First-line therapy for chronic lymphocytic leukemia in patients older than 79 years is feasible and achieves good results: A FILO retrospective study
First-line therapy for chronic lymphocytic leukemia in patients older than 79 years is feasible and achieves good results: A FILO retrospective study
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DOI：
10.1002/hon.2370
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发表时间：
2017-12-01
影响因子：
3.3
通讯作者：
Feugier, Pierre
中科院分区：
文献类型：
--
作者：
Meunier, Godelieve;Ysebaert, Loic;Feugier, Pierre
诊断慢性淋巴细胞白血病（CLL）的平均年龄为72岁，其中22.8%的患者年龄超过80岁。然而，老年人在CLL的临床研究中代表性不足。我们对2003年至2013年期间在法国CLL（法国创新白血病组织）附属医院开始一线治疗的80岁或以上CLL患者进行了回顾性研究。在这里，我们描述了201例患者的临床和生物学特征，治疗和结果。队列的中位年龄为83.2岁（80-92岁）。中位累积指数评定量表合并症评分为5分，中位肌酐清除率为48 mL/min（Cockcroft-Gault公式）。治疗开始时，Binet分期为A（26.4%）、B（27.9%）或C（40.3%）。治疗主要包括苯丁酸氮芥（65.7%）、苯达莫司汀（10.5%）和利妥昔单抗（44.3%），具体如下：单用苯丁酸氮芥（45.3%）或免疫化疗（48.3%）联合利妥昔单抗+苯丁酸氮芥（22.7%）、利妥昔单抗+苯达莫司汀（10.4%）或利妥昔单抗+环磷酰胺+地塞米松（5.5%）。总有效率66.2%，临床完全缓解率31.8%。从治疗开始的中位总生存期和无进展生存期分别为53.7和18.3个月。这些结果表明，治疗在这个年龄组是可行的。即使是免疫化疗。因此。前瞻性试验应针对这一人群，老年肿瘤学评估和新的靶向治疗应成为未来此类试验的一部分。
The mean age at diagnosis of chronic lymphocytic leukemia (CLL) is 72 years, with 22.8% of patients being older than 80 years. However, the elderly are underrepresented in clinical studies of CLL. We performed a retrospective study of CLL patients aged 80 years or older at the initiation of first-line therapy in hospitals affiliated with the French intergroup on CLL (French Innovative Leukemia Organization) between 2003 and 2013. Here, we describe the clinical and biological characteristics, treatment, and outcomes for 201 patients. The median age of the cohort was 83.2 years (80-92 years). The median Cumulative Index Rating Scale comorbidity score was 5 and the median creatinine clearance was 48 mL/min (Cockcroft-Gault formula). At treatment initiation, Binet stage was A (26.4%), B (27.9%), or C (40.3%). Therapy consisted mainly of chlorambucil (65.7%), bendamustine (10.5%), and rituximab (44.3%) as follows: chlorambucil alone (45.3%) or immunochemotherapy (48.3%) with rituximab + chlorambucil (22.7%), rituximab + bendamustine (10.4%), or rituximab + cyclophosphamide + dexamethasone (5.5%). The overall response rate was 66.2% with 31.8% dinical complete remission. The median overall and progression-free survival from treatment initiation was 53.7 and 18.3 months, respectively. These results suggest that treatment is feasible in this age group. even with immunochemotherapy. Thus. prospective trials should target this population and oncogeriatric evaluation and new targeted therapies should be part of such future trials.