CML - stopping tki's

 

EURO-SKI 2016

-       821 patients on 1st line imatinib or after IFN, dasatinib or nilotinib at 1st or more line, excluding patients with prior resistance

-       Minimum 3 years Rx, with minimum 1 year in MR4

o   Trial outcome suggests best prognosis is min. 6 yrs treatment, 3yrs in MR4

-       Definition of molecular relapse was loss of MMR – 45% of patients by 18 months

 

DESTINY 2017

-       For patients in MR4

-       Reduced dose for 12 months, and then stopped if patient had not lost MMR

-       Conclusions:

o   Reducing dose is safe (may help with SE’s)

o   If you stop after prior dose reduction, better chance of staying in MR4 (vs EUROSKI)

mantle cell lymphoma

 

NORDIC MCL2 STUDY 2008

- Alternating cycles of R-Maxi-CHOP and High dose cytarabine for 6 cycles, followed by autograft

- 5-year EFS >60%

- 2016 update: No plateau in the survival curve, with ongoing late relapse events

- 2016 update: 40% of low and intermediate risk patients still in 1st remission at 12 years

 

LyMa TRIAL 2017

- 299 patients, R-DHAPx4, followed by BEAM Autograft (R-CHOPx4 given is not in CR/PR post DHAP)

- The R-DHAP could be with cisplatin or oxalaplatin

- Post autograft, randomised to rituximab maintenance or not

- 4-year OS 78%, PFS 67% and superior in the R-maintenance arm

chronic lymphocytic leukaemia

CLL10 2013

- FCR x6 vs R-Benda x6

- FCR superior for ORR, MRD-neg remissions, length of first remission in young, fit patients

- FCR arm had more serious adverse events

- Overall survival similar for both arms

CLL11 2014

- Chlorambucil-Obinutuzumab vs Chlorambucil-Rituximab vs Chlormabucil alone

- Chlorambucil-Obinutuzumab had superior PFS and TTNT

- Infusion reactions more common with obinutuzumab

COMPLEMENT-1 2015

- Chlorambucil-Ofatunumab vs Chlormabucil alone

- Combo better PFS but no difference in OS

- Hard to compare to CLL11 as different dose of chlorambucil used

cns lymphoma

IELSG32 2016

- 219 patients. Phase 2 randomised trial for 1st treatment of primary CNS lymhpoma

- HD-MTX + Cytarabine vs additional Rituximab vs additional Rituximab and Thiotepa (MATRix)

- Followed by Whole Brain Radiotherapy vs High Dose Autograft

- CR of 23%, 30% and 49% respectively for the induction regimens given above

- 69% 2 year OS

- 6% treatment-related mortality (TRM)