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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Treatment approaches for DLBCL in the targeted therapy era

演題番号 : SY3-4

Jonathan W. Friedberg:1

1:Department of Hematology/Oncology, Wilmot Cancer Center, University of Rochester, USA

 

For more than a decade, the standard therapy approach to the management of diffuse large B-cell lymphoma (DLBCL) has been the combination of CHOP chemotherapy with rituximab. Large international trials have revealed that a 21 day schedule is equivalent to a 14 day schedule, with lower toxicity. Although PFS improvements were demonstrated with the addition of consolidative high dose therapy and autologous stem cell transplantation, there is no improvement in overall survival. Thus, for all patients at present with advanced stage DLBCL, R-CHOP-21 remains the standard of care.

We have appreciated that DLBCL is a heterogeneous disease. Gene expression profiling studies evaluating cell-of-origin have shown there are at least three broad groups of DLBCL: “ABC” type, “GCB” type, and primary mediastinal type. Rational novel therapeutics may be considered for each type of DLBCL, and indeed some studies recently have suggested enhanced activity of ibrutinib and lenalidomide in relapsed “ABC” DLBCL. A large international study is evaluating the role of bortezomib in “ABC” DLBCL in combination with R-CHOP as first line therapy. In this presentation, we will explore rational therapeutic targets for each subtype of DLBCL, in the context of current and planned clinical trials, both upfront and in the relapsed setting.

Recent studies have revealed that patients with c-myc positive DLBCL represent a very high risk group, particularly when combined with bcl-2 overexpression. These “double hit” cases may represent up to 30% of DLBCL when immunohistochemistry is utilized to classify these patients and outcomes with standard therapy are dismal for these patients. This group is probably the most unmet clinical need in DLBCL, and treatment options for these patients will be discussed.

In conclusion, it is hoped that we will finally begin to incorporate this genomic information into treatment paradigms for DLBCL in the near future.

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