Question: Is the Wait and Watch philosophy still practical in the - PowerPoint PPT Presentation

Question: Is the “Wait and Watch” philosophy still practical in the treatment of CLL, even in younger patients? YES: Kanti Rai NO: Federico Caligaris-Cappio 1 1

Pre – Mutation / Zap Era • Francesca Mauro et al (Rome and Turin) Blood 94: 448, 1999. – Out of 1011 pts (bet 1984-1994) 204 were 55 or younger • Features included in multivariate: 1. Total blood lymphocyte count 2. Clinical Stage 3. Pattern of lymph infiltration in BM biopsy 4. Smoldering disease 5. LDT 6. Active Disease 2 2

Pre – Mutation / Zap Era • Mauro, 1999. – 204 pts 55 or younger • Only those with rapid LDT (16%) or evidence of active disease (30%) had significantly worse survival 3 3

Pre – Mutation / Zap Era • Mauro, 1999. • Overall response rate to first line treatment was similar in younger and older patients • Overall actuarial median survival time from diagnosis was similar in younger and older patients (10 years) 4 4

First-line Rx of younger CLL • Eichhorst et al. Blood 107; 885, 2006. • N=375 Randomized F vs FC CR% ORR% PFS FC 24 94 48m F 7 83 20m P < .001 5 5

First-line Rx of younger CLL • Eichhorst, 2006. • FC caused significantly more myelotoxicity (54% F vs. 72% FC) 6 6

First-line Rx of younger CLL • Eichhorst, 2006. • Stronger initial treatment in younger CLL is more effective than mild treatment • More CRs and longer PFS • Does that make a difference in overall survival? 7 7

First-line Rx of younger CLL • Eichhorst, 2006. 3-yr surv. (median) FC 80.3% F 80.7% 8 8

In Conclusion If we do not have a cure in hand, If the treatment does not even prolong life, If the treatment will certainly cause toxicities, Then what right do we have to reject “Wait and Watch” policy? 9 9