patients Case presentation 1 A case of diffuse large Bcell lymphoma Pierre Soubeyran Institut Bergonié Bordeaux Disclosure Research SupportPI Employee No relevant conflicts of interest to declare ID: 935396
Download Presentation The PPT/PDF document "Management of haematological malignancie..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Management of haematological malignancies in older vulnerable/frail patientsCase presentation 1: A case of diffuse large B-cell lymphoma
Pierre Soubeyran, Institut Bergonié, Bordeaux
Slide2Disclosure
Research Support/P.I.
Employee
No relevant conflicts of interest to declare
Consultant
No relevant conflicts of interest to declareMajor StockholderNo relevant conflicts of interest to declareSpeakers BureauNo relevant conflicts of interest to declareHonorariaCELGENE, TEVAScientific Advisory BoardTEVA, SANDOZ, BMS
Slide385-year-old lady58 kg, 1,54 mLives with her husband in RoyanIndependentRides her bicycle for shopping
every dayOne son living closelyNo major clinical backgroundNo severe comorbidities
3
Slide4JanuaryAbdominal painLow intensity then intensifiedLeft flank
then epigastricFebruaryGeneral practitionerCT scan
Bulky
retro-
peritoneal
and coeliac lymph nodes (16 cm)Right pleural effusionBiopsy by laparoscopyDiffuse large B-cell lymphoma, germinal center type485-year-old lady
Slide5February : consultation at Institut Bergonié PS = 3 Weight loss 4 kg (58 to 54 kg)No
fever, no sweatsDyspnea, Insomnia, lower back painSuperficial
epigastric
mass
4 cm
Palpable abdominal mass 8 x 10 cmLeft inguinal lymph node 2 cmLeg edema585-year-old lady
Slide6February : consultation at Institut Bergonié PS = 3 Weight loss 4 kg (58 to 54 kg)No
fever, no sweatsDyspnea, Insomnia, lower back painSuperficial
epigastric
mass
4 cm
Palpable abdominal mass 8 x 10 cmLeft inguinal lymph node 2 cmLeg edema685-year-old lady
Slide7Creatinine clearance (Cockroft)58 ml/mn after hydrationLVEF (ventriculography) =
35%Albumin = 25 g/lCRP = 146 mg/lAnemia = 10 g/dl hemoglobinLDH
= 2947 U
(N<480)
Stage IVA,
aaIPI 3785-year-old lady
Slide8Geriatric assessmentMMS 24IADL/8 2ADL/6 4,5Get
up and go 23 sMNA 21GDS15 68
85-year-old lady
Slide9QuestionsWhat are the options for the treatment of this aggressive lymphoma?Should we propose geriatric intervention on the observed geriatric impairments and, if yes, how?What should be your objective at the end of treatment and what should be your attitude is there are discrepancies with patient’s will at baseline?
Slide10Case report follow-up slides
Slide11Proposal of FRAIL06 trialRandomized phase II studyR-CVP vs R-COPY (liposomal doxorubicin 40 mg/m²) )
Received R-CVP cycle 1 prophylactic G-CSF and EPO11
85-year-old lady
Slide121285-year-old lady
Follow-up of R-CVP cycle 1
Day 2 = PS 4
Confused
Slow ideation, disoriented
Increase of dyspnea Need for oxygen, evacuation of pleural effusionDay 11 = Febrile neutropeniaStaphylococcus identified
Slide13Follow-up of R-CVP cycle 1Day 15 = improvement of general statusApyrexiaImproved consciousness
Improved LVEF: 56%Still PS 413
85-year-old lady
Slide141485-year-old lady
Follow-up of R-CVP cycle 1
Day
15
=
improvement of general statusApyrexiaImproved consciousnessImproved LVEF: 56%Still PS 4Disappearance of any palpable mass
Slide151585-year-old lady
Second R-CVP cycle at d27
R-CVP
with
50
% reduction cyclophosphamideDay 7: improvement of general status One hour per day in armchairStop O2PS 4Transfer to the Geriatric Department
Slide16Geriatricians attitudeTreat functional declineBladder catheter removedPhysiotherapyParallel barsReinforcement of lower legsTreat depression
1685-year-old lady
Slide17After
3 cycles of R-CVPComplete remission PET-
negative
After
6
cycles of R-CVPCR confirmedFive years later90 years oldPersistent CRDoes not ride bicycle anymore 1785-year-old lady
Slide18After
3 cycles of R-CVPComplete remission PET-
negative
After
6
cycles of R-CVPCR confirmedFive years later90 years oldPersistent CRDoes not ride bicycle anymoreSwims everyday up to 2 km in the bay of Royan1885-year-old lady
Slide19After
3 cycles
of R-CVP
Complete
remission PET-negativeAfter 6 cycles of R-CVPCR confirmedFive years later90 years oldPersistent CRDoes not ride bicycle anymoreSwims everyday up to 2 km in the bay of Royan1985-year-old lady