Download - Cladribine + Rituximab in HCL : UPDATE
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Cladribine + Rituximab in HCL : UPDATE
Farhad Ravandi, MDProfessor of Medicine
University of Texas – M. D. AndersonCancer Center
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• Can we design a regimen with higher efficacy than single agent nucleoside analogs? (with no increased toxicity)
• Can we predict those who relapse?
• Can we design a better regimen for variant HCL?
HCL - Questions
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Cladribine followed by Rituximab
Days: 1 2 3 4 5 28 Weeks: 1 2 3 4 5 6 7 8
C C C C C R R R R R R R RBM BMBM
C - CladribineR - Rituximab
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Enrollment and Response
Number Achieved CR (%)
Relapsed (%)
Died
Untreated 48 48 (100) 1 (2) 1 (2)*
Inevaluable 3
First relapse
14 14 (100) 0 (0) 0 (0)
HCLv 6 6 (100) 2 (33) 3 (50)**
* 1 Patient died in CR from other malignancies** 2 Patients died in CR from other malignancies
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Remission Duration
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Survival
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P 0.001
Response to first, second, third line therapy
Else M, Cancer, 2005
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P=0.00005
DFS after successive courses of NA
Else M, Cancer, 2005
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Patients Treated in First RelapsePatient Prior
therapyCR1 duration
(Years)CR2 duration
(Years)
1 Cladribine 9 8.5
2 Cladribine 1 7.1
3 Cladribine 5.5 4.1
4 Cladribine 9 7.2
5 Cladribine 2.6 5.1
6 Cladribine 1 6.2
7 DCF 6.4 3.8
8 Cladribine 4.5 1.8
9 Cladribine 5.5 1.1
10 Cladribine 6 1.3
11 Cladribine 6.5 1.4
12 Rituximab 0 0.6
13 Cladribine 1 0.6
14 Cladribine 8.3 0.0
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NCT00412594 - Cladribine followed by Rituximab in frontline HCL
NCT01829711 - Moxetumomab Pasudotox in relapsed HCL
NCT01841723 - Ibrutinib in relapsed HCL
NCT02034110 - Debrafenib+Trametinib in relapsed HCL
Ongoing Trials at MDACC