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

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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

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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

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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

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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)

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First-line Rx of younger CLL

• Eichhorst et al. Blood 107; 885, 2006.
• N=375

Randomized F vs FC P < .001 CR% ORR% PFS FC 24 94 48m F 7 83 20m

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First-line Rx of younger CLL

• Eichhorst, 2006.
• FC caused significantly more myelotoxicity

(54% F vs. 72% FC)

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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?

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First-line Rx of younger CLL

• Eichhorst, 2006.

3-yr surv. (median) FC 80.3% F 80.7%

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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?