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Cyclophosphamide, fludarabine, alemtuzumab, and rituximab as salvage therapy for heavily pretreated patients with chronic lymphocytic leukemia.
- Source :
-
Blood [Blood] 2011 Aug 25; Vol. 118 (8), pp. 2085-93. Date of Electronic Publication: 2011 Jun 13. - Publication Year :
- 2011
-
Abstract
- Patients with relapsed chronic lymphocytic leukemia (CLL) and high-risk features, such as fludarabine refractoriness, complex karyotype, or abnormalities of chromosome 17p, experience poor outcomes after standard fludaradine-based regimens. Alemtuzumab is a chimeric CD52 monoclonal antibody with activity in CLL patients with fludarabine-refractory disease and 17p deletion. We report the outcome for 80 relapsed or refractory patients with CLL enrolled in a phase 2 study of cyclophosphamide, fludarabine, alemtuzumab, and rituximab (CFAR). All patients were assessed for response and progression according to the 1996 CLL-working group criteria. For the intention-to-treat analysis, the overall response rate was 65%, including 29% complete response. The estimated progression-free survival was 10.6 months and median overall survival was 16.7 months. Although we noted higher complete response in high-risk patients after CFAR compared with a similar population who had received fludarabine, cyclophosphamide, and rituximab as salvage therapy, there was no significant improvement in progression-free survival and overall survival appeared worse. CFAR was associated with a high rate of infectious complications with 37 patients (46%) experiencing a serious infection during therapy and 28% of evaluable patients experiencing late serious infections. Although CFAR produced good response rates in this highly pretreated high-risk group of patients, there was no benefit in survival outcomes.
- Subjects :
- Adult
Aged
Alemtuzumab
Antibodies, Monoclonal adverse effects
Antibodies, Monoclonal, Humanized
Antibodies, Monoclonal, Murine-Derived administration & dosage
Antibodies, Monoclonal, Murine-Derived adverse effects
Antibodies, Neoplasm administration & dosage
Antibodies, Neoplasm adverse effects
Chromosome Deletion
Chromosomes, Human, Pair 17
Combined Modality Therapy
Cyclophosphamide administration & dosage
Cyclophosphamide adverse effects
Disease-Free Survival
Humans
Infections etiology
Leukemia, Lymphocytic, Chronic, B-Cell genetics
Middle Aged
Rituximab
Salvage Therapy
Smith-Magenis Syndrome
Stem Cell Transplantation
Transplantation, Homologous
Vidarabine administration & dosage
Vidarabine adverse effects
Vidarabine analogs & derivatives
Antibodies, Monoclonal administration & dosage
Antineoplastic Combined Chemotherapy Protocols adverse effects
Leukemia, Lymphocytic, Chronic, B-Cell drug therapy
Leukemia, Lymphocytic, Chronic, B-Cell therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 118
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 21670470
- Full Text :
- https://doi.org/10.1182/blood-2011-03-341032