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First line therapy in chronic lymphocytic leukemia : a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013

Eketorp Sylvan, Sandra ; Asklid, Anna ; Johansson, Hemming ; Klintman, Jenny LU ; Bjellvi, Jenny ; Tolvgård, Staffan ; Kimby, Eva ; Norin, Stefan ; Andersson, Per-Ola and Karlsson, Claes , et al. (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.

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publishing date
type
Contribution to journal
publication status
published
subject
in
Haematologica
volume
104
issue
4
pages
797 - 804
publisher
Ferrata Storti Foundation
external identifiers
  • scopus:85064000594
  • pmid:30467205
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
2020-10-27 03:57:44
@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},
}