title: Fludarabine, cyclophosphamide, and mitoxantrone as initial therapy of chronic lymphocytic leukemia: high response rate and disease eradication.
abstract: 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.
authors.affiliation: Department of Haematology, Hospital Clínic de Barcelona, Barcelona, Spain. fbosch@clinic.ub.es
authors.forename: Francesc
authors.initials: F
authors.lastname: Bosch
authors.forename: Ana
authors.initials: A
authors.lastname: Ferrer
authors.forename: Neus
authors.initials: N
authors.lastname: Villamor
authors.forename: Marcos
authors.initials: M
authors.lastname: González
authors.forename: Javier
authors.initials: J
authors.lastname: Briones
authors.forename: Eva
authors.initials: E
authors.lastname: González-Barca
authors.forename: Eugenia
authors.initials: E
authors.lastname: Abella
authors.forename: Santiago
authors.initials: S
authors.lastname: Gardella
authors.forename: Lourdes
authors.initials: L
authors.lastname: Escoda
authors.forename: Elena
authors.initials: E
authors.lastname: Pérez-Ceballos
authors.forename: Antoni
authors.initials: A
authors.lastname: Asensi
authors.forename: Ma José
authors.initials: MJ
authors.lastname: Sayas
authors.forename: Llorenç
authors.initials: L
authors.lastname: Font
authors.forename: Albert
authors.initials: A
authors.lastname: Altés
authors.forename: Ana
authors.initials: A
authors.lastname: Muntañola
authors.forename: Paola
authors.initials: P
authors.lastname: Bertazzoni
authors.forename: María
authors.initials: M
authors.lastname: Rozman
authors.forename: Marta
authors.initials: M
authors.lastname: Aymerich
authors.forename: Eva
authors.initials: E
authors.lastname: Giné
authors.forename: Emili
authors.initials: E
authors.lastname: Montserrat
mesh_terms: 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
chemical_list: 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