TY - JOUR
T1 - The HOVON68 CLL trial revisited
T2 - performance status and comorbidity affect survival in elderly patients with chronic lymphocytic leukemia
AU - Vojdeman, Fie Juhl
AU - Van't Veer, Mars B
AU - Tjønnfjord, Geir E
AU - Itälä-Remes, Maija
AU - Kimby, Eva
AU - Polliack, Aaron
AU - Wu, Ka L
AU - Doorduijn, Jeanette K
AU - Alemayehu, Wendimagegn G
AU - Wittebol, Shulamiet
AU - Kozak, Tomas
AU - Walewski, Jan
AU - Abrahamse-Testroote, Martine C J
AU - van Oers, Marinus H J
AU - Geisler, Christian Hartmann
PY - 2017/3
Y1 - 2017/3
N2 - In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.
AB - In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Antineoplastic Combined Chemotherapy Protocols/adverse effects
KW - Cause of Death
KW - Clinical Trials as Topic
KW - Combined Modality Therapy
KW - Comorbidity
KW - Female
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
KW - Male
KW - Mortality
KW - Transplantation, Homologous
U2 - 10.1080/10428194.2016.1213831
DO - 10.1080/10428194.2016.1213831
M3 - Journal article
C2 - 27484290
SN - 1042-8194
VL - 58
SP - 594
EP - 600
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 3
ER -