CLL: mode of progression after first-line therapy linked to outcomes

  • Al-Sawaf O & al.
  • Am J Hematol
  • 20 Jun 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • Among patients with chronic lymphocytic leukemia (CLL) with progressive disease (PD) after initial remission with first-line therapy, those with PD because of lymphadenopathy (Ly group) experienced inferior outcomes vs with PD because of increasing absolute lymphocyte count (ALC group).

Why this matters

  • Phenotype of PD after initial therapy can be highly heterogeneous.

Study design

  • Analysis of 3 phase 3 trials in patients with CLL to investigate associations between mode of PD after first-line (immuno)-chemotherapy and outcomes.
  • Funding: None disclosed.

Key results

  • In fit patients treated with FC/FCR (fludarabine+cyclophosphamide with/without rituximab) or BR (bendamustine+R; n=1378):
    • Median time to next treatment (TTNT): 12.3 months in the Ly group vs 17.0 months in the ALC group (HR, 1.299; 95% CI, 1.036-1.628; P=.024).
    • Median OS: 45.1 months in the Ly group vs 42.4 months in the ALC group (HR, 1.023; 95% CI, 0.753-1.389; P=.885).
  • In unfit patients treated with CLB (chlorambucil), CLB-R (CLCB+rituximab), or CLB-Ob (CLB+obinutuzumab; n=781):
    • Median TTNT: 11.7 months in the Ly group vs 21.4 months in the ALC group (HR, 1.357; 95% CI, 1.051-1.753; P=.019).
    • Median OS: 42.8 months in the Ly group vs not reached in the ALC group (HR, 1.851; 95% CI, 1.280-2.677; P=.001).

Limitations

  • Retrospective data.