X

Download About Follicular Lymphoma PowerPoint Presentation

SlidesFinder-Advertising-Design.jpg

Login   OR  Register
X


Iframe embed code :



Presentation url :

Home / Health & Wellness / Health & Wellness Presentations / About Follicular Lymphoma PowerPoint Presentation

About Follicular Lymphoma PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

PowerPoint is the world's most popular presentation software which can let you create professional About Follicular Lymphoma powerpoint presentation easily and in no time. This helps you give your presentation on About Follicular Lymphoma in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this About Follicular Lymphoma powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by onlinesearch in Health & Wellness ppt presentation category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

About This Presentation

About Follicular Lymphoma Presentation Transcript

Slide 1 - Follicular Lymphoma Michael Bassetti PhD July 26th, 2007 Clinical Rotation Talk
Slide 2 - Overview of Presentation Follicular Lymphoma Epidemiology Diagnosis Grade/Stage Treatments Future Directions radioimmunotherapy
Slide 3 - Lymphomas 11858 cases of follicular lymphoma (2002 SEER database. O’Connor)
Slide 4 - Follicular Lymphoma Cancer arising from lymphocytes Mature B cell origin Rising in incidence (4% per year) Median age of onset is 60 Accounts for 70% of low grade lymphomas Slight female:male predominance Less common in Asian and African Americans Extremely sensitive to radiation, and to chemotherapy. Association with hepatitis C. Response to IFN/ribavirin
Slide 5 - Typical Presentation Lymphadenopathy Typically cervical, axillary, inguinal, but can be in anywhere including extranodal nontender, firm, rubbery Waxing and waning 10% B symptoms Fever, night sweats, weight loss 50% splenomegaly
Slide 6 - Genetic Changes t(14:18)(q32;q21) Bcl-2 translocation in 85% of cases. Bcl-2/Ig heavy chain Bcl-2 is a potent suppressor of apoptosis Bcl-6 is also occasionally expressed P53 mutations are associated with transformation to more DLBCL type Immunophenotype - Ig(+), CD10(+), CD19(+), CD20(+), CD21(+), HLA-DR(+) CD3(-), CD5(-),
Slide 7 - Ann Arbor Staging Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (IE) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extra-lymphatic organ or site (IIE) Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (IIIE), spleen (IIIS), or both (IIISE) Stage IV Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph-node involvement; the organ(s) involved should be identified by a symbol: (P) pulmonary, (O) osseous, or (H) hepatic. In addition, (A) indicates an asymptomatic patient; (B) indicates the presence of fever, night sweats, or weight loss > 10% of body weight. * The designation "E" generally refers to extranodal contiguous extension
Slide 8 - Ann Arbor Staging Lymphomation.com
Slide 9 - Diagnostic workup Pathology by excisional biopsy or core, avoid FNA if possible CBC with differential and blood smear Serum electrolytes and creatinine Chest x-ray, CT chest, abdomen and pelvis PET/CT Liver function tests Serum LDH, uric acid Serum protein electrophoresis Bone marrow biopsy
Slide 10 - Normal reactive lymph node Follicular Lymphoma Why its called “Follicular”
Slide 11 - Follicular Lymphomas Express Bcl-2 Follicular Lymphoma Normal Reactive Follicle Warnke et al
Slide 12 - Warnke et al Grade III Grade I Grade II Centrocytes Mixed Centroblasts Follicular Lymphoma Grading >15 centroblasts/HPF 6-15 centroblasts/HPF 0-5 centroblasts/HPF “Small cleaved follicle cells” “large blastic follicle cells”
Slide 13 - Peripheral Blood Centrocytes Warnke et al
Slide 14 - International Prognostic Index Age greater than 60 years Stage III or IV disease Elevated serum LDH ECOG performance status of 2, 3, or 4 More than 1 extranodal site
Slide 15 - Solal-Céligny et al. FLIPI- Follicular Lymphoma International Prognostic Index
Slide 16 - Grade Determines Outcomes Years Months Weeks Untreated Survival:
Slide 17 - Treatments Indolent Aggressive
Slide 18 - IFRT +/- Chemotherapy in Stage I,II Follicular Lymphoma Tsang et al
Slide 19 - Stanford Study
Slide 20 - RT for Stage I, II Follicular Lymphoma IFRT produces local control for >95% of patients No benefit to adding chemotherapy Without therapy 38% require treatment by a median of 7 years. Relapses after 10 years <10% Relapses occur outside irradiated field ~40-50% potential cure rate
Slide 21 - Treatments
Slide 22 - Treatment Stage I,II Intermediate Grade, “aggressive” Lymphoma IFRT was the historical treatment cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is used for systemic control
Slide 23 - No Advantage of Alternative Chemotherapy over CHOP Freedom from Treatment Failure Overall Survival
Slide 24 - Standard Treatment Stage I,II Intermediate Grade, “aggressive” Lymphoma Horning et al, JCO 2004 ; ECOG E1484 Miller et al, NEJM 1998 ; SWOG 8735
Slide 25 - Miller et al, NEJM 1998 ; SWOG 8735
Slide 26 - Rituximab (anti-CD20 MAb) Feugier et al
Slide 27 - Subsequent R-CHOP becomes standard of care with multiple trials showing increased PFS and OS. RT comes with it based of CHOP+ RT trials
Slide 28 - Treatment
Slide 29 - Follow up Every 3 months for first 2 years Every 6 months for next 3 years H&P, labs, CXR +/- CT, PET scans
Slide 30 - Recap
Slide 31 - Salvage Treatment Initial Rx Salvage Rx Haas et al; JCO 2003; 21(13)
Slide 32 - Palliative RT for Relapsed Indolent Lymphoma Progression Free Survival Haas et al
Slide 33 - Local Progression Free Survival Haas et al
Slide 34 - Anti-CD20 Immunotherapy Two FDA approved anti-CD20 radiolabelled antibodies Bexxar, tositumomab, iodine 131 Beta and Gamma emitter, half life of 8 days, tissue penetration ~ 1 mm effective half life is much less. Zevalin, Ibritumomab, yttrium 90 Beta emitter, half life of 64h, tissue penetration ~ 5 mm
Slide 35 - Infusions and scan
Slide 36 - Initial Therapy in Advanced low grade NHL 76 patients with Stage III, IV Follicular lymphoma 75cGy of total body irradiation Median follow up 5.1 years Kaminski et al; NEJM 352 (5); 2005
Slide 37 - Conclusions Low Grade Follicular Lymphoma Early stage radiation therapy ~50% curative Late stage non-curative. Chemotherapy, radioimmunotherapy,or trials. Intermediate Grade Radiation and Chemotherapy together with immunotherapy Salvage Treatment Low dose radiation can give sustained palliation, and be used repeatedly
Slide 38 - Future direction of Treatments Autologous transplants Bcl-2 small molecule inhibitors Low dose 4 Gy palliative treatment Immunotherapy Radioimmunotherapy Bexxar I131 tositumomab Zevalin Y90 ibritumomab tiuxetan
Slide 39 - The End
Slide 40 - Freedom From Treatment Failure and Survival Curves Freedom from Treatment Failure Overall Survival Time (Years) Time (Years) Survival Probability Guadagnolo et al