Is there a place for allogeneic stem cell transplantation in chronic lymphocytic leukaemia in the era of the new molecules?
|
|
- Angelica Butler
- 5 years ago
- Views:
Transcription
1 185 Is there a place for allogeneic stem cell transplantation in chronic lymphocytic leukaemia in the era of the new molecules? D. Selleslag, MD SUMMARY Allogeneic stem cell transplantation can cure about 40% of patients with chronic lymphocytic leukaemia. The early transplant related mortality with reduced intensity conditioning is low, but the late non relapse mortality is around 20% due to the high incidence of chronic graft versus host disease. The graft versus leukaemia effect is crucial for cure of chronic lymphocytic leukaemia after allogeneic stem cell transplantation and can be obtained by immune interventions. The place of allogeneic stem cell transplantation needs to be redefined in the era of novel targeted treatments (BCR pathway inhibitors and BCL2 inhibitors). Taking into consideration the promising results of BCR pathway inhibitors in genetically high-risk chronic lymphocytic leukaemia (with 17p deletion/tp53 mutation or complex karyotype) and fludarabine resistant chronic lymphocytic leukaemia, the current recommendation is to proceed with allogeneic stem cell transplantation in chronic lymphocytic leukaemia patients failing a BCR pathway inhibitor. The question when to proceed with allogeneic stem cell transplantation in responding patients remains unanswered. In the absence of randomised or prospective observational studies comparing novel agents to allogeneic stem cell transplantation the decision should be individualised and depend on the estimated transplantation risks and the patient s desires. (BELG J HEMATOL 2017;8(5):185-91) INTRODUCTION Chronic lymphocytic leukaemia (CLL) is the most common type of leukaemia in the Western hemisphere. While emergence of novel targeted therapies has significantly improved the outcome of CLL and has completely altered the therapeutic landscape in recent years the disease remains only curable by allogeneic stem cell transplantation (allosct). In 2014, about 2% (total number 353) of all allosct reported to the European Group of Blood and Marrow Transplantation (EBMT) were performed for CLL. Since 2000, the number of allosct for CLL is constantly increasing while autologous transplantation for CLL has almost completely disappeared (only nineteen autosct performed in 2014). 1 In 2007, EBMT defined consensus recommendations for allosct in CLL. AlloSCT candidates were considered those patients with high-risk CLL defined by the following criteria: not achieving a response or relapsing within twelve months after purine analogue therapy (fludarabine resistant CLL); relapsing within 24 months after intensive treatment (purine analogue containing combination chemotherapy, autologous SCT); presence of p53 mutation or 17p deletion and requiring therapy. 2 The 2007 recommendations were based on the poor outcome of these patients with conventional therapies. The long-term results of first salvage therapy in patients relapsing after Fludarabine-Cyclophosphamide-Rituximab (FCR) therapy demonstrate that patients with a first remission Department of Haematology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. Please send all correspondence to: D. Selleslag, MD, AZ Sint-Jan Brugge-Oostende, Department of Haematology, Ruddershove 10, 8000 Brugge, Belgium, tel: , Dominik.selleslag@azsintjan.be. Conflict of interest: The author has nothing to disclose and indicates no potential conflict of interest. Keywords: allogeneic stem cell transplantation, chronic lymphocytic leukaemia, ibrutinib, idelalisib, venetoclax.
2 REVIEW HEMATOLOGY 186 TABLE 1. Results of RIC allosct for CLL in largest recent studies. Fred Hutchinson Cancer Centre German CLL Study Group MD Anderson Cancer Centre Dana Farber Cancer Institute Sorror 2008 Dreger 2010 Khouri 2011 Brown 2013 Number of patients Conditioning regimen Flu/low dose TBI FluCy +/- ATG FluCy +/- RTX FluBu Donors, % (Sib vs MUD) 63/37 41/59 50/50 37/63 Median follow-up (months) Early mortality, % (<100 days) <10 <3 <3 <3 NRM (%) Acute GVHD, grade 3-4, % Severe chronic GVHD, % PFS, % 39 (5 years) 38 (6 years) 36 (6 years) 43 (6 years) Overall survival, % 50 (5 years) 58 (6 years) 51 (6 years) 63 (6 years) Abbreviations: RIC: reduced intensity conditioning; sib: sibling; MUD: matched unrelated donor; GVHD: graft versus host disease; PFS: progression free survival; Flu: fludarabine; TBI: total body irradiation; FluCy: fludarabine cyclophosphamide; FluBu: fludarabine busulfan; ATG: anti-thymoglobulin; RTX: rituximab. duration of <1 year after FCR had a median overall survival of only thirteen months and those with a remission duration of one to three years had a median overall survival of 27 months. 3 The long-term results of alemtuzumab-dexamethasone treatment in patients with del17p (first-line and relapse) have been presented by Stilgenbauer at ASH Progression free survival at three years improved significantly from 20 to 50% with allosct versus alemtuzumab-dexamethasone maintenance. Several randomised trials and a meta-analysis have shown that high dose chemotherapy and autologous SCT does not offer a survival advantage in CLL compared to conventional chemotherapy and immunochemotherapy. Autologous SCT has been abandoned from current treatment algorithms for CLL and previous autologous SCT is no longer a prerequisite for allosct. 4 The effectiveness of targeted treatments has challenged the appropriateness of the 2007 EBMT consensus recommendations. Targeted treatments of CLL include inhibitors of the BCR pathway (ibrutininb, idelalisib) and BCL2 inhibitors (venetoclax). The place of allosct in the era of these novel targeted treatments will be the focus of this manuscript. RESULTS OF ALLOSCT IN CLL There are no randomised studies comparing reduced intensity conditioning (RIC) with myeloablative conditioning as preparative regimen for allosct in CLL. The Centre for International Blood and Marrow Transplant Research (CIBMTR) reported in a retrospective study the outcomes of matched sibling donor SCT in CLL with RIC versus myeloablative conditioning. Transplants performed after 2000 with RIC conditioning had a significantly superior survival and progression free survival as compared to myeloablative transplants. 5 The current practice is to offer a RIC conditioning to nearly all transplant candidates with CLL. Table 1 shows the results of the largest series of CLL patients undergoing RIC transplants. From this table it is evident that the cure rate with RIC allosct is around 40% with a low early mortality rate of <10% and a late non relapse mortality rate of around 20% due to a 50% incidence of severe chronic graft versus host disease (GVHD). 6 There are no prospective randomised controlled trials comparing allosct with other non-transplant strategies. Three recently published non-randomised studies comparing allosct versus non-transplant strategies provide evidence favouring 5
3 187 the option of allosct for relapsed or refractory CLL. 7,8,9 A Markov decision analysis from Moffitt Cancer Centre demonstrated a better overall life expectancy for allosct (35 months versus 25 months). 7 Similarly, a retrospective comparative analysis of donor versus no-donor from Heidelberg, once again in the RIC context, showed a 2-year overall survival advantage that favoured allosct (88% versus 38%, p<0.0001) for poor risk CLL as defined by 2007 EBMT criteria. 8 A third retrospective comparative analysis from the MD Anderson Cancer Centre using a consult-transplant versus consult-do not transplant design, limited to patients with del17p, also showed a 2-year overall survival advantage that favoured allosct (64% versus 25%, p=0.001). 9 These studies are not generalisable beyond the use of RIC regimens for allografting and preceded the approval of novel targeted therapies. GRAFT VERSUS LEUKAEMIA EFFECT IS CRUCIAL FOR CURING CLL AFTER ALLOSCT The basis for allosct in CLL is graft-versus-leukaemia (GVL) activity. Efficacy of GVL in CLL is supported by the lower relapse risk after chronic GVHD and the higher relapse risk associated with T-cell depletion. The strongest proof of the GVL principle in CLL comes from studies that analyse minimal residual disease (MRD). MRD kinetics studies after HSCT for high-risk CLL demonstrate that MRD clearance often occurs late after allosct in the context of chronic GVHD or immune interventions, such as tapering of immunosuppression or donor lymphocyte infusions (DLI). A study from Heidelberg demonstrated that long-term disease control in CLL is dependent on the GVL pattern: patients achieving immediate MRD negativity after allosct had a higher relapse risk beyond twelve months than patients achieving MRD negativity with immunomodulation such as tapering of immunosuppression or DLI. This finding emphasises the importance of GVL for the cure of CLL. 10 A study from the German CLL study group has shown that CLL patients with MRD positivity at twelve months after allosct have a much higher risk of clinical relapse during later follow-up. 11 The current recommendation is to start MRD monitoring between day 30 and day 90 after allosct. 