Management of untreated cll for web (2015)
•Download as PPTX, PDF•
5 likes•35,535 views
This represents my current thinking on how to treat patients with previously untreated chronic lymphocytic leukemia. New research changing fast so possibly outdated soon.
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Management of untreated cll for web (2015)
Similar to Management of untreated cll for web (2015) (20)
Recently uploaded
Recently uploaded (20)
Management of untreated cll for web (2015)
- 1. Management of Untreated CLL 2015 Jeff Sharman M.D. Medical Director Hematology Research US Oncology
- 2. Long Term Follow Up FCR at MD Anderson
- 11. Untreated CLL High RiskIntermediate(Very) Low Risk Maximal Tolerated Therapy Do No Harm Novel Agents IgHV Mutated No Int/High Risk SF3B1 / NOTCH1 / 11Q IgHV Unmutated 17P / TP53 BIRC3
- 12. TP53 Gene Mutation 17P Deletion
- 16. Idelalisib in Untreated CLL
- 17. High Risk CLL Summary High risk CLL includes abnormal TP53 (del17P/mut) or BIRC3 mutation These patients die quickly with traditional therapy Novel agents most appropriate initial therapy in high risk CLL
- 18. Untreated CLL High RiskIntermediate(Very) Low Risk Maximal Tolerated Therapy Do No Harm Novel Agents IgHV Mutated No Int/High Risk SF3B1 / NOTCH1 / 11Q IgHV Unmutated 17P / TP53 BIRC3
- 19. Untreated CLL (Very) Low Risk IgHV Mutated No Int/High Risk Super Fit Fit Unfit FCR BR / BG Gazyva
- 20. Can CLL be Cured? MD Anderson CLL8 FCR vs FC
- 21. FCR vs BR in IgHV Mutated Improved FCR outcomes only age < 65 Greater neutropenia and infection More durable immune dysfunction Greater secondary malignancy
- 22. What is Fitness? • Median age MDA = 57 • Median age CLL8 = 61 • Median age SEER = 71 • Age associated with: – Higher comorbidity – Lower renal function – More advanced disease at treatment initiation • Approximately 20% CLL patients meet enrollment criteria for CLL 8/10 at first line rx
- 23. Mortality Following First Line Therapy Setting Median Age Regimen 12 Month Mortality MD Anderson 57 FCR 1% German CLL8 61 FCR vs FC 4% Community 74 Any 10%
- 28. Overall Approach in Low Risk CLL
- 29. Low Risk Summary • (Very) Low risk CLL lacks 17P/11Q deletions or NOTCH1, SF3B1, BIRC3, TP53 mutations • When treated aggressively, high fraction with durable response, many possibly cured • Benefit of FCR primarily in patients with most favorable genomics and ideal fitness with age less than 65 • Obinutuzumab is more effective than rituximab and is appropriate therapy in patients not suitable for chemoimmunotherapy – or in combination with bendamustine on this trial
- 30. Untreated CLL High RiskIntermediate(Very) Low Risk Maximal Tolerated Therapy Do No Harm Novel Agents IgHV Mutated No Int/High Risk SF3B1 / NOTCH1 / 11Q IgHV Unmutated 17P / TP53 BIRC3
- 31. FCR vs BR – When Better isn’t Best
- 32. Untreated CLL High RiskIntermediate(Very) Low Risk Maximal Tolerated Therapy Do No Harm Novel Agents IgHV Mutated No Int/High Risk SF3B1 / NOTCH1 / 11Q IgHV Unmutated 17P / TP53 BIRC3
- 33. How I Manage Untreated CLL High risk patients (17P/TP53/BIRC3) are treated with novel agents preferably on trial Low risk patients (No high/int risk markers) are treated with maximal tolerated therapy. In community setting FCR use is uncommon Intermediate risk patients (no high risk, but have an intermediate marker such as 11Q/SF3B1/NOTCH1/IgHV unmutated) do not receive FCR but get either BR (BG) or Gazyva
- 34. Using Gazyva Infusion reactions / management First cycle cytopenias Lymphocyte clearance kinetics Growth factor support
- 35. Questions?