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THE ROLE OF MAINTENANCE THERAPY IN THE TREATMENT OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA
Author(s):
Aleksei Kuvshinov
,
Aleksei Kuvshinov
Affiliations:
Russian Scientific Research Institute of Hematology and Transfusiology,Saint-Petersburg,Russian Federation
Sergey Voloshin
,
Sergey Voloshin
Affiliations:
Russian Scientific Research Institute of Hematology and Transfusiology,Saint-Petersburg,Russian Federation
Irina Martynkevich
,
Irina Martynkevich
Affiliations:
Russian Scientific Research Institute of Hematology and Transfusiology,Saint-Petersburg,Russian Federation
Andrey Garifullin
,
Andrey Garifullin
Affiliations:
Russian Scientific Research Institute of Hematology and Transfusiology,Saint-Petersburg,Russian Federation
Elizaveta Kleina
Elizaveta Kleina
Affiliations:
Russian Scientific Research Institute of Hematology and Transfusiology,Saint-Petersburg,Russian Federation
(Abstract release date: 05/18/17) EHA Library. Kuvshinov A. 05/18/17; 182501; PB1787
Dr. Aleksei Kuvshinov
Dr. Aleksei Kuvshinov
Contributions
PDF Abstract
Abstract

Abstract: PB1787

Type: Publication Only

Background
The inclusion in the treatment program of new drugs (including new monoclonal antibodies and targeted therapies) allowed the majority of patients with chronic lymphocytic leukemia (CLL) to achieve disease remission (complete or partial) after combined therapy. So, at now, the urgent task is long-term preservation and the deepening of the therapeutic response, if it is possible. This problem can be solved by intensification of therapy (including autologous transplantation of hematopoietic stem cells) or maintenance therapy (MT)

Aims
To estimate the importance of maintenance therapy in the treatment of patients with CLL

Methods
The study included 198 patients. Male to female ratio - 1.3:1. We have used NCI revised guidelines (Hallek M, et al., 2008) for treatment initiation, assessment of response and minimal residual disease (MRD). Induction chemotherapy was conducted under the following programs: RB, FC, RFC, R-CHOP, Ibrutinib-RB, Ibrutinib-R. Evaluation of MRD was performed using 5-color flow cytometry of the bone marrow cells. The maintenance therapy was conducted 144 (72.7%) patients: Rituximab 500 mg/m2 intravenously every 8 weeks (n=116) for 2 years; Ibrutinib 420 mg, orally, daily (n=28) continuously. The remaining patients (n=54) were under dynamic observation without therapy

Results

The increasing the depth of response (from partial (PR) to complete remission (CR)) was observed only in group of patients receiving MT – 10.4% (15/144) (p=0.013). The frequency of increase the depth of remission in the patients treated with MT of Ibrutinib was 28.6% (8/28), MT of Rituximab – 6.0% (7/144) (p=0.0005). The medians of PFS and duration of response were a longer in the patients with MT versus in the patients without MT: PFS – 48 months and 37 months, respectively (p=0.03); duration of response – 44.0 months and 25.5 months, respectively (p=0.0006). The median of duration of response in the patients with MT of Ibrutinib was not reached, in the patients with MT of Rituximab – 41.9 month, in the patient without MT – 25.5 month (p=0.004). The frequency of relapses in the group of patients with MT was 39.6% (57/144), in the group of patients without MT – 66.7% (36/54) (p=0.0007). Recurrence of the disease occurred more frequently in the group of patients treated with MT of Rituximab, compared with Ibrutinib: 45.7% (53/116) and 14.3% (4/28), respectively (p=0.002). The median duration of observation in the group with rituximab was 22 months, while in the group with Ibrutinib – 11 months.
MRD was not detected after 6-12 months of MT in 23.5% (12/51) had previously MRD-positive patients.
Among patients with MRD-negative CR relapse is less common than in patients with MRD-positive CR – 20.0% (4/20) versus 62.5% (10/16), respectively (p=0.009).
Significant differences in the incidence of infectious complications between patients with MT and without of MT were not detected (p˃0.05)

Conclusion
The conducting of MT patients with CLL allows to achieve increasing the depth achieved remission and increase the duration of its preservation. MT may be a means of control over the minimal residual disease and the method of its eradication

Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical

Keyword(s): Maintenance, Chronic Lymphocytic Leukemia, Targeted therapy, Minimal residual disease (MRD)

Abstract: PB1787

Type: Publication Only

Background
The inclusion in the treatment program of new drugs (including new monoclonal antibodies and targeted therapies) allowed the majority of patients with chronic lymphocytic leukemia (CLL) to achieve disease remission (complete or partial) after combined therapy. So, at now, the urgent task is long-term preservation and the deepening of the therapeutic response, if it is possible. This problem can be solved by intensification of therapy (including autologous transplantation of hematopoietic stem cells) or maintenance therapy (MT)

Aims
To estimate the importance of maintenance therapy in the treatment of patients with CLL

Methods
The study included 198 patients. Male to female ratio - 1.3:1. We have used NCI revised guidelines (Hallek M, et al., 2008) for treatment initiation, assessment of response and minimal residual disease (MRD). Induction chemotherapy was conducted under the following programs: RB, FC, RFC, R-CHOP, Ibrutinib-RB, Ibrutinib-R. Evaluation of MRD was performed using 5-color flow cytometry of the bone marrow cells. The maintenance therapy was conducted 144 (72.7%) patients: Rituximab 500 mg/m2 intravenously every 8 weeks (n=116) for 2 years; Ibrutinib 420 mg, orally, daily (n=28) continuously. The remaining patients (n=54) were under dynamic observation without therapy

Results

The increasing the depth of response (from partial (PR) to complete remission (CR)) was observed only in group of patients receiving MT – 10.4% (15/144) (p=0.013). The frequency of increase the depth of remission in the patients treated with MT of Ibrutinib was 28.6% (8/28), MT of Rituximab – 6.0% (7/144) (p=0.0005). The medians of PFS and duration of response were a longer in the patients with MT versus in the patients without MT: PFS – 48 months and 37 months, respectively (p=0.03); duration of response – 44.0 months and 25.5 months, respectively (p=0.0006). The median of duration of response in the patients with MT of Ibrutinib was not reached, in the patients with MT of Rituximab – 41.9 month, in the patient without MT – 25.5 month (p=0.004). The frequency of relapses in the group of patients with MT was 39.6% (57/144), in the group of patients without MT – 66.7% (36/54) (p=0.0007). Recurrence of the disease occurred more frequently in the group of patients treated with MT of Rituximab, compared with Ibrutinib: 45.7% (53/116) and 14.3% (4/28), respectively (p=0.002). The median duration of observation in the group with rituximab was 22 months, while in the group with Ibrutinib – 11 months.
MRD was not detected after 6-12 months of MT in 23.5% (12/51) had previously MRD-positive patients.
Among patients with MRD-negative CR relapse is less common than in patients with MRD-positive CR – 20.0% (4/20) versus 62.5% (10/16), respectively (p=0.009).
Significant differences in the incidence of infectious complications between patients with MT and without of MT were not detected (p˃0.05)

Conclusion
The conducting of MT patients with CLL allows to achieve increasing the depth achieved remission and increase the duration of its preservation. MT may be a means of control over the minimal residual disease and the method of its eradication

Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical

Keyword(s): Maintenance, Chronic Lymphocytic Leukemia, Targeted therapy, Minimal residual disease (MRD)

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