Lunch debate on Saturday

Chair: A Lister .

In favour: Ch Gisselbrecht.

Against: M.H.J.van Ors.

The debate centered on the question of the optimum treatment of FL and the difficulty in interpreting long term data from patients receiving autografting versus the relatively shorter follow up of patients receiving high dose sequential chemotherapy (HDS) with biological agents such as Rituximab (R) and I 131 anti CD20 (‘Zevalin’).

Dr Gisselbrecht emphasized the long term remission rate with autografting and the possibilities of altering the conditioning regimens with the inclusion of radio immune modulators such as I 131 anti CD20 which has been shown in preliminary studies to be feasible and effective. The addition of Zevalin to ‘BEAM’ chemotherapy may also add efficacy.

Dr van Ors pointed out the improved quality of responses with HDS i.e. more molecular remissions and a reduction in the numbers of secondary leukaemias. The GITMO study showed a CR rate of 87% and a superior DFS when R-HDS was compared to R-CHOP.

The question will only be solved over time with properly conducted studies.

Both speakers agreed that R-CHOP should be used for remission induction and Rituximab maintenance should be compared with autografting and Rituximab maintenance.

The audience voted in favour of chemotherapy combined with newer biological agents over autografting for FL..