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Cuneo A, Mato AR, Rigolin GM, Piciocchi A, Gentile M, Laurenti L, Allan JN, Pagel JM, Brander DM, Hill BT, Winter A, Lamanna N, Tam CS, Jacobs R, Lansigan F, Barr PM, Shadman M, Skarbnik AP, Pu JJ, Sehgal AR, Schuster SJ, Shah NN, Ujjani CS, Roeker L, Orlandi EM, Billio A, Trentin L, Spacek M, Marchetti M, Tedeschi A, Ilariucci F, Gaidano G, Doubek M, Farina L, Molica S, Di Raimondo F, Coscia M, Mauro FR, de la Serna J, Medina Perez A, Ferrarini I, Cimino G, Cavallari M, Cucci R, Vignetti M, Foà R, Ghia P. Efficacy of bendamustine and rituximab in unfit patients with previously untreated chronic lymphocytic leukemia. Indirect comparison with ibrutinib in a real-world setting. A GIMEMA-ERIC and US study. Cancer Med 2020; 9:8468-8479. [PMID: 32969597 PMCID: PMC7666748 DOI: 10.1002/cam4.3470] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
Limited information is available on the efficacy of front‐line bendamustine and rituximab (BR) in chronic lymphocytic leukemia (CLL) with reduced renal function or coexisting conditions. We therefore analyzed a cohort of real‐world patients and performed a matched adjusted indirect comparison with a cohort of patients treated with ibrutinib. One hundred and fifty‐seven patients with creatinine clearance (CrCl) <70 mL/min and/or CIRS score >6 were treated with BR. The median age was 72 years; 69% of patients had ≥2 comorbidities and the median CrCl was 59.8 mL/min. 17.6% of patients carried TP53 disruption. The median progression‐free survival (PFS) was 45 months; TP53 disruption was associated with a shorter PFS (P = 0.05). The overall survival (OS) at 12, 24, and 36 months was 96.2%, 90.1%, and 79.5%, respectively. TP53 disruption was associated with an increased risk of death (P = 0.01). Data on 162 patients ≥65 years treated with ibrutinib were analyzed and compared with 165 patients ≥65 years treated with BR. Factors predicting for a longer PFS at multivariable analysis in the total patient population treated with BR and ibrutinib were age (HR 1.06, 95% CI 1.02‐1.10, P < 0.01) and treatment with ibrutinib (HR 0.55, 95% CI 0.33‐0.93, P = 0.03). In a post hoc analysis of patients in advanced stage, a significant PFS advantage was observed in patient who had received ibrutinib (P = 0.03), who showed a trend for OS advantage (P = 0.08). We arrived at the following conclusions: (a) BR is a relatively effective first‐line regimen in a real‐world population of unfit patients without TP53 disruption, (b) ibrutinib provided longer disease control than BR in patients with advanced disease stage.
