Outcomes of salvage therapy for patients with chronic lymphocytic leukemia

This study aimed to investigate outcomes of salvage therapy after treatment with fludarabine, cyclophosphamidine and rituximab fails in patients with chronic lymphocytic leukemia. This study concluded that salvage therapy can provide excellent outcomes for these patients.

Fludarabine (Fludara) is a chemotherapy used to treat lymphoma or leukemia. Cyclophosphamidine (Cytoxan) is used as a chemotherapy and to suppress the immune system. Rituximab (Rituxan) is used to treat autoimmune diseases and some cancers. These three drugs (FCR) are a combination used to treat chronic lymphocytic leukemia (CLL). Patients treated with FCR who had a short duration remission of less than 24 months had a poor prognosis. Patients who stopped FCR treatment due to side effects had good outcomes with salvage therapies. Salvage therapies are one used when no response is achieved with an initial therapy.

The outcomes of salvage therapy in patients who had been treated with FCR were not known.

This study involved 126 CLL patients treated with FCR as their initial treatment. 50% of patients received a salvage therapy. The reasons for this were relapse in 65% of patients, refractory disease in 14% and previous side effects in 21%. Patients were followed for an average 67 months (37 months from salvage therapy). Time to next treatment (TTNT) was calculated from beginning FCR to initiation of salvage therapy. Overall (OS, time from treatment until death from any cause) and event-free survival (EFS, time from treatment until next treatment or death) were calculated from initiation of salvage treatment.

TTNT less than 24 months was associated with shorter OS and EFS. OS was 19 months which was similar for patients with primary refractory disease (23 months).  EFS was 12 months which was similar for patients with primary refractory disease (9 months).

TTNT greater than or equal to 24 months led to longer OS and EFS. OS was 48 months and EFS was 20 months. EFS was 41 months for patients who received salvage therapy after FCR due to toxicity.

This study concluded that patients with CLL who discontinue FCR and receive a salvage treatment may achieve excellent outcomes. It was also concluded that patients progressing less than 24 months after FCR have poorer outcomes than those progressing later.

Larger studies need to be carried out.