Incidence of therapy-related myeloid neoplasia after initial therapy for chronic lymphocytic leukemia with fludarabine-cyclophosphamide versus fludarabine: long-term follow-up of US Intergroup Study E2997.

Abstract:

:Chemotherapy-related myeloid neoplasia (t-MN) is a significant late toxicity concern after cancer therapy. In the randomized intergroup phase 3 E2997 trial, initial therapy of chronic lymphocytic leukemia with fludarabine plus cyclophosphamide (FC) compared with fludarabine alone yielded higher complete and overall response rates and longer progression-free, but not overall, survival. Here, we report t-MN incidence in 278 patients enrolled in E2997 with a median 6.4-year follow-up. Thirteen cases (4.7%) of t-MN occurred at a median of 5 years from initial therapy for chronic lymphocytic leukemia, 9 after FC and 4 after fludarabine alone. By cumulative incidence methodology, rates of t-MN at 7 years were 8.2% after FC and 4.6% after fludarabine alone (P = .09). Seven of the 9 cases of t-MN after FC occurred without additional therapy. Abnormalities involving chromosomes 5 or 7 were found in 10 cases, which suggests alkylator involvement. These data suggest that FC may induce more t-MN than fludarabine alone.

journal_name

Blood

journal_title

Blood

authors

Smith MR,Neuberg D,Flinn IW,Grever MR,Lazarus HM,Rowe JM,Dewald G,Bennett JM,Paietta EM,Byrd JC,Hussein MA,Appelbaum FR,Larson RA,Litzow MR,Tallman MS

doi

10.1182/blood-2011-03-342485

subject

Has Abstract

pub_date

2011-09-29 00:00:00

pages

3525-7

issue

13

eissn

0006-4971

issn

1528-0020

pii

blood-2011-03-342485

journal_volume

118

pub_type

杂志文章,多中心研究,随机对照试验

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