Cladribine + Rituximab in HCL : UPDATE

Cladribine+ Rituximab in HCL : UPDATE Farhad Ravandi, MD Professor of Medicine University of Texas – M. D. Anderson Cancer Center

HCL - Questions • Can we design a regimen with higher efficacy than single agent nucleoside analogs? (with no increased toxicity) • Can we predict those who relapse? • Can we design a better regimen for variant HCL?

Cladribine followed by Rituximab BM C C C C C BM R R R R R R R R BM Days: 1 2 3 4 5 28 Weeks: 1 2 3 4 5 6 7 8 C - Cladribine R - Rituximab

Enrollment and Response * 1 Patient died in CR from other malignancies ** 2 Patients died in CR from other malignancies

Remission Duration

Survival

Response to first, second, third line therapy P 0.001 Else M, Cancer, 2005

DFS after successive courses of NA P=0.00005 Else M, Cancer, 2005

Patients Treated in First Relapse

Ongoing Trials at MDACC NCT00412594 -Cladribinefollowed by rituximab in frontline HCLNCT01829711 -MoxetumomabPasudotox in relapsed HCLNCT01841723 -Ibrutinib in relapsed HCLNCT02034110 -Debrafenib+Trametinib in relapsed HCL

Thank you fravandi@mdanderson.org 713-745-0394

Cladribine + Rituximab in HCL : UPDATE