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The 1st World Congress on Controversies in Hematology (COHEM) Rome, Italy 3 September, 2010: CLL
Is eradication of MRD feasible and worthwhile in CLL?
Moderator: K. Rai, USA Yes: G. Marti, USA No: G. Gaidano, Italy
The 1st World Congress on Controversies in Hematology (COHEM) Rome, - - PowerPoint PPT Presentation
The 1st World Congress on Controversies in Hematology (COHEM) Rome, - - PowerPoint PPT Presentation
The 1st World Congress on Controversies in Hematology (COHEM) Rome, Italy 3 September, 2010: CLL Is eradication of MRD feasible and worthwhile in CLL? Moderator: K. Rai, USA Yes: G. Marti, USA No: G. Gaidano, Italy Bioethical Approach to
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677-514-1014 H&E
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102 103 104 105 <PerCP-A>: CD19 PerCP Cy55 102 103 104 105 <APC-A>: CD5 APC 13.5 8.54 75.7 9.93 4.14
102 103 104 105 <FITC-A>: Kappa-MONO FITC 102 103 104 105 <PE-A>: Lambda-MONO PE 11.1 86 63.8
102 103 104 105 <FITC-A>: Kappa-MONO FITC 102 103 104 105 <PE-A>: Lambda-MONO PE
102 103 104 105 <FITC-A>: Kappa-MONO FITC 102 103 104 105 <PE-A>: Lambda-MONO PE
Overall B cells Clone NR B cell
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102 103 104 105 <PerCP-A>: CD19 PerCP Cy55 102 103 104 105 <APC-A>: CD5 APC 82.1 8.94 4.2 0.22 3.48
102 103 104 105 <FITC-A>: Kappa-MONO FITC 102 103 104 105 <PE-A>: Lambda-MONO PE 60.4 32.4 7.42 102 103 104 105 102 103 104 105 <PE-A>: Lambda-MONO PE
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102 103 104 105 <PE-A>: Lambda-MONO PE Over all B cell clone NR B cell
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Rawstron Blood 2001, FCM MRD PFS and OS
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Moreton et al 2005 J ClinOnc
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Wierda, W, et al 2005, PCR IVGH, FCR, Refractory
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Moreno,C et al, 2006 Blood, Autologous SCT
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Schweighofer et al 2008 BJH, RQ-PCR
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Tam, CS, et al, Blood, 2008, CD5CD19 and PCR IVGH
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Del Poeta, et al, Cancer 2008, MRD+ with and without Consolidation/Maintenance Del Poeta, et al,Cancer 2008,MRD+ with Consolidation/Maintenance Versus MRD-
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Del Poeta, et al, Cancer 2008, ZAP70+
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Editorial Montserrat E. (2005) Treatment of chronic lymphocytic leukemia: achieving minimal residual disease-negative status as a goal. Journal of Clinical Oncology 23(13), 2884-2885. Called for Standardization and revision of 1996 NCI WG Response Guidelines MRD-CR?
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Rawstron, A et al Leukemia, Standardization
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Hallek et al Guidelines for the diagnosis and treatment
- f CLL: a report from the International WS on Chronic
Lymphocytic Leukemia updating the NCI WG 1996 guidelines; Blood, Jan 2008 On-Line MRD The complete eradication of the leukemia is an obvious desired end point. MC FCM and RT qPCR, have determined that many patients who achieved a complete response by the 1996 NCI-WG guidelines have detectable minimal residual disease (MRD)…Patients will be defined as having a clinical remission in the absence of MRD when they have blood or marrow with less than one CLL cell per 10 000 leucocytes. The blood generally can be used for making this assessment except …Future clinical trials that aim toward achieving long- lasting CRs should include at least one test to assess MRD because the lack of leukemia persistence using these sensitive tests seems to have a strong, positive prognostic impact.
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What has emerged? Palliative versus control versus the realistic possibility of a cure MRD is a surrogate marker for comparing responses of differing therapies (Montillo, Schinkoethe, an Elter). MDR would be a maker for: PFS, TTT, OS Nodular PR benign and malignant; Predict favorable outcome Monitoring to predict clinical evolution Due to the correlation between the blood and marrow, for patient comfort, the blood should be the first site tested for MRD What is the single objection? Patients that achieve MRD- status may have less aggressive or more favorable biologic disease meaning a better clinical prognosis in the first place.
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Andritsos L, Byrd J, Hewes B, Kipps T, Johns D, and Jan A.
- Burger. Preliminary results from a phase I dose escalation study