Evaluating abbreviated induction with fludarabine, cyclophosphamide, and dose-dense rituximab in elderly patients with chronic lymphocytic leukemia

Caroline Dartigeas (1) , Eric van den Neste , Christian Berthou (2, 3) , Hervé Maisonneuve (4) , Stéphane Leprêtre (5) , Marie-Sarah Dilhuydy (6) , Marie-Christine Béné (7) , Florence Nguyen-Khac (8, 9) , Rémi Letestu (10) , Florence Cymbalista (10) , Sophie de Guibert (11, 12) , Thérèse Aurran , Kamel Laribi , Jean-Pierre Vilque (13) , Olivier Tournilhac (14, 15) , Alain Delmer (16) , Pierre Feugier (17, 18) , Bruno Cazin (19) , Anne-Sophie Michallet (20) , Vincent Levy (21) , Xavier Troussard (22, 23) , Roselyne Delépine (24) , Elsa Tavernier , Philippe Colombat (25) , Véronique Leblond (9)

1 N2C - Nutrition, croissance et cancer (U 1069)
2 CHU-Brest-Hemato - CHRU Brest - Service d'Hématologie
3 EA2216 - Immunologie et Pathologie
4 Service d'hématologie
5 GPL - Groupe d'étude des proliférations lymphoïdes
6 Service des maladies du sang
7 CHU Nantes - Centre hospitalier universitaire de Nantes
8 CRC - Centre de Recherche des Cordeliers
9 Service d'hématologie biologique [CHU Pitié-Salpêtrière]
10 ASIH - Adaptateurs de signalisation en hématologie
11 CHU Pontchaillou [Rennes]
12 CIC - Centre d'Investigation Clinique [Rennes]
13 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
14 Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire
15 EA7283, CIC501
16 Service d'hématologie et immunologie pédiatrique
17 Service d'Hématologie [CHRU Nancy]
18 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
19 Service des maladies du sang
20 Service d'Hematologie
21 AP HP, Clin Res Unit
22 Registre général des cancers du Tarn
23 Registre des hémopathies malignes de Basse-Normandie [CHU Caen]
24 Service d'hématologie [Tours]
25 Service d'Hématologie

Elderly patients with chronic lymphocytic leukemia (CLL) are underrepresented in trials evaluating fludarabine, cyclophosphamide, and rituximab (FCR). We assessed four cycles of FCR with two additional rituximab doses on day 14 of cycles 1 and 2 in 194 untreated CLL patients \textgreater 65 years (median age 71.2) without del17p. Four FCR cycles were administered to 90.7% (176/194), with (n = 74) or without (n = 102) dose-delay and/or dose-reduction. A total of 50% grade 3/4 neutropenia occurred after each cycle. Only 6.2% cycles were associated with severe infection. Complete remission (CR) was achieved in 19.7%, and partial remission (PR) in 73.9% of patients. Minimal residual disease (MRD) was negative in 36.7%. Overall survival at 36 months was estimated at 87.4%. Oral FC and dose-dense rituximab is feasible and active in fit elderly CLL patients. However, myelosuppression is significant and frequent dose adaptations are required implying that these results cannot be generalized to unfit or frail elderly CLL

Keywords: immunotherapeutic approaches; chronic lymphocytic leukemia; Chemotherapeutic approaches; lymphoid leukemias; purine analogues

Domains: Life Sciences [q-bio]

Caroline Dartigeas, Eric van den Neste, Christian Berthou, Hervé Maisonneuve, Stéphane Leprêtre, et al.. Evaluating abbreviated induction with fludarabine, cyclophosphamide, and dose-dense rituximab in elderly patients with chronic lymphocytic leukemia. Leukemia & lymphoma, 2016, 57 (2), pp.328--334. ⟨10.3109/10428194.2015.1063139⟩. ⟨hal-01272930⟩