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Follicular & Aggressive B-Cell

Lymphomas. Follicular & Aggressive B-Cell. Five-year TTF and Response Duration (RD) According to FLIPI Risk Group. Adapted from Hoster et al. 10-ICML 2008, abstract 330. Characteristics Still True of Follicular Lymphoma in 2008. Most common single type of lymphoma in North America

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Follicular & Aggressive B-Cell

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  1. Lymphomas Follicular & Aggressive B-Cell

  2. Five-year TTF and Response Duration (RD) According to FLIPI Risk Group Adapted from Hoster et al. 10-ICML 2008, abstract 330.

  3. Characteristics Still True of Follicular Lymphoma in 2008 • Most common single type of lymphoma in North America • Median age at presentation: 65 years • 90% harbour advanced-stage disease requiring systemic intervention • 40% asymptomatic patients  no initial intervention needed • >80% of asymptomatic patients require treatment within 4–5 years • Median survival • >7–8 years overall • >12–15 years in patients <65 years old • 10% to 20% die in the first 2 years • Most patients die due to lymphoma • Transformation to DLBCL 3% per year and often proves rapidly fatal Adapted from Connors JM. 10-ICML 2008.

  4. Results with Addition of Rituximab • Addition to primary chemotherapy improves • Progression-free survival (PFS) • Overall survival (OS) • Addition to second-line chemotherapy improves • PFS and OS • Maintenance therapy with rituximab improves • PFS and OS • Definite after second-line immunochemotherapy • Probable after primary immunochemotherapy • It can be given safely by rapid infusion, sparing treatment resources • It substantially improves outcomes for transformed lymphoma Adapted from Connors JM. 10-ICML 2008.

  5. Follicular Lymphoma:BC Cancer Agency Approach • Limited stage • Involved field radiation 50% eventually progress • Advanced stage, asymptomatic • Observation 90% eventually progress • Advanced stage, symptomatic • R-CVP x 8 cycles • Maintenance rituximab 375 mg/m2 q 3 months x 8 doses (2 years) • All doses of rituximab after first dose given by rapid infusion (90 min) • 20% over 30 min (50 or 100 mL) • 80% over 60 min (200 or 400 mL) Adapted from Connors JM. 10-ICML 2008.

  6. Follicular Lymphoma: BC Cancer Agency Approach Previously untreated patients with symptomatic FL R-CVP x 8 cycles >90% with responsive disease also receive maintenance rituximab 375 mg/m2 q 3months for 2 years Transformed disease: add doxorubicin (R-CHOP) + rituximab maintenance • Benefits: • Reserves doxorubicin until crucially necessary • Maximizes impact of immunotherapy with rituximab • Minimizes overall impact on resources • Rapid rituximab infusion convenient for outpatient treatment: (maintenance with 8 cycles) Adapted from Connors JM. 10-ICML 2008.

  7. European MCL Network: Results of Combined Immunochemotherapy at 12 Months n=269 n=286 Adapted from Dreyling et al. 10-ICML 2008, abstract 300.

  8. DA-EPOCH-R Regimen Adapted from Dunleavy et al. 10-ICML 2008, abstract 009.

  9. DA-EPOCH-R: Results and Conclusions in Patients with Untreated Burkitt’s Lymphoma (BL) • Median follow-up: 28 months • Responses (n=24):Toxicity: • CR/CRu 100% One case of tumour • OS 100% lysis syndrome • EFS 96% FN in 16% of cycles • Conclusions: • Highly effective in BL • Low toxicity in all patient groups • Future study planned in BL with risk-adaptive design Adapted from Dunleavy et al. 10-ICML 2008, abstract 009.

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