title: Long-term results of first salvage treatment in CLL patients treated initially with FCR (fludarabine, cyclophosphamide, rituximab).
abstract: Although fludarabine, cyclophosphamide, and rituximab (FCR) together are established as a standard first-line treatment of younger patients with chronic lymphocytic leukemia (CLL), there is little information to guide the management of patients with CLL refractory to, or who have relapsed after, receiving frontline FCR treatment. To define optimal salvage strategy and identify patients unsuitable for retreatment with FCR, we examined the survival and treatment outcome of 300 patients enrolled in a phase 2 study of FCR. After a median 142 months of follow-up, 156 patients developed progressive CLL, with a median survival of 51 months after disease progression. The duration of first remission (REM1) was a key determinant of survival after disease progression and first salvage. Patients with a short REM1 (<3 years) had a short survival period, irrespective of salvage therapy received; these patients have high unmet medical needs and are good candidates for investigation of novel therapies. In patients with a long REM1 (≥3 years), salvage treatment with either repeat FCR or lenalidomide-based therapy results in subsequent median survival exceeding 5 years; for these patients, FCR rechallenge represents a reasonable standard of care.
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX; Hematology Department, Peter MacCallum Cancer Center, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; and.
authors.forename: Constantine S
authors.initials: CS
authors.lastname: Tam
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: William
authors.initials: W
authors.lastname: Plunkett
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: William
authors.initials: W
authors.lastname: Wierda
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
authors.affiliation: Biostatistics Department and.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Biostatistics Department and.
authors.forename: Kim-Anh
authors.initials: KA
authors.lastname: Do
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.affiliation: Stem Cell Transplantation and Cellular Therapies, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Issa
authors.initials: I
authors.lastname: Khouri
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Susan
authors.initials: S
authors.lastname: Lerner
authors.affiliation: Leukemia Department, University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine