A Canadian Evidence-Based Guideline for the First-Line Treatment of Follicular Lymphoma: Joint Consensus of the Lymphoma Canada Scientific Advisory Board

2015 ◽  
Vol 15 (2) ◽  
pp. 59-74 ◽  
Author(s):  
John Kuruvilla ◽  
Sarit Assouline ◽  
David Hodgson ◽  
David MacDonald ◽  
Doug Stewart ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Advisory Board ◽  
Evidence Based ◽  
Line Treatment ◽  
First Line ◽  
Scientific Advisory Board ◽  
Scientific Advisory ◽  
Evidence Based Guideline ◽  
First Line Treatment

scholarly journals Canadian evidence-based guideline for the first-line treatment of chronic lymphocytic leukemia

2018 ◽  
Vol 25 (5) ◽  
Author(s):  
C. Owen ◽  
A. S. Gerrie ◽  
V. Banerji ◽  
S. Assouline ◽  
C. Chen ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Health Care Professionals ◽  
Treatment Guideline ◽  
Lymphocytic Leukemia ◽  
Evidence Based ◽  
Line Treatment ◽  
First Line ◽  
Adult Leukemia ◽  
Evidence Based Guideline ◽  
First Line Treatment

Chronic lymphocytic leukemia (cll) is the most common adult leukemia in North America. In Canada, no unified national guideline exists for the front-line treatment of cll; provincial guidelines vary and are largely based on funding. A group of clinical experts from across Canada developed a national evidence-based treatment guideline to provide health care professionals with clear guidance on the first-line management of cll. Consensus recommendations based on available evidence are presented for the first-line treatment of cll.

Experience with an evidence-based protocol using fibrinolysis as first line treatment for empyema in children

2013 ◽  
Vol 48 (6) ◽  
pp. 1312-1315 ◽  
Author(s):  
Alessandra C. Gasior ◽  
E. Marty Knott ◽  
Susan W. Sharp ◽  
Daniel J. Ostlie ◽  
George W. Holcomb ◽  
...  
Keyword(s):  
Evidence Based ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

scholarly journals SYSTEMIC FRONT LINE THERAPY OF FOLLICULAR LYMPHOMA: WHEN, TO WHOM AND HOW

2016 ◽  
Vol 8 ◽  
pp. e2016062 ◽  
Author(s):  
Francesca Pavanello ◽  
Sara Steffanoni ◽  
Michele Ghielmini ◽  
Emanuele Zucca
Keyword(s):  
Monoclonal Antibodies ◽  
Follicular Lymphoma ◽  
Target Therapy ◽  
Single Agent ◽  
New Drugs ◽  
Response To Treatment ◽  
Line Treatment ◽  
First Line ◽  
Line Therapy ◽  
First Line Treatment

The natural history of follicular lymphoma is usually characterized by an indolent course with a high response rate to the first line therapy followed by recurrent relapses, with a time to next treatment becoming shorter after each subsequent treatment line. More than 80% of patients have advanced stage disease at diagnosis. The time of initiation and the nature of the treatment is mainly conditioned by symptoms, tumor burden, lymphoma grading, co-morbidities and patients preference. A number of clinical and biological factors have been determined to be prognostic in this disease, but the majority of them could not show to be predictive of response to treatment, and therefore can’t be used to guide the treatment choice. CD20 expression is the only predictive factor recognized in the treatment of FL and justifies the use of “naked” or “conjugated” anti-CD20 monoclonal antibodies as single agent or in combination with chemo- or targeted therapy. Nevertheless, as this marker is almost universally found in FL, it has little role for the choice of treatment. The outcome of patients with FL improved significantly in the last years, mainly due to the widespread use of rituximab, autologous and allogeneic transplantation in young and fit relapsed patients, the introduction of new drugs and the improvement in diagnostic accuracy and management of side effects. Agents as new monoclonal antibodies, immuno-modulating drugs and target therapy have recently been developed and approved for the relapsed setting, while studies to evaluate their role in first line treatment are still ongoing. Here we report our considerations on first line treatment approach and on the potential factors which could help in the choice of therapy.

