The outcome of chronic lymphocytic leukemia patients who relapsed after fludarabine, cyclophosphamide, and rituximab

• Published in: European journal of haematology Vol. 90; no. 6; pp. 479 - 485
• Main Authors: Panovská, Anna, Smolej, Lukáš, Lysák, Daniel, Brychtová, Yvona, Šimkovič, Martin, Motyčková, Monika, Vodárek, Pavel, Lindtnerová, Michaela, Trbušek, Martin, Malčíková, Jitka, Pospíšilová, Šárka, Mayer, Jiří, Doubek, Michael
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2013
• Subjects: Adult; Age; Aged; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; chronic lymphocytic leukemia; Cyclophosphamide - administration & dosage; Disease-Free Survival; FCR chemoimmunotherapy; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy; Leukemia, Lymphocytic, Chronic, B-Cell - mortality; Male; Middle Aged; Recurrence; relapse; Retrospective Studies; Rituximab; survival; Survival Rate; Time Factors; Vidarabine - administration & dosage; Vidarabine - analogs & derivatives
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.12106

Background There are minimal data about the efficacy of subsequent therapy in patients with relapse after FCR (fludarabine, cyclophosphamide, and rituximab) chemoimmunotherapy. Methods We retrospectively analyzed the outcomes of 119 patients who relapsed after standard‐dose FCR. The patient cohort consisted of patients who relapsed after FCR administered as first‐line therapy (Group 1, n = 63) and patients relapsing after FCR administered in second/subsequent line; (Group 2, n = 56). Results Basic parameters (age, clinical stage, cytogenetics, molecular genetics) did not differ significantly between these subgroups. Likewise, median progression‐free survival (PFS) was not considerably different after FCR (18.6 vs. 14.7 months). Subsequent therapy for relapsed disease included FCR retreatment, R‐CHOP, alemtuzumab, or rituximab plus high‐dose dexamethasone. Overall response rates for the two groups did not significantly differ (59% vs. 44%). Although PFS after subsequent therapy was relatively short, longer PFS was observed in Group 1 (13.3 vs. 5.9 months; P = 0.01), in patients with response duration ≥24 months after previous FCR (13 vs. 6.1 months; P < 0.01), and in patients who achieved complete remission after FCR (10.8 vs. 7.9 months in partial remission; P = 0.01). Newly detected 17p deletions were observed in 5/62 patients, and new p53 mutations in 6/34 FCR‐treated patients. Conclusion Our data indicate that the prognosis of patients who relapse after FCR remains poor regardless of the subsequent treatment regimen.