Targeted Therapy in Hematology Dieter Hoelzer – Frankfurt am Main Christoph Zielinski – Vienna, Austria Hans-Joachim Schmoll – Halle, Germany Richard Greil.

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Presentation transcript:

Targeted Therapy in Hematology Dieter Hoelzer – Frankfurt am Main Christoph Zielinski – Vienna, Austria Hans-Joachim Schmoll – Halle, Germany Richard Greil – Salzburg, Austria

“Magic bullets” in Hematology Rituximab (Mab Thera  ) in B-cell NHL Imatinib (Gleevec  ) in CML Thalidomide in multiple myeloma Bortezomib (Velcade  ) in multiple myeloma

Rituximab in Non-Hodgkin’s Lymphoma (1) Indications –Follicular lymphoma first line + CT (CVP) –Follicular lymphoma in third line –Diffuse B cell large cell lymphoma in combination with conventional chemotherapy Treatment –375 mg/m², i.v. –weekly as single agent –Three weekly with chemotherapy –Infusion reaction

Rituximab in Non-Hodgkin’s Lymphoma (2) Questions Other indications for rituximab? Is Id vaccination following chemotherapy superior to passive treatment with anti-CD20 mAb following chemotherapy? Role of radioimmunotherapy for NHL? New antibodies targeting CD20 any better? Other targets in case of resistance against rituximab?

Imatinib (Gleevec  ) in CML (1) Indication Philadelphia chromosome (Ph) positive CML in first line  hematologic, cytogenetic and molecular response Treatment –Orally, mg/day –GI complaints, muscle cramps, superficial edema, leucopenia, neutropenia

Imatinib (Gleevec  ) in CML (2) Questions Second generation of targeted therapic long-term safety? What to do with AMN107 and BMS resistant mutants? Combination of drugs any future?

Thalidomide in Multiple Myeloma (1) Indication Early relapse after 1st and 2nd line therapy or chemotherapy-refractory disease Treatment Orally, mg Teratogenic Fatigue – sleepy – constipation, skin rash Polyneuropathy: sometimes irreversible DVT: 1-3%

Thalidomide in Multiple Myeloma (2) Questions Thalidomide plus dexamethasone standard? Role of lenalidomide (+ dexamethasone)? Long-term outcome?

Bortezomib (Velcade  ) in MM (1) Indication MM patients, who have received at least 2 prior treatment regimens, showing PD Treatment –1.3 mg/m² i.v. push –One cycle: 2 x/week during 2 weeks, then 10 days rest –GI symptomes, tiredness, neuropathy (30%) cytopenia/thrombocytopenia (30%) orthostatic hypotension

Bortezomib (Velcade  ) in MM (2) Questions Can it be used in combination with lenalidomide and lower doses of dexamethasone in order to enhance cytotoxicity end decrease toxicity? Where should bortezomib be positioned?