1. How I Treat : Chronic Lymphocytic Leukemia Thanyaphong Na Nakorn, MD, PhD Division of Hematology, Department of Medicine Faculty of Medicine, Chulalongkorn University King Chulalongkorn Memorial Hospital
18. BSCH Recommendation for flow cytometry diagnosis of LPD Assess morphology, apply the first line Ab panel ( CD19, CD22, CD23, FMC7, sIgM, kappa, lambda, CD3, CD5 ) and assign CLL score CLL score 3-5 Typical CLL morphology CLL CLL score 0-2 Non-CLL or atypical morphology T-cell Apply second line Ab panel
19. FCM Scoring System for CLL Marker CLL Score sIg (kappa or lambda) weak 1 CD5 pos 1 CD23 pos 1 CD79b/CD22 weak 1 FMC7 neg 1
34. Recommendation for F/U and treatment in early-stage CLL based on risk stratification Shanafelt TD, et al. ASH Education Book 2007 Low risk Intermediate risk High risk Median expected survival (y) >15 10 3-8 Median expected treatment-free survival (y) >5 3-4 1-4 Recommended F/U mo. 6-12 6-12 3-6 Immediate Treatment indicated No No Consider clinical trial
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37. Survival curves for CLL patients younger than 70 years in Binet stage B / C Improving survival in patients with CLL ( 1980-2008 ): the Hospital Cl í nic of Barcelona experience Blood 2009:114; 2044-2050
42. CLL: Progress in response over 10 years 1. Rai KR, et al. New Engl J Med 2000; 343:1750–1757. 2. Eichhorst BF, et al. Blood 2006; 107:885–891. 3. Hallek M, et al. Blood 2008; 112:Abstract 325. Therapy n CR (%) ORR (%) Rai et al. 2000 1 Chlorambucil 181 4 33 Fludarabine 170 20 43 GCLLSG CLL4 Eichhorst et al. 2006 2 Fludarabine 164 7 83 FC 164 24 95 GCLLSG CLL8 Hallek et al. 2008 3 FC 409 23 85 R-FC 408 45 93
43. FC significantly improves PFS compared with fludarabine or chlorambucil 1. Catovsky D, et al. Lancet 2007; 370:230–239. See also: Eichhorst BF, et al. Blood 2006; 107:885–891; Flinn IW, et al. J Clin Oncol 2007; 25:793–798. PFS (%) FC F Clb p = 0.00005 Time (years) 0 5 1 2 3 4 0 50 100 PFS 1
51. Bendamustine: Structural similarities to cyclophosphamide and cladribine N N CH 3 COOH N ClH 2 C ClH 2 C Bendamustine Nitrogen mustard N N N N NH 2 Cl O OH HOCH 2 Cladribine Benzimidazole ring Carboxylic acid N Cl Cl N P O O H Cyclophosphamide
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53. Bendamustine 100 mg/m2/d iv on days 1 to 2, or Chlorambucil 0.8 mg/kg orally on days 1 and 15; treatment cycles were repeated every 4 weeks for a maximum of six cycles