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Chronic Lymphocytic Leukemia
High prognostic value of measurable residual disease detection by flow cytometry in chronic lymphocytic leukemia patients treated with front-line fludarabine, cyclophosphamide, and rituximab, followed by three years of rituximab maintenance
Ferrata Storti Foundation
Haematologica 2019 Volume 104(11):2249-2257
José A. García-Marco,1 Javier López Jiménez,2 Valle Recasens,3 Miguel Fernández Zarzoso,4 Eva González-Barca,5 Nieves Somolinos De Marcos,6
M. Jose Ramírez,7 Francisco Javier Peñalver Parraga,8 Lucrecia Yañez,9 Javier De La Serna Torroba,10 Maria Dolores Garcia Malo,11 Guillermo Deben Ariznavarreta,12 Ernesto Perez Persona,13 M. Angeles Ruiz Guinaldo,14 Raquel De Paz Arias,15 Elena Bañas Llanos,16 Isidro Jarque,17 M. del Carmen Fernandez Valle,18 Ana Carral Tatay,19 Jaime Perez De Oteyza,20 Eva Maria Donato Martin,21 Inmaculada Perez Fernández,22 Rafael Martinez Martinez,23 M. Angeles Andreu Costa,24 Diana Champ,25 Julio García Suarez,26 Marcos González Díaz,27 Secundino Ferrer,4 Félix Carbonell28 and José A. García-Vela29 on behalf of the GELLC Study Group
1Hematology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid; 2Hematology, Hospital Ramon y Cajal, Madrid; 3Hematology, Hospital Miguel Servet, Zaragoza; 4Hematology, Hospital Universitario Dr Peset, Valencia; 5Hematology, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona; 6Hematology, Hospital Universitario de Getafe, Madrid; 7Hematology, Hospital de Jerez de la Frontera, Jerez; 8Fundación Hospital de Alcorcón, Madrid; 9Hospital Universitario Marqués de Valdecilla, Servicio de Hematologia, Santander; 10Department of Hematology, Hospital Doce de Octubre, Madrid; 11Hematology, Hospital Morales Meseguer, Murcia; 12Hematology, CHU Juan Canalejo, A Coruña; 13Hematology, Hospital Txagorritxu, Vitoria; 14Hematology, Hospital Francesc Borja, Valencia; 15Hematology, Hospital La Paz, Madrid; 16Hematology, Hospital San Pedro de Alcantara, Caceres; 17Hematology, Hospital Universitario La Fe, Valencia; 18Hematology, Hospital Universitario Puerta del Mar, Cadiz; 19Hematology, Hospital de Sagunto, Valencia; 20Hematology, Hospital Madrid Norte Sanchinarro, Madrid; 21Hematology, Hospital General Castellon, Castellon; 22Hematology, Hospital Regional Universitario de Málaga, Málaga; 23Hematology, Hospital Clínico Universitario San Carlos, Madrid; 24Hematology, Hospital General de Móstoles, Madrid; 25Roche Farma, S.A., Madrid; 26Hematology, Hospital Universitario Príncipe Asturias, Madrid; 27Hematology, University Hospital of Salamanca- IBSAL, CIBERONC, USAL-CSIC, CIC-IBMCC, Salamanca; 28Hematology, Consorcio Hospital General Universitario, Valencia and 29Hematology, Hospital Universitario de Getafe, Madrid, Spain
ABSTRACT
It has been postulated that monitoring measurable residual disease (MRD) could be used as a surrogate marker of progression-free survival (PFS) in chronic lymphocytic leukemia (CLL) patients after treatment with immunochemotherapy regimens. In this study, we analyzed the out- come of 84 patients at 3 years of follow-up after first-line treatment with fludarabine, cyclophosphamide and rituximab (FCR) induction followed by 36 months of rituximab maintenance thearpy. MRD was assessed by a quantitative four-color flow cytometry panel with a sensitivity level of 10-4. Eighty out of 84 evaluable patients (95.2%) achieved at least a partial response or better at the end of induction. After clinical evaluation, 74 patients went into rituximab maintenance and the primary endpoint was assessed in the final analysis at 3 years of follow-up. Bone marrow (BM) MRD analysis was performed after the last planned induction course and every 6 months in cases with detectable residual disease during the 36 months of maintenance therapy. Thirty-seven patients (44%) did not have detectable residual disease in the BM prior to maintenance therapy. Interestingly, 29 patients with detectable residual disease in the BM after
Correspondence:
JOSÉ GARCÍA-MARCO
jagarciam@aehh.org
Received: August 20, 2018. Accepted: March 18, 2019. Pre-published: March 19, 2019.
doi:10.3324/haematol.2018.204891
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/11/2249
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haematologica | 2019; 104(11)
2249
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