Cytogenetic prioritization with inclusion of molecular markers predicts outcome in previously untreated patients with chronic lymphocytic leukemia treated with fludarabine or fludarabine plus cyclophosphamide: a long-term follow-up study of the US intergroup phase III trial E2997
David M Lucas, Amy S Ruppert, Gerard Lozanski, Gordon W Dewald, Arletta Lozanski, Rainer Claus, Christoph Plass, Ian W Flinn, Donna S Neuberg, Elisabeth M Paietta, John M Bennett, Diane F Jelinek, John G Gribben, Mohamad A Hussein, Frederick R Appelbaum, Richard A Larson, Dennis F Moore Jr, Martin S Tallman, John C Byrd, Michael R Grever, David M Lucas, Amy S Ruppert, Gerard Lozanski, Gordon W Dewald, Arletta Lozanski, Rainer Claus, Christoph Plass, Ian W Flinn, Donna S Neuberg, Elisabeth M Paietta, John M Bennett, Diane F Jelinek, John G Gribben, Mohamad A Hussein, Frederick R Appelbaum, Richard A Larson, Dennis F Moore Jr, Martin S Tallman, John C Byrd, Michael R Grever
Abstract
Fludarabine (F) and cyclophosphamide (C) remain backbones of up-front chemotherapy regimens for chronic lymphocytic leukemia (CLL). We report long-term follow-up of a randomized F vs. FC trial in untreated CLL (#) . With median follow-up of 88 months, estimated median progression-free survival (PFS) was 19.3 vs. 48.1 months for F (n = 109) and FC (n = 118), respectively (p < 0.0001), and median overall survival (OS) was 88.0 vs. 79.1 months (p = 0.96). In multivariable analyses, variables associated with inferior PFS and OS respectively were age (p = 0.002, p < 0.001), Rai stage (p = 0.006, p = 0.02) and sex (p = 0.03, PFS only). Del(17)(p13.1) predicted shorter PFS and OS (p < 0.0001 for each), as did del(11q)(22.3) (p < 0.0001, p = 0.005, respectively), trisomy 12 with mutated Notch1 (p = 0.003, p = 0.03, respectively) and unmutated IGHV (p = 0.009, p = 0.002, respectively), all relative to patients without these features. These data confirm results from shorter follow-up and further justify targeted therapies for CLL.
Trial registration: ClinicalTrials.gov NCT00003764.
Keywords: Fludarabine; chemotherapy; chronic lymphocytic leukemia; cyclophosphamide.
Conflict of interest statement
CONFLICT OF INTEREST STATEMENT: No authors have conflicts of interest with this work.
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Source: PubMed