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OP53 Autologous versus allogenic stem cell transplantation for multiple myeloma
S58
Sessions / Symposia / Special Lectures
OP53 Autologous versus allogenic stem cell transplantation for multiple myeloma M. Attal. Hematology Department, University Hospital, Nantes, France Abstract not submitted.
Non-Hodgkin’s lymphoma I OP54 Front-line therapy for indolent B-cell lymphoma P. McLaughlin. Department of Molecular & Structural Biochemistry, North Carolina State University, Raleigh, NC, USA Front-line treatment approaches for patients with follicular lymphoma have been in a remarkable state of evolution in the past decade, most notably in the setting of advanced stage disease. But there are also important observations concerning patients with stage I-II disease, for whom external beam radiation therapy has traditionally been the mainstay of treatment. Follicular lymphoma is stage I-II at diagnosis in only about 15-20% of cases. While such patients can be observed without therapy, many investigators have reported long-term disease control, and possible cure, in almost 50% of patients. In a compelling long-term follow-up report from the Princess Margaret Hospital in Toronto, the cumulative incidence of relapse plateaus at about 55-60% following involved field radiation therapy alone [1]; in other words, almost half of patients never relapse and can be considered cured. Some prospective trials from the pre-rituximab era indicate that a combined chemotherapy-radiotherapy approach may result in higher rates of long-term remission [2]. Randomized trials are underway to follow-up on those observations. Notably, the potential role of anti-CD20 antibody therapy has not yet been well tested in the stage I-II setting. With the known role of external beam XRT in the stage I-II situation, and with the report by Kaminski et al of the efficacy of radioimmunotherapy alone in the management of patients with advanced stage follicular lymphoma [3], it is likely that there will be future innovations in the management of stage I-II follicular lymphoma. Deferral of therapy may be tempting option for some patients, but the potential for cure is an opportunity that should usually be taken. The integration of anti-CD20 antibodies, particularly rituximab, into the treatment of patients with advanced stage indolent lymphoma has greatly expanded and improved our options for these patients. In contrast to the prevailing sense of therapeutic stagnation in the 1970’s – 80’s, many groups have reported recently on improving treatment results for patients with advanced stage indolent lymphoma. One aspect of the improvement has been the incorporation of anti-CD20 monoclonal antibody therapy into front-line treatment programs. The efficacy of single-agent rituximab and radioimmunother-
apy has been notable, and simple biological combinations of rituximab with cytokines may improve results with little extra toxicity. But some of the most impressive results with anti-CD20 antibody therapy have been in combination with chemotherapy, including COP, CHOP, FCM, FND, and MCP. Maintenance rituximab after salvage regimens (R-CHOP and R-FCM) has also been highly effective [4,5]. The role of maintenance rituximab after front-line immunochemotherapy in follicular lymphoma is being explored. As we await results from those studies, we should keep in mind the provocative observation by Habermann et al [6] that rituximab maintenance appears to offer no benefit in DLBCL if the initial therapy includes rituximab (viz., R-CHOP). Observations about improving results for patients with advanced stage indolent lymphoma need to be examined critically. If survival is the endpoint being examined, it may be the impact not only of the initial therapy but also of salvage therapy that conveys benefit. Rituximab and radioimmunotherapy are examples of effective salvage therapy strategies, as are nucleoside analog combination programs such as FND, and transplant strategies including allogeneic transplant. Despite its complexity, allogeneic transplant deserves strong consideration for candidate patients, because this is a potentially curative strategy [7]. An important consideration in the comparative analysis of different eras of therapy is the potential for imbalances of prognostic factors among cohorts of patients on different trials. The prognostic profiling of follicular lymphoma patients has been substantially improved by the development of the follicular lymphoma international prognostic index (FLIPI) [8]. In our recent report of five sequential treatment strategies over a 25-year period for patients with stage IV indolent lymphoma [9], we assessed not only survival patterns, but also failure-free survival and survival after relapse. We also performed stratified analyses broken down by FLIPI score. All aspects of our analyses indicate that treatment results are improving for patients with advanced stage indolent lymphoma. References [1] [2] [3] [4] [5] [6] [7] [8] [9]
Peterson P, et al., Proc ASCO 2004; 23: 561 Seymour J, et al, J Clin Oncol 2003; 21: 2115 Kaminski M, et al, N Engl J Med 2005; 352: 441 Van Oers M, et al, Blood 2006; 108: 3295 Forstpointner R, et al, Blood 2006; 108: 4003 Habermann T, et al, J Clin Oncol 2006; 24: 3121 Van Besien K, et al, Blood 1998; 92:1832 Solal-Celigny P, et al, Blood 2004; 104: 1258 Liu Q, et al, J Clin Oncol 2006; 24: 1582
OP55 Management of relapsed indolent lymphoma F. Cabanillas. Auxilio Mutuo Cancer Center, San Juan, Puerto Rico Although patients with follicular lymphoma often achieve a
Sessions / Symposia / Special Lectures
OP53 Autologous versus allogenic stem cell transplantation for multiple myeloma M. Attal. Hematology Department, University Hospital, Nantes, France Abstract not submitted.
Non-Hodgkin’s lymphoma I OP54 Front-line therapy for indolent B-cell lymphoma P. McLaughlin. Department of Molecular & Structural Biochemistry, North Carolina State University, Raleigh, NC, USA Front-line treatment approaches for patients with follicular lymphoma have been in a remarkable state of evolution in the past decade, most notably in the setting of advanced stage disease. But there are also important observations concerning patients with stage I-II disease, for whom external beam radiation therapy has traditionally been the mainstay of treatment. Follicular lymphoma is stage I-II at diagnosis in only about 15-20% of cases. While such patients can be observed without therapy, many investigators have reported long-term disease control, and possible cure, in almost 50% of patients. In a compelling long-term follow-up report from the Princess Margaret Hospital in Toronto, the cumulative incidence of relapse plateaus at about 55-60% following involved field radiation therapy alone [1]; in other words, almost half of patients never relapse and can be considered cured. Some prospective trials from the pre-rituximab era indicate that a combined chemotherapy-radiotherapy approach may result in higher rates of long-term remission [2]. Randomized trials are underway to follow-up on those observations. Notably, the potential role of anti-CD20 antibody therapy has not yet been well tested in the stage I-II setting. With the known role of external beam XRT in the stage I-II situation, and with the report by Kaminski et al of the efficacy of radioimmunotherapy alone in the management of patients with advanced stage follicular lymphoma [3], it is likely that there will be future innovations in the management of stage I-II follicular lymphoma. Deferral of therapy may be tempting option for some patients, but the potential for cure is an opportunity that should usually be taken. The integration of anti-CD20 antibodies, particularly rituximab, into the treatment of patients with advanced stage indolent lymphoma has greatly expanded and improved our options for these patients. In contrast to the prevailing sense of therapeutic stagnation in the 1970’s – 80’s, many groups have reported recently on improving treatment results for patients with advanced stage indolent lymphoma. One aspect of the improvement has been the incorporation of anti-CD20 monoclonal antibody therapy into front-line treatment programs. The efficacy of single-agent rituximab and radioimmunother-
apy has been notable, and simple biological combinations of rituximab with cytokines may improve results with little extra toxicity. But some of the most impressive results with anti-CD20 antibody therapy have been in combination with chemotherapy, including COP, CHOP, FCM, FND, and MCP. Maintenance rituximab after salvage regimens (R-CHOP and R-FCM) has also been highly effective [4,5]. The role of maintenance rituximab after front-line immunochemotherapy in follicular lymphoma is being explored. As we await results from those studies, we should keep in mind the provocative observation by Habermann et al [6] that rituximab maintenance appears to offer no benefit in DLBCL if the initial therapy includes rituximab (viz., R-CHOP). Observations about improving results for patients with advanced stage indolent lymphoma need to be examined critically. If survival is the endpoint being examined, it may be the impact not only of the initial therapy but also of salvage therapy that conveys benefit. Rituximab and radioimmunotherapy are examples of effective salvage therapy strategies, as are nucleoside analog combination programs such as FND, and transplant strategies including allogeneic transplant. Despite its complexity, allogeneic transplant deserves strong consideration for candidate patients, because this is a potentially curative strategy [7]. An important consideration in the comparative analysis of different eras of therapy is the potential for imbalances of prognostic factors among cohorts of patients on different trials. The prognostic profiling of follicular lymphoma patients has been substantially improved by the development of the follicular lymphoma international prognostic index (FLIPI) [8]. In our recent report of five sequential treatment strategies over a 25-year period for patients with stage IV indolent lymphoma [9], we assessed not only survival patterns, but also failure-free survival and survival after relapse. We also performed stratified analyses broken down by FLIPI score. All aspects of our analyses indicate that treatment results are improving for patients with advanced stage indolent lymphoma. References [1] [2] [3] [4] [5] [6] [7] [8] [9]
Peterson P, et al., Proc ASCO 2004; 23: 561 Seymour J, et al, J Clin Oncol 2003; 21: 2115 Kaminski M, et al, N Engl J Med 2005; 352: 441 Van Oers M, et al, Blood 2006; 108: 3295 Forstpointner R, et al, Blood 2006; 108: 4003 Habermann T, et al, J Clin Oncol 2006; 24: 3121 Van Besien K, et al, Blood 1998; 92:1832 Solal-Celigny P, et al, Blood 2004; 104: 1258 Liu Q, et al, J Clin Oncol 2006; 24: 1582
OP55 Management of relapsed indolent lymphoma F. Cabanillas. Auxilio Mutuo Cancer Center, San Juan, Puerto Rico Although patients with follicular lymphoma often achieve a