Skip to main content
Top
Published in: Pathology & Oncology Research 2/2019

Open Access 01-04-2019 | Original Article

Effectiveness of the Combination of Rituximab and Standard Chemotherapeutic Regimens in Previously Untreated Patients with Chronic Lymphocytic Leukaemia in Real-Life: Results from a Noninterventional Study (CILI Study)

Authors: Róbert Szász, Elvira Altai, Katalin Pál, Péter Dombi, János Iványi, János Jakucs, Natália Jóni, Árpád Illés, Ilona Tárkányi, László Szerafin, Zsolt Nagy, Péter Farkas, Ágnes Nagy, Klára Piukovics, György Ujj, Tamás Schneider

Published in: Pathology & Oncology Research | Issue 2/2019

Login to get access

Abstract

Chronic lymphocytic leukemia (CLL) is one of the most common haematological malignancies exhibiting remarkable heterogeneity in clinical course. Rituximab added to standard chemotherapy has been proven to increase response rate and eventually survival among previously untreated CLL patients. CILI was an open-label, non-randomized, single arm, multicentric, observational study aimed to collect real-life effectiveness data for rituximab used according to the current label in combination with standard chemotherapy in previously untreated CLL patients. Overall response rates (ORR) in the entire study population as well as in various subgroups were estimated. Adverse events were recorded during the entire course of the study. A total number of 150 patients were enrolled by 15 Hungarian study sites. Out of these, 82 patients received 6 cycles of rituximab containing treatment. Overall response rates of 88.24% (CI95%: 81.6–93.12%) and 94.59% (CI95%: 86.73–98.51%) were recorded in the intent-to-treat (ITT) and per-protocol (PP) populations, respectively. In both study populations, somewhat higher ORR was observed in patients aged ≥65 years. Subgroups defined according to either chromosomal aberrations (presence of 11q and 17p deletions) showed apparently high ORRs, though these rates were most probably biased by low patient numbers. 144 adverse events were reported during the study, of which 15 AEs were considered to be related to the administration of rituximab. Analyses of the efficacy variables have revealed comparable results to those previously reported by controlled clinical trials.
Literature
1.
go back to reference Yu EM, Kittai A, Tabbara IA (2015) Chronic lymphocytic leukemia: current concepts. Anticancer Res 35(10):5149–5165PubMed Yu EM, Kittai A, Tabbara IA (2015) Chronic lymphocytic leukemia: current concepts. Anticancer Res 35(10):5149–5165PubMed
2.
go back to reference Matutes E, Polliack A (2000) Morphological and immunophenotypic features of chronic lymphocytic leukemia. Rev Clin Exp Hematol 4(1):22–47CrossRefPubMed Matutes E, Polliack A (2000) Morphological and immunophenotypic features of chronic lymphocytic leukemia. Rev Clin Exp Hematol 4(1):22–47CrossRefPubMed
3.
go back to reference Binet JL, Auquier A, Dighiero G et al (1981) A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 48:198–206CrossRefPubMed Binet JL, Auquier A, Dighiero G et al (1981) A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 48:198–206CrossRefPubMed
4.
go back to reference Rai KR, Sawitsky A, Cronkite EP et al (1975) Clinical staging of chronic lymphocytic leukemia. Blood 46:219–234PubMed Rai KR, Sawitsky A, Cronkite EP et al (1975) Clinical staging of chronic lymphocytic leukemia. Blood 46:219–234PubMed
5.
go back to reference Baliakas P, Mattsson M, Stamatopoulos K et al (2015) Prognostic indices in chronic lymphocytic leukaemia: where do we stand how do we proceed? J Intern Med 279(4):347–357CrossRefPubMed Baliakas P, Mattsson M, Stamatopoulos K et al (2015) Prognostic indices in chronic lymphocytic leukaemia: where do we stand how do we proceed? J Intern Med 279(4):347–357CrossRefPubMed
6.
go back to reference Rossi D, Terzi-di-Bergamo L, De Paoli L et al (2015) Molecular prediction of durable remission after first-line fludarabine-cyclophosphamide-rituximab in chronic lymphocytic leukemia. Blood 126(16):1921–1924CrossRefPubMedPubMedCentral Rossi D, Terzi-di-Bergamo L, De Paoli L et al (2015) Molecular prediction of durable remission after first-line fludarabine-cyclophosphamide-rituximab in chronic lymphocytic leukemia. Blood 126(16):1921–1924CrossRefPubMedPubMedCentral
