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Follicular & Aggressive B-Cell PowerPoint PPT Presentation


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Lymphomas. Follicular & Aggressive B-Cell. Five-year TTF and Response Duration (RD) According to FLIPI Risk Group. Adapted from Hoster et al. 10-ICML 2008, abstract 330. Characteristics Still True of Follicular Lymphoma in 2008. Most common single type of lymphoma in North America

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Follicular & Aggressive B-Cell

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Follicular aggressive b cell

Lymphomas

Follicular

&

Aggressive B-Cell


Follicular aggressive b cell

Five-year TTF and Response Duration (RD) According to FLIPI Risk Group

Adapted from Hoster et al. 10-ICML 2008, abstract 330.


Follicular aggressive b cell

Characteristics Still True of Follicular Lymphoma in 2008

  • Most common single type of lymphoma in North America

  • Median age at presentation: 65 years

  • 90% harbour advanced-stage disease requiring systemic intervention

  • 40% asymptomatic patients  no initial intervention needed

  • >80% of asymptomatic patients require treatment within 4–5 years

  • Median survival

    • >7–8 years overall

    • >12–15 years in patients <65 years old

  • 10% to 20% die in the first 2 years

  • Most patients die due to lymphoma

  • Transformation to DLBCL 3% per year and often proves rapidly fatal

Adapted from Connors JM. 10-ICML 2008.


Follicular aggressive b cell

Results with Addition of Rituximab

  • Addition to primary chemotherapy improves

    • Progression-free survival (PFS)

    • Overall survival (OS)

  • Addition to second-line chemotherapy improves

    • PFS and OS

  • Maintenance therapy with rituximab improves

    • PFS and OS

      • Definite after second-line immunochemotherapy

      • Probable after primary immunochemotherapy

  • It can be given safely by rapid infusion, sparing treatment resources

  • It substantially improves outcomes for transformed lymphoma

Adapted from Connors JM. 10-ICML 2008.


Follicular aggressive b cell

Follicular Lymphoma:BC Cancer Agency Approach

  • Limited stage

    • Involved field radiation 50% eventually progress

  • Advanced stage, asymptomatic

    • Observation 90% eventually progress

  • Advanced stage, symptomatic

    • R-CVP x 8 cycles

    • Maintenance rituximab 375 mg/m2 q 3 months x 8 doses (2 years)

    • All doses of rituximab after first dose given by rapid infusion (90 min)

      • 20% over 30 min (50 or 100 mL)

      • 80% over 60 min (200 or 400 mL)

Adapted from Connors JM. 10-ICML 2008.


Follicular aggressive b cell

Follicular Lymphoma: BC Cancer Agency Approach

Previously untreated patients with symptomatic FL

R-CVP x 8 cycles

>90% with responsive disease also receive maintenance rituximab 375 mg/m2 q 3months for 2 years

Transformed disease: add doxorubicin (R-CHOP) + rituximab maintenance

  • Benefits:

  • Reserves doxorubicin until crucially necessary

  • Maximizes impact of immunotherapy with rituximab

  • Minimizes overall impact on resources

  • Rapid rituximab infusion convenient for outpatient treatment: (maintenance with 8 cycles)

Adapted from Connors JM. 10-ICML 2008.


Follicular aggressive b cell

European MCL Network: Results of Combined Immunochemotherapy at 12 Months

n=269

n=286

Adapted from Dreyling et al. 10-ICML 2008, abstract 300.


Follicular aggressive b cell

DA-EPOCH-R Regimen

Adapted from Dunleavy et al. 10-ICML 2008, abstract 009.


Follicular aggressive b cell

DA-EPOCH-R: Results and Conclusions in Patients with Untreated Burkitt’s Lymphoma (BL)

  • Median follow-up: 28 months

  • Responses (n=24):Toxicity:

  • CR/CRu100%One case of tumour

  • OS100%lysis syndrome

  • EFS 96%FN in 16% of cycles

  • Conclusions:

  • Highly effective in BL

  • Low toxicity in all patient groups

  • Future study planned in BL with risk-adaptive design

Adapted from Dunleavy et al. 10-ICML 2008, abstract 009.


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