title: The outcome of chronic lymphocytic leukemia patients who relapsed after fludarabine, cyclophosphamide, and rituximab.
abstract: BACKGROUND
  There are minimal data about the efficacy of subsequent therapy in patients with relapse after FCR (fludarabine, cyclophosphamide, and rituximab) chemoimmunotherapy.
  
  
  METHODS
  We retrospectively analyzed the outcomes of 119 patients who relapsed after standard-dose FCR. The patient cohort consisted of patients who relapsed after FCR administered as first-line therapy (Group 1, n = 63) and patients relapsing after FCR administered in second/subsequent line; (Group 2, n = 56).
  
  
  RESULTS
  Basic parameters (age, clinical stage, cytogenetics, molecular genetics) did not differ significantly between these subgroups. Likewise, median progression-free survival (PFS) was not considerably different after FCR (18.6 vs. 14.7 months). Subsequent therapy for relapsed disease included FCR retreatment, R-CHOP, alemtuzumab, or rituximab plus high-dose dexamethasone. Overall response rates for the two groups did not significantly differ (59% vs. 44%). Although PFS after subsequent therapy was relatively short, longer PFS was observed in Group 1 (13.3 vs. 5.9 months; P = 0.01), in patients with response duration ≥ 24 months after previous FCR (13 vs. 6.1 months; P < 0.01), and in patients who achieved complete remission after FCR (10.8 vs. 7.9 months in partial remission; P = 0.01). Newly detected 17p deletions were observed in 5/62 patients, and new p53 mutations in 6/34 FCR-treated patients.
  
  
  CONCLUSIONS
  Our data indicate that the prognosis of patients who relapse after FCR remains poor regardless of the subsequent treatment regimen.
authors.affiliation: Department of Internal Medicine - Hematology and Oncology, University Hospital, Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: Anna
authors.initials: A
authors.lastname: Panovská
authors.forename: Lukáš
authors.initials: L
authors.lastname: Smolej
authors.forename: Daniel
authors.initials: D
authors.lastname: Lysák
authors.forename: Yvona
authors.initials: Y
authors.lastname: Brychtová
authors.forename: Martin
authors.initials: M
authors.lastname: Šimkovič
authors.forename: Monika
authors.initials: M
authors.lastname: Motyčková
authors.forename: Pavel
authors.initials: P
authors.lastname: Vodárek
authors.forename: Michaela
authors.initials: M
authors.lastname: Lindtnerová
authors.forename: Martin
authors.initials: M
authors.lastname: Trbušek
authors.forename: Jitka
authors.initials: J
authors.lastname: Malčíková
authors.forename: Šárka
authors.initials: Š
authors.lastname: Pospíšilová
authors.forename: Jiří
authors.initials: J
authors.lastname: Mayer
authors.forename: Michael
authors.initials: M
authors.lastname: Doubek
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D013997:Time Factors; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine