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Puła B, Długosz-Danecka M, Salomon-Perzyński A, Szymczyk A, Subocz E, Budziszewska BK, Rybka J, Gil L, Waszczuk-Gajda A, Iskierka-Jażdżewska E, Zaucha JM, Osowiecki M, Piszczek W, Steckiewicz P, Szukalski Ł, Hus M, Lech-Marańda E, Jurczak W, Jamroziak K. Efficacy of high-dose corticosteroid-based treatment for chronic lymphocytic leukemia patients with p53 abnormalities in the era of B-cell receptor inhibitors. Adv Med Sci 2020; 65:371-377. [PMID: 32659728 DOI: 10.1016/j.advms.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/04/2020] [Accepted: 06/06/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE High-dose methylprednisolone (HDMP) with or without anti-CD20 antibody treatment in the pre B-cell receptor inhibitor (BCRi) era was used as potential salvage therapy for relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (r/r CLL/SLL) patients bearing the 17p deletion. PATIENTS AND METHODS Outcomes were compared in retrospect between r/r patients treated with HDMP (n = 20), ibrutinib (n = 39) and idelalisib with rituximab (n = 14). RESULTS Higher overall response rates were found in those patients undergoing BCRi therapy compared to HDMP (79.2% vs. 0%; p < 0.0001), along with longer median progression-free survival (not reached vs. 24.1 months; p < 0.01). Nevertheless, there were no differences in the overall survival (HDMP 35.87 months vs. not reached; p = 0.58). CONCLUSION HDMP treatment was significantly inferior in terms of response rate and progression-free survival in r/r CLL/SLL patients with the 17p deletion, and may only be used whenever novel compounds are unavailable.
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Iskierka-Jażdżewska E, Puła B, Szeremet A, Hus M, Gołos A, Hołojda J, Piszczek W, Steckiewicz P, Wojciechowska M, Zaucha JM, Warzocha K, Jamroziak K. Ibrutinib discontinuation in patients with relapsed or refractory chronic lymphocytic leukemia treated in a compassionate use program: A report from the Polish Adult Leukemia Study Group (PALG). ADV CLIN EXP MED 2019; 28:1051-1057. [PMID: 31199879 DOI: 10.17219/acem/99911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Development of a novel class of drugs, the B-cell receptor-signaling inhibitors, including ibrutinib, has been a major achievement in the therapy of refractory or relapsed chronic lymphocytic leukemia (CLL). However, the CLL patients who have discontinued the ibrutinib treatment in clinical trials have been reported to have poor prognosis. OBJECTIVES In this retrospective study by the Polish Adult Leukemia Group (PALG), we analyzed the reasons for ibrutinib cessation and outcomes after discontinuing ibrutinib in refractory or relapsed CLL patients treated in a compassionate use program in Poland. MATERIAL AND METHODS Polish CLL patients were included if they discontinued ibrutinib for any reason. The clinical data on the course of ibrutinib treatment was collected anonymously using electronic Case Report Forms (CRFs). The causes of discontinuation of ibrutinib as reported by the treating physicians were analyzed. RESULTS Thirty-seven patients who discontinued ibrutinib were identified. The median duration of ibrutinib treatment in this group was 4.4 months (range: 0.2-25.2). The main reason for discontinuing ibrutinib was adverse events (n = 20, 54%), while 14 (38%) patients discontinued therapy due to disease progression and 3 (8%) due to other causes. The most common treatment complications that led to ibrutinib cessation were severe respiratory tract infections (9 patients, 24%). In the group discontinuing ibrutinib for progressive disease, 11 patients progressed with untransformed CLL, while in 3 patients, a rare type of Richter transformation to Hodgkin's lymphoma was diagnosed. Twenty-nine patients (78%) died during the follow-up period, and median overall survival (OS) reached 2.0 months (95% CI = 0.8-5.5 months). Importantly, no significant survival difference was detected between patients who discontinued ibrutinib due to disease progression and due to adverse events. CONCLUSIONS The results of this analysis indicate that ibrutinib discontinuation in relapsed or refractory CLL is associated with poor prognosis regardless of the reason for ibrutinib cessation.
