Publication Date:
2012-11-16
Description:
Abstract 3936 Introduction: A substantial improvement of treatment outcomes in patients with CLL was achieved during the last decades, but almost all patients (pts) eventually relapse. According to ESMO-guidelines, a repetition of 1st-line therapy is a reasonable approach in case of a relapse 〉24 months after initial treatment [Eichhorst et al., Ann Oncol., 2011]. This recommendation has not yet been confirmed by clinical trials and little is known which therapy should be chosen in case of an earlier relapse. Methods: 1558 pts treated in five prospective trials of the GCLLSG were included in the analysis. Three randomised phase-III-trials for 1st-line treatment evaluated fludarabine (F) vs. F + cyclophosphamide (FC) [CLL4], chlorambucile (Clb) vs. F [CLL5] and FC without or with rituximab (FCR) [CLL8]. Two trials were designed for both 1st-line and relapse treatment and tested FC + alemtuzumab (FCC) [CLL2L] as well as bendamustine + rituximab (BR) [CLL2M]. For statistical analyses Kaplan-Meier estimators and curves, as well as log-rank tests were used. Results: Most common 1st-line therapies were those tested in the above mentioned five GCLLSG-trials: 588 pts received FC (38%), 402 pts FCR (26%), 299 pts F (19%), 134 pts Clb with/without steroids (9%) and 116 pts BR (7%). Treatment-free (TFS) and overall survival (OS) were shorter in pts treated with Clb, F or FC in comparison to patients treated with FCR or BR chemoimmunotherapy (see figure 1). So far, 704 of 1558 pts received 2nd-line treatment for progressive CLL. These 2nd-line therapies were quite heterogeneous, most common regimen were: FC (79 pts, 11%), BR (75 pts, 11%), F (65 pts, 9%), B with/without steroids (63 pts, 9%), CHOP-R (56 pts, 8%), Clb with/without steroids (55pts, 8%), FCR (54 pts, 8%), as well as alemtuzumab with/without steroids (43 pts, 6%) and FCC (32 pts, 5%). Patients treated with antibody-based regimen had a significantly longer OS than patients never treated with antibodies (OS after 60 months: 76% vs 64%, p
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine