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Blood. 2015 Oct 15;126(16):1921-4. doi: 10.1182/blood-2015-05-647925. Epub 2015 Aug 14.

Molecular prediction of durable remission after first-line fludarabine-cyclophosphamide-rituximab in chronic lymphocytic leukemia.

Author information

1
Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy;
2
Hematology, Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy;
3
Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy;
4
Department of Cell Therapy and Hematology, Ospedale San Bortolo, Vicenza, Italy;
5
Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy;
6
Hematology Unit, Department of Onco-Hematology, Hospital of Cosenza, Cosenza, Italy;
7
Department of Hematology Oncology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy;
8
Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi" Department of Experimental and Clinical Medical Sciences (DISM), Azienda Ospedaliera Universitaria S. Maria Misericordia, Udine, Italy;
9
Cancer Sciences Unit, Southampton Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centre, University of Southampton, Southampton, United Kingdom; Division of Hematology, University of Siena, Siena, Italy;
10
Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy;
11
Hematology Unit, Hospital of Reggio Calabria, Reggio Calabria, Italy;
12
Department of Hematology, Spedali Civili, Brescia, Italy;
13
Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza and University of Turin, Turin, Italy;
14
Hematology Section, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy;
15
Department of Oncology/Haematology, Niguarda Cancer Center, Niguarda Ca Granda Hospital, Milan, Italy;
16
Department of Clinical Sciences and Community Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy;
17
Division of Hematology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy;
18
Section of Hematology, Department of Medicine, University of Verona, Verona, Italy;
19
Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
20
Department of Hematology, Tor Vergata University, Rome, Italy;
21
Hematology and Cell Therapy Unit, Ospedale Mauriziano and University of Turin, Turin, Italy; and.
22
Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy.

Abstract

Fludarabine, cyclophosphamide, and rituximab (FCR) has represented a significant treatment advancement in chronic lymphocytic leukemia (CLL). In the new scenario of targeted agents, there is an increasing interest in identifying patients who gain the maximum benefit from FCR. In this observational multicenter retrospective analysis of 404 CLL patients receiving frontline FCR, the combination of three biomarkers that are widely tested before treatment (IGHV mutation status, 11q deletion and 17p deletion; available in 80% of the study cohort) allowed to identify a very low-risk category of patients carrying mutated IGHV genes but neither 11q or 17p deletion that accounted for 28% of all cases. The majority of very low-risk patients (71%) remained free of progression after treatment and their hazard of relapse decreased after 4 years from FCR. The life expectancy of very low-risk patients (91% at 5 years) was superimposable to that observed in the matched normal general population, indicating that neither the disease nor complications of its treatment affected survival in this favorable CLL group. These findings need a prospective validation and may be helpful for the design of clinical trials aimed at comparing FCR to new targeted treatments of CLL, and, possibly, for optimized disease management.

Comment in

PMID:
26276669
PMCID:
PMC4743433
DOI:
10.1182/blood-2015-05-647925
[Indexed for MEDLINE]
Free PMC Article

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