anco ash 2005 review acute leukemias feb 22 2006 charles linker md
Download
Skip this Video
Download Presentation
ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD

Loading in 2 Seconds...

play fullscreen
1 / 30

ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD - PowerPoint PPT Presentation


  • 129 Views
  • Uploaded on

ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD. Abstract # 43 Mini-allo for AML Herr et al EBMT Review. Mini-allo for AML EBMT Registry. n = 204 Age 58 (median) Sib and MUD donors Regimen - Flu/Bu, Flu/TBI FU 13mo 1-yr TRM 15\% 1-yr Rel 34\% 1-yr LFS 50\%

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'ANCO ASH 2005 Review Acute Leukemias Feb 22, 2006 Charles Linker MD' - luyu


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
mini allo for aml ebmt registry
Mini-allo for AMLEBMT Registry

n = 204

Age 58 (median)

Sib and MUD donors

Regimen - Flu/Bu, Flu/TBI

FU 13mo

1-yr TRM 15%

1-yr Rel 34%

1-yr LFS 50%

1-yr OS 62%

mini allo aml israel
Mini-allo AMLIsrael

n = 67

Age > 55

Sib and MUD donors

Regimen - Flu/Bu

FU 22mo

2-yr TRM 8%

2-yr OS 47%

If CR1: 2-yr OS 80%, TRM 0%

calgb 100103 phase ii study of mini allo for aml cr1 age 60
CALGB 100103Phase II Study of mini-allo for AML CR1, age > 60

Study Chair: Steve Devine

CTN co-chair: Sergio Giralt

calgb 100103 background 1
CALGB 100103Background - 1
  • Poor results of chemotherapy
  • No signs of progress in chemotherapy
  • New approaches are warranted
calgb 100103 calgb background data
CALGB 100103CALGB background data
  • Analysis of 600 CALGB AML age > 60 with cytogenetics

CR 50%

5-year OS 7% !!!

Cytogenetics predictive of outcome

aml cr1 age 60 dfs by cytogenetics
P<0.001

< 5 Abnormalities

5 Abnormalities

AML CR1, age > 60DFS by Cytogenetics
calgb 100103 background 2
CALGB 100103Background - 2
  • Results in best group are still poor (n = 276)

CR1

Age 60-75

Receive first consolidation on randomized trial

  • 2-year DFS 24%
  • 3-year DFS 17%
calgb 100103 eligibility 1
CALGB 100103Eligibility - 1
  • AML CR1

Prior MDS, t-AML allowed

< 2 cycles induction

< 2 courses consolidation

< 6 months in CR1

exclude APL, prior MPD

  • Age 60-74
  • Matched sibling or 10/10 MUD donor
calgb 100103 eligibility 2
CALGB 100103Eligibility - 2
  • PS 0 - 2
  • Adequate organ function

DLCO > 40%

EF > 30%

Creatinine clearance > 40

Bili < 2.0

AST < 3x normal

calgb 100103 preparative regimen
CALGB 100103 Preparative Regimen
  • Fludarabine 30 mg/m2 x 5 days -7 to -3
  • Busulfan 0.8 mg/kg IV x 8 days -4 to -3
  • Thymoglobulin 2.5 mg/kg x 3 days -4 to -2
  • Stem cell infusion day 0
calgb 100103 gvh prophylaxis
CALGB 100103 GVH Prophylaxis
  • Tacrolimus day - 2 to +90
  • MTX 5 mg/m2 days, +1, 3, 6, 11
  • Taper tac day +90 to +150/+180
calgb 100103 statistics
CALGB 100103 Statistics
  • Primary objective 2-year DFS > 35%

90% power to exclude DFS < 20%

  • Accrual goal = 61
  • Stopping rules for TRM

Assume true TRM 20%

Unacceptable TRM 40%

calgb 100103
CALGB 100103
  • Currently active in CALGB

sib donors only

  • Amendment in process

Add CTN

Add MUD

mini allo for aml age 60
Mini-allo for AML, age > 60
  • Currently treatments work poorly
  • Mini-allo is feasible
  • Several pilot studies show DFS > 40%
  • Deserves testing in Group setting
  • CALGB 100103 is last chance for USA study
ph all age 55 treatment
Ph+ ALL,age > 55Treatment
  • Pre-phase

Prednisone x 1 week

  • Induction

CyDVP

Imatinib 600 x 2 mo

  • Consolidation

10 blocks of chemo

2 x 2 mo imatinib

  • CNS-P

i.t. mtx + cranial RT

ph all age 55 results
Ph+ ALL, age > 55Results

N = 30

Age 66 (58 - 78)

FU 15mo

CR 20/29 ( vs 6/21 historical control)

1-yr OS 71% (11% control)

1-yr EFS 57% (5% control)

ph all role of imatinib
Ph+ ALLRole of Imatinib
  • Plays major role in induction

Safe to combine with chemotherapy

Increases remission rate

  • Encouraging results post-remission
  • May play role in transplant

Allo transplant is treatment of first choice

Patients get to transplant in remission

May reduce relapse rate

ASCT being tested in CALGB 10001

May allow PCR neg stem cells for ASCT

calgb 19801 de angelo et al ash 743 2002
CALGB 19801De Angelo et alASH #743 (2002)
  • Eligibility

T-ALL or T-LL

Relapse or refractory

  • Treatment

Nelarabine (GW 506U) 1.5g/m2 days 1, 3, 5

q3 weeks x 2 cycles

Responders may get additional 2 cycles

  • Results

10/38 CR (26%)

MDCR 10mo

1-yr DFS 40%

nelarabine patients and treatment
NelarabinePatients and Treatment
  • n = 53
  • Age 31 (19 - 81)
  • Disease category:

First relapse 36

Second relapse 7

Relapse after transplant 7

Refractory 3

  • Treatment:

Nelarabine 1.5g/m2 days 1, 3, 5

nelarabine results
NelarabineResults

25/53 CR (47%)

19/25 Cr go to transplant

OS 16%

OS of CR 27%

nelarabine for t all
Nelarabine for T-ALL
  • Important new agent
  • Good choice for relapse
  • Should be tested up front
ad