title: The HOVON68 CLL trial revisited: performance status and comorbidity affect survival in elderly patients with chronic lymphocytic leukemia.
abstract: In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.
authors.affiliation: a Department of Hematology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Fie Juhl
authors.initials: FJ
authors.lastname: Vojdeman
authors.affiliation: b Department of Hematology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: Mars B
authors.initials: MB
authors.lastname: Van't Veer
authors.affiliation: c Department of Hematology , Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
authors.forename: Geir E
authors.initials: GE
authors.lastname: Tjønnfjord
authors.affiliation: d Turku Central University Hospital , Turku , Finland.
authors.forename: Maija
authors.initials: M
authors.lastname: Itälä-Remes
authors.affiliation: e Division of Hematology, Department of Medicine at Huddinge , Karolinska Institute , Stockholm , Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Kimby
authors.affiliation: f Department of Hematology , Hadassah University Hospital, Hebrew University Medical School , Jerusalem , Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
authors.affiliation: g Department of Hematology , Stuivenberg Hospital , Antwerpen , Belgium.
authors.forename: Ka L
authors.initials: KL
authors.lastname: Wu
authors.affiliation: h Department of Hematology , Erasmus MC Cancer Center , Rotterdam , The Netherlands.
authors.forename: Jeanette K
authors.initials: JK
authors.lastname: Doorduijn
authors.affiliation: i HOVON Data Centre, Erasmus MC , Rotterdam , The Netherlands.
authors.forename: Wendimagegn G
authors.initials: WG
authors.lastname: Alemayehu
authors.affiliation: j Department of Internal Medicine , Gelderse Vallei, Amersfoot , The Netherlands.
authors.forename: Shulamiet
authors.initials: S
authors.lastname: Wittebol
authors.affiliation: k Department of Clinical Hematology, Third Faculty of Medicine , Charles University Hospital Kralovske Vinohrady , Prague , Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kozak
authors.affiliation: l Lymphoid Malignancies , Maria Sklodowska-Curie Memorial Institute and Oncology Centre , Warszawa , Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Walewski
authors.affiliation: i HOVON Data Centre, Erasmus MC , Rotterdam , The Netherlands.
authors.forename: Martine C J
authors.initials: MC
authors.lastname: Abrahamse-Testroote
authors.affiliation: m Department of Hematology , Academisch Medisch Centrum , Amsterdam , The Netherlands.
authors.forename: Marinus H J
authors.initials: MH
authors.lastname: van Oers
authors.affiliation: a Department of Hematology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Christian Hartmann
authors.initials: CH
authors.lastname: Geisler
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D009026:Mortality; D014184:Transplantation, Homologous
keywords: CLL; alemtuzumab; chemo-immunotherapy; comorbidity; elderly; performance status