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. 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: 248-255

6. 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): 1607-1614

7. 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): 1607-1614

8. 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): 1607-1614 3jaar 91% vs 86% (p = 0.08)

9. 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: 248-255 onderhoud rituximab 1e lijn

10. PRIMA study?????

11. autologe SCT in 1e lijn

12. 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

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

14. 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

15. 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)

16. 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

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

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

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

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

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

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

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

27. 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

28. 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

29. 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

30. rituximab onderhoud

31. -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 rituximab onderhoud

32. -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

33. 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

34. 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

35. 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: 3295 3 jrn: 71.9% vs 82.5% (p = 0.096)

36. 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

37. 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: 3295 3 jaar; 77.1% vs 85.1% (p = 0.011)

38. 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 20981 phase III randomized intergroup study. Blood 2008; 112: 108: 3295 5 jaar OS; 74% vs 64% (p = 0.07) (veel R als salvage)

39. 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

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

41. 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: 248-255

42. 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