Outcomes of second‐line treatment after fludarabine cyclophosphamide and rituximab in patients with chronic lymphocytic leukemia outside clinical trials. (3rd August 2018)

• Record Type: Journal Article
• Authors: Joffe, Erel; Goldschmidt, Neta; Bairey, Osnat; Fineman, Riva; Ruchlemer, Rosa; Rahimi‐Levene, Naomi; Shvidel, Lev; Greenbaum, Uri; Aviv, Ariel; Tadmor, Tamar; Braester, Andrea; Arad, Ariela; Polliack, Aaron; Herishanu, Yair
• Is Part Of: European journal of haematology. Volume 101:Number 3(2018)
• Page Start: 399
• Page End: 406
• Publication Date: 2018-08-03
• Subjects: CLL -- FCR -- relapse -- salvage -- therapy -- toxicity; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; Blood -- Periodicals; 616.15005
• DOI: 10.1111/ejh.13129
• Languages: English
• ISSNs: 0902-4441

Abstract

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.