

More Related