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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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slide1

Lymphomas

Follicular

&

Aggressive B-Cell

slide2

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

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

slide3

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.

slide4

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.

slide5

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.

slide6

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.

slide7

European MCL Network: Results of Combined Immunochemotherapy at 12 Months

n=269

n=286

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

slide8

DA-EPOCH-R Regimen

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

slide9

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

  • Median follow-up: 28 months
  • Responses (n=24):Toxicity:
  • CR/CRu 100% One case of tumour
  • OS 100% 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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