M. BENDARI, M. Rachid, S. Marouane, A. Quessar, S. Benchekroun Department of Hematology-Oncology...
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Follicular Lymphoma: A retrospective study (68 cases) M. BENDARI, M. Rachid, S. Marouane, A. Quessar, S. Benchekroun Department of Hematology-Oncology pediatric Hospital 20 Aout, CHU Ibn Rochd Casablanca.
M. BENDARI, M. Rachid, S. Marouane, A. Quessar, S. Benchekroun Department of Hematology-Oncology pediatric Hospital 20 Aout, CHU Ibn Rochd Casablanca
M. BENDARI, M. Rachid, S. Marouane, A. Quessar, S. Benchekroun
Department of Hematology-Oncology pediatric Hospital 20 Aout, CHU
Ibn Rochd Casablanca.
Slide 2
Background Follicular lymphomas (FL) : 30% of malignant non-
Hodgkin B Lymphoma. They are indolent. The cells of FL express
surface immunoglobulin more frequently IgM. CD5-, CD23-/+, CD43-,
CD 10+, and CD11c-. Translocation (14.18).
Slide 3
Background Incurable disease. The transformation into an
aggressive lymphoma diffuse B cell is possible. No chemotherapy
regimen for first-line therapy of FL has been established as a
standard regimen worldwide.
Slide 4
Purpose The aim of this study is to investigate the
epidemiology and clinical evolution of patients followed in our
department.
Slide 5
Materials and methods: Descriptive study including all patients
with FL treated between January 2004 and December 2011 Follicular
lymphoma of any histological grade expressing. The diagnosis was
done by histological study of lymph biopsy or primary lesion
biopsy. Histological type according to WHO classification.
Pathologic diagnostic obtained by standard staining procedures and
immunohistochemical analysis comprising a panel of antibodies.
Slide 6
Materials and methods: The staging was systematically done :
Physical exam Blood test Chest X ray Abdominal ultrasonography CT
scan Bone marrow biopsy LDH Pre- therapeutic exam: liver and kidney
fonction serology : HIV, HVB, HVC
Slide 7
Materials and methods Each patient received a FLIPI score based
on: Age < 60 vs. 60 Hemoglobin level 12g/dL vs. < 12g/dL
Serum LDH level ULN vs. > ULN Ann Arbor stage I II vs. III IV
Number of nodal sites involved 4 vs. > 4
Slide 8
Materials and methods: Positif diagnosis: histological
study
Slide 9
Histopathology Follicular lymphoma showing characteristic
pattern of closely packed nodules with some variation in size and
shape
Slide 10
GRADING Grade 2 Grade 3 Grade 1
Slide 11
Panel of antibodies: CD20, CD5, CD10, Bcl 2, Bcl 6.
Slide 12
Materials and methods :Treatment Therapeutic decision :
Localised Stage : abstention or radiotherapy Advanced Stage, Bulky
lesion : treatment is necessary Use of Rituximab in maintenance
therapy
Slide 13
Materials and methods: evolution Clinical response criteria:
Disease response and progression : physical examination and
scannography : Before chemotherapy, After 3 or 4 cycles of therapy
At the end of chemotherapy. A complete remission : Resolution of
all palpable peripheral adenopathy, Disappearance of imaging
evidence of disease and of all disease related symptoms,
Normalization of the standard biochemical abnormalities assignable
to the lymphoma.
Slide 14
Materials and methods: Statistical analysis: Follow-up time was
calculated using Kaplan-Meier, after completion of therapy Patients
were followed every 3 months. Progression-free survival (PFS) was
calculated from entry into the study until disease progression in
patients with CR or PR.
Slide 15
Results Characteristics of patients: N 68 N68 Sex-Ratio M/F2
Median of age57 years ( 28 77) Mean delay to doagnosis8 months ( 1-
60 months) Clinical prsentationasymptomatic6 (9%) Fatigue10 (14%)
Peripheral lymph nodes 20 (30%) B symptoms32 (47%)
Slide 16
Results: Grading Grade 1 28 cases (41%) Grade 2 25 cases (36%)
Grade 3 3a: 3 cases 3b: 6 cases Histological grade The grade was
not specified in 6 cases
Mean to follow-up 25 months N50 Relapse 12(24%) CR2: 3
Faillure: 5 Lost to follow- up : 4 CCR: 20 cases (40%) Lost to
follow-up 18 (36%) In CR: 6 In RP: 3 In Progressing disease :
9
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Discussion Follicular lyphoma: is one of the most common types
of Non Hodgkins Lymphomas ( ~ 20-25%)
Discussion Incidence : 6% vs 25% in literature report ? Delay
to diagnosis? Transformed forms? ethnic particulatity of our
region
Slide 31
Molecular biology : Transformed forms DLBCL National Lymphoma
Register
Slide 32
Discussion FL : indolent lymphoma / incurable disease Treatment
? no consensus exists as to the optimal selection or sequence of
available regimens
Slide 33
In the past : - Alkylant: Clorambucil, Cyclofosphamid -
Radiotherapy - Anthracycline ( CHOP) - Interfron-alpha -
Fludarabine - Auto or allogeneic stem cell transplantation -
Rituximab (alone, with chemotherapy or on maintenance therapy)
Slide 34
Rituximab The addition of Rituximab to chemotherapy potentiates
of the antitumor effect of chemotherapy. Recently, it has been
shown, that Rituximab has a clear benefit.
Slide 35
Rituximab : Marcus R, JCO 2008 CVP versus rituximab + CVP Time
to progression, relapse or death
Rituximab : maintenance therapy The use of Rituximab for
maintenance therapy is well tolerated and improved overall survival
Ghielmini M, et al. J Clin Oncol 2010
Slide 38
Conclusion The FL is typically indolent lymphoma: Successive
relapses, Decreasing chemosensitivity, Shorter duration of
remission, with successive courses of chemotherapy. Significant
improvement in outcome for patients with FL has been accomplished
in recent years especially with use of Rituximab combined to
chemotherapy.
Slide 39
Conclusion: The treatment of patients with FL must be adapted
to the patients individual status depending on the aggressiveness
of the disease. In Casablanca: low incidence/ Heterogeneous therapy
( CVP / CHOP): Try to establish a standard regimen including
Rituximab Maintenance therapy with Rituximab: increasingly used
Necessary to have a National Register including all cases of
lymphomas treating in all Moroccan centers. Maghreb Register of
lymphoma
