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Bendamustine versus chlorambucil in treatment of chronic lymphocytic leukaemia in China: a randomized, open-label, parallel-controlled, phase III clinical trial. Invest New Drugs 2022; 40:349-360. [PMID: 35031896 DOI: 10.1007/s10637-021-01206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic lymphoblastic leukemia (CLL) is the most common adult leukemia and mainly affects the elderly. Chemoimmunotherapy still has a role in the standard frontline therapy for specific population. However, the clinical activity of bendamustine has not been investigated in unfit Chinese patients with CLL. This study aimed to compare the efficacy and safety of bendamustine versus chlorambucil for untreated Chinese patients with Binet stage B/C CLL. METHODS In this multi-center, randomized, open-label, parallel-controlled, phase III trial, patients with previously untreated CLL were enrolled and randomly assigned (1:1) to receive bendamustine or chlorambucil. The primary endpoint was the objective response rate. Secondary endpoints included progression-free survival, the duration of response, and overall survival. Adverse events were recorded to evaluate safety. RESULTS Of 158 screened patients, 147 were enrolled and randomly allocated to receive bendamustine (n = 72) or chlorambucil (n = 75). After a median follow-up of 25.6 months (IQR 12.5-27.7), 69.0% (95% CI, 56.9-79.5) of bendamustine-treated patients achieved objective response and 37.0% (95% CI, 26.0-49.1) of chlorambucil with a difference of 32.0% (95%CI: 16.6-47.5), demonstrating the superiority of bendamustine to chlorambucil (p < 0.001). The median progression-free survival was longer for bendamustine (16.5 months; 95% CI, 11.3-24.7) versus chlorambucil (9.6 months; 95% CI, 8.7-11.8; p < 0.001). A longer median duration of response was seen in those receiving bendamustine (19.2 months; 95% CI, 11.8-29.1) than chlorambucil (10.7 months; 95% CI, 5.6-13.6; p = 0.0018). Median overall survival was not reached in either group. Overall survival at 18 months was 88% for bendamustine versus 85% for chlorambucil. Most common adverse events in both groups were neutropenia and thrombocytopenia. CONCLUSION In untreated Chinese patients with Binet stage B/C CLL, bendamustine induced the better objective response and resulted in longer progression-free survival than chlorambucil. Overall, these results validate the role of bendamustine as an effective and safe first-line therapy in this population.
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Wołowiec D, Szymczyk A, Potoczek S, Krochmalczyk D, Zawirska D, Piotrowska M, Malenda A, Soroka-Wojtaszko M, Kopacz A, Wąsik-Szczepanek E, Graboś-Michalak J, Raźny M, Wichary R, Bramowicz-Jarosz B, Seweryn M, Długosz-Danecka M, Hus I. Safety and Efficacy of Bendamustine Monotherapy in the First-Line Treatment of Patients with Chronic Lymphocytic Leukemia: Polish Lymphoma Research Group Real-Life Analysis. Chemotherapy 2019; 64:155-162. [PMID: 31715597 DOI: 10.1159/000503220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
Bendamustine is a cytostatic drug with a unique structure, combining the features of purine nucleoside analogs and alkylating agents. In patients with chronic lymphocytic leukemia (CLL) it is commonly used in combination with rituximab (BR protocol) both in the first-line as well as subsequent lines of therapy, and in clinical trials it is often combined with new targeted therapies. Therefore, the data on its real-life safety and efficacy are of clinical significance. As the Polish Lymphoma Research Group (PLRG), we retrospectively analyzed the efficacy and tolerability of bendamustine monotherapy in 96 patients with CLL. The median number of bendamustine cycles was 5, and 44 patients did not complete the planned 6 cycles (46%). Among the adverse events associated with the earlier termination of bendamustine treatment, infections were the most common (20.5%), followed by neutropenia (15.9%) and thrombocytopenia (15.9%). Dose reductions and/or delays occurred in 31% of treatment cycles (132 of 425) with neutropenia (17.9%) as the most frequent cause. Efficacy analysis showed an overall response rate of 88.2% with complete remission and partial remission achieved in 43.8 and 41.7% of patients, respectively. At the 24th month of follow-up, progression-free survival was 52% and overall survival was 69.7%. Bendamustine in monotherapy was found to be safe and efficacious, at least in terms of early response. Special attention should be paid to infectious complications, and especially that immune disorders are characteristic in the clinical course of CLL. Our observations suggest efforts must be made to ensure the proper timing and proper dose in the administration of the drug, and to avoid the premature termination of the treatment.
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Affiliation(s)
- Dariusz Wołowiec
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Szymczyk
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland,
| | - Stanisław Potoczek
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Krochmalczyk
- Department of Hematology, Collegium Medicum, Jagiellonian University, Kracow, Poland
| | - Daria Zawirska
- Department of Hematology, Collegium Medicum, Jagiellonian University, Kracow, Poland
| | - Magdalena Piotrowska
- Department of Hematology, Collegium Medicum, Jagiellonian University, Kracow, Poland
| | - Agata Malenda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Lublin, Poland
| | - Maria Soroka-Wojtaszko
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kopacz
- Department of Hematology, Clinical Hospital No. 2 in Rzeszów, Rzeszów, Poland
| | - Ewa Wąsik-Szczepanek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | | | - Małgorzata Raźny
- Department of Hematology, Ludwik Rydygier Memorial Specialized Hospital, Kracow, Poland
| | - Ryszard Wichary
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | | | - Marek Seweryn
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | | | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
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Martínez‐Calle N, Hartley S, Ahearne M, Kasenda B, Beech A, Knight H, Balotis C, Kennedy B, Wagner S, Dyer MJS, Smith D, McMillan AK, Miall F, Bishton M, Fox CP. Kinetics of T‐cell subset reconstitution following treatment with bendamustine and rituximab for low‐grade lymphoproliferative disease: a population‐based analysis. Br J Haematol 2018; 184:957-968. [DOI: 10.1111/bjh.15722] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolás Martínez‐Calle
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Sarah Hartley
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Matthew Ahearne
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Benjamin Kasenda
- Department of Medical Oncology & Department of Haematology University Hospital Basel Basel Switzerland
| | - Amy Beech
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Helen Knight
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Constantine Balotis
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Ben Kennedy
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Simon Wagner
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Martin J. S. Dyer
- Ernest and Helen Scott Haematological Research Institute University of Leicester Leicester UK
| | - Dean Smith
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Andrew K. McMillan
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Fiona Miall
- Haematology Department University Hospitals of Leicester NHS Trust Leicester UK
| | - Mark Bishton
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
| | - Christopher P. Fox
- Department of Clinical Haematology Nottingham University Hospitals NHS Trust Nottingham UK
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