12 UPDATED RECOMMENDATIONS FOR ALLOSCT IN CLL IN THE ERA OF NOVEL AGENTS HIGH-RISK CLL WITH UNFAVOURABLE GENETIC FEATURES The outcome of treatment-naive and relapsing CLL patients with del 17p or TP53 mutation has significantly improved with novel targeted therapies. Treatment outcomes achieved with these drugs are the best ever reported in patients with del(17p)/tp53 mutations. In a phase II study 51 high-risk CLL patients (del17p, TP53 mutations) of whom 35 (69%) were treatment-naïve, received ibrutinib. The response rate in the treatment-naïve patients was 97% and the estimated 2-year survival was 84%. In patients with relapsed/refractory CLL, the response rate was 80% and 2-year survival was 74%. Progression rate at two years was 9% for previously untreated and 20% for relapsed/refractory CLL. 13 In another study, older treatment-naïve CLL patients with del 17p or TP53 mutations had a progression free survival of 100% at two years with idelalisib and rituximab. 14 More mature results are now available for ibrutinib in relapsed CLL with del17p/tp53 mutations showing a progression free survival of 48% and a survival rate of 65% at 30 months. 15 Venetoclax produced an overall response rate of 79% and a one year progression free survival of 72% in patients with relapsed/ refractory CLL with del(17p). Based on these results a recent international consensus panel of predominantly American CLL experts does not recommend offering allosct in the front-line consolidation for CLL patients with del17p/tp53 mutations. This is a paradigm shift from the 2007 EBMT consensus criteria. The panel recommends offering allosct to CLL with del17p/ TP53 mutations relapsing after conventional first-line therapy and responding to BCR-inhibitors or BCL-2 inhibitors. Also patients refractory to these agents should be offered allosct. 12 Complex karyotype is an even stronger predictor than del17p for inferior outcome in relapsed and refractory CLL treated with ibrutinib. 16 In the international consensus recommendations CLL with complex karyotype is considered as high-risk CLL and should be offered allosct in the same way as CLL with del17p/tp53 mutations. 12 It should be emphasised that CLL with complex karyotype continues to have an inferior outcome after allosct as compared to CLL without complex karyotype. 17 Patients with TP53 mutated CLL have a similar outcome after allosct as patients without TP53 mutations. 18 OTHER HIGH RISK PATIENTS CLL that is refractory to or relapsing within months after initial fludarabine based therapy is still considered as high-risk disease. Even with ibrutinib the outcome of fludarabine resistant CLL is still inferior as compared to fludarabine sensitive CLL. 16 The consensus panel did not consider fludarabine resistance as an indication for immediate allosct. The avoidance of immediate allosct is a major shift from the previous 2007 EBMT consensus recommendations that results from the emergence of promising novel
4 REVIEW HEMATOLOGY 188 FIGURE 1. Allo SCT in patients with high risk CLL responding to targeted drugs: balancing pros and cons. therapies for high-risk CLL. Initial overall response rates of 71% are obtained with ibrutinib even in heavily pre-treated CLL patients (who had received prior fludarabine therapy) and rise over time to 90% with a 30-month progression free survival of 69%. 14 Similar encouraging findings were reported for idelalisib combined with rituximab in previously treated CLL who had failed fludarabine in over 50% of cases. 19 Patients with documented Richter transformation who demonstrate an objective response to treatment with anthracycline based chemotherapy should be offered allosct. Responses to combination chemotherapy are generally shortlived with a median progression free survival of only ten months. Limited experience with allosct in Richter transformation shows an overall survival for patients allografted in complete or partial remission of 41-75% at three years. 20 STANDARD RISK CLL Standard risk CLL is defined as CLL with absence of del17p and P53 mutations and without complex karyotype. The international consensus panel recommends offering an allosct only when there is lack of response or evidence of progression after BCR inhibitors. Concerns remain about the difficulty of re-inducing remission after relapse or progression on BCR inhibitors. No randomised data exists, to date, which compares allosct versus non-transplant strategies in patients who do not respond or progress on BCR inhibitors. Several mechanisms of resistance to ibrutinib have been reported predominantly in subjects with high-risk features who develop a cysteine-to-serine mutation in Bruton s Tyrosine Kinase (BTK) at the binding site of ibrutinib and/or activating mutations in PLCγ2, which is directly downstream of BTK. 21 Investigators have shown a median OS of only 3.1 months after discontinuation of ibrutinib for various reasons, emphasising the urgency in identifying these cases and initiating a search for an HLA identical donor as soon as possible. 22 Madocks et al. reported a cumulative incidence of Richter transformation of 4.5% at twelve months during ibrutinib treatment for CLL. 23 While the incidence of Richter transformation appears to be relatively low, early identification of these cases and prompt referral to transplant centres is important considering the short-lived responses and the aggressive biology of this disease. There are no established guidelines about the optimal timeframe to offer allosct for CLL with del 11q. The comparative efficacy of therapies such as ibrutinib or chemoimmunotherapy in patients with del11q as compared to non-del11q suggests that del11q patients may be more appropriately incorporated within standard-risk treatment algorithms, unless they show evidence of clonal progression with del17p or complex karyotype or Richter transformation. 15 5
5 189 FIGURE 2. Factors affecting the balance between immediate and delayed allosct. CAN NOVEL TARGETED MOLECULES IM- PROVE THE OUTCOME OF ALLOSCT IN CLL? Several studies have demonstrated that the outcome of CLL after allosct is superior in patients allografted in complete or partial remission as compared to patients with stable or progressive disease. 24,25 An effective salvage remission induction regimen for fludarabine refractory CLL is R-DHAP (rituximab, dexamethasone, high dose Ara-C and cisplatin) immunochemotherapy enabling the majority of patients to proceed to allosct. 26 This regimen can be given to patients who have no access or do not respond to targeted therapies. To date, there is virtually no published experience on the outcome of allosct in patients who have been exposed to BCR inhibitors, and also data on the use of these drugs after allosct is scarce. However, some theoretical considerations on the interaction between BCR inhibitors and allosct can be made: 1. How will pre-transplant exposure to BCR inhibitors affect the outcome of subsequent allosct? Given the pronounced capacity of ibrutinib and idelalisib of clearing bulky lymph nodes by redistributing CLL cells to the circulation, it is tempting to speculate that these agents could be particularly suitable to optimise the remission status prior to allosct. However, preliminary experience indicates that responses achieved with BCR inhibitors in high-risk CLL may be less stable after cessation of the drug (tumour flare) than those achieved with chemoimmunotherapy, implying that BCR inhibitor-mediated remissions could not be durable enough for allowing the GVL activity to become effective. Thus, it remains to be seen whether BCR inhibitors increase the quality of response before transplant. In this context, the EBMT is currently running a registry study aimed at collecting feasibility and efficacy data on allosct after BCR/BCL2 inhibitor exposure in patients with high-risk CLL. 2. Will allosct outcomes be improved by giving BCR/BCL2 inhibitors post transplant? Post transplant BCR/BCL2 inhibitor administration might be considered as preventive, pre-emptive (MRD-triggered), or therapeutic upon clinical relapse. To date, only anecdotal information is available on the use of ibrutinib for treatment of CLL relapsing after allosct. In a murine model ibrutinib ameliorated chronic GVHD by inhibition of interleukin-2-inducible kinase (ITK). 27 Preliminary clinical results suggest that ibrutinib treatment might indeed improve the outcome of clinical CLL relapse after allosct without risk of eliciting GVHD. 28 In conclusion, the introduction of BCR/BCL2 inhibitors could improve the outcome of transplant approaches in highrisk CLL, but their actual effect remains largely speculative with limited evidence available to date.
