IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment: a Danish nationwide population-based study
| Autor: | Caspar da Cunha-Bang, Klaus Rostgaard, Carsten Utoft Niemann, Gudrun Jakubsdottir Egholm, Emelie Curovic Rotbain, Christian Bjørn Poulsen, Banafsheh Zahedi, Lisbeth Enggard, Henrik Hjalgrim, Henrik Frederiksen |
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| Rok vydání: | 2019 |
| Předmět: |
Bendamustine
Oncology medicine.medical_specialty Chronic lymphocytic leukemia Denmark Population 03 medical and health sciences 0302 clinical medicine Chemoimmunotherapy Internal medicine hemic and lymphatic diseases Antineoplastic Combined Chemotherapy Protocols Medicine Bendamustine Hydrochloride Humans Chronic Lymphocytic Leukemia education education.field_of_study Chlorambucil business.industry Hematology Articles medicine.disease Leukemia Lymphocytic Chronic B-Cell Fludarabine Treatment Outcome Rituximab business IGHV@ 030215 immunology medicine.drug |
| Zdroj: | Haematologica Rotbain, E C, Frederiksen, H, Hjalgrim, H, Rostgaard, K, Egholm, G J, Zahedi, B, Poulsen, C B, Enggard, L, Da Cunha-Bang, C & Niemann, C U 2020, ' IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment : A danish nationwide population-based study ', Haematologica, vol. 105, no. 6, pp. 1621-1629 . https://doi.org/10.3324/haematol.2019.220194 Rotbain, E C, Frederiksen, H, Hjalgrim, H, Rostgaard, K, Egholm, G J, Zahedi, B, Poulsen, C B, Enggard, L, da Cunha-Bang, C & Niemann, C U 2020, ' IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment : a Danish nationwide population-based study ', Haematologica, vol. 105, no. 6, pp. 1621-1629 . https://doi.org/10.3324/haematol.2019.220194 |
| ISSN: | 1592-8721 |
| Popis: | Patients with chronic lymphocytic leukemia and unmutated immunoglobulin heavy-chain variable region gene (IGHV) have inferior survival from time of treatment in clinical studies. We assessed real-world outcomes based on mutational status and treatment regimen in a nationwide population-based cohort, comprising all 4,135 patients from the Danish chronic lymphocytic leukemia registry diagnosed between 2008 and 2017. In total, 850 patients with known mutational status received treatment: 42% of patients received intensive chemoimmunotherapy consisting of fludarabine, cyclophosphamide plus rituximab, or bendamustine plus rituximab; 27% received chlorambucil in combination with anti-CD20 antibodies or as monotherapy, and 31% received other, less common treatments. No difference in overall survival from time of first treatment according to mutational status was observed, while treatment-free survival from start of first treatment was inferior for patients with unmutated IGHV. The median treatment-free survival was 2.5 years for patients treated with chlorambucil plus anti-CD20, and 1 year for those who received chlorambucil monotherapy. The 3-year treatment-free survival rates for patients treated with fludarabine, cyclophosphamide plus rituximab, and bendamustine plus rituximab were 90% and 91% for those with mutated IGHV, and 76% and 53% for those with unmutated IGHV, respectively, and the 3-year overall survival rates were similar for the two regimens (86-88%). Thus, it appears that, in the real-world setting, patients progressing after intensive chemoimmunotherapy as first-line therapy can be rescued by subsequent treatment, without jeopardizing their long overall survival. Intensive chemoimmunotherapy remains a legitimate option alongside targeted agents, and part of a personalized treatment landscape in chronic lymphocytic leukemia, while improved supportive care and treatment options are warranted for unfit patients. |
| Databáze: | OpenAIRE |
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