Division of Hematology, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA.
Haematologica. 2012 Mar;97(3):423-7. doi: 10.3324/haematol.2011.047324. Epub 2012 Jan 22.
Older chronic lymphocytic leukemia patients have poor outcomes with standard treatments and are underrepresented in clinical trials. We retrospectively reviewed outcomes of refractory chronic lymphocytic leukemia patients in two age categories (≥70 and <70 years) treated with single-agent flavopiridol, a drug active in genomically high-risk patients, during two trials. No significant difference between older and younger patients was observed in response rates (43 vs. 47%) or progression-free survival (median 8.7 vs. 9.9 months, P>0.80). Although overall survival was worse in older patients (median 2.1 vs. 2.4 years, P=0.02); when adjusted for other factors this difference was no longer significant (P≥0.10). With the exception of infections (older 29% vs. younger 62%) no significant association with toxicity was observed. These data demonstrate that flavopiridol administration to older chronic lymphocytic leukemia patients is feasible, tolerable, and may have similar efficacy to that in younger patients. Development of treatment approaches including flavopiridol should be considered for these older patients.
老年慢性淋巴细胞白血病患者对标准治疗的反应较差,且在临床试验中的代表性不足。我们回顾性分析了两项试验中,接受单药 flavopiridol 治疗的难治性慢性淋巴细胞白血病患者(年龄≥70 岁和<70 岁)的结局。在缓解率(43% vs. 47%)或无进展生存期(中位数 8.7 个月 vs. 9.9 个月,P>0.80)方面,老年患者与年轻患者之间无显著差异。尽管老年患者的总生存期较差(中位数 2.1 年 vs. 2.4 年,P=0.02);但在调整其他因素后,这种差异不再显著(P≥0.10)。除感染(老年患者为 29%,年轻患者为 62%)外,与毒性无显著相关性。这些数据表明,flavopiridol 对老年慢性淋巴细胞白血病患者的治疗是可行的、耐受的,且疗效可能与年轻患者相似。应考虑为这些老年患者开发包括 flavopiridol 在内的治疗方法。