Sustained remissions in CLL after frontline FCR treatment with very-long-term follow-up
- Author(s)
- Thompson, PA; Bazinet, A; Wierda, WG; Tam, CS; O'Brien, SM; Saha, S; Peterson, CB; Plunkett, W; Keating, MJ;
- Details
- Publication Year 2023-11-23,Volume 142,Issue #21,Page 1784-1788
- Journal Title
- Blood
- Publication Type
- Research article
- Abstract
- Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) achieves durable remissions, with flattening of the progression-free survival (PFS) curve in patients with mutated immunoglobulin heavy chain variable gene (IGHV-M). We updated long-term follow-up results from the original 300-patient FCR study initiated at MD Anderson in 1999. The current median follow-up is 19.0 years. With this extended follow-up, the median PFS for patients with IGHV-M was 14.6 years vs 4.2 years for patients with unmutated IGHV (IGHV-UM). Disease progression beyond 10 years was uncommon. In total, 16 of 94 (17%) patients in remission at 10 years subsequently progressed with the additional follow-up compared with the patients in our prior report in 2015. Only 4 of 45 patients (9%) with IGHV-M progressed beyond 10 years. Excluding Richter transformation, 96 of 300 patients (32%) developed 106 other malignancies, with 19 of 300 (6.3%) developing therapy-related myeloid neoplasms (tMNs), which were fatal in 16 of 19 (84%). No pretreatment patient characteristics predicted the risk of tMNs. In summary, FCR remains an option for patients with IGHV-M chronic lymphocytic leukemia (CLL), with a significant fraction achieving functional cure of CLL. A risk-benefit assessment is warranted when counseling patients, balancing potential functional cure with the risk of late relapses and serious secondary malignancies.
- Publisher
- American Society of Hematology
- Keywords
- Humans; *Leukemia, Lymphocytic, Chronic, B-Cell/genetics; Rituximab; Follow-Up Studies; Treatment Outcome; Antineoplastic Combined Chemotherapy Protocols/adverse effects; Cyclophosphamide; Vidarabine
- Department(s)
- Clinical Haematology
- Publisher's Version
- https://doi.org/10.1182/blood.2023020158
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-01-04 02:56:44
Last Modified: 2024-01-04 02:57:34