Zaw htet

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Zaw htet

  1. 1. Analysis of Prognostic Factors Influencing the Survival of Patients with Relapsed Follicular Lymphoma M.V.LOMONOSOV MOSCOW STATE UNIVERSITY FAULTY OF BASIC MEDICINE Presented by: Dr.Zaw Htet Scientific supervisors: Prof.Dr.B.I.Polikov, Dr.D.A.Bykov Moscow,2010
  2. 2. Introduction <ul><li>Follicular lymphoma(FL) – formerly called follicle center lymphoma (centrocytes and centroblasts) </li></ul><ul><li>2 nd most common Non-Hodgkin’s lymphoma </li></ul><ul><li>20 % of all NHLs </li></ul><ul><li>Mostly presented in middle age and elderly </li></ul><ul><li>Male : Female = 1:1.7 </li></ul>
  3. 3. Prognosis <ul><li>Is determined by FLIPI scoring system-that include: age of patient, stage, no: of involved nodal areas, serum lactate dehydrogenase and haemoglobin level. </li></ul><ul><li>Also depends on tumor grading </li></ul>
  4. 4. Purpose of Study <ul><li>To indentify the important clinical factors that influence the prognosis of disease and also predict the survival of the patients with follicular lymphoma at relapse. </li></ul>
  5. 5. Main Tasks of Study <ul><li>To establish the important clinical factors that influence the survival after progression (SFP) of patients with follicular lymphoma. </li></ul><ul><li>To indentify the cause-specific SFP of patients with follicular lymphoma. </li></ul>
  6. 6. Patients and Methods <ul><li>Retrospective study </li></ul>151 69 (46%) 60 (40%) 21 (14%) 32 (47%) 37 (64%) 69 Complete Response Partial Response Undetermined Disease Progression (median follow up: 4.5 yrs) Median age: 56 yrs, 36 males, 33 females
  7. 7. Main Characteristics of Patients at diagnosis and at relapse (n=69)
  8. 8. Prognostic factors for survival from progression(SFP) in patients with follicular lymphoma at relapse : Results of univariate analysis (n=69) Variable No. of Patients Mortality (%) 5-year SFP P value Stage at diagnosis I-II III-IV Age <60 years ≥ 60 years Bulky disease No Yes ECOG 0-1 ≥ 2 Serum LDH <450 U/L ≥ 450 U/L Bone marrow involvement No Yes 11 61 42 30 56 7 57 8 38 10 18 15 14 53 41 54 35 89 37 90 27 67 17 53 82 42 60 28 54 22 53 11 56 44 81 23 0.02 0.07 0.007 0.0002 0.015 0.002
  9. 9. Continued: Variable No. of patients Mortality (%) 5-year SFP P value Stage at relapse I-II III-IV IPI Low Inter/High Duration of response <2 years ≥ 2 years Transformation No Yes Initial Response CR PR Response to salavage therapy CR PR NR 22 44 38 28 41 31 28 7 31 38 26 22 15 26 51 25 66 55 36 33 33 44 49 26 48 90 68 34 72 13 33 63 63 62 44 48 57 59 0 0.003 <0.0001 0.012 NS NS <0.0001
  10. 10. Multivariate analysis <ul><li>For that analysis, variables with prognostic significance in univariate study ( P value <0.1) and with a sufficient number of assessable cases were selected. </li></ul><ul><li>LDH level, bone marrow involvement were not included </li></ul><ul><li>Response to initial treatment (CR versus PR) was included </li></ul>
  11. 11. <ul><li>Survival from progression(SFP) according to the duration of response (RD) to first-line therapy </li></ul>
  12. 12. 5-years SFP according to response duration(RD) to first line therapy
  13. 13. 5-years SFP according to performance status (ECOG) and response duration(RD)
  14. 14. 5-years SFP according to performance status(ECOG) and response duration (RD)
  15. 15. Cause-specific SFP <ul><li>30 of 69 patients died from lymphoma </li></ul><ul><li>2 patients died from non-lymphoma related causes </li></ul>
  16. 16. Cause-specific survival from progression
  17. 17. Discussion <ul><li>The natural history of follicular lymphoma is characterized by continuous relapses that become progressively less sensitive to chemotherapy. </li></ul><ul><li>Older age, poor performance status, advanced stage, bulky disease, leukaemic expression, high serum LDH level and high risk according to IPI have consistently been found to be associated with a poor outcome. </li></ul><ul><li>Although patients with relapsed follicullar lymphoma often still respond to further therapy. </li></ul><ul><li>Duration of response becomes shorter after each relapse and most patients die due to the disease. </li></ul><ul><li>New therapeutic approaches, such as purine analogs alone or in combination, monoclonal antibodies, stem cell transplantation and biological response modifiers, are being developed. </li></ul>
  18. 18. Conclusion <ul><li>In univariate analysis, clinical characteristics at progression; age at relapse, stage of disease, performance status, international prognostics index, bone marrow involvement, serum LDH level , as well as the duration of response to first-line therapy , are the clinical factors that influence the survival of patients with follicular lymphoma at relapse. </li></ul><ul><li>In multivariate analysis, response duration(RD) emerged as an important prognostic factor, with a 5-years SFP ranging from 33% (RD <2 years) to 63%(RD ≥2 years). </li></ul><ul><li>Performance status at relapse emerged as the most important factor to predict cause-specific SFP. </li></ul>

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