4.3 Article

Outcomes of patients with fludarabine-refractory chronic lymphocytic leukemia: a population-based study from a well-defined geographic region

Journal

LEUKEMIA & LYMPHOMA
Volume 55, Issue 8, Pages 1774-1780

Publisher

TAYLOR & FRANCIS LTD
DOI: 10.3109/10428194.2013.827786

Keywords

CLL; fludarabine-refractory; time to treatment failure; survival

Funding

  1. Swedish Cancer Society
  2. Cancer Society in Stockholm
  3. King Gustav V Jubilee Fund
  4. Cancer and Allergy Foundation
  5. Karolinska Institutet Foundations
  6. Stockholm County Council
  7. GlaxoSmithKline Ltd

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Patients with fludarabine-refractory (FR) chronic lymphocytic leukemia (CLL) receive novel agents in pivotal, non-randomised phase-2 trials. Understanding outcome of FR-CLL in health-care may provide important contextual information. Recordsfrom 1301 patients (Stockholm-Cancer-Registry 1991-2010) identified 92 FR-patients; bulky lymph-nodes (BFR-group), double-refractory (DR-group), or Others'-group for outcome-analysis. Median age was 69 years 67% had Rai-stage III/IV with median 3 prior therapies. Overall response-rate was 20%; significantly lower in BFR (8%, p = 0.01) and DR (20%, p = 0.01) than in 'Others' (31%). Time-to-treatment-failure (months) was significantly longer in 'Others' (9.2) than in BFR/DR (5.3/4.4) (p < 0.01) and significantly longer (p < 0.05) in antibody-treated patients (9.1) compared to other regimens (5.2). Early-death occurred in 5%, grade Ill-infections in 20%. Median overall-survival (OS) was 18 months; 29 in BFR vs 13 in DR (p = 0.054). Male sex was the only prognostic factor on OS (p = 0.01, HR 2.2, multivariate-Cox-regression). Our results, without external referrals, facilitate interpretation of non-randomised trials/novel drugs in advanced-stage-CLL.

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