7.
go back to reference Eichhorst BF, Busch R, Hopfinger G et al (2006) Fludarabine plus cyclophosphamide versus fludarabine alone in first-line therapy of younger patients with chronic lymphocytic leukemia. Blood 107:885–891CrossRefPubMed Eichhorst BF, Busch R, Hopfinger G et al (2006) Fludarabine plus cyclophosphamide versus fludarabine alone in first-line therapy of younger patients with chronic lymphocytic leukemia. Blood 107:885–891CrossRefPubMed
8.
go back to reference Flinn IW, Neuberg DS, Grever MR et al (2007) Phase III trial of fludarabine plus cyclophosphamide compared with fludarabine for patients with previously untreated chronic lymphocytic leukemia: US intergroup trial E2997. J Clin Oncol 25:793–798CrossRefPubMed Flinn IW, Neuberg DS, Grever MR et al (2007) Phase III trial of fludarabine plus cyclophosphamide compared with fludarabine for patients with previously untreated chronic lymphocytic leukemia: US intergroup trial E2997. J Clin Oncol 25:793–798CrossRefPubMed
9.
go back to reference Byrd JC, Peterson BL, Morrison VA et al (2003) Randomized phase 2 study of fludarabine with concurrent versus sequential treatment with rituximab in symptomatic, untreated patients with B-cell chronic lymphocytic leukemia: results from Cancer and leukemia group B 9712 (CALGB 9712). Blood 101(1):6–14CrossRefPubMed Byrd JC, Peterson BL, Morrison VA et al (2003) Randomized phase 2 study of fludarabine with concurrent versus sequential treatment with rituximab in symptomatic, untreated patients with B-cell chronic lymphocytic leukemia: results from Cancer and leukemia group B 9712 (CALGB 9712). Blood 101(1):6–14CrossRefPubMed
10.
go back to reference Cramer P, Isfort S, Bahlo J et al (2015) Outcome of advanced chronic lymphocytic leukemia following different first-line and relapse therapies: a meta-analysis of five prospective trials by the German CLL study group (GCLLSG). Haematologica 100(11):1451–1459CrossRefPubMedPubMedCentral Cramer P, Isfort S, Bahlo J et al (2015) Outcome of advanced chronic lymphocytic leukemia following different first-line and relapse therapies: a meta-analysis of five prospective trials by the German CLL study group (GCLLSG). Haematologica 100(11):1451–1459CrossRefPubMedPubMedCentral
11.
go back to reference Foà R, Del Giudice I, Cuneo A et al (2014) Chlorambucil plus rituximab with or without maintenance rituximab as first-line treatment for elderly chronic lymphocytic leukemia patients. Am J Hematol 89(5):480–486CrossRefPubMed Foà R, Del Giudice I, Cuneo A et al (2014) Chlorambucil plus rituximab with or without maintenance rituximab as first-line treatment for elderly chronic lymphocytic leukemia patients. Am J Hematol 89(5):480–486CrossRefPubMed
12.
go back to reference Goede V, Fischer K, Busch R et al (2014) Obinutuzumab plus Chlorambucil in patients with CLL and coexisting conditions. N Engl J Med 370:1101–1110CrossRef Goede V, Fischer K, Busch R et al (2014) Obinutuzumab plus Chlorambucil in patients with CLL and coexisting conditions. N Engl J Med 370:1101–1110CrossRef
13.
go back to reference Tedder TF, Engel P (1994) CD20: a regulator of cell-cycle progression of B lymphocytes. Immunol Today 15:450–454CrossRefPubMed Tedder TF, Engel P (1994) CD20: a regulator of cell-cycle progression of B lymphocytes. Immunol Today 15:450–454CrossRefPubMed
14.
go back to reference Reff ME, Carner K, Chambers KS (1994) Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood 83:435–445PubMed Reff ME, Carner K, Chambers KS (1994) Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood 83:435–445PubMed
15.
go back to reference Maloney D, Smith B, Appelbaum F (1996) The anti-tumor effect of monoclonal anti-CD20 antibody (MAB) therapy includes direct anti-proliferative activity and induction of apoptosis in CD20 positive non-Hodgkin’s lymphoma (NHL) cell lines. Blood 637a:88 Maloney D, Smith B, Appelbaum F (1996) The anti-tumor effect of monoclonal anti-CD20 antibody (MAB) therapy includes direct anti-proliferative activity and induction of apoptosis in CD20 positive non-Hodgkin’s lymphoma (NHL) cell lines. Blood 637a:88
16.
go back to reference Maloney DG, Liles TM, Czerwinski DK et al (1994) Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Blood 84:2457–2466PubMed Maloney DG, Liles TM, Czerwinski DK et al (1994) Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Blood 84:2457–2466PubMed
17.
go back to reference Eichhorst B, Robak T, Montserrat E et al (2015) Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v78–v84CrossRefPubMed Eichhorst B, Robak T, Montserrat E et al (2015) Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v78–v84CrossRefPubMed
18.
go back to reference Thurmes P, Call T, Slager S et al (2009) Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia. Leuk Lymphoma 49:49–56CrossRef Thurmes P, Call T, Slager S et al (2009) Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia. Leuk Lymphoma 49:49–56CrossRef
20.
go back to reference Hallek M (2017) Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment. Am J Hematol 92(9):946–965CrossRefPubMed Hallek M (2017) Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment. Am J Hematol 92(9):946–965CrossRefPubMed
21.
go back to reference Schulz H, Klein SK, Rehwald U (2002) Phase 2 study of a combined immunochemotherapy using rituximab and fludarabine in patients with chronic lymphocytic leukemia. Blood 100(9):3115–3120CrossRefPubMed Schulz H, Klein SK, Rehwald U (2002) Phase 2 study of a combined immunochemotherapy using rituximab and fludarabine in patients with chronic lymphocytic leukemia. Blood 100(9):3115–3120CrossRefPubMed
22.
go back to reference Fischer K, Cramer P, Busch R et al (2012) Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: a multicenter phase II trial of the German chronic lymphocytic leukemia study group. J Clin Oncol 30(26):3209–3216CrossRefPubMed Fischer K, Cramer P, Busch R et al (2012) Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: a multicenter phase II trial of the German chronic lymphocytic leukemia study group. J Clin Oncol 30(26):3209–3216CrossRefPubMed
23.
go back to reference Keating MJ, O'Brien S, Albitar M et al (2005) Early results of a chemoimmunotherapy regimen of fludarabine, cyclophosphamide, and rituximab as initial therapy for chronic lymphocytic leukemia. J Clin Oncol 23(18):4079–4088CrossRefPubMed Keating MJ, O'Brien S, Albitar M et al (2005) Early results of a chemoimmunotherapy regimen of fludarabine, cyclophosphamide, and rituximab as initial therapy for chronic lymphocytic leukemia. J Clin Oncol 23(18):4079–4088CrossRefPubMed
24.
go back to reference Hallek M, Fischer K, Fingerle-Rowson G et al (2010) Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet 376(9747):1164–1174CrossRefPubMed Hallek M, Fischer K, Fingerle-Rowson G et al (2010) Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet 376(9747):1164–1174CrossRefPubMed
25.
go back to reference Foon KA, Boyiadzis M, Land SR et al (2009) Chemoimmunotherapy with low-dose fludarabine and cyclophosphamide and high dose rituximab in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 27(4):498–503CrossRefPubMed Foon KA, Boyiadzis M, Land SR et al (2009) Chemoimmunotherapy with low-dose fludarabine and cyclophosphamide and high dose rituximab in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 27(4):498–503CrossRefPubMed
26.
go back to reference Döhner H, Stilgenbauer S, Benner A et al (2000) Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 343(26):1910–1916CrossRefPubMed Döhner H, Stilgenbauer S, Benner A et al (2000) Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 343(26):1910–1916CrossRefPubMed
Metadata
Title
Effectiveness of the Combination of Rituximab and Standard Chemotherapeutic Regimens in Previously Untreated Patients with Chronic Lymphocytic Leukaemia in Real-Life: Results from a Noninterventional Study (CILI Study)
Authors
Róbert Szász
Elvira Altai
Katalin Pál
Péter Dombi
János Iványi
János Jakucs
Natália Jóni
Árpád Illés
Ilona Tárkányi
László Szerafin
Zsolt Nagy
Péter Farkas
Ágnes Nagy
Klára Piukovics
György Ujj
Tamás Schneider
Publication date
01-04-2019
Publisher
Springer Netherlands
Published in
Pathology & Oncology Research / Issue 2/2019
Print ISSN: 1219-4956
Electronic ISSN: 1532-2807
DOI
https://doi.org/10.1007/s12253-018-0474-9

Other articles of this Issue 2/2019

Pathology & Oncology Research 2/2019 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine