1. Prognostic role of CD4 T-cell depletion after frontline fludarabine, cyclophosphamide and rituximab in chronic lymphocytic leukaemia.
- Author
-
Gauthier M, Durrieu F, Martin E, Peres M, Vergez F, Filleron T, Obéric L, Bijou F, Quillet Mary A, and Ysebaert L
- Subjects
- Antineoplastic Combined Chemotherapy Protocols adverse effects, CD4-Positive T-Lymphocytes drug effects, Cyclophosphamide adverse effects, Cyclophosphamide therapeutic use, Female, Follow-Up Studies, Humans, Immunoglobulin Variable Region genetics, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Leukemia, Lymphocytic, Chronic, B-Cell diagnosis, Leukemia, Lymphocytic, Chronic, B-Cell immunology, Leukemia, Lymphocytic, Chronic, B-Cell pathology, Lymphocyte Count, Male, Middle Aged, Mutation, Neoplasm, Residual, Prognosis, Rituximab adverse effects, Rituximab therapeutic use, Survival Analysis, Treatment Outcome, Vidarabine adverse effects, Vidarabine analogs & derivatives, Vidarabine therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, CD4-Positive T-Lymphocytes pathology, Leukemia, Lymphocytic, Chronic, B-Cell drug therapy
- Abstract
Background: Eradication of minimal residual disease (MRD), at the end of Fludarabine-Cyclophosphamide-Rituximab (FCR) treatment, is a validated surrogate marker for progression-free and overall survival in chronic lymphocytic leukaemia. But such deep responses are also associated with severe immuno-depletion, leading to infections and the development of secondary cancers., Methods: We assessed, blood MRD and normal immune cell levels at the end of treatment, in 162 first-line FCR patients, and analysed survival and adverse event., Results: Multivariate Landmark analysis 3 months after FCR completion identified unmutated IGHV status (HR, 2.03, p = 0.043), the level of MRD reached (intermediate versus low, HR, 2.43, p = 0.002; high versus low, HR, 4.56, p = 0.002) and CD4 > 200/mm
3 (HR, 3.30, p < 0.001) as factors independently associated with progression-free survival (PFS); neither CD8 nor NK counts were associated with PFS. The CD4 count was associated with PFS irrespective of IGHV mutational status, but only in patients with detectable MRD (HR, 3.51, p = 0.0004, whereas it had no prognostic impact in MRD < 10- 4 patients: p = 0.6998). We next used a competitive risk model to investigate whether immune cell subsets could be associated with the risk of infection and found no association between CD4, CD8 and NK cells and infection., Conclusions: Consolidation/maintenance trials based on detectable MRD after FCR should investigate CD4 T-cell numbers both as a selection and a response criterion, and consolidation treatments should target B-cell/T-cell interactions.- Published
- 2019
- Full Text
- View/download PDF