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Front-line fludarabine-cyclophosphamide-rituximab (FCR) in 110 patients with chronic lymphocytic leukaemia (CLL): real-life experience with long-term outcomes, toxicities and responses to second-line therapies. Int J Hematol 2023; 117:388-397. [PMID: 36449134 DOI: 10.1007/s12185-022-03488-5] [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: 06/16/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022]
Abstract
Fludarabine-cyclophosphamide-rituximab (FCR) has been the gold standard front-line treatment for fit CLL patients until novel agent's introduction. Decision between either time-limited FCR or "endless" Bruton's tyrosine kinase inhibitor (BTKi) therapy may be difficult in fit IGHV-mutated-non-TP53 cases. We describe the outcomes after front-line FCR in 110 CLL patients from 5 centres in Catalonia, Spain, over a period of more than 10 years. ORR was 96.3% and CR 74.5%. Median second-treatment free survival (TFS1) was 6.2 years and median OS was 10.8 years. 50 (45.5%) patients required a subsequent therapy. Median third-treatment free survival was better for BTKi than for chemotherapy ± antiCD20 strategies (not reached vs 3.1 years, p = 0.003). Only 50 (45.5%) patients completed 6 cycles of FCR, and the main reason for discontinuation was cytopenia 29 (26.4%). 15 (13.6%) patients developed a second cancer, and 5 (4.5%) patients experienced a Richter's transformation (RT). At the end of follow-up, 50 (45.5%) patients remained in CR. Response rates, TFS1, OS, RT, and second cancers did not differ between patients treated with 6 vs 4 cycles of FCR. In conclusion, front-line FCR treatment leads to very long CR in almost half of patients, and BTKi yields excellent outcomes in relapsed patients.
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2
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Levi S, Bronstein Y, Goldschmidt N, Morabito F, Ziv-Baran T, Del Poeta G, Bairey O, Del Principe MI, Fineman R, Mauro FR, Gutwein O, Reda G, Ruchlemer R, Sportoletti P, Laurenti L, Shvidel L, Coscia M, Tadmor T, Varettoni M, Aviv A, Murru R, Braester A, Chiarenza A, Visentin A, Pietrasanta D, Loseto G, Zucchetto A, Bomben R, Olivieri J, Neri A, Rossi D, Gaidano G, Trentin L, Foà R, Cuneo A, Perry C, Gattei V, Gentile M, Herishanu Y. Efficacy of front-line ibrutinib versus fludarabine, cyclophosphamide, and rituximab in patients with chronic lymphocytic leukemia: A retrospective multicenter "Real-World" study. Am J Hematol 2023; 98:E24-E27. [PMID: 36349541 DOI: 10.1002/ajh.26779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yotam Bronstein
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Fortunato Morabito
- Biothechnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | | | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi", Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Antonio Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Rossi
- Department of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Chava Perry
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
ABSTRACT In this article, we carry out an overview on the management options available for chronic lymphocytic leukemia (CLL) patients and discuss possible treatment decisions, taking into account the issue of sustainability and availability. Targeted agents have shown to be superior compared with chemoimmunotherapy (CIT) in terms of progression-free survival in high-risk CLL. In the majority of studies, however, continuous treatment was compared with fixed-duration CIT and no overall survival or progression-free survival-2 (time from randomization to second progression or death) advantage could be documented. Meanwhile, a substantial financial burden on both patients and payers has raised issues about affordability and adherence to treatment. Therefore, value-based pricing of new drugs has been used to set up price negotiation policies in several countries, and fixed-duration therapy has shown to be less costly than continuous treatment. Thus, CIT continues to have a role in the treatment of CLL patients with a favorable genetic profile, that is, with a mutated IGHV gene profile and a wild-type TP53. Targeted treatment represents the preferred choice in patients with an unmutated IGHV gene configuration and/or a TP53 disruption, provided that adherence to treatment is guaranteed and bearing in mind that should costly drugs not be available for frontline treatment, new agents can be very effective as first salvage treatment.
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4
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Vanura K. Sex as decisive variable in lymphoid neoplasms-an update. ESMO Open 2020; 6:100001. [PMID: 33399069 PMCID: PMC7808098 DOI: 10.1016/j.esmoop.2020.100001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/09/2020] [Accepted: 10/31/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- K Vanura
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.
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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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6
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Herishanu Y, Shaulov A, Fineman R, Bašić‐Kinda S, Aviv A, Wasik‐Szczepanek E, Jaksic O, Zdrenghea M, Greenbaum U, Mandac I, Simkovic M, Morawska M, Benjamini O, Spacek M, Nemets A, Bairey O, Trentin L, Ruchlemer R, Laurenti L, Stanca Ciocan O, Doubek M, Shvidel L, Dali N, Mirás F, De Meûter A, Dimou M, Mauro FR, Coscia M, Bumbea H, Szász R, Tadmor T, Gutwein O, Gentile M, Scarfò L, Tedeschi A, Sportoletti P, Gimeno Vázquez E, Marquet J, Assouline S, Papaioannou M, Braester A, Levato L, Gregor M, Rigolin GM, Loscertales J, Medina Perez A, Nijziel MR, Popov VM, Collado R, Slavutsky I, Itchaki G, Ringelstein S, Goldschmidt N, Perry C, Levi S, Polliack A, Ghia P. Frontline treatment with the combination obinutuzumab ± chlorambucil for chronic lymphocytic leukemia outside clinical trials: Results of a multinational, multicenter study by ERIC and the Israeli CLL study group. Am J Hematol 2020; 95:604-611. [PMID: 32096887 DOI: 10.1002/ajh.25766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
In recent years, considerable progress has been made in frontline therapy for elderly/physically unfit patients with CLL. The combination of obinutuzumab and chlorambucil (O-Clb) has been shown to prolong progression free survival (PFS, median PFS-31.5 months) and overall survival (OS) compared to chlorambucil alone. More recently, obinutuzumab given in combination with either ibrutinib or venetoclax improved PFS but not OS when compared to O-Clb. In this retrospective multinational, multicenter co-operative study, we evaluated the efficacy and safety of frontline treatment with O ± Clb in unfit patients with CLL, in a "real-world" setting. Patients with documented del (17p13.1)/TP53 mutation were excluded. A total of 437 patients (median age, 75.9 years; median CIRS score, 8; median creatinine clearance, 61.1 mL/min) were included. The clinical overall response rate was 80.3% (clinical complete and partial responses in 38.7% and 41.6% of patients, respectively). Median observation time was 14.1 months and estimated median PFS was 27.6 months (95% CI, 24.2-31.0). In a multivariate analysis, high-risk disease [del (11q22.3) and/or IGHV-unmutated], lymph nodes of diameter > 5 cm, obinutuzumab monotherapy and reduced cumulative dose of obinutuzumab, were all independently associated with shorter PFS. The median OS has not yet been reached and estimated 2-year OS is 88%. In conclusion, in a "real-world" setting, frontline treatment with O-Clb achieves PFS comparable to that reported in clinical trials. Inferior outcomes were noted in patients with del (11q22.3) and/or unmutated IGHV and those treated with obinutuzumab-monotherapy. Thus, O-Clb can be still considered as legitimate frontline therapy for unfit CLL patients with low-risk disease.
