The HOVON68 CLL trial revisited: performance status and comorbidity affect survival in elderly patients with chronic lymphocytic leukemia. Issue 3 (4th March 2017)

• Record Type: Journal Article
• Authors: Vojdeman, Fie Juhl; van't Veer, Mars B.; Tjønnfjord, Geir E.; Itälä-Remes, Maija; Kimby, Eva; Polliack, Aaron; Wu, Ka L.; Doorduijn, Jeanette K.; Alemayehu, Wendimagegn G.; Wittebol, Shulamiet; Kozak, Tomas; Walewski, Jan; Abrahamse-Testroote, Martine C. J.; van Oers, Marinus H. J.; Geisler, Christian Hartmann
• Is Part Of: Leukemia & lymphoma. Volume 58:Issue 3(2017)
• Page Start: 594
• Page End: 600
• Publication Date: 2017-03-04
• Subjects: CLL -- alemtuzumab -- chemo-immunotherapy -- elderly -- comorbidity -- performance status; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2016.1213831
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.