In a nutshell
This study examined the effect of gender on treatment outcomes with chemo-immunotherapy for chronic lymphocytic leukemia (CLL). Researchers reported better survival and disease progression outcomes for female patients receiving rituximab-based (Rituxan) therapy.
Some background
Men are more likely to develop CLL than women. Gender is also known to affect the progression and prognosis of CLL. Studies have shown that female patients have longer survival and lower chances of disease progression after treatment with chemotherapy. However, standard treatment for CLL usually involves a combination of chemotherapy and immunotherapy. The effect of gender on outcomes with chemo-immunotherapy is less well understood.
Methods & findings
This study analyzed the effect of gender on a total of 2,247 CLL patients. 1,078 patients were treated with FCR (fludarabine, cyclophosphamide, and rituximab) or BR (bendamustine and rituximab). Of these, 27% were women and 73% were men. A further 657 patients received chlorambucil-based therapy (CLB) with either rituximab or obinutuzumab. Of these, 38.5% were women and 61.5% were men. 512 patients were treated with chemotherapy only and were analyzed separately.
Complete remission with FCR treatment was 50% in female patients and 41.9% in male patients. For BR treatment, it was 29.5% for women and 29.1% for men. Gender did not affect the presence of minimal residual disease (small number of leukemia cancer cells that remain after treatment). 66.4% of women and 66.7% of men were achieved negative minimal residual disease after FCR/BR.
24.7% of female patients and 19.8% of male patients achieved complete remission after CLB. Negative minimal residual disease was more frequently observed in female patients.
Following FCR or BR, the average time until disease progression for women was 60.3 months. This was significantly longer compared to men (49 months). Progression-free survival was also significantly longer in women treated with CLB plus rituximab (18.1 months) compared to men (14.3 months). No significant gender differences were observed in patients treated with CLB plus obinutuzumab.
The 5-year overall survival rate (proportion who have not died from any cause since treatment) for FCR/BR-treated women was 81.8%. It was 78.4% for men. This difference was not statistically significant. In patients treated with CLB plus rituximab, the 4-year overall survival rate was significantly higher in women (76.6%) than in men (64%). No such significant differences were noted for CLB plus obinutuzumab.
The bottom line
This study concluded that gender is an independent predictor for disease progression in CLL patients receiving rituximab-based therapy.
Published By :
Leukemia
Date :
Jul 28, 2017
