A retrospective comparison of three sequential groups of patients with Recurrent/Refractory chronic lymphocytic leukemia treated with fludarabine-based regimens.

Abstract

BACKGROUND:

Combining therapeutics with single-agent activity has improved treatment for patients with many malignancies. Debate continues about the impact of treatment on survival in patients with chronic lymphocytic leukemia (CLL). Purine analogues are the most active agents for treatment of patients with CLL. Recently, it was shown that a chemoimmunotherapy regimen combining fludarabine (F), cyclophosphamide (C), and rituximab (R) (FCR) was very effective in treating patients with recurrent and/or refractory CLL. The objective of the current analysis was to determine whether improvements in treatment have had an impact on survival for patients with CLL.

METHODS:

Three nonoverlapping, sequential groups of patients enrolled on Phase II studies who received treatment with F (n = 251 patients), FC (n = 111 patients), or FCR (n = 143 patients) were analyzed. Pretreatment characteristics, responses to treatment, and overall survival were compared.

RESULTS:

Patients who were treated with FCR had a higher complete remission rate compared with patients who were treated with combined F and C or with F alone. Statistically significantly longer estimated median survival was noted for patients who received FCR. A Cox proportional hazards, multivariable model for overall survival that included all patients (n = 505) showed that patients who received FCR had longer survival (P < 0.0001) after adjusting for other significant (P < 0.05) pretreatment characteristics, including age, hemoglobin, beta-2 microglobulin, and the number of prior treatments.

CONCLUSIONS:

The results of this retrospective comparison of patients with recurrent and refractory CLL indicated a higher complete remission rate and the longest estimated survival for patients who were treated with FCR, providing the basis for randomized clinical trials of this regimen.

• Authors: William Wierda, Susan O'brien, Stefan Faderl, Alessandra Ferrajoli, Xuemei Wang, Kim-Anh Do, Guillermo Garcia-Manero, Deborah Thomas, Jorge Cortes, Farhad Ravandi-Kashani, Francis Giles, Susan Lerner, Hagop Kantarjian, Michael Keating
• Journal: Cancer (Cancer) Vol. 106 Issue 2 Pg. 337-45 (Jan 15 2006) ISSN: 0008-543X [Print] United States
• PMID: 16353201 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents
• Rituximab
• Cyclophosphamide
• Vidarabine
• fludarabine

Topics

• Adult
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents (adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Clinical Trials, Phase II as Topic
• Cyclophosphamide (therapeutic use)
• Disease-Free Survival
• Female
• Humans
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy, mortality)
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Rituximab
• Treatment Outcome
• Vidarabine (analogs & derivatives, therapeutic use)