The outcome of chronic lymphocytic leukemia patients who relapsed after fludarabine, cyclophosphamide, and rituximab
Abstract
Background There are minimal data about the efficacy of subsequent therapy in patients with relapse after FCR (fludarabine, cyclophosphamide, and rituximab) chemoimmunotherapy. Methods We retrospectively analyzed the outcomes of 119 patients who relapsed after standard-dose FCR.
The patient cohort consisted of patients who relapsed after FCR administered as first-line therapy (Group 1, n=63) and patients relapsing after FCR administered in second/subsequentline; (Group 2, n=56). Results Basic parameters (age, clinical stage, cytogenetics, molecular genetics) did not differ significantly between these subgroups.
Likewise, median progression-free survival (PFS) was not considerably different after FCR (18.6 vs. 14.7months). Subsequent therapy for relapsed disease included FCR retreatment, R-CHOP, alemtuzumab, or rituximab plus high-dose dexamethasone.
Overall response rates for the two groups did not significantly differ (59% vs. 44%). Although PFS after subsequenttherapy was relatively short, longer PFS was observed in Group 1 (13.3 vs. 5.9months; P=0.01), in patients with response duration 24months after previous FCR (13 vs. 6.1months; P<0.01), and in patients who achieved complete remission after FCR (10.8 vs. 7.9months in partial remission; P=0.01).
Newly detected 17p deletions were observed in 5/62 patients, and new p53 mutations in 6/34 FCR-treated patients. Conclusion Our data indicate that the prognosis of patients who relapse after FCR remains poor regardless of the subsequent treatment regimen.