IGHV@
化学免疫疗法
氟达拉滨
医学
美罗华
内科学
环磷酰胺
肿瘤科
胃肠病学
免疫学
慢性淋巴细胞白血病
化疗
淋巴瘤
白血病
作者
P. A. Thompson,Alexandre Bazinet,William G. Wierda,Constantine S. Tam,Susan O’Brien,Satabdi Saha,Christine B. Peterson,William Plunkett,Michael J. Keating
出处
期刊:Blood
[American Society of Hematology]
日期:2023-11-23
卷期号:142 (21): 1784-1788
被引量:5
标识
DOI:10.1182/blood.2023020158
摘要
Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab (FCR) achieves durable remissions, with flattening of the progression-free survival (PFS) curve in patients with mutated immunoglobulin heavy chain variable gene (IGHV-M). We updated long-term follow-up results from the original 300-patient FCR study initiated at MD Anderson in 1999. The current median follow-up is 19.0 years. With this extended follow-up, the median PFS for patients with IGHV-M was 14.6 years vs 4.2 years for patients with unmutated IGHV (IGHV-UM). Disease progression beyond 10 years was uncommon. In total, 16 of 94 (17%) patients in remission at 10 years subsequently progressed with the additional follow-up compared with the patients in our prior report in 2015. Only 4 of 45 patients (9%) with IGHV-M progressed beyond 10 years. Excluding Richter transformation, 96 of 300 patients (32%) developed 106 other malignancies, with 19 of 300 (6.3%) developing therapy-related myeloid neoplasms (tMNs), which were fatal in 16 of 19 (84%). No pretreatment patient characteristics predicted the risk of tMNs. In summary, FCR remains an option for patients with IGHV-M chronic lymphocytic leukemia (CLL), with a significant fraction achieving functional cure of CLL. A risk-benefit assessment is warranted when counseling patients, balancing potential functional cure with the risk of late relapses and serious secondary malignancies.
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