Salvage outcomes in patients with first relapse after fludarabine, cyclophosphamide, and rituximab for chronic lymphocytic leukemia: the French intergroup experience.
The optimal management of patients with relapsed chronic lymphocytic leukemia (CLL) is dictated by the type of prior therapy, duration of prior response, presence of genomic aberrations, age, and comorbidities. The patterns of relapses and the clinical outcomes of second-line options after fludarabine-cyclophosphamide-rituximab (FCR) is given as a frontline treatment are currently unknown. In this retrospective and non-randomized study, we report the outcomes of 132 patients from databases of 14 French CLL study group centers who needed a second-line treatment after FCR frontline. Bendamustine + rituximab (BR) was the most frequently used second-line regimen, followed by alemtuzumab-based regimens, R-CHOP, and FCR. Median progression-free survival (PFS) was 18 months after BR with a median overall survival (OS) not reached. We also found that response durations of < 36 months and the presence of del(17p) are critical factors that contribute to poor overall survival. BR appears to be an effective salvage regimen in our series, both in terms of progression-free and overall survival. Patients who relapsed less than 36 months after FCR have a poor outcome, not significantly different in this study from patients with early relapses less than 12 or 24 months.
Department of Hematology, Hôpitaux Universitaires De Strasbourg, Strasbourg, France.
Luc-Matthieu
LM
Fornecker
Department of Hematology, Institut Paoli-Calmettes, Marseille, France.
Thérèse
T
Aurran-Schleinitz
Department of Hematology, Centre Hospitalier Lyon Sud, Hospices Civils De Lyon, Lyon, France.
Anne-Sophie
AS
Michallet
Department of Hematology, CHU, Lille, France.
Bruno
B
Cazin
Department of Hematology, CHU De Clermont-Ferrand, Hôpital Estaing, Université Clermont 1, EA7283, CREaT, Clermont-Ferrand, France.
Romain
R
Guieze
Department of Hematology, CHU, Bordeaux, France.
Marie-Sarah
MS
Dilhuydy
Department of Hematology, Hôpital Saint-Louis, AP-HP, Paris, France.
Jean-Marc
JM
Zini
Department of Hematology, CHU, Poitiers, France.
Cécile
C
Tomowiak
Department of Hematology, Centre Henri Becquerel, Rouen, France.
Stéphane
S
Lepretre
Department of Hematology, Hôpital Avicenne, AP-HP, Bobigny, France.
Florence
F
Cymbalista
Department of Hematology, CHU Jean Minjoz, Besançon, France.
Annie
A
Brion
Department of Hematology, CHU, Nancy, France.
Pierre
P
Feugier
Department of Hematology, CHU, Reims, France.
Alain
A
Delmer
Department of Hematology, Hôpital De La Pitié-Salpétrière, AP-HP, Paris, France.
Véronique
V
Leblond
Department of Hematology, IUCT-Oncopole, Toulouse, France.
Loïc
L
Ysebaert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002872:Chromosome Deletion; D002886:Chromosomes, Human, Pair 17 / Q000235:genetics; D003520:Cyclophosphamide / Q000008:administration & dosage; D016208:Databases, Factual; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage
D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone