title: First-line therapy for chronic lymphocytic leukemia in patients older than 79 years is feasible and achieves good results: A FILO retrospective study.
abstract: The mean age at diagnosis of chronic lymphocytic leukemia (CLL) is 72 years, with 22.8% of patients being older than 80 years. However, the elderly are underrepresented in clinical studies of CLL. We performed a retrospective study of CLL patients aged 80 years or older at the initiation of first-line therapy in hospitals affiliated with the French intergroup on CLL (French Innovative Leukemia Organization) between 2003 and 2013. Here, we describe the clinical and biological characteristics, treatment, and outcomes for 201 patients. The median age of the cohort was 83.2 years (80-92 years). The median Cumulative Index Rating Scale comorbidity score was 5 and the median creatinine clearance was 48 mL/min (Cockcroft-Gault formula). At treatment initiation, Binet stage was A (26.4%), B (27.9%), or C (40.3%). Therapy consisted mainly of chlorambucil (65.7%), bendamustine (10.5%), and rituximab (44.3%) as follows: chlorambucil alone (45.3%) or immunochemotherapy (48.3%) with rituximab + chlorambucil (22.7%), rituximab + bendamustine (10.4%), or rituximab + cyclophosphamide + dexamethasone (5.5%). The overall response rate was 66.2% with 31.8% clinical complete remission. The median overall and progression-free survival from treatment initiation was 53.7 and 18.3 months, respectively. These results suggest that treatment is feasible in this age group, even with immunochemotherapy. Thus, prospective trials should target this population and oncogeriatric evaluation and new targeted therapies should be part of such future trials.
authors.affiliation: Nancy University Hospital, France.
authors.forename: Godelieve
authors.initials: G
authors.lastname: Meunier
authors.affiliation: Toulouse University Cancer Hospital, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Ysebaert
authors.affiliation: Nancy University Hospital, France.
authors.forename: Phi Linh
authors.initials: PL
authors.lastname: Nguyen-Thi
authors.affiliation: Rouen Henri Becquerel Cancer Center, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lepretre
authors.affiliation: Reims University Hospital, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Quinquenel
authors.affiliation: Creteil Henri Mondor University Hospital, France.
authors.forename: Jehan
authors.initials: J
authors.lastname: Dupuis
authors.affiliation: Clermont-Ferrand Estaing University Hospital, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Lemal
authors.affiliation: Marseille Paoli Calmettes Cancer Center, France.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Aurran
authors.affiliation: Poitiers University Hospital, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Tomowiak
authors.affiliation: Bobigny Avicenne University Hospital, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Cymbalista
authors.affiliation: Bordeaux University Hospital, France.
authors.forename: Marie Sarah
authors.initials: MS
authors.lastname: Dilhuydy
authors.affiliation: Besançon Jean-Minjoz University Hospital, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Brion
authors.affiliation: Lens General Hospital, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Morel
authors.affiliation: Lille University Hospital, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cazin
authors.affiliation: Paris la Pitié Salpêtrière University Hospital, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Leblond
authors.affiliation: Montpellier University Hospital, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cartron
authors.affiliation: Antibes General Hospital, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ré
authors.affiliation: Nantes Hôtel-Dieu University Hospital, France.
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Béné
authors.affiliation: Lyon Léon Bérard Cancer Center, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Michallet
authors.affiliation: Nancy University Hospital, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Feugier
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D002869:Chromosome Aberrations; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D009154:Mutation; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: chronic lymphocytic leukemia; elderly; first-line treatment