Long-term results of the fludarabine, cyclophosphamide, and rituximab regimen as initial therapy of chronic lymphocytic leukemia
Long-term results of the fludarabine, cyclophosphamide, and rituximab regimen as initial therapy of chronic lymphocytic leukemia
复制标题
DOI：
10.1182/blood-2008-02-140582
复制
发表时间：
2008-08-15
期刊：
影响因子：
20.3
通讯作者：
Keating, Michael J.
中科院分区：
文献类型：
--
作者：
Tam, Constantine S.;O'Brien, Susan;Keating, Michael J.
氟达拉滨、环磷酰胺和利妥昔单抗(FCR)方案在224例患者中的早期结果表明，作为慢性淋巴细胞白血病的初始治疗，它是非常有效的。在这份报告中，我们展示了所有300名研究患者的最终结果，平均随访时间为6年。总有效率为95%，其中完全缓解72%，结节部分缓解10%，细胞减少部分缓解7%，残留病变部分缓解6%。2名患者(1%)在开始治疗后3个月内死亡。六年总存活率和无失败存活率分别为77%和51%。中位进展时间为80个月。与不良反应独立相关的治疗特征有：年龄70岁或以上，β2-微球蛋白是正常上限(2N)的两倍或以上，白细胞计数150×10(9)/L或以上，17号染色体异常，乳酸脱氢酶2N或以上。无治疗特征与完全缓解时间缩短独立相关。在缓解的第一年和第二年，晚期感染的风险分别为10%和4%，在第三年以后，晚期感染的风险每年低于1.5%。在我们中心对接受氟达拉滨治疗的患者进行的多因素分析中，FCR治疗成为最强的独立生存决定因素。
Early results of the fludarabine, cyclophosphamide, and rituximab (FCR) regimen in 224 patients showed that it was highly active as initial therapy of chronic lymphocytic leukemia. In this report, we present the final results of all 300 study patients at a median follow up of 6 years. The overall response rate was 95%, with complete remission in 72%, nodular partial remission in 10%, partial remission due to cytopenia in 7%, and partial remission due to residual disease in 6%. Two patients (< 1%) died within 3 months of starting therapy. Six-year overall and failure-free survival were 77% and 51%, respectively. Median time to progression was 80 months. Pretreatment characteristics independently associated with inferior response were age 70 years or older, beta 2-microglobulin twice the upper limit of normal (2N) or more, white cell count 150 x 10(9)/L or more, abnormal chromosome 17, and lactate dehydrogenase 2N or more. No pretreatment characteristic was independently associated with decreased complete remission duration. The risk of late infection was 10% and 4% for the first and second years of remission, respectively, and less than 1.5% per year for the third year onward. In a multivariate analysis of patients receiving fludarabine-based therapy at our center, FCR therapy emerged as the strongest independent determinant of survival.