CLL Coverage from Every Angle

Older Patients With CLL: Long-Term Results With Low-Dose Chemotherapy Plus Rituximab

By: Joseph Fanelli
Posted: Wednesday, June 9, 2021

For elderly and/or comorbid patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL), treatment with low-dose fludarabine and cyclophosphamide combined with rituximab may be a suitable first-line option, according to findings from the Czech CLL Study Group presented in the British Journal of Haematology. The treatment results featured favorable biologic prognostic features such as mutated immunoglobulin heavy-chain variable-region gene (IGHV) and the absence of chromosome 11q and 17p deletion, concluded Tomáš Kozák, PhD, of the University Hospital Královské Vinohrady, Prague, and colleagues.

“This is in agreement with the current therapeutic guidelines that contain chemo-immunotherapy as a valid option for treatment-naive patients with mutated IGHV,” the authors said.

In this trial, the authors enrolled 107 patients with treatment-naive CLL or SLL who could not receive full-dose treatment of fludarabine and cyclophosphamide combined with rituximab because of prognostic factors such as age and serious comorbidities. The doses of chemotherapy were reduced: 12 mg/m2 intravenously or 20 mg/m2 orally of fludarabine and 150 mg/m2 of cyclophosphamide orally. In addition, patients received a standard dose of rituximab (375 mg/m2).

The authors observed grade 3 or 4 neutropenia in more than half of patients (56%), but only 15% experienced serious infections. The median progression-free survival was 29 months, and the median overall survival was 59 months. Progression-free survival was longer for patients with mutated IGHV at 53 months, especially in the absence of deletion 11q or 17p (74 months).

There was an overall response rate of 81% and a complete response rate of 37%. Those figures improved to 85% and 48%, respectively, if patients with deletion 17p were excluded. The authors noted that the overall response and complete response rates were “reasonable” considering the “context of the patient demographic and combination of unfavorable prognostic factors.”

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