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First-line therapy ...
First-line therapy in chronic lymphocytic leukemia : a Swedish nation-wide real-world study on 1053 consecutive patients treated between 2007 and 2013
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- Sylvan, Sandra Eketorp (author)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Asklid, Anna (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Johansson, Hemming (author)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Klintman, Jenny (author)
- Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Lund, Sweden;Lund Univ, Dept Translat Med, Lund, Sweden
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- Bjellvi, Jenny (author)
- Sahlgrens Univ Hosp, Dept Hematol, Gothenburg, Sweden
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- Tolvgård, Staffan (author)
- Ostersunds Hosp, Dept Internal Med, Ostersund, Sweden
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- Kimby, Eva (author)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Norin, Stefan (author)
- Karolinska Inst, Dept Internal Med Huddinge, Stockholm, Sweden
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- Andersson, Per-Ola (author)
- South Alvsborg Hosp, Dept Hematol, Boras, Sweden
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- Karlsson, Claes (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Karlsson, Karin (author)
- Skane Univ Hosp, Dept Hematol Oncol & Radiat Phys, Lund, Sweden
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- Lauri, Birgitta (author)
- Sunderby Hosp, Dept Hematol, Sunderbyn Lulea, Sweden
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- Mattsson, Mattias (author)
- Uppsala universitet,Hematologi,Uppsala Univ Hosp, Sweden
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- Sandstedt, Anna (author)
- Linköpings universitet,Institutionen för samhälls- och välfärdsstudier,Medicinska fakulteten,Region Östergötland, Hematologiska kliniken US
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- Strandberg, Maria (author)
- Sundsvall Hosp, Dept Med, Sundsvall, Sweden
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- Österborg, Anders (author)
- Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden;Karolinska Univ Hosp, Dept Hematol, Stockholm, Sweden
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- Hansson, Lotta (author)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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(creator_code:org_t)
- 2018-11-22
- 2019
- English.
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In: Haematologica. - : FERRATA STORTI FOUNDATION. - 0390-6078 .- 1592-8721. ; 104:4, s. 797-805
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Abstract
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- The aim of this study was to investigate long-term outcome following first-line therapy in consecutive chronic lymphocytic leukemia (CLL) patients in a well-defined geographic area: Sweden. All patients diagnosed with CLL (2007-2013) (n=3672) were identified from national registries, screening of patient files identified all (100%) treated first line (n=1053) and for those, an in-depth analysis was performed. End points were overall response rate, progression-free survival (PFS), overall survival (OS), and safety. Median age was 71 years; 53% had Rai stage III-IV and 97% had performance status grade 0-2. Fluorescence in situ hybridization (FISH) was performed in 57% of patients: 15% had del(17p). Chlorambucil + prednisone was used in 39% (5% also received rituximab). Fludarabine+cyclophosphamide+rituximab or fludarabine+cyclophosphamide was used in 43% and bendamustine + rituximab in 6%. Overall response rate was 64%; chlorambucil 43%, fludarabine+cyclophosphamide+rituximab 84%, fludarabine+cyclophosphamide 75% and bendamustine + rituximab 75%. Median PFS and OS was 24 and 58 months, respectively, both were significantly associated (multivariate analysis) with type of treatment, del(17p), performance status, gender, age and geographical region (OS only). Chlorambucil-treated patients had a median PFS and OS of only 9 and 33 months, respectively. Chlorambucil usage declined gradually throughout the study period, but one-third of patients still received chlorambucil + rituximab in 2013. Infections >= grade III were significantly associated with treatment; chlorambucil 19% versus fludarabine+cyclophosphamide+rituximab 30%. Richter transformation occurred in 5.5% of the patients, equally distributed across therapies. This is the largest retrospective, real-world cohort of consecutive first-line treated CLL patients with a complete follow up. In elderly patients, an unmet need for more effective, well-tolerated therapies was identified.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Hematologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Hematology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Sylvan, Sandra E ...
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Asklid, Anna
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Johansson, Hemmi ...
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Klintman, Jenny
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Bjellvi, Jenny
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Tolvgård, Staffa ...
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Kimby, Eva
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Norin, Stefan
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Andersson, Per-O ...
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Karlsson, Claes
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Karlsson, Karin
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Lauri, Birgitta
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Mattsson, Mattia ...
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Sandstedt, Anna
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Strandberg, Mari ...
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Österborg, Ander ...
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Hansson, Lotta
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Hematology
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
- Articles in the publication
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Haematologica
- By the university
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Uppsala University
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Karolinska Institutet
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Linköping University