What is the best treatment for relapsed CLL? The MDACC group makes a plea that it is still FCR. In the Blood of 17th March a final report of the large phase II study of FCR in relapsed CLL is made. The overall response rate was 74% and the CR rate 30%. The median overall survival was 47 months and progression-free survival 21 months.
They proposed a hierarchical model of the likelihood of a good response. Patients who were previously exposed to antibody therapy or purine analogues but not to alkylating agents had the highest response rates and survival. Patients who had previous exposure to purine analogues and alkylating agents had a perfectly acceptable respons unless they were refractory to fludarabine. Patients refractory to fludarabine or those who had received more than three previous types of treatment should not be offered FCR.
Drawing from the REACH trial, FCR still seems to have an advantage in patients with del 11q, but obviously not with patients with del 17p.
There were too few data on patients with other modern prognostic markers to draw any conclusions about them.
There are risks with older patients especially in patients who have received prior FCR. Prolonged cytopenias may be more of a risk than from other problems, but from these data it it seems that younger patients who had experienced a remission of at least 3 years are candidates for retreatment with FCR.
Doc,
ReplyDeleteHow would you say that FCR compares with Bendamustine for salvage treatment?
They have never been compared but I am not a bendamustine fan.
ReplyDeleteRe: not a bendabmustine fan
ReplyDeleteWhy not? I'm asking because bendamustine & rituxan is being proposed as my husband's upcoming treatment after his WBC is rising (now 100k) a year and a half after being treated w RCD. (77 yrs, Coombs pos.,11q del,unmutated.)
Thx.....
Because the Bendamustine v chlorambucil trial was rigged in bendamustine's favor. See my previous posting. IMO bendamustine is just another way of giving a big dose of alkylating agent iv at a profit.
ReplyDeleteDr. Hamblin,
ReplyDeleteMy Father 74 has relapsed after 30 months of 5 cycles of FCR. You and our Hematologist both suggested Bendamustine + Rituximab.
Our Hematologist is very much against FCR due to infection risk last time my father faced.
Is B+R more effective on nodes than blood? My Father has more of SLL.
I don't think B + R has any particular characteristics.
ReplyDeleteReference your comment "Patients refractory to fludarabine or those who had received more than three previous types of treatment should not be offered FCR". I was interested in knowing if you would still be of the same opinion for patients in the UK where it’s normal practice to screen for 17p deletions and double mutational status (sorry I may have the wording not quite right on the IgVH)?
ReplyDeleteNot sure what you mean by double mutational status. FCR could be offered to multiply treated patients who have never had fludarabine, but even in the UK that is now unlikely.
ReplyDelete