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

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Presentation transcript:

vervolg CASUS

september inmiddels 6 kuren R-CVP ondergaan -restadiering: PR EN NU?

september watch and wait -onderhoud rituximab -autologe SCT

onderhoud rituximab 1e lijn

Vidal et al. Rituximab tmaintenance for the treatment of patient with follicular lymphoma: systematic review and meta-analysis of randomized trials. J Natl Cancer Inst 2009; 101:

onderhoud rituximab 1e lijn Hochster et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednison prolongs progression-free survival in advanced indolent lymphoma: results of the randomized phase III ECOG 1496 study. J Clin Oncol 2009; 27 (10):

onderhoud rituximab 1e lijn 3jaar 4.3 jr vs 1.3 jr (p<0.001) Hochster et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednison prolongs progression-free survival in advanced indolent lymphoma: results of the randomized phase III ECOG 1496 study. J Clin Oncol 2009; 27 (10):

onderhoud rituximab 1e lijn Hochster et al. Maintenance rituximab after cyclophosphamide, vincristine, and prednison prolongs progression-free survival in advanced indolent lymphoma: results of the randomized phase III ECOG 1496 study. J Clin Oncol 2009; 27 (10): jaar 91% vs 86% (p = 0.08)

Vidal et al. Rituximab tmaintenance for the treatment of patient with follicular lymphoma: systematic review and meta-analysis of randomized trials. J Natl Cancer Inst 2009; 101: onderhoud rituximab 1e lijn

PRIMA study?????

autologe SCT in 1e lijn

Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood

autologe in 1e lijn conditionering middels TBI en cyclofosfamide

autologe SCT in 1e lijn Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood 64% vs 39% (p = 0.004) plateau na 7 jaar

autologe SCT in 1e lijn Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood 76% vs 80% (NS)

autologe SCT in 1e lijn Deconinck E, et al. High-dose therapy followed by autologeous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood

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

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

allo SCT autologe SCT RCHOP plus onderhoud R

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003; 102: 3521 allo?

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003; 102: 3521

allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003; 102: 3521

allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003; 102: 3521

allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 203; 102: 3521

allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003; 102: % vs 62% vs 55%

allo? Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 2003; 102: 3521

allo? Khouri et al. Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111

allo? Khouri et al. Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111

allo? Khouri et al. Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab. Blood 2008; 111

rituximab onderhoud

-1:1 open label trial fase III trial -nov 1998 – april graad 1-3 FL stadium 3-4 -relapse after or resistance to a maximum of 2 nonanthracycline-containing chemotherapy rituximab onderhoud

-remissie-inductie: * CHOP * RCHOP indien na 6 kuren PR of CR  2e randomisatie * observatie167 * onderhoud rituximab 167 (375 mg/m2 per 3 maanden) rituximab onderhoud

remissie-inductie; response rates Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295

remissie-inductie; PFS Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295 median PFS 20.2 vs 33.1 months P < 0.001

remissie-inductie; OS Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: jrn: 71.9% vs 82.5% (p = 0.096)

rituximab onderhoud; PFS Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295 median PFS 51.5 vs 14.9 months P < 0.001

rituximab onderhoud; OS Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: jaar; 77.1% vs 85.1% (p = 0.011)

rituximab onderhoud; OS Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma: Long-term outcome of the EORTC phase III randomized intergroup study. Blood 2008; 112: 108: jaar OS; 74% vs 64% (p = 0.07) (veel R als salvage)

Overall survival Van Oers et al. Rituximab mainterance improves clinical outcome of relapsed/resistant follicular lnon-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006;108: 3295

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

Vidal et al. Rituximab tmaintenance for the treatment of patient with follicular lymphoma: systematic review and meta-analysis of randomized trials. J Natl Cancer Inst 2009; 101:

autologe SCT

autologe SCT; PFS

autologe SCT; OS

discussiepunten: -early closure (planned evalueerbaar) -pre rituximab tijdperk

Wat indien pt laat recidief had gehad?

-allo SCT -autologe SCT -RCHOP met onderhoud R -opnieuw RCVP