Long-term results of first salvage treatment in CLL patients treated initially with FCR (fludarabine, cyclophosphamide, rituximab)

Constantine S. Tam, Susan O'Brien, William Plunkett, William Wierda, Alessandra Ferrajoli, Xuemei Wang, Kim Anh Do, Jorge Cortes, Issa Khouri, Hagop Kantarjian, Susan Lerner, Michael J. Keating

Research output: Contribution to journalArticle

62 Scopus citations

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 durationof 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 investigationofnovel therapies. Inpatients withalong 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.

Original languageEnglish (US)
Pages (from-to)3059-3064
Number of pages6
JournalBlood
Volume124
Issue number20
DOIs
StatePublished - Nov 13 2014

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Tam, C. S., O'Brien, S., Plunkett, W., Wierda, W., Ferrajoli, A., Wang, X., Do, K. A., Cortes, J., Khouri, I., Kantarjian, H., Lerner, S., & Keating, M. J. (2014). Long-term results of first salvage treatment in CLL patients treated initially with FCR (fludarabine, cyclophosphamide, rituximab). Blood, 124(20), 3059-3064. https://doi.org/10.1182/blood-2014-06-583765