6 REVIEW HEMATOLOGY 190 KEY MESSAGES FOR CLINICAL PRACTICE 1 Allogeneic stem cell transplantation (allosct) can cure 40% of patients with CLL. 2 Early transplant related mortality with reduced intensity conditioning is low. 3 Late non relapse mortality is around 20% due to the high incidence of chronic graft versus host disease. 4 Graft versus leukaemia effect is crucial for curing CLL after allosct and can be obtained by immune interventions (DLI, tapering immunosuppression). 5 The promising results of BCR pathway inhibitors in genetically high-risk CLL (with 17p deletion/tp53 mutation or complex karyotype) and fludarabine resistant CLL led to the current recommendation to proceed with allosct in CLL patients failing a BCR pathway inhibitor. 6 The question when to proceed with allosct in patients responding to a BCR pathway inhibitor remains unanswered. Randomised or prospective observational studies comparing novel agents to allosct are lacking. At this time the decision should be individualised and depends on the estimated transplantation risks and the patient s desires. 7 Patients with documented Richter transformation who demonstrate an objective response to treatment with anthracycline based chemotherapy should be offered allosct. 8 Knowledge on the optimal use of BCR/BCL2 inhibitors pre- or post transplant is limited and is a field of active investigation. BALANCING PROS AND CONS OF ALLOSCT IN HIGH-RISK CLL RESPONDING TO NOVEL DRUGS (Figure 1) Compared to allosct, BCR/BCL2 inhibitors have the advantage of much less procedure-related mortality and morbidity. On the other hand, disadvantages of these novel agents are the absence of curative potential, the uncertainty of durability of response after salvage therapy with alternative BCR/BCL2 inhibitors in case of disease progression, and less efficacy in del17p/tp53 mutated CLL. In contrast, allosct has curative potential even in genetically very unfavourable disease with effective salvage options such as DLI for patients relapsing after transplant. Downsides of allosct are limitations related to age, comorbidity, and donor availability. Taking these points into consideration, the European Research Initiative on CLL (ERIC) and the EBMT have proposed a rational approach to counselling patients with high-risk CLL about the optimal treatment strategy including the transplant option. 29 CONCLUSION HOW TO COUNSEL THE CLL PATIENT IN THE ERA OF NOVEL AGENTS ON IMMEDIATE VERSUS DELAYED ALLOSCT? If possible, every patient with high-risk CLL should be offered one of the new drugs to induce remission. Once maximum response is achieved, there are two options to maintain it: either performing a consolidating allosct or continuing on BCR/BCL2 inhibitors until progression, thereby postponing allohsct until failure to novel drugs is observed. In the absence of controlled studies, in the relapsed/refractory setting, available evidence does not suggest a superiority of one of these two choices over the other, survival being comparable with both options during the first 24 months. Thereafter, survival of patients allografted in a sensitive disease status is well documented, whereas the information on prognosis with continued treatment with BCR/BCL2 inhibitors is still limited. An abstract presented at ASH 2016 described 5-year follow-up with ibrutininb in relapsed refractory CLL: estimated progression free survival at 5-years was 43% and median progression free survival was 52 months. Although these figures are comparable to the outcome of allosct, median follow-up with ibrutinib was still shorter (39 versus >60 months). 30 Decision for immediate or delayed allosct has to be taken after careful discussion of risks and chances of the two options, taking into account the individual situation. Factors affecting the balance between immediate versus delayed allosct are listed in Figure 2. If ever possible, the two options should be compared within a clinical trial or, alternatively, within the framework of an observational study. 5
7 191 REVIEW HEMATOLOGY REFERENCES 1. Passweg JR, Baldomero H, Bader P, et al. Hematopoietic stem cell transplantation in Europe 2014: more than transplants annually. Bone Marrow Transplant. 2016;51(6): Dreger P, Corradini P, Kimby E, et al. Indications for allogeneic stem cell transplantation in chronic lymphocytic leukaemia: the EBMT transplant consensus. Leukemia. 2007;21(1): Tam CS, O Brien S, Plunkett W, et al. Long-term results of first salvage treatment in CLL patients treated initially with FCR (fludarabine, cyclophosphamide, rituximab). Blood. 2014;124(20): Reljic T, Kumar A, Djulbegovic B, et al. High-dose therapy and autologous hematopoietic cell transplantation as front-line consolidation in chronic lymphocytic leukaemia: a systematic review. Bone Marrow Transplant. 2015;50(8): Sobecks RM, Leis JF, Gale RP, et al. Outcomes of human leukocyte antigenmatched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukaemia: myeloablative versus reduced-intensity conditioning regimens. Biol Blood Marrow Transplant. 