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Therapeutic results of diffuse large B-cell lymphoma LNH 2008 Groupe d’Etude des Lymphomes en Tunisie Sousse, 25 th May 2012.

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Presentation on theme: "Therapeutic results of diffuse large B-cell lymphoma LNH 2008 Groupe d’Etude des Lymphomes en Tunisie Sousse, 25 th May 2012."— Presentation transcript:

1 Therapeutic results of diffuse large B-cell lymphoma LNH 2008 Groupe d’Etude des Lymphomes en Tunisie Sousse, 25 th May 2012

2 Introduction  LNH 2008: third protocol …after LNH 97 and LNH 2002  Between september 2008- august 2011

3 LNH 97 LNH 2002 aa-IPI=0, 16-65y 3CHOP+RT aa-IPI=0, 16-70y aa-IPI=1,2,3 16-55 4 ACVBP+conso aa-IPI=1, 16-60y 4 R-ACVBP+ Auto aa-IPI=2-3,16-60y aa-IPI=1,2,3, 56-65y 8 (R)-CHOP aa-IPI=1,2,3, 61-70y aa-IPI=0, > 65y 4 mini-CEOP+RT aa-IPI=0, > 70y aa-IPI=1,2,3, > 65y 6 CVP or 6 mini-CEOP aa-IPI=1,2,3, > 70y

4

5 LNH 2002 OS = 58%

6 LNH 2002-1 OS = 87 %

7 LNH 2002-2A OS = 82%

8 LNH 2002-2B OS = 46%

9 LNH 2002-3 OS = 52%

10 LNH 2002-5 OS = 38%

11 3 d prospective protocol LNH 2008 September 2008- August 2011 Oncology Tunis: 65 patients Hematology Tunis HO: 47 patients Oncology Sousse: 31 patients Hematology+Oncology Sfax: 27 patients Hematology Military: 22 patients Hematology Monastir: 20 patients Hematology Sousse: 17 patients CNGMO

12 LNH 2008 Risk Stratification aa- IPI aa- IPI 0 2008-1 2008-4 2008-4 1 2008-2A 2008-2A 2008-3 2008-3 2008-5 2008-5 2-3 2-3 2008-2B 2008-2B Age 60 y 70 y

13 LNH 2008 (16 - 70 y) B, 0 factor B, 1,2,3 factor(s) 16 - 59 y 60 - 70 y 16 - 59 y 60 - 70 y 2008-1 2008-2 2008-3 2008-1 2008-2 2008-3 6 R - CHOP 14 8 R-CHOP 14 8 R-CHOP 21 Prognostic Factors : LDH > 1N ; Stage III, IV ; PS > 2 1 factor 2-3 factors 2008-2A 2008-2B 4 R-ACVBP + PBSCT

14 LNH 2008 (> 70 y) Prognostic Factors : LDH > 1N ; Stage III, IV ; PS > 2 2008-4 2008-5 6 R-CHOP 21 6 mini CEOP B >75 y or B, 71-75 1,2,3 factor(s) B, 71-75 PS > 2, 1,2,3 factor(s) B, 71-75 y, PS<2 0, 1, 2 factor(s)

15 Patient’ characteristics  Age: 54 y (16-86y)  Gender: M: 136 sex-ratio: 1.46 F: 93  6 groups: LNH 2008-1: 60 patients LNH 2008-2A: 50 patients LNH 2008-2B: 51 patients LNH 2008-3: 23 patients LNH 2008-4: 13 patients LNH 2008-5: 32 patients

16 Sites at diagnosis Site of diagnosis (%) All12A2B345 Nodes 46245965265447 GIT 2232236262322 ORL 143226181512 Skin 32426 Others 1510122130813

17 Sites at diagnosis Site of diagnosis (%) All12A2B345 Nodes 46245965265447 GIT 2232236262322 ORL 143226181512 Skin 32426 Others 1510122130813

18 Sites at diagnosis Site of diagnosis (%) All12A2B345 Nodes 46245965265447 GIT 2232236262322 ORL 143226181512 Skin 32426 Others 1510122130813

19 Localisation (%) All12A2B345 Nodal352541 223140 Nodal + extra nodal 32181543484622 Extra nodal 33572416302338

20 Localisation (%) All12A2B345 Nodal352541 223140 Nodal + extra nodal 32181543484622 Extra nodal 33572416302338

21 Localisation (%) All12A2B345 Nodal352541 223140 Nodal + extra nodal 32181543484622 Extra nodal 33572416302338

22 Pronostic factors %All12A2B345 B41102878573853 ECOG 2-3 19023748041 LDH5005465703950 III-IV4804196706253 E57774451576250 Bulky16714414812

23 Pronostic factors %All12A2B345 B41102878573853 ECOG 2-3 19023748041 LDH5005465703950 III-IV4804196706253 E57774451576250 Bulky16714414812

24 Response %All12A2B345 CR75948254708466 PR63410906 Failure1331222121618 Death602169010

25 Response %All12A2B345 CR75948254708466 PR63410906 Failure1331222121618 Death602169010

26 Response %All12A2B345 CR75948254708466 PR63410906 Failure1331222121618 Death602169010

27 Response  LNH 2008-2B CR+PR: 32 patients Auto: 23 patients

28 Toxicity %All12A2B345 Time between cures 7978 747788 G-CSF4530528630466 Grade 3-4 164143822233 Death60216909

29 Toxicity %All12A2B345 Time between cures 7978 747788 G-CSF4530528630466 Grade 3-4 164143822233 Death60216909

30 Relapse (18 patients) All12A2B345 N%N% 18 10 2424 5 12 1414 3 19 4 36 3 14

31 Relapse (18 patients) All12A2B345 N%N% 18 10 2424 5 12 1414 3 19 4 36 3 14

32 Final Assessment (median follow-up:18 months) %All12A2B345 CR172927464614662 CR232648 Progression 434615 Death2131632353138

33 Final Assessment %All12A2B345 CR172927464614662 CR232648 Progression 434615 Death2131632353138

34 Final Assessment %All12A2B345 CR172927464614662 CR232648 Progression 434615 Death2131632353138

35 LNH 2008 OS = 75%

36 LNH 2008 EFS = 69%

37 LNH 2008-1 OS = 93%

38 LNH 2008-1 EFS = 90%

39 LNH 2008-2A OS = 79%

40 LNH 2008-2A EFS = 71%

41 LNH 2008-2B OS = 67%

42 LNH 2008-2B EFS = 59%

43 LNH 2008-3 OS = 62%

44 LNH 2008-3 EFS = 54%

45 LNH 2008-4 OS = 63%

46 LNH 2008-4 EFS = 41%

47 LNH 2008-5 OS = 56%

48 LNH 2008-5 EFS = 61%

49 Conclusions  LNH 2008-1: 6 R-CHOP14 is a good option (CHOP+RT)  LNH 2008-2A: 8 R-CHOP14 / 4 R-ACVBP+conso  LNH 2008-2B: 4 R-ACVBP  toxicity++ PBSCT is the standard  LNH 2008-3: 8 R-CHOP 21 +++  LNH 2008-4: testing for treatment of elderly patients with CHOP (EFS < 2008-5)  LNH 2008-5: 6 R-miniCEOP

50 ACKNOWLEDGEMENTS All the members of GELT Ben Lakhal Raihane Ben Othman Tarek Elloumi Moez Gharbi Olfa Mezlini Amel Msadek Fehmi Toumi Nabil Zahra Kmira Laatiri M. Adnène

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