title: Poor efficacy and tolerability of R-CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation.
abstract: This phase II trial evaluated efficacy and tolerability of R-CHOP for up to 8 courses in Richter transformation (RT) and up to 6 courses in CLL plus autoimmune cytopenia (AIC) or high-risk (HR) features. HR was defined as fludarabine-refractoriness or early relapse (<36 months) after fludarabine-based treatment; 26 patients were included as HR, 19 patients had AIC, and 15 patients had RT. In the HR cohort, overall response rate was 54%, progression-free and overall survival were 9 and 21 months. In AIC patients overall response rate was 74%, progression-free and overall-survival were 10 and 41 months, respectively, and median increase in hemoglobin was 3.4 g/L. RT patients responded in 67%, progression-free was 10 and overall survival 21 months. The most common adverse events were hematologic toxicities in 92%. Severe infections occurred in 28%. Treatment was discontinued early in 45% of all patients mainly as a result of toxicity. This trial shows that R-CHOP has no role in treating complicated CLL. R-CHOP is associated with significant toxicities and fairly low efficacy compared with almost every other CLL-regimen. In RT, it might still be used as an induction therapy before allogeneic stem cell transplantation.
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology (CIO), and CECAD-Cluster of Excellence "Cellular Stress Responses in Aging-Associated Diseases," University of Cologne, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Langerbeins
authors.forename: Raymonde
authors.initials: R
authors.lastname: Busch
authors.forename: Nadine
authors.initials: N
authors.lastname: Anheier
authors.forename: Jan
authors.initials: J
authors.lastname: Dürig
authors.forename: Manuela
authors.initials: M
authors.lastname: Bergmann
authors.forename: Maria-Elisabeth
authors.initials: ME
authors.lastname: Goebeler
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Hurtz
authors.forename: Martina B
authors.initials: MB
authors.lastname: Stauch
authors.forename: Stephan
authors.initials: S
authors.lastname: Stilgenbauer
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Fink
authors.forename: Paula
authors.initials: P
authors.lastname: Cramer
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fischer
authors.forename: Clemens-Martin
authors.initials: CM
authors.lastname: Wendtner
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.forename: Barbara
authors.initials: B
authors.lastname: Eichhorst
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012008:Recurrence; D000069283:Rituximab; D016019:Survival Analysis; D017211:Treatment Failure; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006454:Hemoglobins; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone