Poor efficacy and tolerability of R‐CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation |
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| Authors: | Petra Langerbeins Raymonde Busch Nadine Anheier Jan Dürig Manuela Bergmann Maria‐Elisabeth Goebeler Hans‐Jürgen Hurtz Martina B Stauch Stephan Stilgenbauer Hartmut Döhner Anna‐Maria Fink Paula Cramer Kirsten Fischer Clemens‐Martin Wendtner Michael Hallek Barbara Eichhorst |
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| Affiliation: | 1. Department I of Internal Medicine, Center of Integrated Oncology (CIO), and CECAD‐Cluster of Excellence “Cellular Stress Responses in Aging‐Associated Diseases,” University of Cologne, Germany;2. Institute of Medical Statistics and Epidemiology, Technical University, Munich, Germany;3. Department I of Internal Medicine, Clinical Center Schwabing, Munich, Germany;4. Department of Hematology, University Hospital Essen, Germany;5. Department for Internal Medicine II, University Hospital of Würzburg, Germany;6. Hematology/Oncology Group Practice, Halle, Germany;7. Private Practice Oncology and Hematology, Kronach, Germany;8. Department III of Internal Medicine, University Hospital, Ulm, Germany |
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| Abstract: | This phase II trial evaluated efficacy and tolerability of R‐CHOP for up to 8 courses in Richter transformation (RT) and up to 6 courses in CLL plus autoimmune cytopenia (AIC) or high‐risk (HR) features. HR was defined as fludarabine‐refractoriness or early relapse (<36 months) after fludarabine‐based treatment; 26 patients were included as HR, 19 patients had AIC, and 15 patients had RT. In the HR cohort, overall response rate was 54%, progression‐free and overall survival were 9 and 21 months. In AIC patients overall response rate was 74%, progression‐free and overall‐survival were 10 and 41 months, respectively, and median increase in hemoglobin was 3.4 g/L. RT patients responded in 67%, progression‐free was 10 and overall survival 21 months. The most common adverse events were hematologic toxicities in 92%. Severe infections occurred in 28%. Treatment was discontinued early in 45% of all patients mainly as a result of toxicity. This trial shows that R‐CHOP has no role in treating complicated CLL. R‐CHOP is associated with significant toxicities and fairly low efficacy compared with almost every other CLL‐regimen. In RT, it might still be used as an induction therapy before allogeneic stem cell transplantation. Am. J. Hematol. 89:E239–E243, 2014. © 2014 Wiley Periodicals, Inc. |
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