Pentostatin, cyclophosphamide, and rituximab regimen in older patients with chronic lymphocytic leukemia

Tait D. Shanafelt, Thomas Lin, Susan M. Geyer, Clive S. Zent, Nelson Leung, Brian Kabat, Deborah Bowen, Michael R. Grever, John C. Byrd, Neil E. Kay

Research output: Contribution to journalArticle

131 Scopus citations

Abstract

BACKGROUND. The prevalence of chronic lymphocytic leukemia (CLL) increases with age. Although chemoimmunotherapy (CIT) has dramatically improved response rates in patients with CLL, some ClT regimens are not well tolerated by many patients ≥70 years of age. METHODS. Sixty-four previously untreated patients with CLL and serum creatinine <1.5 times the upper limit of normal who met National Cancer Institute (NCI) 96-WG criteria for treatment received pentostatin (2 mg/m2), cyclophosphamide (600 mg/m2), and rituximab (375 mg/m2). The authors measured performance status at study entry and used age, weight, and baseline creatinine to calculate creatinine clearance (CrCl). RESULTS. Eighteen of 64 (28%) patients were ages ≥70 years. Although individuals ages ≥70 years were more likely to have delayed treatment cycles (28% vs 7%; P = .03), there were no significant differences in the number of cycles administered, need for dose reductions, or grade 3-4 hematologic, infectious, or other toxicides. No significant differences in overall response rate, complete response rate, or progression-free survival were observed by age. Twenty-five (39%) patients had a CrCl < 70 mL/min (range, 34-67). Although individuals with CrCl < 70 mL/min were more likely to require dose reduction (24% vs 5%; P = .05), there were no significant differences in the number of cycles administered or grade 3-4 hematologic, infectious, or other toxicities. No significant difference in overall response rate, complete response rate, or progression-free survival were observed between patients with CrCl ≥ 70 mL/min and those with CrCl < 70 mL/min. CONCLUSIONS. In this clinical trial, the PCR regimen was well tolerated by older patients and individuals with CrCl ≤ 70. The efficacy of PCR was not significantly affected by age or renal function. These findings suggest PCR may be a good therapeutic option for older patients and those with modestly decreased renal function.

Original languageEnglish (US)
Pages (from-to)2291-2298
Number of pages8
JournalCancer
Volume109
Issue number11
DOIs
StatePublished - Jun 1 2007

Keywords

  • Chemoimmunotherapy
  • Chronic lymphocytic leukemia
  • Elderly patients
  • Renal failure
  • Treatment
  • β-2 microglobulin

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Pentostatin, cyclophosphamide, and rituximab regimen in older patients with chronic lymphocytic leukemia'. Together they form a unique fingerprint.

  • Cite this

    Shanafelt, T. D., Lin, T., Geyer, S. M., Zent, C. S., Leung, N., Kabat, B., Bowen, D., Grever, M. R., Byrd, J. C., & Kay, N. E. (2007). Pentostatin, cyclophosphamide, and rituximab regimen in older patients with chronic lymphocytic leukemia. Cancer, 109(11), 2291-2298. https://doi.org/10.1002/cncr.22662