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Affiliation(s)
- Yair Herishanu
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
| | - Adir Shaulov
- Hadassah Hebrew University Medical Center Jerusalem Israel
| | - Riva Fineman
- Department of HematologyRambam Health Care Campus Haifa Israel
| | | | - Ariel Aviv
- Department of HematologyHaEmek Medical Center Afula Israel
- Faculty of MedicineTechnion Israel Institute of Technology Haifa Israel
| | - Ewa Wasik‐Szczepanek
- Department of Hematooncologyand Bone Marrow Transplantation Medical University Lublin Poland
| | | | - Mihnea Zdrenghea
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj‐Napoca Romania
| | - Uri Greenbaum
- Ben‐Gurion University, Soroka University Medical Center Beer Sheva Israel
| | | | - Martin Simkovic
- University Hospital and Medical School Hradec Kralove Hradec Kralove Czech Republic
| | | | - Ohad Benjamini
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
- Hematology DivisionChaim Sheba Medical Center Ramat Gan Israel
| | - Martin Spacek
- Charles University and General Hospital in Prague Prague Czech Republic
| | | | - Osnat Bairey
- Rabin Medical Center, Beilinson Hospital; Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | | | - Rosa Ruchlemer
- Department of HematologyShaare Zedek Medical Center Jerusalem Israel
| | - Luca Laurenti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | | | - Michael Doubek
- Department of Internal Medicine‐Hematology and OncologyMedical Faculty of Masaryk University and University Hospital Brno Brno Czech Republic
| | - Lev Shvidel
- Department of HematologyKaplan Medical Center Rehovot Israel
- Hebrew University of Jerusalem Jerusalem Israel
| | | | | | | | - Maria Dimou
- Hematology Section ‐ 1st Department Of Propaedeutic Internal MedicineLaikon Hospital Athens Greece
| | - Francesca R. Mauro
- Hematology, Department of Translational and Precision MedicineSapienza University, Policlinico Umberto I Rome Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health SciencesUniversity of Torino Torino Italy
| | - Horia Bumbea
- Emergency University Clinical Hospital Bucharest Romania
| | - Róbert Szász
- Division of Hematology, Department of Internal Medicine, Faculty of MedicineUniversity of Debrecen Debrecen Hungary
| | | | | | - Massimo Gentile
- Hematology Unit and Biotechnology Research Unit, A.O. of Cosenza Cosenza Italy
| | - Lydia Scarfò
- Division of Experimental OncologyIRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
| | - Alessandra Tedeschi
- Department of Haematology, Niguarda Cancer CenterASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato‐Oncological Research, Ospedale S. Maria della Misericordia, University of Perugia Perugia Italy
| | | | - Juan Marquet
- Hematology and HemotherapyHospital Universitario Ramón y Cajal Madrid Spain
| | - Sarit Assouline
- Division of HematologyJewish General Hospital, Montreal Quebec Canada
| | - Maria Papaioannou
- First Department of Internal Medicine, Division of HaematologyAHEPA University Hospital, Aristotle University of Thessaloniki Thessaloniki Greece
| | | | - Luciano Levato
- Department Hematology‐OncologyAzienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Michael Gregor
- Division of HematologyCantonal Hospital of Lucerne Lucerne Switzerland
| | - Gian M. Rigolin
- Hematology Section, Department of Medical SciencesUniversity of Ferrara‐Azienda Ospedaliera‐Universitaria di Ferrara, University of Ferrara Ferrara Italy
| | | | | | | | | | | | | | - Gilad Itchaki
- Rabin Medical Center, Beilinson Hospital; Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | | | | | - Chava Perry
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of MedicineTel Aviv University Tel‐Aviv Israel
| | - Shai Levi
- Department of HematologyTel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Aaron Polliack
- Hadassah Hebrew University Medical Center Jerusalem Israel
| | - Paolo Ghia
- Division of Experimental OncologyIRCCS Ospedale San Raffaele Milan Italy
- Università Vita‐Salute San Raffaele Milan Italy
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7
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Spunarova M, Tom N, Pavlova S, Mraz M, Brychtova Y, Doubek M, Panovska A, Skuhrova Francova H, Brzobohata A, Pospisilova S, Mayer J, Trbusek M. Impact of gene mutations and chromosomal aberrations on progression-free survival in chronic lymphocytic leukemia patients treated with front-line chemoimmunotherapy: Clinical practice experience. Leuk Res 2019; 81:75-81. [DOI: 10.1016/j.leukres.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 02/03/2023]
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8
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Herishanu Y, Tadmor T, Braester A, Bairey O, Aviv A, Rahimi‐Levene N, Fineman R, Levi I, Yuklea M, Ruchlemer R, Shvidel L, Polliack A. Low‐dose fludarabine and cyclophosphamide combined with standard dose rituximab (LD‐FCR) is an effective and safe regimen for elderly untreated patients with chronic lymphocytic leukemia: The Israeli CLL study group experience. Hematol Oncol 2019; 37:185-192. [DOI: 10.1002/hon.2580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/16/2019] [Accepted: 02/07/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Yair Herishanu
