TY - JOUR
T1 - Long-term results of first salvage treatment in CLL patients treated initially with FCR (fludarabine, cyclophosphamide, rituximab)
AU - Tam, Constantine S.
AU - O'Brien, Susan
AU - Plunkett, William
AU - Wierda, William
AU - Ferrajoli, Alessandra
AU - Wang, Xuemei
AU - Do, Kim Anh
AU - Cortes, Jorge
AU - Khouri, Issa
AU - Kantarjian, Hagop
AU - Lerner, Susan
AU - Keating, Michael J.
N1 - Publisher Copyright:
© 2014 by The American Society of Hematology.
PY - 2014/11/13
Y1 - 2014/11/13
N2 - Although fludarabine, cyclophosphamide, and rituximab (FCR) together are established as a standard first-line treatment of younger patients with chronic lymphocytic leukemia (CLL), there is little information to guide the management of patients with CLL refractory to, or who have relapsed after, receiving frontline FCR treatment. To define optimal salvage strategy and identify patients unsuitable for retreatment with FCR, we examined the survival and treatment outcome of 300 patients enrolled in a phase 2 study of FCR. After a median 142 months of follow-up, 156 patients developed progressive CLL, with a median survival of 51 months after disease progression. The durationof first remission (REM1) was a key determinant of survival after disease progression and first salvage. Patients with a short REM1 (<3 years) had a short survival period, irrespective of salvage therapy received; these patients have high unmet medical needs and are good candidates for investigationofnovel therapies. Inpatients withalong REM1 (≥3 years),salvage treatment with either repeat FCR or lenalidomide-based therapy results in subsequent median survival exceeding 5 years; for these patients, FCR rechallenge represents a reasonable standard of care.
AB - Although fludarabine, cyclophosphamide, and rituximab (FCR) together are established as a standard first-line treatment of younger patients with chronic lymphocytic leukemia (CLL), there is little information to guide the management of patients with CLL refractory to, or who have relapsed after, receiving frontline FCR treatment. To define optimal salvage strategy and identify patients unsuitable for retreatment with FCR, we examined the survival and treatment outcome of 300 patients enrolled in a phase 2 study of FCR. After a median 142 months of follow-up, 156 patients developed progressive CLL, with a median survival of 51 months after disease progression. The durationof first remission (REM1) was a key determinant of survival after disease progression and first salvage. Patients with a short REM1 (<3 years) had a short survival period, irrespective of salvage therapy received; these patients have high unmet medical needs and are good candidates for investigationofnovel therapies. Inpatients withalong REM1 (≥3 years),salvage treatment with either repeat FCR or lenalidomide-based therapy results in subsequent median survival exceeding 5 years; for these patients, FCR rechallenge represents a reasonable standard of care.
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U2 - 10.1182/blood-2014-06-583765
DO - 10.1182/blood-2014-06-583765
M3 - Article
C2 - 25281606
AN - SCOPUS:84911933713
SN - 0006-4971
VL - 124
SP - 3059
EP - 3064
JO - Blood
JF - Blood
IS - 20
ER -