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IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment: a Danish nationwide population-based study

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Rotbain, Emelie Curovic ; Frederiksen, Henrik ; Hjalgrim, Henrik ; Rostgaard, Klaus ; Jakupsdottir Egholm, Gudrun ; Zahedi, Banafsheh ; Poulsen, Christian Bjørn ; Enggaard, Lisbeth ; da Cunha-Bang, Caspar ; Niemann, Carsten Utoft. / IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment : a Danish nationwide population-based study. I: Haematologica. 2020 ; Bind 104.

Bibtex

@article{2baf5a0017e64109ad5ecfc0325bf32a,
title = "IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment: a Danish nationwide population-based study",
abstract = "Patients with chronic lymphocytic leukemia and immunoglobulin heavy-chain variable region gene unmutated status have inferior survival from time of treatment in clinical studies. We assessed real-world outcomes based on mutational status and treatment regimen in a nationwide population-based cohort, comprising all 4135 patients from the Danish chronic lymphocytic leukemia registry diagnosed between 2008 and 2017. In total, 850 patients with known mutational status received treatment: 42{\%} of patients received intensive chemoimmunotherapy treatment consisting of fludarabine, cyclophosphamide plus rituximab, or bendamustine plus rituximab; 27{\%} received chlorambucil in combination with anti-CD20 antibodies or as monotherapy, and 31{\%} received other, less common, treatments. No difference in overall survival from time of first treatment according to mutational status was observed, while treatment-free survival from start of first treatment was inferior for unmutated patients. The median treatment-free survival was 2.5 years for patients treated with chlorambucil plus anti-CD20, and 1 year for chlorambucil monotherapy. The 3-year treatment-free survival for fludarabine, cyclophosphamide plus rituximab-, and bendamustine plus rituximab-treated patients was 90{\%} and 91{\%} for mutated, and 76{\%} and 53{\%} for unmutated patients respectively, and the 3-year overall survival was similar for the two regimens (86-88{\%}). Thus, it appears that patients progressing after intensive chemoimmunotherapy as first line therapy can be rescued by subsequent treatment, without jeopardizing long overall survival, in the real-world setting. Intensive chemoimmunotherapy remains a legitimate option alongside targeted agents, and part of a personalized treatment landscape in chronic lymphocytic leukemia, while improved supportive care and treatment options are warranted for unfit patients.",
author = "Rotbain, {Emelie Curovic} and Henrik Frederiksen and Henrik Hjalgrim and Klaus Rostgaard and {Jakupsdottir Egholm}, Gudrun and Banafsheh Zahedi and Poulsen, {Christian Bj{\o}rn} and Lisbeth Enggaard and {da Cunha-Bang}, Caspar and Niemann, {Carsten Utoft}",
note = "Copyright {\circledC} 2019, Ferrata Storti Foundation.",
year = "2020",
doi = "10.3324/haematol.2019.220194",
language = "English",
volume = "104",
journal = "Haematologica",
issn = "0390-6078",
publisher = "Fondazione/Ferrata Storti",

}

RIS

TY - JOUR

T1 - IGHV mutational status and outcome for patients with chronic lymphocytic leukemia upon treatment

T2 - a Danish nationwide population-based study

AU - Rotbain, Emelie Curovic

AU - Frederiksen, Henrik

AU - Hjalgrim, Henrik

AU - Rostgaard, Klaus

AU - Jakupsdottir Egholm, Gudrun

AU - Zahedi, Banafsheh

AU - Poulsen, Christian Bjørn

AU - Enggaard, Lisbeth

AU - da Cunha-Bang, Caspar

AU - Niemann, Carsten Utoft

N1 - Copyright © 2019, Ferrata Storti Foundation.

PY - 2020

Y1 - 2020

N2 - Patients with chronic lymphocytic leukemia and immunoglobulin heavy-chain variable region gene unmutated status have inferior survival from time of treatment in clinical studies. We assessed real-world outcomes based on mutational status and treatment regimen in a nationwide population-based cohort, comprising all 4135 patients from the Danish chronic lymphocytic leukemia registry diagnosed between 2008 and 2017. In total, 850 patients with known mutational status received treatment: 42% of patients received intensive chemoimmunotherapy treatment consisting of fludarabine, cyclophosphamide plus rituximab, or bendamustine plus rituximab; 27% received chlorambucil in combination with anti-CD20 antibodies or as monotherapy, and 31% received other, less common, treatments. No difference in overall survival from time of first treatment according to mutational status was observed, while treatment-free survival from start of first treatment was inferior for unmutated patients. The median treatment-free survival was 2.5 years for patients treated with chlorambucil plus anti-CD20, and 1 year for chlorambucil monotherapy. The 3-year treatment-free survival for fludarabine, cyclophosphamide plus rituximab-, and bendamustine plus rituximab-treated patients was 90% and 91% for mutated, and 76% and 53% for unmutated patients respectively, and the 3-year overall survival was similar for the two regimens (86-88%). Thus, it appears that patients progressing after intensive chemoimmunotherapy as first line therapy can be rescued by subsequent treatment, without jeopardizing long overall survival, in the real-world setting. Intensive chemoimmunotherapy remains a legitimate option alongside targeted agents, and part of a personalized treatment landscape in chronic lymphocytic leukemia, while improved supportive care and treatment options are warranted for unfit patients.

AB - Patients with chronic lymphocytic leukemia and immunoglobulin heavy-chain variable region gene unmutated status have inferior survival from time of treatment in clinical studies. We assessed real-world outcomes based on mutational status and treatment regimen in a nationwide population-based cohort, comprising all 4135 patients from the Danish chronic lymphocytic leukemia registry diagnosed between 2008 and 2017. In total, 850 patients with known mutational status received treatment: 42% of patients received intensive chemoimmunotherapy treatment consisting of fludarabine, cyclophosphamide plus rituximab, or bendamustine plus rituximab; 27% received chlorambucil in combination with anti-CD20 antibodies or as monotherapy, and 31% received other, less common, treatments. No difference in overall survival from time of first treatment according to mutational status was observed, while treatment-free survival from start of first treatment was inferior for unmutated patients. The median treatment-free survival was 2.5 years for patients treated with chlorambucil plus anti-CD20, and 1 year for chlorambucil monotherapy. The 3-year treatment-free survival for fludarabine, cyclophosphamide plus rituximab-, and bendamustine plus rituximab-treated patients was 90% and 91% for mutated, and 76% and 53% for unmutated patients respectively, and the 3-year overall survival was similar for the two regimens (86-88%). Thus, it appears that patients progressing after intensive chemoimmunotherapy as first line therapy can be rescued by subsequent treatment, without jeopardizing long overall survival, in the real-world setting. Intensive chemoimmunotherapy remains a legitimate option alongside targeted agents, and part of a personalized treatment landscape in chronic lymphocytic leukemia, while improved supportive care and treatment options are warranted for unfit patients.

U2 - 10.3324/haematol.2019.220194

DO - 10.3324/haematol.2019.220194

M3 - Journal article

VL - 104

JO - Haematologica

JF - Haematologica

SN - 0390-6078

ER -

ID: 58441705