Impact of Age on Outcomes After Initial Therapy With Chemotherapy and Different Chemoimmunotherapy Regimens in Patients With Chronic Lymphocytic Leukemia: Results of Sequential Cancer and Leukemia Group B Studies
| Autor: | John C. Byrd, Jennifer A. Woyach, Jonathan E. Kolitz, Kanti R. Rai, Vicki A. Morrison, Martin S. Tallman, Amy S. Ruppert, Thomas S. Lin, Richard A. Larson, Susan Geyer, Andrew Belch, Frederick R. Appelbaum |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Oncology Aging Cancer Research medicine.medical_specialty Chronic lymphocytic leukemia medicine.medical_treatment Kaplan-Meier Estimate Antibodies Monoclonal Humanized Disease-Free Survival Antibodies Monoclonal Murine-Derived Chemoimmunotherapy Internal medicine Antineoplastic Combined Chemotherapy Protocols Original Reports medicine Humans Multicenter Studies as Topic Alemtuzumab Aged Randomized Controlled Trials as Topic Retrospective Studies Aged 80 and over Clinical Trials as Topic Chemotherapy Chlorambucil business.industry Age Factors Middle Aged medicine.disease Leukemia Lymphocytic Chronic B-Cell Surgery Fludarabine Leukemia Treatment Outcome Multivariate Analysis Female Rituximab Immunotherapy business Vidarabine medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 31:440-447 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | Purpose Chronic lymphocytic leukemia (CLL) is a disease of the elderly, yet few clinical trials include a significant number of older patients, and outcomes after specific therapies can be different depending on age. Patients and Methods We examined patients enrolled onto successive first-line CALGB CLL trials to determine whether efficacy of regimens varied by age, focusing on ideal chemotherapy choice and benefit of immunotherapy addition to chemotherapy in older patients. Regimens included chlorambucil, fludarabine, fludarabine plus rituximab (FR), fludarabine with consolidation alemtuzumab, and FR with consolidation alemtuzumab. Results A total of 663 patients were evaluated for response, progression-free survival (PFS), and overall survival (OS) by age group. Interaction effects of fludarabine versus chlorambucil by age group (PFS, P = .046; OS, P = .006) showed that among patients younger than 70 years, PFS and OS was improved with fludarabine over chlorambucil (PFS: hazard ratio [HR] = 0.6, 95% CI, 0.5 to 0.8; OS: HR = 0.7, 95% CI, 0.5 to 0.9), but not in older adults (PFS, HR = 1.0, 95% CI, 0.6 to 1.7; OS: HR = 1.5, 95% CI, 0.9 to 2.3). In contrast, FR improved outcomes relative to fludarabine, irrespective of age (PFS: HR = 0.6, 95% CI, 0.4 to 0.7; OS: HR = 0.7, 95% CI, 0.5 to 0.9). Alemtuzumab consolidation did not provide benefit over similar regimens without alemtuzumab (P > .20), irrespective of age. Conclusion These data support the use of chlorambucil as an acceptable treatment for many older patients with CLL and suggest rituximab is beneficial regardless of age. These findings bear relevance to both routine care of CLL patients 70 years and older and also future clinical trials in this population. |
| Databáze: | OpenAIRE |
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