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在未曾治疗的慢性淋巴细胞白血病患者中,采用减低剂量氟达拉滨、环磷酰胺和利妥昔单抗(FCR-Lite)联合来那度胺、随后行来那度胺巩固/维持治疗。

Reduced-dose fludarabine, cyclophosphamide, and rituximab (FCR-Lite) plus lenalidomide, followed by lenalidomide consolidation/maintenance, in previously untreated chronic lymphocytic leukemia.

机构信息

Center for Chronic Lymphocytic Leukemia and Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Department of Medical Affairs, Celgene Corporation, Summit, New Jersey.

出版信息

Am J Hematol. 2015 Jun;90(6):487-92. doi: 10.1002/ajh.23983. Epub 2015 Mar 30.

Abstract

Fludarabine, cyclophosphamide, and rituximab (FCR) remains the standard of care for fit chronic lymphocytic leukemia (CLL) patients requiring first therapy. However, side effects can be significant, and patients with poor risk features have inferior outcomes. The purpose of this study was to evaluate reduced-dose FCR (FCR-Lite) plus lenalidomide (FCR(2) ) followed by lenalidomide maintenance as a strategy to shorten immunochemotherapy in untreated CLL. Patients received four to six cycles of FCR(2) . Patients who were minimal residual disease (MRD) negative in peripheral blood (PB) and bone marrow (BM) initiated 12 months of lenalidomide maintenance after either four or six cycles (based on MRD status). The primary study endpoint was the complete response (CR) rate after four cycles of FCR(2) . Twenty patients were evaluable. After four cycles of FCR(2) , response rates were: CR, 45.0%; CR with incomplete blood count recovery (CRi), 5.0%; partial response (PR), 45.0%; and stable disease (SD), 5.0%. BM and PB samples from 27.8% and 52.9% of patients, respectively, were MRD negative. After six cycles, response rates were: CR, 58.3%; CRi, 16.7%; and PR, 25.0%. BM and PB samples from 50.0% and 72.7% of patients, respectively, were MRD negative. Overall, 75% of evaluable patients achieved a CR or CRi following FCR(2) . After 17.4 months of median follow-up, one progression and one death occurred. Our findings suggest that FCR(2) combines encouraging clinical activity with acceptable toxicity in previously untreated CLL. Lenalidomide can be safely added to FCR and may reduce chemotherapy exposure without compromising outcomes.

摘要

氟达拉滨、环磷酰胺和利妥昔单抗(FCR)仍然是适合接受首次治疗的慢性淋巴细胞白血病(CLL)患者的标准治疗方法。然而,其副作用可能很明显,且具有不良风险特征的患者预后较差。本研究旨在评估减少剂量的 FCR(FCR-Lite)联合来那度胺(FCR(2))作为一种策略,在未经治疗的 CLL 中缩短免疫化疗的疗程。患者接受四到六个周期的 FCR(2)治疗。在四个或六个周期后(根据 MRD 状态),外周血(PB)和骨髓(BM)中最小残留疾病(MRD)阴性的患者开始接受 12 个月的来那度胺维持治疗。主要研究终点是 FCR(2)四个周期后的完全缓解(CR)率。20 例患者可评估。在接受四个周期的 FCR(2)后,反应率为:CR,45.0%;不完全血细胞计数恢复的 CR(CRi),5.0%;部分缓解(PR),45.0%;稳定疾病(SD),5.0%。分别有 27.8%和 52.9%的患者的 BM 和 PB 样本 MRD 阴性。在接受六个周期后,反应率为:CR,58.3%;CRi,16.7%;PR,25.0%。分别有 50.0%和 72.7%的患者的 BM 和 PB 样本 MRD 阴性。总体而言,在接受 FCR(2)治疗后,75%的可评估患者达到 CR 或 CRi。在中位随访 17.4 个月时,发生 1 例进展和 1 例死亡。我们的研究结果表明,FCR(2)在未经治疗的 CLL 中具有令人鼓舞的临床活性和可接受的毒性。来那度胺可以安全地添加到 FCR 中,并且可以减少化疗暴露而不影响结果。

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