Incidence of therapy-related myeloid neoplasia after initial therapy for chronic lymphocytic leukemia with fludarabine-cyclophosphamide versus fludarabine: Long-term follow-up of US intergroup study E2997 Journal Article
| Authors: | Smith, M. R.; Neuberg, D.; Flinn, I. W.; Grever, M. R.; Lazarus, H. M.; Rowe, J. M.; Dewald, G.; Bennett, J. M.; Paietta, E. M.; Byrd, J. C.; Hussein, M. A.; Appelbaum, F. R.; Larson, R. A.; Litzow, M. R.; Tallman, M. S. |
| Article Title: | Incidence of therapy-related myeloid neoplasia after initial therapy for chronic lymphocytic leukemia with fludarabine-cyclophosphamide versus fludarabine: Long-term follow-up of US intergroup study E2997 |
| Abstract: | Chemotherapy-related myeloid neoplasia (t-MN) is a significant late toxicity concern after cancer therapy. In the randomized intergroup phase 3 E2997 trial, initial therapy of chronic lymphocytic leukemia with fludarabine plus cyclophosphamide (FC) compared with fludarabine alone yielded higher complete and overall response rates and longer progressionfree, but not overall, survival. Here, we report t-MN incidence in 278 patients enrolled in E2997 with a median 6.4-year follow-up. Thirteen cases (4.7%) of t-MN occurred at a median of 5 years from initial therapy for chronic lymphocytic leukemia, 9 after FC and 4 after fludarabine alone. By cumulative incidence methodology, rates of t-MN at 7 years were 8.2% after FC and 4.6% after fludarabine alone (P - .09). Seven of the 9 cases of t-MN after FC occurred without additional therapy. Abnormalities involving chromosomes 5 or 7 were found in 10 cases, which suggests alkylator involvement. These data suggest that FC may induce more t-MN than fludarabine alone. © 2011 by The American Society of Hematology. |
| Keywords: | adult; cancer survival; controlled study; aged; aged, 80 and over; middle aged; major clinical study; fludarabine; cancer combination chemotherapy; cancer growth; united states; rituximab; follow up; follow-up studies; disease association; drug eruption; multiple cycle treatment; cohort studies; etoposide; randomized controlled trial; antineoplastic combined chemotherapy protocols; incidence; randomized controlled trials as topic; cytogenetics; alkylating agent; cyclophosphamide; stem cell transplantation; risk factor; time factors; age; immunoglobulin heavy chain; immunoglobulin variable region; clinical trials, phase iii as topic; drug response; neoplasms, second primary; recombinant granulocyte colony stimulating factor; chronic lymphatic leukemia; leukemia, lymphocytic, chronic, b-cell; myeloma; vidarabine; leukemia remission; bone marrow neoplasms; chromosome 7; myeloid neoplasia; chromosome 5 |
| Journal Title: | Blood |
| Volume: | 118 |
| Issue: | 13 |
| ISSN: | 0006-4971 |
| Publisher: | American Society of Hematology |
| Date Published: | 2011-09-29 |
| Start Page: | 3525 |
| End Page: | 3527 |
| Language: | English |
| DOI: | 10.1182/blood-2011-03-342485 |
| PROVIDER: | scopus |
| PMCID: | PMC3186330 |
| PUBMED: | 21803850 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 2 November 2011" - "CODEN: BLOOA" - "Source: Scopus" |
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