vervolg CASUS

september 2009

- inmiddels 6 kuren R-CVP ondergaan

- restadiering: PR

EN NU?

september 2009

- watch and wait

- onderhoud rituximab

- autologe SCT

onderhoud rituximab 1e lijn

onderhoud rituximab 1e lijn

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

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

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

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)

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

onderhoud rituximab 1e lijn

PRIMA study?????

autologe SCT in 1e lijn

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

autologe in 1e lijn

conditionering middels TBI

en cyclofosfamide

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

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)

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

januari 2009

verklaringen:

- better survival rates of relapsing patients in the

chemotherapy arm

- more secondary cancers in HDT arm

januari 2009

progressie….

C/ vroeg recidief (binnen 6 maanden)

EN NU?

allo SCT

autologe SCT

RCHOP plus onderhoud R

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

Blood 2003; 102: 3521

allo?

allo?

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

Blood 2003; 102: 3521

allo?

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

Blood 2003; 102: 3521

allo?

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

Blood 2003; 102: 3521

allo?

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

Blood 203; 102: 3521

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%

allo?

Van Besien K, et al. Comparison of autologeous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

Blood 2003; 102: 3521

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

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

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

rituximab onderhoud

- 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

- remissie-inductie:

* CHOP

* RCHOP

indien na 6 kuren PR of CR 2e randomisatie

* observatie 167

* onderhoud rituximab 167

(375 mg/m2 per 3 maanden)

rituximab onderhoud

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

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

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)

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

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)

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)

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

C/ R maintenance treatment results in a major

improvement in PFS (not OS) both after

chemotherapy and immunotherapy

rituximab onderhoud

rituximab onderhoud

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

autologe SCT

autologe SCT

autologe SCT

autologe SCT; PFS

autologe SCT; OS

discussiepunten:

- early closure (planned 250-89 evalueerbaar)

- pre rituximab tijdperk

Wat indien pt laat recidief had gehad?

- allo SCT

- autologe SCT

- RCHOP met onderhoud R

- opnieuw RCVP