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Chronic Lymphocytic Leukemia
First-line therapy in chronic lymphocytic leukemia: a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013
Sandra Eketorp Sylvan,1 Anna Asklid,1,2 Hemming Johansson,1
Jenny Klintman,3,4 Jenny Bjellvi,5 Staffan Tolvgård,6 Eva Kimby,7 Stefan Norin,7 Per-Ola Andersson,8 Claes Karlsson,1,9 Karin Karlsson,3 Birgitta Lauri,10 Mattias Mattsson,11 Anna Bergendahl Sandstedt,12 Maria Strandberg,13 Anders Österborg,1,9* and Lotta Hansson1,9*
*AO and LH are co-senior authors.
ABSTRACT
The aim of this study was to investigate long-term outcome follow- ing first-line therapy in consecutive chronic lymphocytic leukemia (CLL) patients in a well-defined geographic area: Sweden. All patients diagnosed with CLL (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) treated first line (n=1053) and for those, an in-depth analysis was performed. End points were overall response rate, progression-free survival (PFS), overall survival (OS), and safety. Median age was 71 years; 53% had Rai stage III-IV and 97% had performance status grade 0-2. Fluorescence in situ hybridization (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 flu- darabine+cyclophosphamide was used in 43% and bendamustine + rit- uximab in 6%. Overall response rate was 64%; chlorambucil 43%, flu- darabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophos- phamide 75% and bendamustine + rituximab 75%. Median PFS and OS was 24 and 58 months, respectively, both were significantly associated (multivariate analysis) with type of treatment, del(17p), performance sta- tus, gender, age and geographical region (OS only). Chlorambucil-treated patients had a median PFS and OS 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; chlo- rambucil 19% versus fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distrib- uted across therapies. This is the largest retrospective, real-world cohort of consecutive first-line treated CLL patients with a complete follow up. In elderly patients, an unmet need for more effective, well-tolerated ther- apies was identified.
Ferrata Storti Foundation
Haematologica 2019 Volume 104(4):797-804
1Department of Oncology-Pathology, Karolinska Institutet, Stockholm; 2Department of Oncology, Karolinska University Hospital, Stockholm; 3Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund; 4Department of Translational Medicine, Lund University; 5Department of Hematology, Sahlgrenska University Hospital, Gothenburg; 6Department of Internal Medicine, Östersunds Hospital; 7Department of Internal Medicine Huddinge, Karolinska Institutet, Stockholm; 8Department of Hematology, South Älvsborg Hospital, Borås; 9Department of Hematology, Karolinska University Hospital, Stockholm; 10Department of Hematology, Sunderby Hospital, Sunderbyn-Luleå; 11Department of Hematology, Uppsala University Hospital; 12Department of Hematology, Linköping University Hospital and 13Department of Medicine, Sundsvall Hospital, Sweden
Correspondence:
LOTTA HANSSON
lotta.hansson@sll.se
Received: June 21, 2018. Accepted: November 19, 2018. Pre-published: November 22, 2018.
doi:10.3324/haematol.2018.200204
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/4/797
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