TY - JOUR
T1 - The natural history of fludarabine-refractory chronic lymphocytic leukemia patients who fail alemtuzumab or have bulky lymphadenopathy
AU - Tam, Constantine S.
AU - O'Brien, Susan
AU - Lerner, Susan
AU - Khouri, I.
AU - Ferrajoli, A.
AU - Faderl, S.
AU - Browning, M.
AU - Tsimberidou, Apostolia M.
AU - Kantarjian, Hagop
AU - Wierda, William G.
PY - 2007/10
Y1 - 2007/10
N2 - The natural history and outcome of salvage treatment for patients with fludarabine-refractory chronic lymphocytic leukemia who are either refractory to alemtuzumab ("double-refractory") or ineligible for alemtuzumab due to bulky lymphadenopathy ("bulky fludarabine-refractory") have not been described. We present the outcomes of 99 such patients (double-refractory n = 58, bulky fludarabine-refractory n = 41) undergoing their first salvage treatment at our center. Patients received a variety of salvage regimens including monoclonal antibodies (n = 15), single-agent cytotoxic drugs (n = 14), purine analogue combination regimens (n = 21), intensive combination chemotherapy (n = 36), allogeneic stem cell transplantation (SCT; n = 4), or other therapies (n = 9). Overall response to first salvage therapy other than SCT was 23%, with no complete responses. All four patients who underwent SCT as first salvage achieved complete remission. Early death (within 8 weeks of commencing first salvage) occurred in 13% of patients, and 54% of patients experienced a major infection during therapy. Overall survival was 9 months, with hemoglobin <11 g/dL (hazard ratio 2.3), hepatomegaly (hazard ratio 2.4), and performance status ≥ 2 (hazard ratio 1.9) being significant independent predictors of inferior survival.
AB - The natural history and outcome of salvage treatment for patients with fludarabine-refractory chronic lymphocytic leukemia who are either refractory to alemtuzumab ("double-refractory") or ineligible for alemtuzumab due to bulky lymphadenopathy ("bulky fludarabine-refractory") have not been described. We present the outcomes of 99 such patients (double-refractory n = 58, bulky fludarabine-refractory n = 41) undergoing their first salvage treatment at our center. Patients received a variety of salvage regimens including monoclonal antibodies (n = 15), single-agent cytotoxic drugs (n = 14), purine analogue combination regimens (n = 21), intensive combination chemotherapy (n = 36), allogeneic stem cell transplantation (SCT; n = 4), or other therapies (n = 9). Overall response to first salvage therapy other than SCT was 23%, with no complete responses. All four patients who underwent SCT as first salvage achieved complete remission. Early death (within 8 weeks of commencing first salvage) occurred in 13% of patients, and 54% of patients experienced a major infection during therapy. Overall survival was 9 months, with hemoglobin <11 g/dL (hazard ratio 2.3), hepatomegaly (hazard ratio 2.4), and performance status ≥ 2 (hazard ratio 1.9) being significant independent predictors of inferior survival.
KW - Infection
KW - Monoclonal antibody
KW - Purine analogue
KW - Rituximab
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U2 - 10.1080/10428190701573257
DO - 10.1080/10428190701573257
M3 - Article
C2 - 17917961
AN - SCOPUS:35148849255
SN - 1042-8194
VL - 48
SP - 1931
EP - 1939
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 10
ER -