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vervolg CASUS

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.

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vervolg CASUS

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  1. vervolg CASUS

  2. september 2009 • inmiddels 6 kuren R-CVP ondergaan • restadiering: PR EN NU?

  3. september 2009 • watch and wait • onderhoud rituximab • autologe SCT

  4. onderhoud rituximab 1e lijn

  5. onderhoud rituximab 1e lijn Vidal et al. Rituximabtmaintenancefor the treatment of patient with follicularlymphoma: systematicreview and meta-analysis of randomized trials. J NatlCancerInst 2009; 101: 248-255

  6. onderhoud rituximab 1e lijn Hochster et al. Maintenancerituximabaftercyclophosphamide, vincristine, and prednison prolongsprogression-free survival in advanced indolent lymphoma: results of the randomizedphase III ECOG 1496 study. J ClinOncol 2009; 27 (10): 1607-1614

  7. onderhoud rituximab 1e lijn 3jaar 4.3 jrvs 1.3 jr (p<0.001) Hochster et al. Maintenancerituximabaftercyclophosphamide, vincristine, and prednison prolongsprogression-free survival in advanced indolent lymphoma: results of the randomizedphase III ECOG 1496 study. J ClinOncol 2009; 27 (10): 1607-1614

  8. onderhoud rituximab 1e lijn 3jaar 91% vs 86% (p = 0.08) Hochster et al. Maintenancerituximabaftercyclophosphamide, vincristine, and prednison prolongsprogression-free survival in advanced indolent lymphoma: results of the randomizedphase III ECOG 1496 study. J ClinOncol 2009; 27 (10): 1607-1614

  9. onderhoud rituximab 1e lijn Vidal et al. Rituximabtmaintenancefor the treatment of patient with follicularlymphoma: systematicreview and meta-analysis of randomized trials. J NatlCancerInst 2009; 101: 248-255

  10. onderhoud rituximab 1e lijn PRIMA study?????

  11. autologe SCT in 1e lijn

  12. autologe SCT in 1e lijn Deconinck E, et al. High-dosetherapyfollowedbyautologeouspurgedstem-celltransplantation and doxorubicin-basedchemotherapy in patients with advancedfollicularlymphoma: a randomizedmulticenterstudyby GOELAMS. Blood

  13. autologe in 1e lijn conditionering middels TBI en cyclofosfamide

  14. autologe SCT in 1e lijn plateau na 7 jaar 64% vs 39% (p = 0.004) Deconinck E, et al. High-dosetherapyfollowedbyautologeouspurgedstem-celltransplantation and doxorubicin-basedchemotherapy in patients with advancedfollicularlymphoma: a randomizedmulticenterstudyby GOELAMS. Blood

  15. autologe SCT in 1e lijn 76% vs 80% (NS) Deconinck E, et al. High-dosetherapyfollowedbyautologeouspurgedstem-celltransplantation and doxorubicin-basedchemotherapy in patients with advancedfollicularlymphoma: a randomizedmulticenterstudyby GOELAMS. Blood

  16. autologe SCT in 1e lijn Deconinck E, et al. High-dosetherapyfollowedbyautologeouspurgedstem-celltransplantation and doxorubicin-basedchemotherapy in patients with advancedfollicularlymphoma: a randomizedmulticenterstudyby GOELAMS. Blood

  17. januari 2009 verklaringen: • better survival rates of relapsing patients in the chemotherapy arm • more secondary cancers in HDT arm

  18. januari 2009 progressie…. C/ vroeg recidief (binnen 6 maanden) EN NU?

  19. allo SCT autologe SCT RCHOP plus onderhoud R

  20. allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 2003; 102: 3521

  21. allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 2003; 102: 3521

  22. allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 2003; 102: 3521

  23. allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 2003; 102: 3521

  24. allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 203; 102: 3521

  25. allo? 51% vs 62% vs 55% Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 2003; 102: 3521

  26. allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem celltransplantationforfollicularlymphoma. Blood 2003; 102: 3521

  27. allo? Khouri et al. Eight-yearexperience with allogeneic stem celltransplantationforrelapsedfollicularlymphomaafternonmyeloablativeconditioning with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111

  28. allo? Khouri et al. Eight-yearexperience with allogeneic stem celltransplantationforrelapsedfollicularlymphomaafternonmyeloablativeconditioning with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111

  29. allo? Khouri et al. Eight-yearexperience with allogeneic stem celltransplantationforrelapsedfollicularlymphomaafternonmyeloablativeconditioning with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111

  30. rituximab onderhoud

  31. 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

  32. 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)

  33. remissie-inductie; response rates Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma in patients both with and without rituximabduringinduction: results of a prospectiverandomizedphase 3 intergroup trial. Blood 2006;108: 3295

  34. remissie-inductie; PFS median PFS 20.2 vs 33.1 months P < 0.001 Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma in patients both with and without rituximabduringinduction: results of a prospectiverandomizedphase 3 intergroup trial. Blood 2006;108: 3295

  35. remissie-inductie; OS 3 jrn: 71.9% vs 82.5% (p = 0.096) Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma in patients both with and without rituximabduringinduction: results of a prospectiverandomizedphase 3 intergroup trial. Blood 2006;108: 3295

  36. rituximab onderhoud; PFS median PFS 51.5 vs 14.9 months P < 0.001 Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma in patients both with and without rituximabduringinduction: results of a prospectiverandomizedphase 3 intergroup trial. Blood 2006;108: 3295

  37. rituximab onderhoud; OS 3 jaar; 77.1% vs 85.1% (p = 0.011) Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma in patients both with and without rituximabduringinduction: results of a prospectiverandomizedphase 3 intergroup trial. Blood 2006;108: 3295

  38. rituximab onderhoud; OS 5 jaar OS; 74% vs 64% (p = 0.07) (veel R als salvage) Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma: Long-termoutcome of the EORTC 20981 phase III randomizedintergroupstudy. Blood 2008; 112: 108: 3295

  39. Overall survival Van Oers et al. Rituximabmainteranceimprovesclinicaloutcome of relapsed/resistantfollicularlnon-Hodgkinlymphoma in patients both with and without rituximabduringinduction: results of a prospectiverandomizedphase 3 intergroup trial. Blood 2006;108: 3295

  40. rituximab onderhoud C/ R maintenance treatment results in a major improvement in PFS (not OS) both after chemotherapy and immunotherapy

  41. rituximab onderhoud Vidal et al. Rituximabtmaintenancefor the treatment of patient with follicularlymphoma: systematicreview and meta-analysis of randomized trials. J NatlCancerInst 2009; 101: 248-255

  42. autologe SCT

  43. autologe SCT

  44. autologe SCT

  45. autologe SCT; PFS

  46. autologe SCT; OS

  47. discussiepunten: • early closure (planned 250-89 evalueerbaar) • pre rituximab tijdperk

  48. Wat indien pt laat recidief had gehad?

  49. allo SCT • autologe SCT • RCHOP met onderhoud R • opnieuw RCVP

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