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Affiliation(s)
| | - Bartosz Puła
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Agnieszka Szeremet
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - Marek Hus
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - Aleksandra Gołos
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Jadwiga Hołojda
- Department of Hematology, Specialist District Hospital, Legnica, Poland
| | | | | | | | - Jan Maciej Zaucha
- Department of Oncological Propaedeutics, Medical University of Gdańsk, Poland
- Gdynia Oncology Center, Poland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
| | - Krzysztof Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warszawa, Poland
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Iskierka-Jażdżewska E, Hus M, Giannopoulos K, Mądro E, Hołojda J, Piotrowska M, Zaucha JM, Piszczek W, Szeremet A, Wojciechowska M, Steckiewicz P, Knopińska-Posłuszny W, Osowiecki M, Drozd-Sokołowska J, Kumiega B, Kyrcz-Krzemień S, Hałka J, Dudziński M, Wieszczy P, Robak T, Warzocha K, Jamroziak K. Efficacy and toxicity of compassionate ibrutinib use in relapsed/refractory chronic lymphocytic leukemia in Poland: analysis of the Polish Adult Leukemia Group (PALG). Leuk Lymphoma 2017; 58:2485-2488. [PMID: 28278701 DOI: 10.1080/10428194.2017.1292353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Marek Hus
- b Department of Haematooncology and Bone Marrow Transplantation , Medical University of Lublin , Lublin , Poland
| | - Krzysztof Giannopoulos
- c Experimental Hematooncology Department, Medical University of Lublin & Hematology Department , St. John's Cancer Center , Lublin , Poland
| | - Elżbieta Mądro
- d Department of Hematology , Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Jadwiga Hołojda
- e Department of Hematology , Specialist District Hospital , Legnica , Poland
| | | | - Jan M Zaucha
- g Department of Oncological Propaedeutics , Medical University of Gdansk, Gdansk, Poland & Gdynia Oncology Center , Gdynia , Poland
| | | | - Agnieszka Szeremet
- i Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation , Wroclaw Medical University , Wroclaw , Poland
| | | | - Paweł Steckiewicz
- k Department of Hematology , Holycross Cancer Center , Kielce , Poland
| | - Wanda Knopińska-Posłuszny
- l Department of Hematology, Independent Public Health Care of the Ministry of the Internal Affairs with the Oncology Centre , Olsztyn , Poland
| | - Marek Osowiecki
- m Department of Lymphoid Malignancies , Maria Sklodowska-Curie Memorial Institute and Oncology Centre , Warsaw , Poland
| | - Joanna Drozd-Sokołowska
- n Department of Hematology, Oncology and Internal Diseases , Medical University of Warsaw , Warsaw , Poland
| | - Beata Kumiega
- o Department of Haematooncology , Oncology Centre of the Podkarpackie Province , Brzozow , Poland
| | - Sławomira Kyrcz-Krzemień
- p Department of Hematology and Bone Marrow Transplantation , Silesian Medical University Hospital SPSKM , Katowice , Poland
| | - Janusz Hałka
- q Department of Hematology , Military Institute of Medicine , Warsaw , Poland
| | - Marek Dudziński
- r Department of Hematology , Specialist District Hospital , Rzeszow , Poland
| | - Paulina Wieszczy
- s Department of Gastroenterology, Hepatology and Clinical Oncology , Medical Center for Postgraduate Education , Warsaw , Poland
| | - Tadeusz Robak
- a Department of Hematology , Medical University of Lodz, Copernicus Memorial Hospital , Lodz , Poland
| | - Krzysztof Warzocha
- d Department of Hematology , Institute of Hematology and Transfusion Medicine , Warsaw , Poland
| | - Krzysztof Jamroziak
- d Department of Hematology , Institute of Hematology and Transfusion Medicine , Warsaw , Poland
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