Abstract | BACKGROUND: The prevalence of chronic lymphocytic leukemia (CLL) increases with age. Although chemoimmunotherapy ( CIT) has dramatically improved response rates in patients with CLL, some CIT regimens are not well tolerated by many patients >or=70 years of age. METHODS: Sixty-four previously untreated patients with CLL and serum creatinine <1.5 times the upper limit of normal who met National Cancer Institute (NCI) 96-WG criteria for treatment received pentostatin (2 mg/m(2)), cyclophosphamide (600 mg/m(2)), and rituximab (375 mg/m(2)). The authors measured performance status at study entry and used age, weight, and baseline creatinine to calculate creatinine clearance (CrCl). RESULTS: Eighteen of 64 (28%) patients were ages >or=70 years. Although individuals ages >or=70 years were more likely to have delayed treatment cycles (28% vs 7%; P=.03), there were no significant differences in the number of cycles administered, need for dose reductions, or grade 3-4 hematologic, infectious, or other toxicities. No significant differences in overall response rate, complete response rate, or progression-free survival were observed by age. Twenty-five (39%) patients had a CrCl < 70 mL/min (range, 34-67). Although individuals with CrCl < 70 were more likely to require dose reduction (24% vs 5%; P=.05), there were no significant differences in the number of cycles administered or grade 3-4 hematologic, infectious, or other toxicities. No significant difference in overall response rate, complete response rate, or progression-free survival were observed between patients with CrCl >or= 70 mL/min and those with CrCl < 70 mL/min. CONCLUSIONS: In this clinical trial, the PCR regimen was well tolerated by older patients and individuals with CrCl <or= 70. The efficacy of PCR was not significantly affected by age or renal function. These findings suggest PCR may be a good therapeutic option for older patients and those with modestly decreased renal function.
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Authors | Tait D Shanafelt, Thomas Lin, Susan M Geyer, Clive S Zent, Nelson Leung, Brian Kabat, Deborah Bowen, Michael R Grever, John C Byrd, Neil E Kay |
Journal | Cancer
(Cancer)
Vol. 109
Issue 11
Pg. 2291-8
(Jun 01 2007)
ISSN: 0008-543X [Print] United States |
PMID | 17514743
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | (c) 2007 American Cancer Society. |
Chemical References |
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Murine-Derived
- Pentostatin
- Rituximab
- Cyclophosphamide
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Topics |
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal
(administration & dosage)
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Cyclophosphamide
(administration & dosage)
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell
(drug therapy)
- Pentostatin
(administration & dosage)
- Prognosis
- Rituximab
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