The frequency, manifestations, and duration of prolonged cytopenias after first-line fludarabine combination chemotherapy.
BACKGROUND
Fludarabine-based chemoimmunotherapy has well-recognised efficacy and short-term toxicity in the treatment of lymphoid malignancies. However, the presence and significance of prolonged cytopenias after completion of treatment have not been thoroughly quantified.


METHODS
Sixty-one patients receiving initial therapy with fludarabine-based regimens were categorised according to the presence of post-treatment cytopenias (haemoglobin <110-130 g/l depending on sex and age, neutrophils <2.0 x 10(9)/l, or platelets <140 x 10(9)/l) lasting >3 months.


RESULTS
Persistent cytopenias unrelated to persistent disease were found in 43% of patients. Cytopenias were associated with clinically important rates of infection and transfusion requirement (P = 0.03) and predicted for worse overall survival (61% versus 96% at 60 months, P = 0.05). Increasing age predicted for persistent cytopenias (P = 0.02), but the presence of pretreatment cytopenias and delivered dose intensity were not predictive. The median times to resolution of anaemia, neutropenia, and thrombocytopenia were 7, 9, and 10 months, respectively.


CONCLUSIONS
Cytopenias often persist >3 months after first-line fludarabine combination therapy and can lead to important clinical sequelae. Although cytopenias generally resolve over time, treating physicians should be aware of these factors when considering fludarabine combination chemotherapy and when documenting treatment response status in chronic lymphocytic leukaemia.
Gill
S
S
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre.
Carney
D
D
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre.
Ritchie
D
D
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Wolf
M
M
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre.
Westerman
D
D
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre.
Prince
H M
HM
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Januszewicz
H
H
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre.
Seymour
J F
JF
Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: john.seymour@petermac.org.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007945:Leukemia, Lymphoid / Q000188:drug therapy* / Q000453:epidemiology; D007970:Leukopenia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009503:Neutropenia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D010198:Pancytopenia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
D014740:Vidarabine; C024352:fludarabine