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
Abstract : 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
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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, Taylor & Francis, 2016, 57 (2), pp.328--334. ⟨10.3109/10428194.2015.1063139⟩. ⟨hal-01272930⟩

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