Abstract
Abstract 2377
Poster Board II-354
Fludarabine containing regimens has become the gold standard for first-line treatment of CLL. The prognosis for the response is usually done by mutation analysis and cytogenetics. These types of analyses are time consuming and could not be available in general practice. Staging is very easy tool for predicting the response, although it is not a matter of individual prognosis.
The aim of the study was to find clinical data predicting the response. As a model, we have evaluated the response after 3 fludarabine containing regimens.
75 patients treated by fludarabin containing regimens (FC and FCR) were included (2002-2008). Staging was performed according to Binet (1977). Stage B and C patients were included. Lymph nodes were evaluated by CT and ultrasound. CD38 was done by CytoFlow (cut off 30%). Mutation analysis was studied by PCR and sequencing with cut off 98%. Early response(ER) was defined as PR and CR after 3 cycles of therapy, others were considered as nER.
CR was defined according to NCI criteria.
The patients were treated and followed-up by the single team of physicians, there were no losses of follow-us.SPSS - 17 statistical program was used for analysis.
In the whole group, median PFS was 25 mons . There were 40 ER pts(33 - PR and 7 - CR).Median PFS in ER patients was 38mons, in other patients (nER) – 17mons (p= 0.0001). After 6 cycles of therapy, the overall response was 100%; CR was 83% and 7% PR I ER pts, in nER- resp- 67%, 23% and 41% ( p < 0,001).
Differences of median PFS according to standard prognostic factors is presented in table 1:
| . | ER - patients, median PFS, mons . | nER - patients, median PFS, mons . | p . |
|---|---|---|---|
| CD 38 + | 31 | 12 | 0,05 |
| CD 38 − | not achieved | 30 | 0,006 |
| Mut + | not achieved | 21 | 0,04 |
| Mut − | 32 | 18 | 0,03 |
| Stage B | 58 | 20 | 0,01 |
| Stage C | 31 | 9 | 0,001 |
| . | ER - patients, median PFS, mons . | nER - patients, median PFS, mons . | p . |
|---|---|---|---|
| CD 38 + | 31 | 12 | 0,05 |
| CD 38 − | not achieved | 30 | 0,006 |
| Mut + | not achieved | 21 | 0,04 |
| Mut − | 32 | 18 | 0,03 |
| Stage B | 58 | 20 | 0,01 |
| Stage C | 31 | 9 | 0,001 |
Thus, ER patients with standard adverse prognostic factors did better than nER with similar prognostic factors.
ER patients in comparison to nER had higher median PFS on both FC (28 mons vs 14 mons, p=0.001) and FCR (58 mons vs 18 mons, p=0.018) regimens.
The early response (PR and CR) after three fluadarabine containing regimens is a good predictor for PFS. More intensive treatment should be considered for patients without early response.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
