First line therapy in chronic lymphocytic leukemia : a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013
(2019) In Haematologica 104(4). p.797-804- Abstract
The aim of this study was to investigate long-term outcome following first line therapy in consecutive chronic lymphocytic leukemia patients in a well defined geographic area (Sweden). All patients diagnosed with chronic lymphocytic leukemia (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) first line treated (n=1053) and for those, depth analysis was performed. Endpoints were overall response rate, progression-free survival, overall survival and safety. Median age was 71 years, 53% had Rai stage III-IV and 97% had performance status grade 0-2. FISH was performed in 57% of patients: 15% had del(17p). Chlorambucil +/- prednisone was used in 39% (5% also received rituximab).... (More)
The aim of this study was to investigate long-term outcome following first line therapy in consecutive chronic lymphocytic leukemia patients in a well defined geographic area (Sweden). All patients diagnosed with chronic lymphocytic leukemia (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) first line treated (n=1053) and for those, depth analysis was performed. Endpoints were overall response rate, progression-free survival, overall survival and safety. Median age was 71 years, 53% had Rai stage III-IV and 97% had performance status grade 0-2. FISH was performed in 57% of patients: 15% had del(17p). Chlorambucil +/- prednisone was used in 39% (5% also received rituximab). Fludarabine+cyclophosphamide+rituximab or fludarabine+cyclophosphamide was used in 43% and bendamustine +/- rituximab in 6%. Overall response rate was 64%; chlorambucil 43%, fludarabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophosphamide 75% and bendamustine +/- rituximab 75%. Median progression free survival and overall survival was 24 and 58 months, respectively; both significantly associated (multivariate analysis) with type of treatment, del(17p), performance status, sex, age and geographical region (overall survival only). Chlorambucil-treated patients had a median progression free survival and overall survival of only 9 and 33 months, respectively. Chlorambucil usage declined gradually throughout the study period, but one-third of patients still received chlorambucil +/- rituximab in 2013. Infections ≥grade III were significantly associated with treatment; chlorambucil 19% vs fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distributed across therapies. This is the largest retrospective, real-world cohort of consecutive first line treated chronic lymphocytic leukemia patients with a complete follow-up. In elderly patients, an unmet need for more effective, well-tolerated therapies was identified.
(Less)
- author
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Haematologica
- volume
- 104
- issue
- 4
- pages
- 797 - 804
- publisher
- Ferrata Storti Foundation
- external identifiers
-
- pmid:30467205
- scopus:85064000594
- ISSN
- 1592-8721
- DOI
- 10.3324/haematol.2018.200204
- language
- English
- LU publication?
- no
- id
- f376b231-67ad-4ef0-b367-7a0d602262d8
- date added to LUP
- 2018-12-13 12:54:36
- date last changed
- 2024-02-14 13:02:07
@article{f376b231-67ad-4ef0-b367-7a0d602262d8,
abstract = {{<p>The aim of this study was to investigate long-term outcome following first line therapy in consecutive chronic lymphocytic leukemia patients in a well defined geographic area (Sweden). All patients diagnosed with chronic lymphocytic leukemia (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) first line treated (n=1053) and for those, depth analysis was performed. Endpoints were overall response rate, progression-free survival, overall survival and safety. Median age was 71 years, 53% had Rai stage III-IV and 97% had performance status grade 0-2. FISH was performed in 57% of patients: 15% had del(17p). Chlorambucil +/- prednisone was used in 39% (5% also received rituximab). Fludarabine+cyclophosphamide+rituximab or fludarabine+cyclophosphamide was used in 43% and bendamustine +/- rituximab in 6%. Overall response rate was 64%; chlorambucil 43%, fludarabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophosphamide 75% and bendamustine +/- rituximab 75%. Median progression free survival and overall survival was 24 and 58 months, respectively; both significantly associated (multivariate analysis) with type of treatment, del(17p), performance status, sex, age and geographical region (overall survival only). Chlorambucil-treated patients had a median progression free survival and overall survival of only 9 and 33 months, respectively. Chlorambucil usage declined gradually throughout the study period, but one-third of patients still received chlorambucil +/- rituximab in 2013. Infections ≥grade III were significantly associated with treatment; chlorambucil 19% vs fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distributed across therapies. This is the largest retrospective, real-world cohort of consecutive first line treated chronic lymphocytic leukemia patients with a complete follow-up. In elderly patients, an unmet need for more effective, well-tolerated therapies was identified.</p>}},
author = {{Eketorp Sylvan, Sandra and Asklid, Anna and Johansson, Hemming and Klintman, Jenny and Bjellvi, Jenny and Tolvgård, Staffan and Kimby, Eva and Norin, Stefan and Andersson, Per-Ola and Karlsson, Claes and Karlsson, Karin and Lauri, Birgitta and Mattsson, Mattias and Bergendahl Sandstedt, Anna and Strandberg, Maria and Österborg, Anders and Hansson, Lotta}},
issn = {{1592-8721}},
language = {{eng}},
number = {{4}},
pages = {{797--804}},
publisher = {{Ferrata Storti Foundation}},
series = {{Haematologica}},
title = {{First line therapy in chronic lymphocytic leukemia : a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013}},
url = {{http://dx.doi.org/10.3324/haematol.2018.200204}},
doi = {{10.3324/haematol.2018.200204}},
volume = {{104}},
year = {{2019}},
}