Frontline chemoimmunotherapy with fludarabine, cyclophosphamide, alemtuzumab, and rituximab for high-risk chronic lymphocytic leukemia

Sameer A. Parikh, Michael J. Keating, Susan O'Brien, Xuemei Wang, Alessandra Ferrajoli, Stefan Faderl, Jan Burger, Charles Koller, Zeev Estrov, Xavier Badoux, Susan Lerner, William G. Wierda

Research output: Contribution to journalArticle

70 Scopus citations

Abstract

Frontline chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) is associated with superior overall survival (OS) for patients with chronic lymphocytic leukemia (CLL). Alemtuzumab (A) was added to FCR (CFAR) in a phase 2 trial for high-risk untreated patients < 70 years with serum β-2 microglobulin (β2M) ≥ 4 mg/L. Sixty patients were enrolled; median age was 59 years (range, 42-69); 75% were male; median β2M was 5.1 mg/L (range, 4-11.6); and 51% were Rai III-IV. Complete remission (CR) was achieved in 70%, partial remission (PR) in 18%, nodular PR in 3%, for an overall response of 92%. Of 14 patients with 17p deletion, CR was achieved by 8 (57%). Of 57 BM samples evaluated by 3-color flow cytometry at the end of treatment, 41 (72%) were negative for residual disease. Grade 3-4 neutropenia and thrombocytopenia occurred with 33% and 13% courses, respectively. The median progression-free survival was 38 months and median OS was not reached. In conclusion, CFAR is an active frontline regimen for high-risk CLL. Response rates and survival are comparable with historic high-risk FCR-treated patients. CFAR may be a useful frontline regimen to achieve CR in patients with 17p deletion before allogeneic stem cell transplantation.

Original languageEnglish (US)
Pages (from-to)2062-2068
Number of pages7
JournalBlood
Volume118
Issue number8
DOIs
StatePublished - Aug 25 2011

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Parikh, S. A., Keating, M. J., O'Brien, S., Wang, X., Ferrajoli, A., Faderl, S., Burger, J., Koller, C., Estrov, Z., Badoux, X., Lerner, S., & Wierda, W. G. (2011). Frontline chemoimmunotherapy with fludarabine, cyclophosphamide, alemtuzumab, and rituximab for high-risk chronic lymphocytic leukemia. Blood, 118(8), 2062-2068. https://doi.org/10.1182/blood-2011-01-329177