氟达拉滨、环磷酰胺和利妥昔单抗治疗后复发的慢性淋巴细胞白血病患者的结局。

The outcome of chronic lymphocytic leukemia patients who relapsed after fludarabine, cyclophosphamide, and rituximab.

机构信息

Department of Internal Medicine - Hematology and Oncology, University Hospital, Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.

出版信息

Eur J Haematol. 2013 Jun;90(6):479-85. doi: 10.1111/ejh.12106. Epub 2013 Apr 27.

DOI:10.1111/ejh.12106

PMID:23506191

Abstract

BACKGROUND

There are minimal data about the efficacy of subsequent therapy in patients with relapse after FCR (fludarabine, cyclophosphamide, and rituximab) chemoimmunotherapy.

METHODS

We retrospectively analyzed the outcomes of 119 patients who relapsed after standard-dose FCR. The patient cohort consisted of patients who relapsed after FCR administered as first-line therapy (Group 1, n = 63) and patients relapsing after FCR administered in second/subsequent line; (Group 2, n = 56).

RESULTS

Basic parameters (age, clinical stage, cytogenetics, molecular genetics) did not differ significantly between these subgroups. Likewise, median progression-free survival (PFS) was not considerably different after FCR (18.6 vs. 14.7 months). Subsequent therapy for relapsed disease included FCR retreatment, R-CHOP, alemtuzumab, or rituximab plus high-dose dexamethasone. Overall response rates for the two groups did not significantly differ (59% vs. 44%). Although PFS after subsequent therapy was relatively short, longer PFS was observed in Group 1 (13.3 vs. 5.9 months; P = 0.01), in patients with response duration ≥ 24 months after previous FCR (13 vs. 6.1 months; P < 0.01), and in patients who achieved complete remission after FCR (10.8 vs. 7.9 months in partial remission; P = 0.01). Newly detected 17p deletions were observed in 5/62 patients, and new p53 mutations in 6/34 FCR-treated patients.

CONCLUSION

Our data indicate that the prognosis of patients who relapse after FCR remains poor regardless of the subsequent treatment regimen.

摘要

背景

关于 FCR（氟达拉滨、环磷酰胺和利妥昔单抗）化疗免疫治疗后复发患者后续治疗疗效的数据很少。

方法

我们回顾性分析了 119 例标准剂量 FCR 治疗后复发患者的结果。患者队列包括 FCR 一线治疗后复发的患者（组 1，n = 63）和 FCR 二线/后续线治疗后复发的患者（组 2，n = 56）。

结果

这些亚组之间的基本参数（年龄、临床分期、细胞遗传学、分子遗传学）无显著差异。同样，FCR 后无进展生存期（PFS）也无显著差异（18.6 与 14.7 个月）。复发后疾病的后续治疗包括 FCR 再治疗、R-CHOP、阿仑单抗或利妥昔单抗联合高剂量地塞米松。两组的总缓解率无显著差异（59%与 44%）。尽管后续治疗后的 PFS 相对较短，但组 1 的 PFS 较长（13.3 与 5.9 个月；P = 0.01），在 FCR 后反应持续时间≥24 个月的患者中（13 与 6.1 个月；P < 0.01），以及在 FCR 后达到完全缓解的患者中（完全缓解与部分缓解的 10.8 与 7.9 个月；P = 0.01）。在 62 例患者中有 5 例新检出 17p 缺失，在 34 例接受 FCR 治疗的患者中有 6 例新检出 p53 突变。