Does the Mode of Disease Progression Affect Outcomes in CLL?
Posted: Tuesday, October 29, 2019
According to research published in the American Journal of Hematology, patients with chronic lymphocytic leukemia (CLL) who had progressive lymphadenopathy experienced inferior survival outcomes compared with those who had an increasing absolute lymphocyte count (ALC), particularly in patients categorized as unfit. These findings are based on data from three phase III trials of the German CLL Study Group: CLL8, CLL10, and CLL11.
“This analysis demonstrates that the mode of progression after first-line therapy with chemotherapy and chemoimmunotherapy correlates with different clinical outcomes,” noted Othman Al-Sawaf, MD, of the University of Cologne, Germany, and colleagues. “Our findings might help physicians to better estimate the clinical course of a progressing CLL patient.”
The study included 2,159 patients from CLL8, CLL10, and CLL11 who were undergoing first-line treatment. The regimens included fludarabine and cyclophosphamide (FC); FC plus rituximab; and chlorambucil plus bendamustine, bendamustine/rituximab, or bendamustine/obinutuzumab.
Participants were evaluated for disease progression. A total of 241 patients experienced progressive disease by an increasing ALC, whereas 727 had disease progression due to lymphadenopathy, including 329 who experienced disease progression due to both ALC and lymphadenopathy. Patients were categorized as either fit or unfit.
Unfit patients with lymphadenopathy experienced significantly reduced survival benefits compared with unfit patients with an increasing ALC. After disease progression, unfit patients with lymphadenopathy experienced a median time to next treatment of 11.7 months versus 21.4 months in patients with an increasing ALC; the median overall survival was 42.8 months in patients with lymphadenopathy versus not reached in those with an increasing ALC. In the fit group, patients with lymphadenopathy also saw worse comparative outcomes, with a median time to next treatment of 12.3 months versus 17.0 in those with an increasing ALC. The median overall survival was similar for fit patients with lymphadenopathy (45.1 months) and those with an increasing ALC (42.4 months). Overall, patients with lymphadenopathy experienced some impairment in quality of life more often than did those with an increasing ALC.
Disclosure: For full disclosures of study authors, visit onlinelibrary.wiley.com.