Dose-reduced fludarabine, cyclophosphamide and rituximab is well tolerated in older patients with chronic lymphocytic leukemia and has preserved therapeutic efficacy
Dose-reduced fludarabine, cyclophosphamide and rituximab is well tolerated in older patients with chronic lymphocytic leukemia and has preserved therapeutic efficacy
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DOI：
10.3109/10428194.2015.1096353
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发表时间：
2016-01-01
影响因子：
2.6
通讯作者：
Tam, Constantine S.
中科院分区：
文献类型：
--
作者：
Lew, Thomas E.;Cheah, Chan Y.;Tam, Constantine S.
尽管在前瞻性试验中其有效性，但在临床实践中，全剂量氟达拉滨、环磷酰胺和利妥昔单抗（FCR）对老年慢性淋巴细胞白血病（CLL）患者可能毒性太大。我们回顾性分析了42例年龄在65-87岁（中位数72岁）的连续患者的FCR治疗剂量减少对结局的影响。尽管中位累积氟达拉滨剂量较全剂量减少50%，但客观缓解率和完全缓解率分别为86%和38%（一线治疗94%/59%;既往治疗80%/24%）。与最小剂量减少（25%）相比，剂量减少25-75%与无进展生存期无显著相关（p=0.49），并且不排除深度缓解，包括6例（14%）微小残留疾病阴性病例。虽然血液学和感染性毒性很常见，但限制治疗的不良反应并不常见。剂量减弱的FCR似乎具有保留的功效，并且可能是患有CLL的老年患者的可行的治疗选择。
Despite its efficacy in prospective trials, full dose fludarabine, cyclophosphamide and rituximab (FCR) may be too toxic for elderly patients with chronic lymphocytic leukemia (CLL) in clinical practice. We retrospectively reviewed the impact of dose reductions in FCR therapy on the outcomes of 42 consecutive patients aged 65-87 (median 72) years. Despite a median cumulative fludarabine dose reduction of 50% from full dose, the objective response and complete response rates were 86% and 38% respectively (frontline 94%/59%; previously treated 80%/24%). Dose reductions of 25-75% were not significantly associated with inferior progression free survival compared to minimal reductions (25%) (p=0.49), and did not preclude deep responses, including six cases (14%) of minimal residual disease negativity. Although hematological and infectious toxicities were common, treatment limiting adverse effects were infrequent. Dose attenuated FCR appears to have preserved efficacy and may be a viable therapeutic option for elderly patients with CLL.