First immunochemotherapy outcomes in elderly patients with CLL: a retrospective analysis.
BACKGROUND
To date, the majority of trials on chronic lymphocytic leukemia (CLL) focused on patients considerably younger than the median age of onset for CLL. As a result, no definitive treatment exists for elderly patients, especially less medically fit patients.


OBJECTIVE
The objectives of this study are to examine the impact of comorbidities on outcome as well as to compare three different therapeutic regimens in outcome efficacy.


METHODS
We retrospectively identified 143 patients aged >65 years, who received fludarabine, cyclophosphamide, and rituximab (FCR) (n=49), fludarabine and rituximab (FR) (n=74), or rituximab with chlorambucil (R-CLB) (n=20) as first initial immunochemotherapy.


RESULTS
At current follow-up (median: 24 months), the proportion of patients with a clinical response was higher with FCR (75%) than FR (57%) and R-CLB (28%). For FCR, FR, and R-CLB patients, 2-year overall survival (OS) was 94%, 76%, and 73%, respectively, (p=0.14), while 2-year progression-free survival (PFS) was 90%, 58%, and 30% (p<0.001). In the fludarabine based regimen (FR and FCR) population, higher rituximab doses (500mg/m(2) vs. 375mg/m(2)) correlated with prolonged PFS.


CONCLUSIONS
Despite the retrospective nature of this study, we demonstrate that elderly patients with CLL benefit from frontline immunochemotherapy, and emphasize the importance of maintaining rituximab dose intensity.
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Department of Hematology, 165 chemin du grand revoyet, 69495 Pierre Bénite, France. Electronic address: anne-sophie.michallet@chu-lyon.fr.
Anne-Sophie
AS
Michallet
Bruno
B
Cazin
Emmanuel
E
Bouvet
Lucie
L
Oberic
Daniel
D
Schlaifer
Laurent
L
Mosser
Gilles
G
Salles
Bertrand
B
Coiffier
Guy
G
Laurent
Loïc
L
Ysebaert
D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002699:Chlorambucil / Q000008:administration & dosage / Q000009:adverse effects; D002872:Chromosome Deletion; D002880:Chromosomes, Human, Pair 11; D015897:Comorbidity; D003404:Creatinine / Q000032:analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality*; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000139:chemically induced; D009503:Neutropenia / Q000139:chemically induced; D012189:Retrospective Studies; D000069283:Rituximab; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
D058846:Antibodies, Monoclonal, Murine-Derived; D002699:Chlorambucil; D000069283:Rituximab; D003520:Cyclophosphamide; D003404:Creatinine; D014740:Vidarabine; C024352:fludarabine