Premium
Outcomes of second‐line treatment after fludarabine cyclophosphamide and rituximab in patients with chronic lymphocytic leukemia outside clinical trials
Author(s) -
Joffe Erel,
Goldschmidt Neta,
Bairey Osnat,
Fineman Riva,
Ruchlemer Rosa,
RahimiLevene Naomi,
Shvidel Lev,
Greenbaum Uri,
Aviv Ariel,
Tadmor Tamar,
Braester Andrea,
Arad Ariela,
Polliack Aaron,
Herishanu Yair
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13129
Subject(s) - medicine , fludarabine , chemoimmunotherapy , rituximab , discontinuation , refractory (planetary science) , cyclophosphamide , chronic lymphocytic leukemia , gastroenterology , toxicity , surgery , chemotherapy , leukemia , lymphoma , physics , astrobiology
Objective To evaluate disease characteristics and long‐term outcomes in patients requiring second‐line treatment following fludarabine, cyclophosphamide, and rituximab ( FCR ), for relapsed/refractory disease (R/R), or following discontinuation due to toxicities. Method A retrospective analysis of 126 chronic lymphocytic leukemia patients treated with frontline FCR : 63 received second‐line treatment (41 relapsed, nine refractory [ SD / PD ], 13 prior toxicity). Time to next treatment ( TTNT ) was calculated from beginning FCR to initiation of second‐line therapy. Overall and event‐free survival was calculated from initiation of salvage treatment ( OS 2/ EFS 2). Results Median follow‐up for the entire cohort was 67 and 37 months from second‐line therapy. TTNT < 24 months was associated with shorter OS 2 and EFS 2 similar to those observed with primary refractory disease ( OS 2 19 and 23 months; EFS 2 12 and 9 months for TTNT < 24 months and SD / PD , respectively). TTNT ≥ 24 months (71% chemotherapy‐based second‐line), had longer OS 2 and EFS 2 (48 and 20 months). Among the 13 patients receiving second‐line therapy after discontinuing FCR due to toxicity EFS 2 was 41 months (59 months from initiation of FCR ). Conclusion With limitations of sample size and treatment heterogeneity, patients progressing <24 months following FCR have poor outcomes, similar to refractory patients, while longer remissions are indicative of a chemoimmunotherapy sensitive disease. Patients who discontinue FCR for toxicities may achieve excellent outcomes with subsequent treatment.