演題詳細

シンポジウム / Symposium

【E】シンポジウム3 (Symposium 3) : New Trends and Challenges in the Management of Malignant Lymphoma
(共催:日本リンパ網内系学会 / The Japanese Society for Lymphoreticular Tissue Research)

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日程
2013年10月11日(金)
時間
13:55 - 16:25
会場
第2会場 / Room No.2 (さっぽろ芸文館 3F 瑞雪)
座長・司会
木下 朝博 (Tomohiro Kinoshita):1、吉野 正 (Tadashi Yoshino):2
1:Aichi Cancer Center Hospital, Japan、2:Department of Pathology, Okayama University, Japan
 
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Progress in the treatment of B-cell lymphoma

演題番号 : SY3-3

永井 宏和 (Hirokazu Nagai):1

1:National Hospital Organization Nagoya Medical Center, Japan

 

Clinical outcomes for patients with B cell lymphoma have improved markedly over the past decade due to the use of the anti-CD20 chimeric antibody, rituximab. In fact the combination chemotherapies with rituximab have been established as a standard therapy for symptomatic follicular lymphoma (FL), and rituximab with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for diffuse large B cell lymphoma (DLBCL). Several studies have investigated how to further increase the efficacy of rituximab. For example, the National Hospital Organization (NHO) conducted a multicenter phase II trial to evaluate the efficacy of intensified rituximab induction (given weekly for eight doses) followed by 2 years of rituximab maintenance. Forty-one patients with rituximab-naïve low-grade B cell lymphoma (LGBCL), including 33 patients with FL, were enrolled from December 2005 to May 2009. The overall response rate was 75.6%, with CR occurring in 63.4%. Three-year PFS at a median follow-up time of 43.0 months was 79.7% (90% CI, 66.6-88.1%). This strategy was demonstrated to have high activity and produce durable PFS in patients with LGBCL. Rituximab dose intensification has also been studied in patients with DLBCL. The Japan Clinical Oncology Group (JCOG) is conducting an ongoing randomized phase III trial to optimize the schedule of rituximab when combined with CHOP-21 (JCOG 0601) in patients with DLBCL; CHOP-21 combined with weekly rituximab for an initial 8 weeks of induction therapy will be compared with standard R-CHOP-21. Another important issue in the rituximab era is the impact of gender on clinical outcomes for patients with mature B cell lymphoma. Some studies have suggested that survival in patients treated with rituximab-containing regimens is better in women than in men. The NHO conducted a multicenter, retrospective study to assess the effect of gender on survival in patients who were treated with rituximab. Patients with newly diagnosed mature B cell lymphoma treated from January 2000 to December 2004 were consecutively registered. A total of 1126 patients received systemic chemotherapies with or without rituximab, and the 2-year PFS was better in women than in men (75.8% vs. 64.2%, p=0.048) in the rituximab treatment group. This difference was not seen in the control group (who were not treated with rituximab). These data suggest that gender-based rituximab dose modification might be appropriate. Some pathologic subtypes of DLBCL are associated with poor outcomes in response to R-CHOP-21; these subtypes include CD5-positive DLBCL, intravascular large B cell lymphoma (IVLBCL), and B cell lymphoma with features intermediate between DLBCL and Burkitt lymphoma. Clinical trials targeting each of these subtypes have already started in Japan. The investigator-initiated clinical trials are expected to further enhance outcomes for patients with B-cell lymphoma.

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