1 / 30

ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD

ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD. Abstract # 43 Mini-allo for AML Herr et al EBMT Review. Mini-allo for AML EBMT Registry. n = 204 Age 58 (median) Sib and MUD donors Regimen - Flu/Bu, Flu/TBI FU 13mo 1-yr TRM 15% 1-yr Rel 34% 1-yr LFS 50%

luyu
Download Presentation

ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD

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. ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006Charles LinkerMD

  2. Abstract # 43Mini-allo for AMLHerr et alEBMT Review

  3. Mini-allo for AMLEBMT Registry n = 204 Age 58 (median) Sib and MUD donors Regimen - Flu/Bu, Flu/TBI FU 13mo 1-yr TRM 15% 1-yr Rel 34% 1-yr LFS 50% 1-yr OS 62%

  4. Abstract # 47Mini-allo for AMLShimoni et alTel Hashomer, Israel

  5. Mini-allo AMLIsrael n = 67 Age > 55 Sib and MUD donors Regimen - Flu/Bu FU 22mo 2-yr TRM 8% 2-yr OS 47% If CR1: 2-yr OS 80%, TRM 0%

  6. CALGB 100103Phase II Study of mini-allo for AML CR1, age > 60 Study Chair: Steve Devine CTN co-chair: Sergio Giralt

  7. CALGB 100103Background - 1 • Poor results of chemotherapy • No signs of progress in chemotherapy • New approaches are warranted

  8. CALGB 100103CALGB background data • Analysis of 600 CALGB AML age > 60 with cytogenetics CR 50% 5-year OS 7% !!! Cytogenetics predictive of outcome

  9. P<0.001 < 5 Abnormalities 5 Abnormalities AML CR1, age > 60DFS by Cytogenetics

  10. AML CR1, age > 60OS by Cytogenetics

  11. AML CR1, age > 60OS by Age

  12. CALGB 100103Background - 2 • Results in best group are still poor (n = 276) CR1 Age 60-75 Receive first consolidation on randomized trial • 2-year DFS 24% • 3-year DFS 17%

  13. CALGB 100103Eligibility - 1 • AML CR1 Prior MDS, t-AML allowed < 2 cycles induction < 2 courses consolidation < 6 months in CR1 exclude APL, prior MPD • Age 60-74 • Matched sibling or 10/10 MUD donor

  14. CALGB 100103Eligibility - 2 • PS 0 - 2 • Adequate organ function DLCO > 40% EF > 30% Creatinine clearance > 40 Bili < 2.0 AST < 3x normal

  15. CALGB 100103 Preparative Regimen • Fludarabine 30 mg/m2 x 5 days -7 to -3 • Busulfan 0.8 mg/kg IV x 8 days -4 to -3 • Thymoglobulin 2.5 mg/kg x 3 days -4 to -2 • Stem cell infusion day 0

  16. CALGB 100103 GVH Prophylaxis • Tacrolimus day - 2 to +90 • MTX 5 mg/m2 days, +1, 3, 6, 11 • Taper tac day +90 to +150/+180

  17. CALGB 100103 Statistics • Primary objective 2-year DFS > 35% 90% power to exclude DFS < 20% • Accrual goal = 61 • Stopping rules for TRM Assume true TRM 20% Unacceptable TRM 40%

  18. CALGB 100103 • Currently active in CALGB sib donors only • Amendment in process Add CTN Add MUD

  19. Mini-allo for AML, age > 60 • Currently treatments work poorly • Mini-allo is feasible • Several pilot studies show DFS > 40% • Deserves testing in Group setting • CALGB 100103 is last chance for USA study

  20. Abstract # 146Ph+ ALLDellanoy et alGRALL, France

  21. Ph+ ALL,age > 55Treatment • Pre-phase Prednisone x 1 week • Induction CyDVP Imatinib 600 x 2 mo • Consolidation 10 blocks of chemo 2 x 2 mo imatinib • CNS-P i.t. mtx + cranial RT

  22. Ph+ ALL, age > 55Results N = 30 Age 66 (58 - 78) FU 15mo CR 20/29 ( vs 6/21 historical control) 1-yr OS 71% (11% control) 1-yr EFS 57% (5% control)

  23. ASCT for high-risk ALLProtocol 9501 & SOC

  24. Protocol 9501 SOC for Ph+Effect of Imatinib

  25. Ph+ ALLRole of Imatinib • Plays major role in induction Safe to combine with chemotherapy Increases remission rate • Encouraging results post-remission • May play role in transplant Allo transplant is treatment of first choice Patients get to transplant in remission May reduce relapse rate ASCT being tested in CALGB 10001 May allow PCR neg stem cells for ASCT

  26. Abstract # 150Nelarabine for T-ALLGoekbuget et alGMALL, Germany

  27. CALGB 19801De Angelo et alASH #743 (2002) • Eligibility T-ALL or T-LL Relapse or refractory • Treatment Nelarabine (GW 506U) 1.5g/m2 days 1, 3, 5 q3 weeks x 2 cycles Responders may get additional 2 cycles • Results 10/38 CR (26%) MDCR 10mo 1-yr DFS 40%

  28. NelarabinePatients and Treatment • n = 53 • Age 31 (19 - 81) • Disease category: First relapse 36 Second relapse 7 Relapse after transplant 7 Refractory 3 • Treatment: Nelarabine 1.5g/m2 days 1, 3, 5

  29. NelarabineResults 25/53 CR (47%) 19/25 Cr go to transplant OS 16% OS of CR 27%

  30. Nelarabine for T-ALL • Important new agent • Good choice for relapse • Should be tested up front

More Related