ESMO Patient Seminar: Latest Developments in Hematological Cancer

Multiple Myeloma. Hodgkin’s Lymphoma … Non-Hodgkin’s Lymphoma. Acute Leukemia. Latest developments in hematological cancer. Dr. L. Jost …

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Latest developments in hematological cancer, Stockholm, 14-09-2008 14:30 Dr. L. Jost, Kantonsspital Bruderholz, Switzerland, Latest developments in hematological cancer, Chronic Lymphatic Leukemia, Chronic Myelogenous Leukemia, Multiple Myeloma, Hodgkin\’s Lymphoma, Low-grade Non-Hodgkin\’s Lymphoma, Aggressive Non-Hodgkin\’s Lymphoma, Acute Leukemia, Dr. L. Jost, Chronic, Lymphatic Leukemia, Rituximab in combination with, chemotherapy improves, response rate and survival, over chemotherapy alone, Alemtuzumab may be used, in selected high-risk CLL patients, at first-line therapy, Role of stem cell transplatation, remains unclear, Kadin, M. ASH Image Bank 2002;2002:100484, Blood smear, Survival with & without Rituximab, Fludara, + cyclophosphamide, + rituximab, Fludara +, cyclophosphamide or, Not randomized !, mitoxantron, Historical control groups !, Modified from, Tam, C. S. et al. Blood 2008;112:975-980, Latest Developments in, Chronic Lymphocytic Leukemia, Alemtuzumab (MabCampath) for relapsed CLL, Monoclonal antibody against CD52,, a protein expressed on most lymphocytes and lymphoma cells, Can be given subcutaneously, May improve response rate and survival if given, – at relapse or, – as monthly maintenance therapy after treatment for relapse, Severe immunosuppression with infectious complications, Myelogenous Leukemia, Imatinib (Gleevec, , Glivec, is the first-line therapy of choice, New generation, tyrosine kinase inhibitors, active against resistant disease, Stem cell transplantation, now usually only considered for, insufficient response or failure, after tyrosine kinase inhibitors, Maslak, P. ASH Image Bank 2004;2004:101019, Bone marrow aspirate, Options after failure of imatinib (Gleevec, Allogeneic stem cell transplantation, preferred option for pts < 50 y, good health, matched donor available, Higher-dose imatinib, May work in, 30% for some time, Dasatinib (Sprycel, Higher hematological toxicity, pleural effusions at doses >100 mg/day, immune suppression may be higher than with imatinib, Nilotinib (Tasigna, Less data as of yet, elevation of blood sugar and pancreatic enzymes, There are, new kids on the block !, Thalidomide + Dexamethasone (Dex) /, Thalidomide + Melphalan + Prednisone, Lenalidomide (Revlimid, ) Dex, Bortezomib (Velcade, TAD- versus VAD-regimen, VAD as initial therapy obsolete, How many transplants, if any ?, Individualized therapy ?!, Lazarchick, J. ASH Image Bank 2004;2004:101003, Induction therapy with melphalan + prednisone, thalidomide, in elderly patients with multiple myeloma, CR+PR, 2y-EFS, 3y-OAS, 47.6, MP + T, 76.0, Palumbo A. et al. Lancet 2006; 367(9513):825-31, Induction therapy with dexamethasone, Rajkumar, S. V. et al. J Clin Oncol; 26:2171-2177, 2008, VAD versus Velcade + Dexamethasone as Induction, for Transplant Candidates (, 65 years, fit), After Induction Therapy, After Autologous, with VAD or Vel/Dex, Stem Cell Transplant, Does it translate into better relapse-free and overall survival ?, Harousseau JL, et al. Blood; (ASH Annual Meeting Abstracts) 2007 110: Abstract 450, Improvement of response rate after novel induction therapy and ASCT, San-Miguel J, et al. J Clin Oncol; 26(16): 2761 – 2766, 2008, Latest Recommendations for, Patients with asymptomatic (smoldering) multiple myeloma (MM), should not be treated until unequivocal signs of progression appear. Melphalan-prednisone plus thalidomide (MPT) for 12 cycles and using, a thalidomide daily dose of no more than 200 mg is the present, reference treatment for patients with newly diagnosed symptomatic, myeloma who are older than age 65. Upfront single high-dose therapy (200 mg/m2 melphalan) and, autotransplantation are standard of care for young patients. Either thalidomidebortezomibor lenalidomide-containing regimens, may be preferred to VAD-like regimens as induction therapy, Fermand JP, ASCO Educational Book; 2008, No new drugs yet … Optimizing results =, maintaining response +, reducing long-term toxicity, Early Positron-Emission, Tomography (PET) – Scan, may help identify patients, with good and poor risk, ee p, Who does really need escalated BEACOPP ?, Who can be treated safely with ABVD ?, Do all patients need Bleomycin ?, Who can be spared radiotherapy ?, How low can radiation doses become &, how small can the radiation fields become ?, PET-CT – Scan, showing a, single active, lymph node, Survival according to early and final PET-CT, Surviv, Modified from: Hutchings, M. et al. Blood 2006;107:52-59, Low-grade, Non-Hodgkin\’s Lymphoma, Rituximab, improves response rate,, disease-free and overall survival, in follicular lymphoma if used, as or at induction, for maintenance, at relapse, Kadin, M. ASH Image Bank 2003;2003:100691, Lymph node biopsy: follicular lymphoma, Low-grade Lymphomas, After decades without improvement in survival, progress has finally been achieved, Rituximab monotherapy has substantial activity, Adding rituximab to chemotherapy, improves survival at 10 years by 5 – 15%, Rituximab maintenance improves relapse-free survival, Radio-Immunotherapy improves response rate and, may improve relapse-free and overall survival, Interferon maintenance has mostly been abandoned, Open Questions in, Do we really need chemotherapy at first-line treatment?, How intense should first-line chemotherapy be, – with or without anthracyclines ?, – with or without fludarabine / cladribine ?, – with sequential high-dose chemotherapy / ASCT ?, Radio-immunotherapy or rituximab maintenance ?, Conventional re-treatment or autologous stem cell, transplantat or radioimmunotherapy for relapse ?, Role of allogeneic transplant after relapse ?

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