Huang, Steven J., Lee, Lauren J., Gerrie, Alina S., Gillan, Tanya L., Bruyere, Helene, Hrynchak, Monica, Smith, Adam C., Karsan, Aly, Ramadan, Khaled M., Jayasundara, Kavisha S., and Toze, Cynthia L.
This study evaluates outcomes in chronic lymphocytic leukemia (CLL) based on first-line therapy in a large consecutive population-based cohort of 669 patients with fluorescence in-situ hybridization (FISH) data in British Columbia, Canada during the period when chemoimmunotherapy was standard first-line treatment. When analyzed as a time-dependent variable, patients who required treatment (n = 336) had a 4.7 times higher hazard of death than patients who did not (95% confidence interval 2.8–7.9, P < 0.001). The majority of patients received fludarabine-rituximab (FR) in front-line. On multivariate Cox regression analysis, fludarabine-based first-line therapy predicted longer time-to-next-treatment (TTNT) (HR 0.53, 95% confidence interval 0.33–0.87, P = 0.012) but no difference in overall survival (OS) compared to alkylator-based therapy. Deletion 17p was an independent predictor of worse TTNT and OS. The most common second-line treatments were cyclophosphamide-vincristine-prednisone-rituximab and FR. There was no difference in OS between patients retreated in second-line with the same first-line regimen (n = 33) versus different regimen (n = 113). In conclusion, front-line treatment with fludarabine leads to a longer time until need for next treatment than alkylator-based therapy; however, fludarabine or alkylator therapy produces no difference in OS. This study provides a historical baseline for the comparison of novel agents with standard treatments in CLL on a population-level. [ABSTRACT FROM AUTHOR]