- Department of HematologyTel‐Aviv Sourasky Medical Center Tel‐Aviv Israel
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
| | - Tamar Tadmor
- Hematology UnitBnai‐Zion Medical Center Haifa Israel
| | - Andrei Braester
- Department of HematologyGalilee Medical Center and Faculty of Medicine in Galilee Nahariya Israel
| | - Osnat Bairey
- Sackler Faculty of MedicineTel‐Aviv University Tel‐Aviv Israel
- Department of HematologyRabin Medical Center Petah Tikva Israel
| | - Ariel Aviv
- Department of HematologyEmek Medical Center Afula Israel
| | | | - Riva Fineman
- Department of HematologyRambam Medical Center Haifa Israel
| | - Itai Levi
- Department of HematologySoroka Medical Center, Beer Sheba and Ben‐Gurion University, Beer Sheba Israel
| | - Mona Yuklea
- Department of HematologySapir Medical Center Kfar Saba Israel
| | - Rosa Ruchlemer
- Department of HematologyShaare Zedek Medical Center Jerusalem Israel
| | - Lev Shvidel
- Department of HematologyKaplan Medical Center Rehovot Israel
| | - Aaron Polliack
- Department of HematologyHadassah University Hospital and Hebrew University Medical School Jerusalem Israel
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9
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Joffe E, Goldschmidt N, Bairey O, Fineman R, Ruchlemer R, Rahimi-Levene N, Shvidel L, Greenbaum U, Aviv A, Tadmor T, Braester A, Arad A, Polliack A, Herishanu Y. Outcomes of second-line treatment after fludarabine cyclophosphamide and rituximab in patients with chronic lymphocytic leukemia outside clinical trials. Eur J Haematol 2018; 101:399-406. [PMID: 29949186 DOI: 10.1111/ejh.13129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 02/03/2023]
Abstract
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 (OS2/EFS2). RESULTS Median follow-up for the entire cohort was 67 and 37 months from second-line therapy. TTNT < 24 months was associated with shorter OS2 and EFS2 similar to those observed with primary refractory disease (OS2 19 and 23 months; EFS2 12 and 9 months for TTNT < 24 months and SD/PD, respectively). TTNT ≥ 24 months (71% chemotherapy-based second-line), had longer OS2 and EFS2 (48 and 20 months). Among the 13 patients receiving second-line therapy after discontinuing FCR due to toxicity EFS2 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.
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Affiliation(s)
- Erel Joffe
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Osnat Bairey
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Riva Fineman
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Lev Shvidel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.,Department of Hematology, Kaplan Medical Center, Rehovot, Israel
| | - Uri Greenbaum
- Soroka Medical Center, Beer Sheba and Ben-Gurion University, Beer Sheba, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Andrea Braester
- Department of Hematology, Western Galilee Hospital, Nahariya, Israel
| | - Ariela Arad
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yair Herishanu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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10
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Stauder R, Eichhorst B, Hamaker ME, Kaplanov K, Morrison VA, Österborg A, Poddubnaya I, Woyach JA, Shanafelt T, Smolej L, Ysebaert L, Goede V. Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an international Society of Geriatric Oncology (SIOG) Task Force. Ann Oncol 2017; 28:218-227. [PMID: 27803007 DOI: 10.1093/annonc/mdw547] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is > 70 years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated. This includes not only clinical staging and evaluation of disease-specific prognostic biomarkers such as 17p deletion and TP53 mutation, but also of comorbidities, physical capacity, nutritional status, cognitive capacity, ability to perform activities of daily living and social support. Comorbidity scoring and geriatric assessment tools are helpful in achieving such multidimensional evaluation in a systematic manner. The introduction of new drugs including novel monoclonal antibodies and kinase inhibitors offers enhanced opportunities for the treatment of elderly patients with CLL. This position paper of a Task Force of the International Society of Geriatric Oncology (SIOG) reviews currently available evidence relevant to such patients. All types of elderly patient (i.e. chronological age > 65-70 years) are considered, from robust (fit) to vulnerable (unfit) to the terminally ill. Among the topics covered are the following: (i) the relationship between chronological age, prognosis and survival, (ii) assessment of biological aging, (iii) biological age as a determinant of treatment feasibility and tolerance and (iv) tailoring of both first and further-line treatment to the circumstances of the individual patient.
