What's new in the management of chronic lymphocytic leukemia? 2008 ASH Review (New York Medical College, January 31, 2009)

43 [1] retrospectively compared results of a phase II study of pentostatin and rituximab (PR) to previously published results using pentostatin, cyclophosphamide and rituximab (PCR) [2]. The pentostatin dose was increased to 4 mg/m2 in the PR regimen, but demographics of patients in both studies were similar [1]. Overall response rate (OR) and complete response (CR) rates were similar for PR (79%, 30%) and PCR (91%, 41%), but median progression free survival (PFS) was significantly shorter for PR (12 months vs. 31 months) [1]. These results supported previous findings that the addition of cyclophosphamide to fludarabine improves OR, CR and PFS [3-5]. Abstract 325 presented results of the German CLL Study Group (GCLLSG) CLL8 study randomizing 817 previously untreated patients to fludarabine and cyclophosphamide (FC) or fludarabine, cyclophosphamide and rituximab (FCR) [6]. OR, CR and median PFS favored FCR (93%, 45%, 43 months) over FC (85%, 23%, 32 months), although 2-year overall survival (OS) was similar (91% vs. 88%). Abstract 326 demonstrated that median PFS depended upon the ability to eradicate minimal residual disease (MRD) in the peripheral blood, with PFS increasing from 15 months (MRD  10-2) to 34 months (10-4  MRD >10-2) to not reached (MRD <10-4) with increasing eradication of MRD [7]. Furthermore, 67% of patients receiving FCR achieved MRD <10-4, compared to only 34% of FC patients, thus accounting for the improved PFS with FCR.325 presented results of the German CLL Study Group (GCLLSG) CLL8 study randomizing 817 previously untreated patients to fludarabine and cyclophosphamide (FC) or fludarabine, cyclophosphamide and rituximab (FCR) [6]. OR, CR and median PFS favored FCR (93%, 45%, 43 months) over FC (85%, 23%, 32 months), although 2-year overall survival (OS) was similar (91% vs. 88%). Abstract 326 demonstrated that median PFS depended upon the ability to eradicate minimal residual disease (MRD) in the peripheral blood, with PFS increasing from 15 months (MRD  10-2) to 34 months (10-4  MRD >10-2) to not reached (MRD <10-4) with increasing eradication of MRD [7]. Furthermore, 67% of patients receiving FCR achieved MRD <10-4, compared to only 34% of FC patients, thus accounting for the improved PFS with FCR. Abstract 327 randomized 184 patients (80% previously untreated, 20% relapsed) to PCR or FCR, using the MSKCC PCR regimen (pentostatin dose 4 mg/m2) and the Johns Hopkins FCR regimen (fludarabine 20 mg/m2 days 1–5, cyclophosphamide 600 mg/m2 day 1). The primary endpoint, incidence of grade 3–4 infections, was similar for PCR (34%) and FCR (31%). Only 50% of patients in both arms completed therapy, resulting in surprisingly low OR and CR rates for PCR (45%, 7%) and FCR (58%, 17%). The trial was stopped early, so there were no statistically significant differences between the two arms, and no PFS data was presented. Nonetheless, abstract 327 indicated that results from academic centers may not necessarily be reproducible in the community [8].327 randomized 184 patients (80% previously untreated, 20% relapsed) to PCR or FCR, using the MSKCC PCR regimen (pentostatin dose 4 mg/m2) and the Johns Hopkins FCR regimen (fludarabine 20 mg/m2 days 1–5, cyclophosphamide 600 mg/m2 day 1). The primary endpoint, incidence of grade 3–4 infections, was similar for PCR (34%) and FCR (31%). Only 50% of patients in both arms completed therapy, resulting in surprisingly low OR and CR rates for PCR (45%, 7%) and FCR (58%, 17%). The trial was stopped early, so there were no statistically significant differences between the two arms, and no PFS data was presented. Nonetheless, abstract 327 indicated that results from academic centers may not necessarily be reproducible in the community [8]. Abstract 2095 updated results of a phase II study of cyclophosphamide, fludarabine, alemtuzumab and rituximab (CFAR) in 48 previously untreated patients with high-risk features [9]. OR and CR were 94% and 69%, respectively, with OR 77% and CR 54% in 13 patients with del (17p13). Grade 3–4 neutropenia and thrombocytopenia were observed in 71% and 42% of patients, respectively, and 6% and 27% of patients developed major and minor infections, respectively. from Current trends in leukemia, lymphoma and myeloma White Plains, NY, USA. 31 January 20092095 updated results of a phase II study of cyclophosphamide, fludarabine, alemtuzumab and rituximab (CFAR) in 48 previously untreated patients with high-risk features [9]. OR and CR were 94% and 69%, respectively, with OR 77% and CR 54% in 13 patients with del (17p13). Grade 3–4 neutropenia and thrombocytopenia were observed in 71% and 42% of patients, respectively, and 6% and 27% of patients developed major and minor infections, respectively. from Current trends in leukemia, lymphoma and myeloma White Plains, NY, USA. 31 January 2009 Published: 26 June 2009 Journal of Hematology & Oncology 2009, 2(Suppl 1):I1 doi:10.1186/1756-8722-2-S1-I1 Current trends in leukemia, lymphoma, myeloma and ITP: updates and highlights from ASH 2008 Delong Liu Meeting abstracts – A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/pdf/1756-8722-2-S1-info.pdf This article is available from: http://www.jhoonline.org/content/2/S1/I1 © 2009 Maddocks and Lin; licensee BioMed Central Ltd.