Lavoro di gruppo: Linfomi

Firenze. September 20-21st, 2013
Lavoro di
gruppo:
Linfomi
Giuseppe Nunziata,Catello Califano,Silvia
Finotto,Silvia Della Bella,Viviana
Minardi,Silvia Birtolo,Melania Rocco,Fabio
Montanelli,Simone Santini,Emanuele
Cencini,Gabriellla Mometto,Manuela
Giachelia,Samantha Pozzi,Nando
Scarpelli,Umberto Vitolo, Gianni Pizzolo,
Pellegrino Musto, Maria Cantonetti,
Francesco Lauria,Gianluca Gaidano
Lymphomas: questions
ü  Follicular NHL: is it time to move
R-Bendamustine as first line
treatment? Maintenance after BR?
ü  Mantle Cell: what is the role of new
biological agents (Lenalidomide,
Ibrutinib) in the treatment of MCL?
First line? Single agent or in
combination? Induction or
maintenance?
ü  PMBCL and DLBCL: what is the
role of Radiotherapy?
FL: specific questions
A. Follicular NHL: is it time to move R-Bendamustine as
first line treatment?
B. In all patients?
C. Is it cost-effective?
D. Does R-B improve QoL?
E. What is the main advantage perceived by patients?
F. What is the main advantage perceived by physicians?
G. Maintenance after R-B?
H. 2° line after BR
I. Stem cells; when?
Opinione del gruppo
A. Follicular NHL: is it time to move R-Bendamustine as
first line treatment?
B. In all patients? Yes > 65-70 y; ? < 65-70 y
C. Is it cost-effective?
Possibly (reduced febrile neutropenia); need for dedicated
studies
Opinione del gruppo
D. Does R-B improve QoL?
Certainly yes (major strength of the drug)
E. What is the main advantage perceived by patients?
No alopecia; no constipation; no neuropathy, no dysgeusia
F. What is the main advantage perceived by physicians?
Reduced toxicities (including infections)
G. Maintenance after R-B?
Allowed based on indication
Lack of direct and formal evidence (our opinion + Friedman s
JCO editorial); lively discussion and split opinion; however, 3
future scenarios
Toxicity of R-B + R maintenance
Patient choice (informed choice)
Opinione del gruppo
H. 2° line after BR
Young: see question I; elderly: RIT or R single agent (?)
Alternative option: R-CHOP after R-B (but: lack of evidence)
Clinical trials
I. Stem cells; when? No published evidence (but yes expert
opinion by Rummel)
FL: one additional
question
J. EHA new on the never ending story of MRD value in FL?
FL: one additional
question
J. EHA new on the never ending story of MRD value in FL?
Increased evidence toward YES (Ladetto et al, Blood 2013
elderly FL FIL study; Galimberti EHA oral on MRD in FOLL05
Lymphomas: questions
ü  Follicular NHL: is it time to move
R-Bendamustine as first line
treatment? Maintenance after BR?
ü  Mantle Cell: what is the role of
new biological agents
(Lenalidomide, Ibrutinib) in the
treatment of MCL? First line?
Single agent or in combination?
Induction or maintenance?
ü  PMBCL and DLBCL: what is the
role of Radiotherapy?
Opinione del Gruppo
A. Mantle Cell: what is the role of new biological agents
(Lenalidomide, bortezomib, Ibrutinib) in the treatment of
MCL?
Ibrutinib: promising, but still under investigation
Lenalidomide: 2° line; maintenance under investigation
Bortezomib: 2° line
B. Which is the rationale in the context of MCL?
Stronger evidence in other NHL groups
Need for identifying biological subgroups
C. First line?
Clinical trials
D. All ages?
If active, yes
Opinione del Gruppo
E. Induction and/or maintenance?
Both (clinical trials)
F. Sustainability?
?????
G. Value of MRD in ibrutinib treated pts?
???????
Lymphomas: questions
ü  Follicular NHL: is it time to move
R-Bendamustine as first line
treatment? Maintenance after BR?
ü  Mantle Cell: what is the role of new
biological agents (Lenalidomide,
Ibrutinib) in the treatment of MCL?
First line? Single agent or in
combination? Induction or
maintenance?
ü  PMBCL and DLBCL: what is the
role of Radiotherapy?
Opinione del Gruppo
A. Follicular NHL: is it time to move R-Bendamustine as
first line treatment?
B. In all patients?
C. Is it cost-effective?
D. Does R-B improve QoL?
E. What is the main advantage perceived by patients?
F. What is the main advantage perceived by physicians?
G. Maintenance after R-B?
EHA 2013: abstracts 209, Italian 31
Non Hodgkin s Lymphomas:
13 ITALIAN: 5 38%
ITALIAN: 7
POSTER: 52
PUBLICATION ONLY: 59 ITALIAN: 9
ORAL:
Hodgkin s Lymphomas:
ORAL:
5
POSTER:
ITALIAN: 0
13
ITALIAN: 5
PUBLICATION ONLY:
11
Biology:
ORAL:
5
POSTER:
ITALIAN: 0
32
ITALIAN: 3
PUBLICATION ONLY:
19
ITALIAN: 1
ITALIAN: 1
Opinione del Gruppo
Ruolo “coagulante” della