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Br J Haematol. 2018 Dec;183(5):727-735. doi: 10.1111/bjh.15604. Epub 2018 Nov 21.

Outcome of patients aged 80 years or older treated for chronic lymphocytic leukaemia.

Author information

1
Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany.
2
Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Hospital Munich-Schwabing, Munich, Germany.
3
Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany.
4
Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Disease (CECAD), University of Cologne, Cologne, Germany.
5
Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany.

Abstract

Clinical management of chronic lymphocytic leukaemia (CLL) in patients aged ≥80 years is based on limited evidence due to the lack of published information. Therefore, we analysed CLL patients aged ≥80 years using data from seven phase III clinical trials of the German CLL Study Group. Among 3552 participants, 152 were ≥80 years old at initiation of first-line study treatment. Median age was 82 years (range 80-90). Concomitant diseases were present in 99% of the patients, with a median cumulative illness rating scale score of 8 (0-18). Chemoimmunotherapy with chlorambucil-obinutuzumab (CLB-OB) or chlorambucil-rituximab (CLB-R) was administered to 61 (40%) and 56 (37%) patients. The remaining patients received CLB (n = 19) or fludarabine (F, n = 10), F/cyclophosphamide (FC, n = 1), FC/rituximab (FCR, n = 2) or bendamustine/rituximab (BR, n = 3). Rates of grade 3 or 4 neutropenia and infections were 35% and 13%. Overall response rate was 77% with 13% complete remissions. Median progression-free survival and treatment-free survival were 17·2 and 32·3 months, respectively. Median overall survival was 48·3 months; adverse events (22%) and progressive CLL (16·4%) were the most frequent causes of death. These findings suggest that anti-leukaemic treatment including chemoimmunotherapy is feasible and efficacious in ≥80-year-old CLL patients. However, this group of patients lives for a shorter time than age-matched controls of the general population.

KEYWORDS:

CLL ; chemoimmunotherapy; chemotherapy; co-morbidity; elderly

PMID:
30460980
DOI:
10.1111/bjh.15604

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