title: Evaluating abbreviated induction with fludarabine, cyclophosphamide, and dose-dense rituximab in elderly patients with chronic lymphocytic leukemia.
abstract: Elderly patients with chronic lymphocytic leukemia (CLL) are underrepresented in trials evaluating fludarabine, cyclophosphamide, and rituximab (FCR). We assessed four cycles of FCR with two additional rituximab doses on day 14 of cycles 1 and 2 in 194 untreated CLL patients > 65 years (median age 71.2) without del17p. Four FCR cycles were administered to 90.7% (176/194), with (n = 74) or without (n = 102) dose-delay and/or dose-reduction. A total of 50% grade 3/4 neutropenia occurred after each cycle. Only 6.2% cycles were associated with severe infection. Complete remission (CR) was achieved in 19.7%, and partial remission (PR) in 73.9% of patients. Minimal residual disease (MRD) was negative in 36.7%. Overall survival at 36 months was estimated at 87.4%. Oral FC and dose-dense rituximab is feasible and active in fit elderly CLL patients. However, myelosuppression is significant and frequent dose adaptations are required implying that these results cannot be generalized to unfit or frail elderly CLL.
authors.affiliation: a Service d'Hématologie, CHU Bretonneau , Tours , France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Dartigeas
authors.affiliation: b Service d'Hématologie, Cliniques universitaires UCL Saint-Luc , Bruxelles , Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Den Neste
authors.affiliation: c Service d'hématologie, Hôpital Augustin Morvan , Brest , France.
authors.forename: Christian
authors.initials: C
authors.lastname: Berthou
authors.affiliation: d Service de médecine interne et d'hématologie, Centre Hospitalier Départemental , La Roche Sur Yon , France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Maisonneuve
authors.affiliation: e Service d'Hématologie, Centre Henri Becquerel , Rouen , France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leprêtre
authors.affiliation: f Service d'Hématologie, Hôpital Haut-Lévêque , Pessac , France.
authors.forename: Marie-Sarah
authors.initials: MS
authors.lastname: Dilhuydy
authors.affiliation: g Laboratoire d'Hématologie, CHU Nantes , Nantes , France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Béné
authors.affiliation: h Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière , Paris , France.
authors.forename: Florence
authors.initials: F
authors.lastname: Nguyen-Khac
authors.affiliation: i Laboratoire d'Hématologie, CHU INSERM U978 , Avicenne , France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Letestu
authors.affiliation: i Laboratoire d'Hématologie, CHU INSERM U978 , Avicenne , France.
authors.forename: Florence
authors.initials: F
authors.lastname: Cymbalista
authors.affiliation: j Service d'Hématologie, Hôpital Pontchaillou , Rennes , France.
authors.forename: Sophie
authors.initials: S
authors.lastname: De Guibert
authors.affiliation: k Service d'Hématologie, Institut Paoli Calmette , Marseille , France.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Aurran
authors.affiliation: l Service de Médecine Interne Onco-Hématologie, Centre Hospitalier du Mans , Le Mans , France.
authors.forename: Kamel
authors.initials: K
authors.lastname: Laribi
authors.affiliation: m Service d'Hématologie, Centre François Baclesse , Caen , France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vilque
authors.affiliation: n Service d'Hématologie, CHU Estaing , Clermont Ferrand , France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tournilhac
authors.affiliation: o Service d'Hématologie, Hôpital Robert Debré , Reims , France.
authors.forename: Alain
authors.initials: A
authors.lastname: Delmer
authors.affiliation: p Pôle Hématologie, CHU et EA4369, Nancy-Université , Vandoeuvre-lès-Nancy , France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Feugier
authors.affiliation: q Service d'Hématologie, CHRU Hurriez , Lille , France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cazin
authors.affiliation: r Service d'Hématologie, CHU Lyon Sud-Pierre Bénite , Lyon , France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Michallet
authors.affiliation: s Pôle Hématologie-Oncologie Hôpital Avicenne , Bobigny , France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lévy
authors.affiliation: t Laboratoire d'Hématologie, CHU Côte de Nacre , Caen , France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Troussard
authors.affiliation: a Service d'Hématologie, CHU Bretonneau , Tours , France.
authors.forename: Roselyne
authors.initials: R
authors.lastname: Delepine
authors.affiliation: u Centre d'investigation clinique, CHU de Tours , Tours , France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Tavernier
authors.affiliation: a Service d'Hématologie, CHU Bretonneau , Tours , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Colombat
authors.affiliation: v Service d'Hématologie, Hôpital de la Pitié-Salpétrière , France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Leblond
keywords: Chemotherapeutic approaches; chronic lymphocytic leukemia; immunotherapeutic approaches; lymphoid leukemias; purine analogues