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Affiliation(s)
- R Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - B Eichhorst
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - K Kaplanov
- Department of Hematology, Volgograd Regional Clinical Oncology Center, Volgograd, Russian Federation
| | - V A Morrison
- University of Minnesota, Hennepin County Medical Center, Minneapolis, USA
| | - A Österborg
- Karolinska University Hospital and Institute, Stockholm, Sweden
| | - I Poddubnaya
- Russian Medical Academy for Postgraduate Education, Moscow, Russian Federation
| | - J A Woyach
- Department of Internal Medicine, Ohio State University, Ohio, USA
| | - T Shanafelt
- Department of Hematology and Oncology, Mayo Clinic, Rochester, USA
| | - L Smolej
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - L Ysebaert
- Hematology Department, IUC Toulouse-Oncopole, Toulouse, France
| | - V Goede
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany
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11
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Joffe E, Ariela Arad N, Bairey O, Fineman R, Ruchlemer R, Rahimi-Levene N, Shvidel L, Greenbaum U, Aviv A, Tadmor T, Braester A, Goldschmidt N, Polliack A, Herishanu Y. Persistently low lymphocyte counts after FCR therapy for chronic lymphocytic leukemia are associated with longer overall survival. Hematol Oncol 2017. [PMID: 28639416 DOI: 10.1002/hon.2444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Decreased absolute lymphocyte counts (ALCs) following frontline therapy for chronic lymphocytic leukemia may be associated with disease control, even in patients without evidence of minimal residual disease. We studied the prognostic significance of ALCs during the first year following treatment with fludarabine, cyclophosphamide, and rituximab (FCR). We evaluated 99 patients who achieved a partial response without lymphocytosis (<4.0 × 103 cells/μL) or better after FCR. Absolute lymphocyte counts were recorded at 3-, 6-, 9-, and 12-month posttreatment and correlated with overall survival (OS) and event-free survival (EFS). For each time point, analyses were limited to patients without lymphocytosis, so as to avoid possible biases from undocumented disease progressions. Lymphopenia (ALC < 1.0 × 103 cells/μL) at 3 m after FCR (69% of patients n = 68), was associated with a longer OS (5y OS 91% vs 64%, P = .001), as were ALC ≤ 2 × 103 cells/μL at 6 m (5y OS 85% vs 48%, P = .004) and ALC ≤ 1.8 × 103 cells/μL at 9 m (5y OS 93% vs 54%, P = .009). A normal-range ALC (≤4 × 103 cells/μL) at 12 m was also associated with a 91% 5y OS. Higher ALCs (but without lymphocytosis) were associated with shorter EFS (median EFS 27 months for ALC > 1.8 vs not reached for ALC ≤ 0.7 at 9 months, P < .0001). In conclusion, lower ALC levels in the first few months following frontline FCR therapy were associated with longer OS and EFS. Possible explanations may be that lower ALCs reflect deeper clonal suppression or protracted Treg depletion. Absolute lymphocyte count levels may be a cheap and widely available prognostic marker, though the added value for clinical practice is the minimal residual disease era needs to be explored.
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Affiliation(s)
- Erel Joffe
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - N Ariela Arad
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Osnat Bairey
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,Department of Hematology, Rabin Medical Center, Petah Tikva, Israel
| | - Riva Fineman
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Naomi Rahimi-Levene
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,Hematology Institute, Assaf Harofe Medical Center, Zerifin, Israel
| | - Lev Shvidel
- Department of Hematology, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Uri Greenbaum
- Soroka Medical Center, Beer Sheba and Ben-Gurion University, Beer Sheva, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Andrei Braester
- Department of Hematology, Western Galilee Hospital, Nahariya, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Aaron Polliack
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yair Herishanu
- Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Tel Aviv, Israel.,The Hematology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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12
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Peng XX, Feng KR, Ren YJ. Molecular modeling studies of quinazolinone derivatives as novel PI3Kδ selective inhibitors. RSC Adv 2017. [DOI: 10.1039/c7ra10870b] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The main molecular modeling method, the docking results of newly designed compoundD04and the best pharmacophore model are reported herein.
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Affiliation(s)
- Xiu Xiu Peng
- School of Chemical and Environmental Engineering
- Shanghai Institute of Technology
- Shanghai 201418
- China
| | - Kai Rui Feng
- School of Chemical and Environmental Engineering
- Shanghai Institute of Technology
- Shanghai 201418
- China
| | - Yu Jie Ren
- School of Chemical and Environmental Engineering
- Shanghai Institute of Technology
- Shanghai 201418
- China
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13
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Affiliation(s)
- Paolo Ghia
- Strategic Research Program on CLL and B Cell Neoplasia Unit, Division of Experimental Oncology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Cuneo
- Department of Medical Sciences, Hematology Unit. University of Ferrara, Italy
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14
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Autoimmune hemolytic anemia (AIHA) associated with chronic lymphocytic leukemia in the current era of targeted therapy. Leuk Res 2016; 50:31-36. [DOI: 10.1016/j.leukres.2016.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/16/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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15
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Goede V, Hallek M. Pharmacotherapeutic Management of Chronic Lymphocytic Leukaemia in Patients with Comorbidities: New Agents, New Hope. Drugs Aging 2016; 32:877-86. [PMID: 26446155 DOI: 10.1007/s40266-015-0308-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is mostly considered a disease of the elderly. As such, many patients present with comorbidities. Several scores allow for a qualitative and quantitative assessment of comorbidity in patients with CLL. Although our knowledge about the impact of comorbidity on outcomes in patients with CLL is still incomplete, it is becoming increasingly apparent that comorbidities could negatively interfere with CLL treatment. Recently, a number of new agents have been approved for use in patients with previously untreated CLL and comorbidities (i.e. obinutuzumab, ofatumumab), as well as in patients with previously treated or high-risk CLL (i.e. idelalisib, ibrutinib). This review discusses the role of comorbidity in patients with CLL, together with the changing treatment landscape for CLL in this patient population.
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Affiliation(s)
- Valentin Goede
- German CLL Study Group, Department I of Internal Medicine, University Hospital Cologne, Centre of Integrated Oncology Cologne-Bonn, 50924, Cologne, Germany. .,Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany.
| | - Michael Hallek
- German CLL Study Group, Department I of Internal Medicine, University Hospital Cologne, Centre of Integrated Oncology Cologne-Bonn, 50924, Cologne, Germany.,Cluster of Excellence Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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16
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Gentile M, Zirlik K, Ciolli S, Mauro FR, Di Renzo N, Mastrullo L, Angrilli F, Molica S, Tripepi G, Giordano A, Di Raimondo F, Selleri C, Coscia M, Musso M, Orsucci L, Mannina D, Rago A, Giannotta A, Ferrara F, Herishanu Y, Shvidel L, Tadmor T, Scortechini I, Ilariucci F, Murru R, Guarini A, Musuraca G, Mineo G, Vincelli I, Arcari A, Tarantini G, Caparrotti G, Chiarenza A, Levato L, Villa MR, De Paolis MR, Zinzani PL, Polliack A, Morabito F. Combination of bendamustine and rituximab as front-line therapy for patients with chronic lymphocytic leukaemia: multicenter, retrospective clinical practice experience with 279 cases outside of controlled clinical trials. Eur J Cancer 2016; 60:154-65. [PMID: 27127905 DOI: 10.1016/j.ejca.2016.03.069] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/06/2016] [Accepted: 03/14/2016] [Indexed: 12/31/2022]
Abstract
Recently, encouraging results in terms of safety and efficacy have been obtained using bendamustine-rituximab (BR) in untreated chronic lymphocytic leukaemia (CLL) patients enrolled in a phase II study. Here, we report a retrospective international multicenter study of CLL patients treated with BR as front-line therapy. The cohort included 279 patients with progressive CLL from 33 centers (29 Italian, 3 Israeli and 1 German) who received at least 1 cycle of BR as first-line treatment during the 2008-2014 period. The primary objective of this study was to evaluate the efficacy and safety of BR administered as front-line therapy, outside of controlled clinical trials. Median age was 70 years (range, 43-86 years); 62.4% were males and 35.8% had Binet stage C. Forty-two patients (15.2%) were unfit (cumulative illness rating scale [CIRS] score ≥7), and 140 (50.2%) had creatinine clearance ≤70 ml/min. Fluorescent in situ hybridisation analysis, available for 192 cases, showed that 21 (10.9%) had del11q and 18 (9.4%) del17p. The overall response rate (ORR) was 86.4%, with a complete remission rate of 28%. Patients with del17p had an ORR of 66.7%. After median follow-up of 24 months, the 2-year progression-free survival (PFS) was 69.9%; CIRS ≥7, immunoglobulin heavy-chain variable-region (IGHV) unmutated status, del17p and BR dose intensity <80% were independently associated with shorter PFS. Grade III or IV neutropenia, thrombocytopenia, and anaemia were observed in 25.9%, 15.4%, and 15.1% of patients, respectively. Twenty-four patients (8.6%) had severe infections. BR is also an effective and safe regimen for untreated CLL patients, outside of controlled clinical trials.
