Fludarabine, cyclophosphamide, and mitoxantrone as initial therapy of chronic lymphocytic leukemia: high response rate and disease eradication.
OBJECTIVE
Fludarabine, cyclophosphamide, and mitoxantrone (FCM) results in a high response rate in previously treated patients with chronic lymphocytic leukemia (CLL). The aim of this study was to investigate FCM as frontline therapy in CLL.


METHODS
Sixty-nine patients under the age of 65 years with active CLL were treated. Patients received six cycles of fludarabine 25 mg/m(2) i.v. x 3 days, cyclophosphamide 200 mg/m(2) i.v. x 3 days, and mitoxantrone 6 mg/m(2) i.v. x 1 day. Treatment outcome was correlated with clinical and biological variables. The clinical significance of eradicating minimal residual disease (MRD) was also analyzed.


RESULTS
The overall response, MRD-negative complete response (CR), MRD-positive CR, nodular partial response (PR), and PR rates were 90%, 26%, 38%, 14%, and 12%, respectively. Severe (grades 3 or 4) neutropenia developed in 10% of the patients. Major and minor infections were reported in 1% and 8% of cases, respectively. Median response duration was 37 months. Patients with del(17p) failed to attain CR. Patients achieving MRD-negative CR had a longer response duration and overall survival than patients with an inferior response. Low serum lactate dehydrogenase levels, low ZAP-70 expression, and mutated IgV(H) genes predicted longer response duration. Finally, both low ZAP-70 and CD38 expression in leukemic cells correlated with MRD-negativity achievement.


CONCLUSIONS
FCM induces a high response rate, including MRD-negative CRs in untreated patients with active CLL. Treatment toxicity is acceptable. Both high ZAP-70 and increased CD38 expression predict failure to obtain MRD-negative response. Patients in whom MRD can be eradicated have longer response duration and overall survival than those with inferior response. These results indicate that FCM can be an ideal companion for chemoimmunotherapy of patients with CLL.
Bosch
Francesc
F
Department of Haematology, Hospital Clínic de Barcelona, Barcelona, Spain. fbosch@clinic.ub.es
Ferrer
Ana
A
Villamor
Neus
N
González
Marcos
M
Briones
Javier
J
González-Barca
Eva
E
Abella
Eugenia
E
Gardella
Santiago
S
Escoda
Lourdes
L
Pérez-Ceballos
Elena
E
Asensi
Antoni
A
Sayas
Ma José
MJ
Font
Llorenç
L
Altés
Albert
A
Muntañola
Ana
A
Bertazzoni
Paola
P
Rozman
María
M
Aymerich
Marta
M
Giné
Eva
E
Montserrat
Emili
E
D051997:ADP-ribosyl Cyclase 1 / Q000096:biosynthesis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007135:Immunoglobulin Variable Region / Q000235:genetics; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D018365:Neoplasm, Residual / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000096:biosynthesis
D007143:Immunoglobulin Heavy Chains; D007135:Immunoglobulin Variable Region; D003520:Cyclophosphamide; D008942:Mitoxantrone; D007770:L-Lactate Dehydrogenase; D051746:ZAP-70 Protein-Tyrosine Kinase; D051997:ADP-ribosyl Cyclase 1; D014740:Vidarabine; C024352:fludarabine