Poor efficacy and tolerability of R‐CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation
This phase II trial evaluated efficacy and tolerability of R‐CHOP for up to 8 courses in Richter transformation (RT) and up to 6 courses in CLL plus autoimmune cytopenia (AIC) or high‐risk (HR) features. HR was defined as fludarabine‐refractoriness or early relapse (
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| Veröffentlicht in: | American journal of hematology 2014-12, Vol.89 (12), p.E239-E243 |
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| creator | Langerbeins, Petra Busch, Raymonde Anheier, Nadine Dürig, Jan Bergmann, Manuela Goebeler, Maria‐Elisabeth Hurtz, Hans‐Jürgen Stauch, Martina B. Stilgenbauer, Stephan Döhner, Hartmut Fink, Anna‐Maria Cramer, Paula Fischer, Kirsten Wendtner, Clemens‐Martin Hallek, Michael Eichhorst, Barbara |
| description | This phase II trial evaluated efficacy and tolerability of R‐CHOP for up to 8 courses in Richter transformation (RT) and up to 6 courses in CLL plus autoimmune cytopenia (AIC) or high‐risk (HR) features. HR was defined as fludarabine‐refractoriness or early relapse ( |
| doi_str_mv | 10.1002/ajh.23841 |
| format | Article |
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HR was defined as fludarabine‐refractoriness or early relapse (<36 months) after fludarabine‐based treatment; 26 patients were included as HR, 19 patients had AIC, and 15 patients had RT. In the HR cohort, overall response rate was 54%, progression‐free and overall survival were 9 and 21 months. In AIC patients overall response rate was 74%, progression‐free and overall‐survival were 10 and 41 months, respectively, and median increase in hemoglobin was 3.4 g/L. RT patients responded in 67%, progression‐free was 10 and overall survival 21 months. The most common adverse events were hematologic toxicities in 92%. Severe infections occurred in 28%. Treatment was discontinued early in 45% of all patients mainly as a result of toxicity. This trial shows that R‐CHOP has no role in treating complicated CLL. R‐CHOP is associated with significant toxicities and fairly low efficacy compared with almost every other CLL‐regimen. In RT, it might still be used as an induction therapy before allogeneic stem cell transplantation. Am. J. Hematol. 89:E239–E243, 2014. © 2014 Wiley Periodicals, Inc.</description><identifier>ISSN: 0361-8609</identifier><identifier>EISSN: 1096-8652</identifier><identifier>DOI: 10.1002/ajh.23841</identifier><identifier>PMID: 25196783</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject><![CDATA[Adult ; Aged ; Antibodies, Monoclonal, Murine-Derived - administration & dosage ; Antibodies, Monoclonal, Murine-Derived - adverse effects ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Cyclophosphamide - administration & dosage ; Cyclophosphamide - adverse effects ; Doxorubicin - administration & dosage ; Doxorubicin - adverse effects ; Drug Administration Schedule ; Drug Resistance, Neoplasm ; Female ; Hematology ; Hemoglobins - metabolism ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell - complications ; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy ; Leukemia, Lymphocytic, Chronic, B-Cell - mortality ; Leukemia, Lymphocytic, Chronic, B-Cell - pathology ; Male ; Middle Aged ; Prednisone - administration & dosage ; Prednisone - adverse effects ; Purpura, Thrombocytopenic, Idiopathic - complications ; Purpura, Thrombocytopenic, Idiopathic - drug therapy ; Purpura, Thrombocytopenic, Idiopathic - mortality ; Purpura, Thrombocytopenic, Idiopathic - pathology ; Recurrence ; Survival Analysis ; Treatment Failure ; Vidarabine - analogs & derivatives ; Vidarabine - therapeutic use ; Vincristine - administration & dosage ; Vincristine - adverse effects]]></subject><ispartof>American journal of hematology, 2014-12, Vol.89 (12), p.E239-E243</ispartof><rights>2014 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fajh.23841$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fajh.23841$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,1434,27929,27930,45579,45580,46414,46838</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25196783$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Langerbeins, Petra</creatorcontrib><creatorcontrib>Busch, Raymonde</creatorcontrib><creatorcontrib>Anheier, Nadine</creatorcontrib><creatorcontrib>Dürig, Jan</creatorcontrib><creatorcontrib>Bergmann, Manuela</creatorcontrib><creatorcontrib>Goebeler, Maria‐Elisabeth</creatorcontrib><creatorcontrib>Hurtz, Hans‐Jürgen</creatorcontrib><creatorcontrib>Stauch, Martina B.</creatorcontrib><creatorcontrib>Stilgenbauer, Stephan</creatorcontrib><creatorcontrib>Döhner, Hartmut</creatorcontrib><creatorcontrib>Fink, Anna‐Maria</creatorcontrib><creatorcontrib>Cramer, Paula</creatorcontrib><creatorcontrib>Fischer, Kirsten</creatorcontrib><creatorcontrib>Wendtner, Clemens‐Martin</creatorcontrib><creatorcontrib>Hallek, Michael</creatorcontrib><creatorcontrib>Eichhorst, Barbara</creatorcontrib><title>Poor efficacy and tolerability of R‐CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation</title><title>American journal of hematology</title><addtitle>Am J Hematol</addtitle><description>This phase II trial evaluated efficacy and tolerability of R‐CHOP for up to 8 courses in Richter transformation (RT) and up to 6 courses in CLL plus autoimmune cytopenia (AIC) or high‐risk (HR) features. HR was defined as fludarabine‐refractoriness or early relapse (<36 months) after fludarabine‐based treatment; 26 patients were included as HR, 19 patients had AIC, and 15 patients had RT. In the HR cohort, overall response rate was 54%, progression‐free and overall survival were 9 and 21 months. In AIC patients overall response rate was 74%, progression‐free and overall‐survival were 10 and 41 months, respectively, and median increase in hemoglobin was 3.4 g/L. RT patients responded in 67%, progression‐free was 10 and overall survival 21 months. The most common adverse events were hematologic toxicities in 92%. Severe infections occurred in 28%. Treatment was discontinued early in 45% of all patients mainly as a result of toxicity. This trial shows that R‐CHOP has no role in treating complicated CLL. R‐CHOP is associated with significant toxicities and fairly low efficacy compared with almost every other CLL‐regimen. In RT, it might still be used as an induction therapy before allogeneic stem cell transplantation. Am. J. 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Busch, Raymonde ; Anheier, Nadine ; Dürig, Jan ; Bergmann, Manuela ; Goebeler, Maria‐Elisabeth ; Hurtz, Hans‐Jürgen ; Stauch, Martina B. ; Stilgenbauer, Stephan ; Döhner, Hartmut ; Fink, Anna‐Maria ; Cramer, Paula ; Fischer, Kirsten ; Wendtner, Clemens‐Martin ; Hallek, Michael ; Eichhorst, Barbara</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p3141-5627b5981821434ab08ea751e8528fedc5235e07d754d474c649b2d076f0e7753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Monoclonal, Murine-Derived - administration & dosage</topic><topic>Antibodies, Monoclonal, Murine-Derived - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Cyclophosphamide - administration & dosage</topic><topic>Cyclophosphamide - adverse effects</topic><topic>Doxorubicin - administration & dosage</topic><topic>Doxorubicin - adverse effects</topic><topic>Drug Administration Schedule</topic><topic>Drug Resistance, Neoplasm</topic><topic>Female</topic><topic>Hematology</topic><topic>Hemoglobins - metabolism</topic><topic>Humans</topic><topic>Leukemia, Lymphocytic, Chronic, B-Cell - complications</topic><topic>Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy</topic><topic>Leukemia, Lymphocytic, Chronic, B-Cell - mortality</topic><topic>Leukemia, Lymphocytic, Chronic, B-Cell - pathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prednisone - administration & dosage</topic><topic>Prednisone - adverse effects</topic><topic>Purpura, Thrombocytopenic, Idiopathic - complications</topic><topic>Purpura, Thrombocytopenic, Idiopathic - drug therapy</topic><topic>Purpura, Thrombocytopenic, Idiopathic - mortality</topic><topic>Purpura, Thrombocytopenic, Idiopathic - pathology</topic><topic>Recurrence</topic><topic>Survival Analysis</topic><topic>Treatment Failure</topic><topic>Vidarabine - analogs & derivatives</topic><topic>Vidarabine - therapeutic use</topic><topic>Vincristine - administration & dosage</topic><topic>Vincristine - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Langerbeins, Petra</creatorcontrib><creatorcontrib>Busch, Raymonde</creatorcontrib><creatorcontrib>Anheier, Nadine</creatorcontrib><creatorcontrib>Dürig, Jan</creatorcontrib><creatorcontrib>Bergmann, Manuela</creatorcontrib><creatorcontrib>Goebeler, Maria‐Elisabeth</creatorcontrib><creatorcontrib>Hurtz, Hans‐Jürgen</creatorcontrib><creatorcontrib>Stauch, Martina B.