2014;20(9): McClanahan F, Gribben J. Transplantation in Chronic Lymphocytic Leukemia (CLL): does it still matter in the era of novel targeted therapies? Hematol Oncol Clin North Am. 2014;28(6): Kharfan-Dabaja MA, Pidala J, Kumar A, et al. Comparing efficacy of reduced toxicity allogeneic hematopoietic cell transplantation with conventional chemo- (immuno) therapy in patients with relapsed or refractory CLL: a Markov decision analysis. Bone Marrow Transplant. 2012;47: Herth I, Dietrich S, Benner A, et al. The impact of allogeneic stem cell transplantation on the natural course of poor-risk chronic lymphocytic leukaemia as defined by the EBMT consensus criteria: a retrospective donor versus no donor comparison. Ann Oncol. 2014;25: Poon ML, Fox PS, Samuels BI, et al. Allogeneic stem cell transplant in patients with chronic lymphocytic leukaemia with 17p deletion: consult-transplant versus consult- no transplant analysis. Leuk Lymphoma. 2015;56: Hahn M, Böttcher S, Dietrich S, et al. Allogeneic hematopoietic stem cell transplantation for poor-risk CLL: dissecting immune-modulating strategies for disease eradication and treatment of relapse. Bone Marrow Transplant. 2015; 50(10): Dreger P, Döhner H, Ritgen M, et al. Allogeneic stem cell transplantation provides durable disease control in poor-risk chronic lymphocytic leukaemia: long-term clinical and MRD results of the German CLL Study Group CLL3X trial. Blood. 2010;116(14): Kharfan-Dabaja MA, Kumar A, Hamadani M, et al. Clinical Practice Recommendations for Use of Allogeneic Hematopoietic Cell Transplantation in Chronic Lymphocytic Leukemia on Behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2016;22(12): Farooqui M, Valdez J, Martyr S, et al. Ibrutinib for previously untreated and relapsed or refractory chronic lymphocytic leukaemia with TP53 aberrations: a phase 2, single-arm trial. Lancet Oncol. 2015;16(2): O Brien S, Lamanna N, Kipps T, et al. A phase 2 study of idelalisib plus rituximab in treatment-naïve older patients with chronic lymphocytic leukaemia. Blood. 2015;126: Byrd JC, Furman RR, Coutre SE, et al. Three-year follow-up of treatment-naïve and previously treated patients with CLL and SLL receiving single-agent ibrutinib. Blood. 2015;125(16): Thompson PA, O Brien SM, Wierda WG, et al. Complex karyotype is a stronger predictor than del(17p) for an inferior outcome in relapsed or refractory chronic lymphocytic leukaemia patients treated with ibrutinib-based regimens. Cancer. 2015;121(20): Jaglowski SM, Ruppert AS, Heerema NA, et al. Complex karyotype predicts for inferior outcomes following reduced-intensity conditioning allogeneic transplant for chronic lymphocytic leukaemia. Br J Haematol. 2012;159(1): Dreger P, Schnaiter A, Zenz T, et al. TP53, SF3B1, and NOTCH1 mutations and outcome of allotransplantation for chronic lymphocytic leukaemia: six-year follow-up of the GCLLSG CLL3X trial. Blood. 2013;121(16): Furman RR, Sharman JP, Coutre SE, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukaemia. N Engl J Med. 2014;370: El-Asmar J, Kharfan-Dabaja MA. Hematopoietic Cell Transplantation for Richter Syndrome. Biol Blood Marrow Transplant. 2016; 22(11): Woyach JA, Furman RR, Liu TM, et al. Resistance mechanisms for the Bruton s tyrosine kinase inhibitor ibrutinib. N Engl J Med. 2014;370: Jain P, Keating M, Wierda W, et al. Outcomes of patients with chronic lymphocytic leukaemia after discontinuing ibrutinib. Blood. 2015;125: Maddocks KJ, Ruppert AS, Lozanski G, et al. Etiology of Ibrutinib Therapy Discontinuation and Outcomes in Patients With Chronic Lymphocytic Leukemia. JAMA Oncol. 2015;1: Dreger P, Döhner H, Ritgen M, et al. German CLL Study Group. Allogeneic stem cell transplantation provides durable disease control in poor-risk chronic lymphocytic leukaemia: long-term clinical and MRD results of the German CLL Study Group CLL3X trial. Blood. 2010;116(14): Brown JR, Kim HT, Armand P, et al. Long-term follow-up of reduced-intensity allogeneic stem cell transplantation for chronic lymphocytic leukaemia: prognostic model to predict outcome. Leukemia. 2013;27(2): Van Gelder M, Van Oers MH, Alemayehu WG, et al. Efficacy of cisplatinbased immunochemotherapy plus allosct in high-risk chronic lymphocytic leukaemia: final results of a prospective multicenter phase 2 HOVON study. Bone Marrow Transplant. 2016;51(6): Dubovsky JA, Flynn R, Du J, et al. Ibrutinib treatment ameliorates murine chronic graft-versus-host disease. J Clin Invest. 2014;124(11): Coutre S, O Brien S, Byrd J. Safety and efficacy of ibrutinib in patients with relapsed/refractory chronic lymphocytic leukaemia/small lymphocytic lymphoma who have undergone prior allogeneic stem cell transplant. ASH 2014, abstract Dreger P, Schetelig J, Andersen N, et al. Managing high-risk CLL during transition to a new treatment era: stem cell transplantation or novel agents? Blood. 2014;124(26): O Brien S, Furman R, Coutre S, et al. Five-year experience with single-agent ibrutinib in patients with previously untreated and relapsed/refractory chronic lymphocytic leukaemia/small lymphocytic lymphoma. ASH 2016, abstract 233.
GVHD & GVL in the lymphoma setting: The case of CLL
GVHD & GVL in the lymphoma setting: The case of CLL Peter Dreger Dept. Internal Medicine V University of Heidelberg EBMT: SCT for CLL 2000-2010 Update January 2012 allo auto 400 350 300 250 200 150 100
More informationallosct and CLL in the BCRi era time for a study
allosct and CLL in the BCRi era time for a study Patient characteristics in BCRi studies and allosct candidates DIFFER Facts on BCRi no Cure Risk factors for shorter BCRi efficacy in MV analysis? PA-refractory
More informationReduced-intensity Conditioning Transplantation
Reduced-intensity Conditioning Transplantation Current Role and Future Prospect He Huang M.D., Ph.D. Bone Marrow Transplantation Center The First Affiliated Hospital Zhejiang University School of Medicine,
More informationMantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients
Mantle cell lymphoma Allo stem cell transplantation in relapsed and refractory patients Olivier Hermine MD, PhD Department of Hematology INSERM and CNRS, Imagine Institute Necker Hospital Paris, France
More informationBACKGROUND AND RATIONALE
SYNOPSIS Observational study on the use of B cell receptor kinase inhibitors and BCL2 antagonists prior to allogeneic hematopoietic stem cell transplantation for B cell malignancies: A joint project of
More informationAdvances in CLL 2016
Advances in CLL 2016 The Geoffrey P. Herzig Memorial Symposium, Louisville, KY Kanti R. Rai, MD Northwell-Hofstra School of Medicine Long Island Jewish Medical Center New Hyde Park, NY Disclosures Member
More informationDr Claire Burney, Lymphoma Clinical Fellow, Bristol Haematology and Oncology Centre, UK
EMBT LWP 2017-R-05 Research Protocol: Outcomes of patients treated with Ibrutinib post autologous stem cell transplant for mantle cell lymphoma. A retrospective analysis of the LWP-EBMT registry. Principle
More informationManagement of 17p Deleted CLL Patients in the Era of Targeted Therapy
Management of 17p Deleted CLL Patients in the Era of Targeted Therapy Jennifer R Brown, MD PhD Director, CLL Center Dana-Farber Cancer Institute Associate Professor Harvard Medical School November 11,
More informationCLL & SLL: Current Management & Treatment. Dr. Isabelle Bence-Bruckler
CLL & SLL: Current Management & Treatment Dr. Isabelle Bence-Bruckler Chronic Lymphocytic Leukemia Prolonged clinical course Chronic A particular type of white blood cell B lymphocyte Lymphocytic Cancer
More informationSTEM-CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA
STEM-CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA Carol Moreno Department of Hematology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain Introduction
More informationManagement of Patients With Relapsed Chronic Lymphocytic Leukemia
Management of Patients With Relapsed Chronic Lymphocytic Leukemia Polina Shindiapina, MD, PhD, and Farrukh T. Awan, MD Abstract The management of chronic lymphocytic leukemia (CLL) has improved significantly
More informationMedical Benefit Effective Date: 07/01/12 Next Review Date: 05/13 Preauthorization* Yes Review Dates: 04/07, 05/08, 05/11, 05/12
Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic (80115) Medical Benefit Effective Date: 07/01/12 Next Review Date: 05/13 Preauthorization* Yes Review Dates: 04/07, 05/08, 05/11, 05/12 The
More informationChronic lymphocytic leukemia. E. Van Den Neste Cliniques UCL Saint-Luc, Brussels Post-ASH meeting January 2015
Chronic lymphocytic leukemia E. Van Den Neste Cliniques UCL Saint-Luc, Brussels Post-ASH meeting January 2015 Disclosures Travelling to ASH: Roche Consulting services: Janssen Questions in CLL: answers
More informationHematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Policy Number: 8.01.15 Last Review: 6/2017 Origination: 12/2001 Next Review: 6/2018 Policy Blue Cross and
More informationCLL & SLL: Current Management & Treatment. Dr. Peter Anglin
CLL & SLL: Current Management & Treatment Dr. Peter Anglin Chronic Lymphocytic Leukemia Prolonged clinical course Chronic A particular type of blood cell B lymphocyte Lymphocytic Cancer of white blood
More informationMP Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Medical Policy MP 8.01.15 Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma BCBSA Ref. Policy: 8.01.15 Last Review: 01/30/2018 Effective Date: 01/30/2018 Section:
More informationChronic Lymphocytic Leukemia (CLL): Refresher Course for Hematologists Ekarat Rattarittamrong, MD
Chronic Lymphocytic Leukemia (CLL): Refresher Course for Hematologists Ekarat Rattarittamrong, MD Division of Hematology Department of Internal Medicine Faculty of Medicine Chiang-Mai University Outline
More informationCorporate Medical Policy
Corporate Medical Policy Hematopoietic Cell Transplantation for CLL and SLL File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_cell_transplantation_for_cll_and_sll 2/2001
More informationHematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Medical Policy Manual Transplant, Policy No. 45.35 Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Next Review: September 2018 Last Review: December 2017
More informationSequencing of chronic lymphocytic leukemia therapies
CHRONIC LYMPHOCYTIC LEUKEMIA Sequencing of chronic lymphocytic leukemia therapies Jacqueline C. Barrientos CLL Research and Treatment Program, Department of Internal Medicine, Hofstra Northwell School
More informationHematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Policy Number: Original Effective Date: MM.07.011 04/01/2008 Line(s) of Business: Current Effective Date:
More informationAppendix 6: Indications for adult allogeneic bone marrow transplant in New Zealand
Appendix 6: Indications for adult allogeneic bone marrow transplant in New Zealand This list provides indications for the majority of adult BMTs that are performed in New Zealand. A small number of BMTs
More informationState of the Art Treatment for Relapsed Mantle Cell Lymphoma
Winship Cancer Institute of Emory University State of the Art Treatment for Relapsed Mantle Cell Lymphoma Jonathon B. Cohen, MD, MS Assistant Professor, BMT Program Emory University- Winship Cancer Institute
More informationCLL: future therapies. Dr. Nathalie Johnson
CLL: future therapies Dr. Nathalie Johnson Disclosures Consultant and Advisory boards Roche, Abbvie, Gilead, Jansson, Lundbeck,Merck Research funding Roche, Abbvie, Lundbeck Outline Treatment of relapsed
More informationpan-canadian Oncology Drug Review Submitter or Manufacturer Feedback on a pcodr Expert Review Committee Initial Recommendation
pan-canadian Oncology Drug Review Submitter or Manufacturer Feedback on a pcodr Expert Review Committee Initial Recommendation Venetoclax (Venclexta) Chronic Lymphocytic Leukemia March 2, 2018 3 Feedback
More informationCorso nazionale SIE di aggiornamento in ematologia clinica. Il trapianto allogenico nella LLC
Corso nazionale SIE di aggiornamento in ematologia clinica Il trapianto allogenico nella LLC Bolzano, 18-19 giugno 2009 Francesco Zaja - Clinica Ematologica, Udine Curative strategy for CLL Induction Flu-CYT
More informationWe Can Cure Chronic Lymphocytic Leukemia with Current / Soon to be Approved Agents: CON ARGUMENT
We Can Cure Chronic Lymphocytic Leukemia with Current / Soon to be Approved Agents: CON ARGUMENT Danielle M. Brander, MD Duke University Division of Hematologic Malignancies & Cell Therapy CLL & Indolent
More informationAllogeneic Hematopoietic Stem Cell Transplantation: State of the Art in 2018 RICHARD W. CHILDS M.D. BETHESDA MD
Allogeneic Hematopoietic Stem Cell Transplantation: State of the Art in 2018 RICHARD W. CHILDS M.D. BETHESDA MD Overview: Update on allogeneic transplantation for malignant and nonmalignant diseases: state
More informationPatient Selection for allogeneic stem cell transplantation in CLL KOEN VAN BESIEN, MD WEILL CORNELL MEDICAL COLLEGE, NY
Patient Selection for allogeneic stem cell transplantation in CLL KOEN VAN BESIEN, MD WEILL CORNELL MEDICAL COLLEGE, NY Topics CLL Complicated CLL Richter s transformation What did we learn about allotransplant
More informationO Papel do TCH na LLC. Fábio R. Kerbauy
O Papel do TCH na LLC Fábio R. Kerbauy (fkerbauy@gmail.com) Outline Autologous SCT Allogeneic SCT Indications Mieloablative x non-myeloablative Brazilian experience HCT Indications CIBMTR 2012 Pasquini
More informationClinical Overview: MRD in CLL. Dr. Matthias Ritgen UKSH, Medizinische Klinik II, Campus Kiel
Clinical Overview: MRD in CLL Dr. Matthias Ritgen UKSH, Medizinische Klinik II, Campus Kiel m.ritgen@med2.uni-kiel.de Remission in CLL Clinical criteria (NCI->WHO) Lymphadenopathy Splenomegaly Hepatomegaly
More informationHematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Policy Number: 8.01.15 Last Review: 6/2014 Origination: 12/2001 Next Review: 6/2015 Policy Blue Cross
More informationCLL Ireland Information Day Presentation
CLL Ireland Information Day Presentation 5 May 2018 Professor Patrick Thornton Consultant Haematologist, Senior Lecturer RCSI, and Clinical Director Hermitage Medical Clinic Laboratory Chronic Lymphocytic
More information17p Deletion in Chronic Lymphocytic Leukemia
17p Deletion in Chronic Lymphocytic Leukemia Risk Stratification and Therapeutic Approach Andrea Schnaiter, MD, Stephan Stilgenbauer, MD* KEYWORDS CLL 17p deletion High-risk Targeted therapy BTK PI3K BH3
More informationHematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary,
More informationRecent Advances in the Treatment of Non-Hodgkin s Lymphomas
671 Highlights of the NCCN 18th Annual Conference Recent Advances in the Treatment of Presented by Jeremy S. Abramson, MD, and Andrew D. Zelenetz, MD, PhD Abstract Non-Hodgkin s lymphomas (NHL) represent
More informationFCR and BR: When to use, how to use?
FCR and BR: When to use, how to use? Mitchell R. Smith, M.D., Ph.D. Director of Lymphoid Malignancy Program Taussig Cancer Institute Cleveland Clinic, Cleveland, OH DEBATE ISSUE 2013: Which is the optimal
More informationBrad S Kahl, MD. Tracks 1-21
I N T E R V I E W Brad S Kahl, MD Dr Kahl is Associate Professor and Director of the Lymphoma Service at the University of Wisconsin School of Medicine and Public Health and Associate Director for Clinical
More informationEBMT2008_22_44:EBMT :29 Pagina 454 CHAPTER 30. HSCT for Hodgkin s lymphoma in adults. A. Sureda
EBMT2008_22_44:EBMT2008 6-11-2008 9:29 Pagina 454 * CHAPTER 30 HSCT for Hodgkin s lymphoma in adults A. Sureda EBMT2008_22_44:EBMT2008 6-11-2008 9:29 Pagina 455 CHAPTER 30 HL in adults 1. Introduction
More informationRichter s Syndrome: Risk, Predictors and Treatment
Richter s Syndrome: Risk, Predictors and Treatment 10/23/2015 John N. Allan MD Assistant Professor of Medicine Division of Hematology and Medical Oncology CLL Research Center Weill Cornell Medicine Agenda
More informationHematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Policy Number: MM.07.011 Lines of Business: HMO; PPO Precertification: Required see section IV Current
More informationHCT for Myelofibrosis
Allogeneic HSCT for MDS and Myelofibrosis Sunil Abhyankar, MD Professor Medicine, Medical Director, Pheresis and Cell Processing University of Kansas Hospital BMT Program April 27 th, 213 HCT for Myelofibrosis
More informationHighlights in chronic lymphocytic leukemia
Congress Highlights CLL Highlights in chronic lymphocytic leukemia A. Janssens, MD, PhD 1 As new data on indolent non-hodgkin lymphoma (inhl) were not that compelling, only highlights on chronic lymphocytic
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Single Technology Appraisal. Ibrutinib for treating chronic lymphocytic leukaemia.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Single Technology Appraisal Ibrutinib for treating chronic lymphocytic leukaemia Final scope Remit/appraisal objective To appraise the clinical and cost
More informationCLL treatment algorithm and state of the art
CLL treatment algorithm and state of the art Davide Rossi, M.D., Ph.D. Hematology IOSI - Oncology Institute of Southern Switzerland IOR - Institute of Oncology Research Bellinzona - Switzerland CLL subgroups
More informationUNMET NEEDS OF PATIENTS WITH CLL/SLL AND FL. June 6, 2018
UNMET NEEDS OF PATIENTS WITH CLL/SLL AND FL June 6, 2018 0 PRESENTATION OVERVIEW IN CLL/SLL AND FL: Review patient heterogeneity and its connection to unmet needs Explore unmet needs within the CLL/SLL
More informationCorporate Medical Policy
Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem_cell_transplantation_for_waldenstrom_macroglobulinemia
More informationFOLLICULAR LYMPHOMA: US vs. Europe: different approach on first relapse setting?
Indolent Lymphoma Workshop Bologna, Royal Hotel Carlton May 2017 FOLLICULAR LYMPHOMA: US vs. Europe: different approach on first relapse setting? Armando López-Guillermo Department of Hematology, Hospital
More informationCLL: Future Therapies. Dr. Anca Prica
CLL: Future Therapies Dr. Anca Prica Treatment Options: Improved by Decade 1960 1970 1980 1990 2000 2017 5% CR 5% CR Chemo Alkylator chlorambucil or cyclophosphamide 25% CR Chemo Purine analogues Fludarabine
More informationRaising the Bar in CLL Michael E. Williams, MD, ScM Byrd S. Leavell Professor of Medicine Chief, Hematology/Oncology Division
Raising the Bar in CLL Michael E. Williams, MD, ScM Byrd S. Leavell Professor of Medicine Chief, Hematology/Oncology Division University of Virginia Cancer Center The Clinical Continuum of CLL Early asymptomatic
More informationTransplantation in Chronic Lymphocytic Leukemia: Timing and Expectations
CLL Leukemia 2008 Proceedings Transplantation in Chronic Lymphocytic Leukemia: Timing and Expectations Simon Hallam, John G. Gribben Abstract Stem cell transplantation in chronic lymphocytic leukemia (CLL)
More information1. What to test. 2. When to test
Biomarkers: the triad of questions 1. What to test 2. When to test 3. Who to test Biomarkers: the triad of questions 1. What to test 2. When to test 3. Who to test Impact of CLL biological features on
More informationChronic Lymphocytic Leukemia Update. Learning Objectives
Chronic Lymphocytic Leukemia Update Ashley Morris Engemann, PharmD, BCOP, CPP Clinical Associate Adult Stem Cell Transplant Program Duke University Medical Center August 8, 2015 Learning Objectives Recommend
More informationCLL: disease specific biology and current treatment. Dr. Nathalie Johnson
CLL: disease specific biology and current treatment Dr. Nathalie Johnson Disclosures Consultant and Advisory boards Roche, Abbvie, Gilead, Jansson, Lundbeck,Merck Research funding Roche, Abbvie, Lundbeck
More informationAddition of Rituximab to Fludarabine and Cyclophosphamide in Patients with CLL: A Randomized, Open-Label, Phase III Trial
Addition of Rituximab to Fludarabine and Cyclophosphamide in Patients with CLL: A Randomized, Open-Label, Phase III Trial Hallek M et al. Lancet 2010;376:1164-74. Introduction > In patients with CLL, the
More informationHematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Hematopoietic Stem-Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Policy Number: Original Effective Date: MM.07.011 04/01/2008 Line(s) of Business: Current Effective
More informationA.M.W. van Marion. H.M. Lokhorst. N.W.C.J. van de Donk. J.G. van den Tweel. Histopathology 2002, 41 (suppl 2):77-92 (modified)
chapter 4 The significance of monoclonal plasma cells in the bone marrow biopsies of patients with multiple myeloma following allogeneic or autologous stem cell transplantation A.M.W. van Marion H.M. Lokhorst
More informationWhat s a Transplant? What s not?
