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• W2070795857 abstract "At the Twelfth Annual International Congress on Hematologic Malignancies, roundtable discussions were held on current and future directions for the treatment of patients with indolent lymphoma, multiple myeloma (MM), and chronic lymphocytic leukemia (CLL). These discussions resulted in the articles presented in this supplement. The unifying theme is that, after decades of little progress, the clinical outcomes in all of these entities have improved dramatically, and a number of promising avenues are being explored to further this progress. The progress observed in the past 10 to 15 years has resulted from several developments: induction of novel therapeutics, eg, rituximab, bortezomib, flavopiridol, and lenalidomide; “rediscovery” of older drugs such as thalidomide and bendamustine; the integration of drugs into more effective combinations (eg, FCR [fludarabine/ cyclophosphamide/rituximab] and R-CHOP [rituximab plus cyclophosphamide/doxorubicin/vincristine/prednisone] with and without doxorubicin); and the use of high-dose therapy (HDT) with autologous stem cell rescue (ASCR). In the early 1990s, in a review of the outcome of patients with indolent lymphoma, Horning concluded that no improvement had been observed in 4 decades.1 In 1997, the chimeric antiCD20 monoclonal antibody (MoAb) rituximab was approved for the treatment of patients with relapsed/refractory indolent B-cell lymphoma. The important advance in improving outcome in indolent lymphoma was the combination of rituximab with conventional chemotherapy.2 The superiority of chemoimmunotherapy compared with chemotherapy has been validated in a large number of clinical trials, and the incorporation of immunotherapy into treatment has altered the natural history of indolent lymphoma with improved survival.3 Two anti-CD20 radioimmunotherapy drugs, iodine 131 tositumomab and yttrium-90 ibritumomab tiuxetan, have been approved for the treatment of patients with indolent B-cell lymphoma, but definitive evidence of improvement of outcome is still pending, and these drugs have not been widely adopted.4 Bendamustine, a bifunctional alkylator originally developed in East Germany in the 1960s, has been shown in a number of studies to be highly active in indolent B-cell lymphoma. The activity of bendamustine in indolent lymphoma is reviewed by Rummel in this supplement. Preliminary results of a randomized trial in untreated patients with indolent B-cell lymphoma suggest that the combination of rituximab and bendamustine is equivalent to R-CHOP. New MoAbs directed at CD40, CD80, and CD20 are being evaluated in clinical trials. Small molecules such as heat-shock protein–90 inhibitors, immunomodulatory drugs, and anti–Bcl-2 family inhibitors are also being tested in indolent B-cell lymphoma. Multiple myeloma represents another example wherein progress was limited for decades but has been dramatically altered in the past 15 years with improvement in survival.5,6 In the case of MM, improvement came initially from the consolidation of initial response with HDT/ASCR. However, this improvement was limited to the patient eligible for transplantation. Therapy for the patient ineligible for transplantation improved with the inclusion of additional agents to standard melphalan and prednisone such as thalidomide and bortezomib. Further progress has been observed with the introduction of lenalidomide. The outcome improvements have been so dramatic that it raises the question about the role of HDT/ASCR for consolidation of initial remission. With durable initial remissions, HDT/ASCR may be moved to second-line therapy. In this supplement, Lonial discusses these improvements in the treatment of patients with MM, and Jagannath provides an important guide to the practical application of these recent advances, particularly in the setting of patients with comorbid conditions. Single-agent alkylator therapy with chlorambucil remained the standard for care for the management of CLL until the early 1990s, when fludarabine was shown to provide superior response rates and duration of remission, but it did not improve overall survival" @default.
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• W2070795857 date "2008-08-01" @default.
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• W2070795857 title "Lymphoid Malignancies: A Decade and a Half of Dramatic Improvements in Outcome" @default.
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• W2070795857 doi "https://doi.org/10.3816/clm.2008.s.007" @default.
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