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Affiliation(s)
- Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Anthony R Mato
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Massimo Gentile
- Department of Onco-Hematology, Hematology Unit, A.O. of Cosenza, Cosenza, Italy
| | - Luca Laurenti
- Department of Radiological, Radiotherapeutic and Hematological Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison Winter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Constantine S Tam
- Peter McCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Alan P Skarbnik
- Lymphoproliferative Disorders Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Jeffrey J Pu
- SUNY Upstate Medical University, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Stephen J Schuster
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chaitra S Ujjani
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Lindsey Roeker
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Atto Billio
- Hematology and Transplant Unit, San Maurizio Hospital, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Martin Spacek
- Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of eastern Piedmont, Novara, Italy
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucia Farina
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Stefano Molica
- Hematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | | | | | - Isacco Ferrarini
- Hematology, Department of Cell Therapy and Hematology, University Hospital, Verona, Italy
| | - Giuseppe Cimino
- Department of Translational and Precision Medicine, University "La Sapienza", UOC di Ematologia con Trapianto, Ospedale S. Maria Goretti, Latina, Italy
| | - Maurizio Cavallari
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Rosalba Cucci
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Paolo Ghia
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
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Baliakas P, Mattsson M, Hadzidimitriou A, Minga E, Agathangelidis A, Sutton LA, Scarfo L, Davis Z, Yan XJ, Plevova K, Sandberg Y, Vojdeman FJ, Tzenou T, Chu CC, Veronese S, Mansouri L, Smedby KE, Giudicelli V, Nguyen-Khac F, Panagiotidis P, Juliusson G, Anagnostopoulos A, Lefranc MP, Trentin L, Catherwood M, Montillo M, Niemann CU, Langerak AW, Pospisilova S, Stavroyianni N, Chiorazzi N, Oscier D, Jelinek DF, Shanafelt T, Darzentas N, Belessi C, Davi F, Ghia P, Rosenquist R, Stamatopoulos K. No improvement in long-term survival over time for chronic lymphocytic leukemia patients in stereotyped subsets #1 and #2 treated with chemo(immuno)therapy. Haematologica 2017; 103:e158-e161. [PMID: 29269523 DOI: 10.3324/haematol.2017.182634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Panagiotis Baliakas
- Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Mattias Mattsson
- Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden.,Department of Hematology, Uppsala University Hospital, Sweden
| | | | - Eva Minga
- Institute of Applied Biosciences, Thessaloniki, Greece
| | - Andreas Agathangelidis
- Institute of Applied Biosciences, Thessaloniki, Greece.,Università Vita-Salute San Raffaele, Milan, Italy.,Strategic Research Program in CLL, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lesley-Ann Sutton
- Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Lydia Scarfo
- Università Vita-Salute San Raffaele, Milan, Italy.,Strategic Research Program in CLL, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zadie Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Xiao-Jie Yan
- The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Karla Plevova
- CEITEC-Central European Institute of Technology, MasarykBrno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Yorick Sandberg
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Fie J Vojdeman
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Tatiana Tzenou
- First Department of Propaedeutic Medicine, University of Athens, Greece
| | - Charles C Chu
- The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Silvio Veronese
- Molecular Pathology Unit and Haematology Department, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Larry Mansouri
- Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Véronique Giudicelli
- IMGT®, the international ImMunoGeneTics information system®, Université de Montpellier, Laboratoire d'ImmunoGénétique Moléculaire LIGM, Institut de Génétique Humaine IGH, UPR CNRS 1142, Montpellier, France
| | - Florence Nguyen-Khac
- Hematology Department and University Pierre et Marie Curie, Hopital Pitie-Salpetriere, Paris, France
| | | | - Gunnar Juliusson
- Lund University and Hospital Department of Hematology, Lund Stem Cell Center, Sweden
| | | | - Marie-Paule Lefranc
- IMGT®, the international ImMunoGeneTics information system®, Université de Montpellier, Laboratoire d'ImmunoGénétique Moléculaire LIGM, Institut de Génétique Humaine IGH, UPR CNRS 1142, Montpellier, France
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padova University School of Medicine, Italy.,Venetian Institute of Molecular Medicine, Padova, Italy
| | - Mark Catherwood
- Department of Hemato-Oncology, Belfast City Hospital, Belfast, UK
| | - Marco Montillo
- Molecular Pathology Unit and Haematology Department, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | | | - Anton W Langerak
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Sarka Pospisilova
- CEITEC-Central European Institute of Technology, MasarykBrno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Nicholas Chiorazzi
- The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | | | - Tait Shanafelt
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nikos Darzentas
- CEITEC-Central European Institute of Technology, MasarykBrno, Czech Republic
| | | | - Frederic Davi
- Hematology Department and University Pierre et Marie Curie, Hopital Pitie-Salpetriere, Paris, France
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milan, Italy.,Strategic Research Program in CLL, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Richard Rosenquist
- Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kostas Stamatopoulos
- Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden .,Institute of Applied Biosciences, Thessaloniki, Greece.,Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
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