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Affiliation(s)
| | - Katja Zirlik
- Department of Haematology and Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | | | | | | | | | | | - Stefano Molica
- Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Giovanni Tripepi
- Consiglio Nazionale delle Ricerche, Istituto di Fisiologia Clinica, Reggio Calabria, Italy
| | - Annamaria Giordano
- Ematologia-Azienda Ospedaliero-Universitaria, Policlinico consorziale di Bari, Italy
| | - Francesco Di Raimondo
- Department of Biomedical Sciences, Division of Haematology, University of Catania and Ferrarotto Hospital, Catania, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Marta Coscia
- Division of Haematology, University of Torino, A.O. Città della Salute e della Scienza di Torino, Italy
| | - Maurizio Musso
- Hematology and Bone Marrow Transplant Unit, Dept. of Oncology, La Maddalena, Palermo, Italy
| | - Lorella Orsucci
- Division of Hematology II, San Giovanni Battista Hospital, Torino, Italy
| | - Donato Mannina
- Divisione di Ematologia, Ospedale Papardo, Messina, Italy
| | - Angela Rago
- UOC Eatologia Opedale Santa Maria Goretti, Latina, Italy
| | | | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Fiorella Ilariucci
- Hematology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Roberta Murru
- UO Ematologia e CTMO Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Attilio Guarini
- Haematology Unit, National Cancer Research Centre Istituto Tumori, Bari, Italy
| | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Mineo
- Unità di Ematologia, Ospedale San Vincenzo, Taormina, Italy
| | | | - Annalisa Arcari
- Hematology Unit, Department of Onco-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Giuseppe Caparrotti
- Department of Haematology, ASL Caserta (CE), Hospital Moscati, Aversa, CE, Italy
| | - Annalisa Chiarenza
- Department of Biomedical Sciences, Division of Haematology, University of Catania and Ferrarotto Hospital, Catania, Italy
| | - Luciano Levato
- Department of Hematology, Ospedale Santo Spirito, Pescara, Italy
| | | | | | | | - Aaron Polliack
- Department of Hematology, Hadassah University, Hospital and Hebrew University Medical School, Jerusalem, Israel
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17
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Cramer P, Langerbeins P, Fischer K, Eichhorst B, Hallek M, Goede V. Dose-reduced fludarabine, cyclophosphamide and rituximab (FCR) in older patients with chronic lymphocytic leukemia: does one size fit all? Leuk Lymphoma 2016; 57:987-90. [PMID: 27096890 DOI: 10.3109/10428194.2016.1164858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Paula Cramer
- a Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn and German CLL Study Group, University of Cologne , Cologne , Germany
| | - Petra Langerbeins
- a Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn and German CLL Study Group, University of Cologne , Cologne , Germany
| | - Kirsten Fischer
- a Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn and German CLL Study Group, University of Cologne , Cologne , Germany
| | - Barbara Eichhorst
- a Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn and German CLL Study Group, University of Cologne , Cologne , Germany
| | - Michael Hallek
- a Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn and German CLL Study Group, University of Cologne , Cologne , Germany ;,b CECAD - Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases , Cologne , Germany
| | - Valentin Goede
- a Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn and German CLL Study Group, University of Cologne , Cologne , Germany ;,c Department of Geriatric Medicine , St. Marien Hospital , Cologne , Germany
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