Cost-effectiveness of rituximab plus CVP for first-line treatment of advanced indolent lymphoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6583-6583
Author(s):  
J. Hornberger ◽  
C. Reyes ◽  
E. Verhulst ◽  
D. Lubeck ◽  
N. Valente
Keyword(s):  
Overall Survival ◽  
Cost Effectiveness ◽  
Follicular Lymphoma ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Line Treatment ◽  
First Line ◽  
Economic Implications ◽  
The Cost ◽  
First Line Treatment

6583 Background: The addition of rituximab (RTX) to CVP (cyclophosphamide, vincristine, prednisone) in the treatment of advanced follicular lymphoma increases median time to progression by 17 months (15 month v 32 months; p < 0.0001) (Marcus et al, Blood 2005). A societal cost-effectiveness analysis was performed to estimate projected lifetime clinical and economic implications of this treatment. Methods: The cost-effectiveness (CE) of RTX + CVP versus CVP was estimated for a 50 yr old patient. Kaplan-Meier estimates of progression-free and overall survival, up to 4 years, were obtained from the M39021 trial. After 4 years, transition rates from initiation of treatment to progression or death were assumed to be the same in both arms. The clinical and economic implications of relapse and its treatment were included in the model. Incremental costs associated with addition of RTX were estimated using Medicare reimbursement rates and published retail price data. Costs included drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Utility estimates were derived from the literature and a 3% discount rate was employed. Results: Projected mean overall survival is 1.5 yrs longer for patients assigned to RTX+ CVP versus only CVP (13.7 v 12.2 yrs). The addition of RTX to CVP is estimated to cost an additional $26,439 on average, with an expected gain of 0.85 year of quality-adjusted survival. Over a lifetime, the cost per QALY gained is $31,329. Sensitivity analyses revealed that the variables that most influenced cost-effectiveness were the time horizon (range: $18,800- $31,240) and the unit drug cost of RTX (range: $24,000-$38,000). Conclusion: The model estimates a cost-to-QALY gained ratio that is below that of many treatments used for oncology patients. The use of RTX + CVP for first-line treatment of advanced follicular lymphoma is projected to be cost-effective compared to CVP alone under a range of sensitivity analyses. No significant financial relationships to disclose.

Lack of correlation between numbers of circulating t(14;18)-positive cells and response to first-line treatment in follicular lymphoma

Blood ◽  
2001 ◽  
Vol 98 (4) ◽  
pp. 940-944 ◽  
Author(s):  
Caroline M. P. W. Mandigers ◽  
Jules P. P. Meijerink ◽  
Ewald J. B. M. Mensink ◽  
Evelyn L. R. T. M. Tönnissen ◽  
Konnie M. Hebeda ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Peripheral Blood ◽  
Line Treatment ◽  
Molecular Monitoring ◽  
First Line ◽  
Bulky Disease ◽  
Blood Samples ◽  
First Line Treatment

In follicular lymphoma, the t(14;18) status of the peripheral blood and bone marrow analyzed by polymerase chain reaction (PCR) is assumed to correlate with disease activity in patients with relapsed disease. The clinical significance of quantitating circulating lymphoma cells by real-time PCR is reported in patients on first-line treatment. Thirty-four consecutive patients with previously untreated follicular lymphoma and detectable t(14;18)-positive cells in pretreatment peripheral blood samples were monitored. All patients were treated with standard chemotherapy in combination with interferon alfa-2b. Before and after induction therapy, blood samples were taken for quantitative analysis of t(14;18). At presentation, a median of 262 t(14;18)-positive cells per 75 000 normal cells was found (range, 1-75 000). Patients with lower numbers of circulating tumor cells more frequently had bulky disease (P = .02). Seventy-nine percent of the patients responded clinically to treatment. In 22 of 28 patients, including 4 patients in whom treatment had failed clinically, the number of circulating t(14;18)-positive cells decreased to undetectable or low levels after therapy. In the remaining responding patients, circulating tumor cells persisted after therapy. These quantitative data on circulating t(14;18)-positive cells call into question the usefulness of molecular monitoring of the blood in a group of patients with follicular lymphoma uniformly treated with a noncurative first-line regimen. T(14;18)-positive cells decreased in peripheral blood after treatment, irrespective of the clinical response. Therefore, the significance of so-called molecular remission should be reconsidered in follicular lymphoma.

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