What s a Transplant? What s not? How to report the difference? Daniel Weisdorf MD University of Minnesota Anti-cancer effects of BMT or PBSCT [HSCT] Kill the cancer Save the patient Restore immunocompetence
More informationGeorg Hopfinger 3. Med.Abt and LBI for Leukemiaresearch and Haematology Hanusch Krankenhaus,Vienna, Austria
Chronic lymphocytic Leukemia Georg Hopfinger 3. Med.Abt and LBI for Leukemiaresearch and Haematology Hanusch Krankenhaus,Vienna, Austria georg.hopfinger@wgkk.at CLL Diagnosis and Staging Risk Profile Assessment
More informationChronic lymphocytic leukemia is eradication feasible and worthwhile?
Chronic lymphocytic leukemia is eradication feasible and worthwhile? Gianluca Gaidano, MD, PhD Division of Hematology Department of Clinical and Experimental Medicine Amedeo Avogardo University of Eastern
More informationLEUCEMIA LINFATICA CRONICA: TERAPIA DEL PAZIENTE IN RECIDIVA
CORSO TEORICO-PRATICO PER LA GESTIONE OTTIMALE DEI PAZIENTI AFFETTI DA LINFOMA MANTELLARE, LINFOMA FOLLICOLARE E LEUCEMIA LINFATICA CRONICA Torino, 21-23 Maggio 2018 LEUCEMIA LINFATICA CRONICA: TERAPIA
More informationMUD SCT. Pimjai Niparuck Division of Hematology, Department of Medicine Ramathibodi Hospital, Mahidol University
MUD SCT Pimjai Niparuck Division of Hematology, Department of Medicine Ramathibodi Hospital, Mahidol University Outlines Optimal match criteria for unrelated adult donors Role of ATG in MUD-SCT Post-transplant
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): October 1, 2014 Most Recent Review Date (Revised): May 20, 2014 Effective Date: October 1, 2014 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT
More informationMRD Negativity as an Outcome in CLL: Ongoing Challenges with Del 17p Patients
MRD Negativity as an Outcome in CLL: Ongoing Challenges with Del 17p Patients Jennifer R Brown, MD PhD Director, CLL Center Dana-Farber Cancer Institute Associate Professor Harvard Medical School November
More informationWhat s new in Blood and Marrow Transplant? Saar Gill, MD PhD Jan 22, 2016
What s new in Blood and Marrow Transplant? Saar Gill, MD PhD Jan 22, 2016 Division of Hematology-Oncology University of Pennsylvania Perelman School of Medicine 1 Who should be transplanted and how? Updates
More informationBone Marrow Transplantation and the Potential Role of Iomab-B
Bone Marrow Transplantation and the Potential Role of Iomab-B Hillard M. Lazarus, MD, FACP Professor of Medicine, Director of Novel Cell Therapy Case Western Reserve University 1 Hematopoietic Cell Transplantation
More informationMantle Cell Lymphoma. A schizophrenic disease
23 maggio, 2018 Mantle Cell Lymphoma A schizophrenic disease Patients relapsed after Auto transplant EBMT registry 2000-2009 (n=360) 19 months OS 24 months OS Dietrich S, Ann Oncol 2014 Patients receiving
More informationAML:Transplant or ChemoTherapy?
AML:Transplant or ChemoTherapy? 1960 s: Importance of HLA type in Animal Models Survival of Dogs Given 1000 RAD TBI and a Marrow Infusion from a Littermate Matched or Mismatched for Dog Leucocyte Antigens
More informationChronic lymphocytic Leukemia
Chronic lymphocytic Leukemia after IwCLL, ICML and EHA 2017 Ann Janssens, MD, PhD Hematology, UZ Leuven Brussels, 14 september 2017 Front line treatment CLL Active or progressive disease No active or progressive
More informationCLL what do I need to know as an Internist in Taimur Sher MD Associate Professor of Medicine Mayo Clinic
CLL what do I need to know as an Internist in 218 Taimur Sher MD Associate Professor of Medicine Mayo Clinic Case 1 7 y/o white male for yearly medical evaluation Doing well and healthy Past medical history
More informationCLL Biology and Initial Management. Gordon D. Ginder, MD Director, Massey Cancer Center Lipman Chair in Oncology
CLL Biology and Initial Management Gordon D. Ginder, MD Director, Massey Cancer Center Lipman Chair in Oncology CLL- Epidemiology Most common adult leukemia 25-30% in western world Incidence in US 4.5
More informationCLL - venetoclax. Peter Hillmen St James s University Hospital Leeds 10 th May 2016
CLL - venetoclax Peter Hillmen peter.hillmen@nhs.net St James s University Hospital Leeds 10 th May 2016 Pathophysiology of CLL: Proliferation vs Apoptosis Proliferation Apoptosis Ki-67 Expression Bcl-2
More informationNew Evidence reports on presentations given at EHA/ICML Bendamustine in the Treatment of Lymphoproliferative Disorders
New Evidence reports on presentations given at EHA/ICML 2011 Bendamustine in the Treatment of Lymphoproliferative Disorders Report on EHA/ICML 2011 presentations Efficacy and safety of bendamustine plus
More informationMedication Policy Manual. Topic: Arzerra, ofatumumab Date of Origin: January 15, 2010
Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Policy No: dru196 Topic: Arzerra, ofatumumab Date of Origin: January 15, 2010 Committee Approval Date: January
More informationLeukemia. Roland B. Walter, MD PhD MS. Fred Hutchinson Cancer Research Center University of Washington
Leukemia Roland B. Walter, MD PhD MS Fred Hutchinson Cancer Research Center University of Washington Discussed Abstracts Confirmatory open-label, single-arm, multicenter phase 2 study of the BiTE antibody
More informationUpdate: Chronic Lymphocytic Leukemia
ASH 2008 Update: Chronic Lymphocytic Leukemia Improving Patient Response to Treatment with the Addition of Rituximab to Fludarabine-Cyclophosphamide ASH 2008: Update on chronic lymphocytic leukemia CLL-8
More informationKEY WORDS: CRp, Platelet recovery, AML, MDS, Transplant
Platelet Recovery Before Allogeneic Stem Cell Transplantation Predicts Posttransplantation Outcomes in Patients with Acute Myelogenous Leukemia and Myelodysplastic Syndrome Gheath Alatrash, Matteo Pelosini,
More informationThe role of stem cell transplant for lymphoma in 2017
DOI: 10.1002/hon.2396 SUPPLEMENT ARTICLE The role of stem cell transplant for in 2017 John G. Gribben Barts Cancer Institute, Queen Mary University of London, London, UK Correspondence John G. Gribben,
More informationQuando e se è possibile e u/le o0enere una remissione completa
Quando e se è possibile e u/le o0enere una remissione completa 1) Clinical heterogeneity Disease characteris:cs Pa:ent characteris:cs 2) Modern chemoimmunotherpy approaches 3) New mechanism- based treatment
More informationCorporate Medical Policy
Corporate Medical Policy Hematopoietic Cell Transplantation for Hodgkin Lymphoma File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_cell_transplantation_for_hodgkin_lymphoma
More informationLymphoma 101. Nathalie Johnson, MDPhD. Division of Hematology Jewish General Hospital Associate Professor of Medicine, McGill University
Lymphoma 101 Nathalie Johnson, MDPhD Division of Hematology Jewish General Hospital Associate Professor of Medicine, McGill University Disclosures Consultant and Advisory boards for multiple companies
More informationMyeloablative and Reduced Intensity Conditioning for HSCT Annalisa Ruggeri, MD, Hôpital Saint Antoine Eurocord- Hôpital Saint Louis, Paris
Myeloablative and Reduced Intensity Conditioning for HSCT Annalisa Ruggeri, MD, Hôpital Saint Antoine Eurocord- Hôpital Saint Louis, Paris 18th ESH - EBMT Training Course on HSCT 8-10 May 2014, Vienna,
More informationThe International Peer-Reviewed Journal for The the International Practicing Oncologist/Hematologist. Other Advances in Leukemia/MDS ALL AML MDS
The Oncologist The International Peer-Reviewed Journal for The the International Practicing Oncologist/Hematologist Peer-Reviewed Journal for the Practicing Oncologist/Hematologist 20 th Anniversary Overview
More informationStem cell transplantation for patients with AML in Republic of Macedonia: - 15 years of experience -
Stem cell transplantation for patients with AML in Republic of Macedonia: - 15 years of experience - R E S E A R C H A S S O C I A T E P R O F. D - R Z L A T E S T O J A N O S K I Definition Acute myeloid
More informationIdelalisib given front-line for the treatment of CLL results in frequent and severe immune-mediated toxicities
Idelalisib given front-line for the treatment of CLL results in frequent and severe immune-mediated toxicities Benjamin L. Lampson, Tiago R. Matos, Siddha N. Kasar, Haesook Kim, Elizabeth A. Morgan, Laura
More informationReduced Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation for LLM: Hype, Reality or Time for a Rethink
Reduced Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation for LLM: Hype, Reality or Time for a Rethink Avichi Shimoni, Arnon Nagler Hematology Division and BMT, Chaim Sheba Medical Center,
More informationBENDAMUSTINE + RITUXIMAB IN CLL
BENDAMUSTINE + RITUXIMAB IN CLL Barbara Eichhorst Bologna 13. November 2017 CONFLICT OF INTERESTS 1. Advisory Boards Janssen, Gilead, Roche, Abbvie, GSK 2. Honoraria Roche, GSK, Gilead, Janssen, Abbvie,
More informationReviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and Dr. Matt Cheung (Staff Hematologist, University of Toronto)
CLL Updated March 2017 by Doreen Ezeife Reviewed by Dr. Michelle Geddes (Staff Hematologist, University of Calgary) and Dr. Matt Cheung (Staff Hematologist, University of Toronto) DISCLAIMER: The following
More informationHow to incorporate new therapies into the treatment algorithm of patients with mantle cell lymphoma
How to incorporate new therapies into the treatment algorithm of patients with mantle cell lymphoma Dr. Guillermo Rodríguez García Hospital Universitario Virgen Macarena Hospital Universitario Virgen del
More informationMolecular Pathology Evaluation Panel and Molecular Pathology Consortium Advice Note
Molecular Pathology Evaluation Panel and Molecular Pathology Consortium Advice Note MPEP/MPC Advice Note 2016-02 June 2016 Test evaluated: Tumour Protein p53 (TP53) Molecular Pathology Evaluation Panel
More informationBlood Cancers. Blood Cells. Blood Cancers: Progress and Promise. Bone Marrow and Blood. Lymph Nodes and Spleen
Blood Cancers: Progress and Promise Mike Barnett & Khaled Ramadan Division of Hematology Department of Medicine Providence Health Care & UBC Blood Cancers Significant health problem Arise from normal cells
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 6 October 2010
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 6 October 2010 ARZERRA 100 mg, concentrate for solution for infusion B/3 (CIP code: 577 117-9) B/10 (CIP code: 577
More informationMyeloproliferative Disorders - D Savage - 9 Jan 2002
Disease Usual phenotype acute leukemia precursor chronic leukemia low grade lymphoma myeloma differentiated Total WBC > 60 leukemoid reaction acute leukemia Blast Pro Myel Meta Band Seg Lymph 0 0 0 2
More informationUpdate on Management of CLL. Presenter Disclosure Information. Chronic Lymphocytic Leukemia. Audience Response Question?
Welcome to Master Class for Oncologists New York, NY May 14, 2010 Session 5: 4:20 PM - 5:00 PM Update on Management of CLL John C. Byrd, MD D Warren Brown Professor of Leukemia Research Professor of Medicine
More informationASH up-date: Changing the Standard of Care for Patients with. (or: Who to treat with What When?)
ASH up-date: Changing the Standard of Care for Patients with B-cell Chronic Lymphocytic Leukaemia (or: Who to treat with What When?) Dr Anna Schuh, MD, PhD, MRCP, FRCPath Consultant and Senior Lecturer
More informationWatch and Wait Actualities in the Treatment of Chronic Lymphocytic Leukemia
CLINICAL UPDATE HEMATOLOGY // INTERNAL MEDICINE Watch and Wait Actualities in the Treatment of Chronic Lymphocytic Leukemia Szilárd Bíró 1, István Benedek Jr 1,2, Árpád Bzduch 1, Johanna Sándor-Kéri 1,2,
More informationCHRONIC LYMPHOCYTIC LEUKEMIA
CHRONIC LYMPHOCYTIC LEUKEMIA Effective Date: January, 2017 The recommendations contained in this guideline are a consensus of the Alberta Provincial Hematology Tumour Team synthesis of currently accepted
More informationAIH, Marseille 30/09/06
ALLOGENEIC STEM CELL TRANSPLANTATION FOR MYELOID MALIGNANCIES Transplant and Cellular Therapy Unit Institut Paoli Calmettes Inserm U599 Université de la Méditerranée ée Marseille, France AIH, Marseille
More informationHaploidentical Transplants for Lymphoma. Andrea Bacigalupo Universita Cattolica Policlinico Gemelli Roma - Italy
Haploidentical Transplants for Lymphoma Andrea Bacigalupo Universita Cattolica Policlinico Gemelli Roma - Italy HODGKIN NON HODGKIN Non Myelo Ablative Regimen Luznik L et al BBMT 2008 Comparison of Outcomes
More informationDr. A. Van Hoof Hematology A.Z. St.Jan, Brugge. ASH 2012 Atlanta
Dr. A. Van Hoof Hematology A.Z. St.Jan, Brugge ASH 2012 Atlanta DLBCL How to improve on R-CHOP What at relapse Mantle cell lymphoma Do we cure patients Treatment at relapse Follicular lymphoma Watch and
More information