</creatorcontrib><creatorcontrib>Stilgenbauer, Stephan</creatorcontrib><creatorcontrib>Döhner, Hartmut</creatorcontrib><creatorcontrib>Fink, Anna‐Maria</creatorcontrib><creatorcontrib>Cramer, Paula</creatorcontrib><creatorcontrib>Fischer, Kirsten</creatorcontrib><creatorcontrib>Wendtner, Clemens‐Martin</creatorcontrib><creatorcontrib>Hallek, Michael</creatorcontrib><creatorcontrib>Eichhorst, Barbara</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>American journal of hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Langerbeins, Petra</au><au>Busch, Raymonde</au><au>Anheier, Nadine</au><au>Dürig, Jan</au><au>Bergmann, Manuela</au><au>Goebeler, Maria‐Elisabeth</au><au>Hurtz, Hans‐Jürgen</au><au>Stauch, Martina B.</au><au>Stilgenbauer, Stephan</au><au>Döhner, Hartmut</au><au>Fink, Anna‐Maria</au><au>Cramer, Paula</au><au>Fischer, Kirsten</au><au>Wendtner, Clemens‐Martin</au><au>Hallek, Michael</au><au>Eichhorst, Barbara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Poor efficacy and tolerability of R‐CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation</atitle><jtitle>American journal of hematology</jtitle><addtitle>Am J Hematol</addtitle><date>2014-12</date><risdate>2014</risdate><volume>89</volume><issue>12</issue><spage>E239</spage><epage>E243</epage><pages>E239-E243</pages><issn>0361-8609</issn><eissn>1096-8652</eissn><abstract>This phase II trial evaluated efficacy and tolerability of R‐CHOP for up to 8 courses in Richter transformation (RT) and up to 6 courses in CLL plus autoimmune cytopenia (AIC) or high‐risk (HR) features. HR was defined as fludarabine‐refractoriness or early relapse (<36 months) after fludarabine‐based treatment; 26 patients were included as HR, 19 patients had AIC, and 15 patients had RT. In the HR cohort, overall response rate was 54%, progression‐free and overall survival were 9 and 21 months. In AIC patients overall response rate was 74%, progression‐free and overall‐survival were 10 and 41 months, respectively, and median increase in hemoglobin was 3.4 g/L. RT patients responded in 67%, progression‐free was 10 and overall survival 21 months. The most common adverse events were hematologic toxicities in 92%. Severe infections occurred in 28%. Treatment was discontinued early in 45% of all patients mainly as a result of toxicity. This trial shows that R‐CHOP has no role in treating complicated CLL. R‐CHOP is associated with significant toxicities and fairly low efficacy compared with almost every other CLL‐regimen. In RT, it might still be used as an induction therapy before allogeneic stem cell transplantation. Am. J. Hematol. 89:E239–E243, 2014. © 2014 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25196783</pmid><doi>10.1002/ajh.23841</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Antibodies, Monoclonal, Murine-Derived - administration & dosage Antibodies, Monoclonal, Murine-Derived - adverse effects Antineoplastic Combined Chemotherapy Protocols - administration & dosage Antineoplastic Combined Chemotherapy Protocols - adverse effects Cyclophosphamide - administration & dosage Cyclophosphamide - adverse effects Doxorubicin - administration & dosage Doxorubicin - adverse effects Drug Administration Schedule Drug Resistance, Neoplasm Female Hematology Hemoglobins - metabolism Humans Leukemia, Lymphocytic, Chronic, B-Cell - complications Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy Leukemia, Lymphocytic, Chronic, B-Cell - mortality Leukemia, Lymphocytic, Chronic, B-Cell - pathology Male Middle Aged Prednisone - administration & dosage Prednisone - adverse effects Purpura, Thrombocytopenic, Idiopathic - complications Purpura, Thrombocytopenic, Idiopathic - drug therapy Purpura, Thrombocytopenic, Idiopathic - mortality Purpura, Thrombocytopenic, Idiopathic - pathology Recurrence Survival Analysis Treatment Failure Vidarabine - analogs & derivatives Vidarabine - therapeutic use Vincristine - administration & dosage Vincristine - adverse effects |
| title | Poor efficacy and tolerability of R‐CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation |
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