المؤلفون: Thompson, Philip A., Lévy, Vincent, Tam, Constantine S., Al Nawakil, Chadi, Goudot, François‐Xavier, Quinquenel, Anne, Ysebaert, Loic, Michallet, Anne‐Sophie, Dilhuydy, Marie‐Sarah, Van Den Neste, Eric, Dupuis, Jehan, Keating, Michael J., Meune, Christophe, Cymbalista, Florence

المصدر: British Journal of Haematology; Nov2016, Vol. 175 Issue 3, p462-466, 5p, 1 Diagram, 1 Chart

مصطلحات موضوعية: ATRIAL fibrillation treatment, HEMORRHAGE treatment, HEART failure treatment, CHRONIC lymphocytic leukemia treatment, ADVERSE health care events, MEDICAL protocols

مستخلص: Atrial fibrillation ( AF) occurs in 5-9% of patients treated with ibrutinib for chronic lymphocytic leukaemia ( CLL); the clinical consequences and optimal management are unclear. We retrospectively studied 56 CLL patients who received ibrutinib and developed AF. Median time to onset was 3·8 months. AF was persistent in 35/56 (62%) cases despite treatment. Clinical consequences included: three episodes of severe cardiac failure (one fatal) and one stroke; eight non-thrombocytopenic patients (14%) experienced severe bleeding adverse events. Altogether, ibrutinib was permanently discontinued in 26/56 cases (46%). Data to guide optimal management are lacking and clinical practice guidelines are urgently needed. [ABSTRACT FROM AUTHOR]

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المؤلفون: Dartigeas, Caroline, Van Den Neste, Eric, Berthou, Christian, Maisonneuve, Hervé, Leprêtre, Stéphane, Dilhuydy, Marie-Sarah, Béné, Marie-Christine, Nguyen-Khac, Florence, Letestu, Rémi, Cymbalista, Florence, De Guibert, Sophie, Aurran, Thérèse, Laribi, Kamel, Vilque, Jean-Pierre, Tournilhac, Olivier, Delmer, Alain, Feugier, Pierre, Cazin, Bruno, Michallet, Anne-Sophie, Lévy, Vincent

المصدر: Leukemia & Lymphoma; Feb2016, Vol. 57 Issue 2, p328-334, 7p

مصطلحات موضوعية: CHRONIC lymphocytic leukemia treatment, FLUDARABINE, CYCLOPHOSPHAMIDE, RITUXIMAB, MYELOSUPPRESSION, THERAPEUTICS

مستخلص: Elderly patients with chronic lymphocytic leukemia (CLL) are underrepresented in trials evaluating fludarabine, cyclophosphamide, and rituximab (FCR). We assessed four cycles of FCR with two additional rituximab doses on day 14 of cycles 1 and 2 in 194 untreated CLL patients > 65 years (median age 71.2) without del17p. Four FCR cycles were administered to 90.7% (176/194), with (n= 74) or without (n= 102) dose-delay and/or dose-reduction. A total of 50% grade 3/4 neutropenia occurred after each cycle. Only 6.2% cycles were associated with severe infection. Complete remission (CR) was achieved in 19.7%, and partial remission (PR) in 73.9% of patients. Minimal residual disease (MRD) was negative in 36.7%. Overall survival at 36 months was estimated at 87.4%. Oral FC and dose-dense rituximab is feasible and active in fit elderly CLL patients. However, myelosuppression is significant and frequent dose adaptations are required implying that these results cannot be generalized to unfit or frail elderly CLL. [ABSTRACT FROM PUBLISHER]

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المؤلفون: Michallet, Anne-Sophie, Cazin, Bruno, Bouvet, Emmanuel, Oberic, Lucie, Schlaifer, Daniel, Mosser, Laurent, Salles, Gilles, Coiffier, Bertrand, Laurent, Guy, Ysebaert, Loïc

المصدر: Journal of Geriatric Oncology; Apr2013, Vol. 4 Issue 2, p141-147, 7p

مصطلحات موضوعية: CANCER immunotherapy, CANCER chemotherapy, OLDER patients, CHRONIC lymphocytic leukemia treatment, HEALTH outcome assessment, RITUXIMAB, DRUG dosage, CANCER

مستخلص: Abstract: Background: To date, the majority of trials on chronic lymphocytic leukemia (CLL) focused on patients considerably younger than the median age of onset for CLL. As a result, no definitive treatment exists for elderly patients, especially less medically fit patients. Objectives: The objectives of this study are to examine the impact of comorbidities on outcome as well as to compare three different therapeutic regimens in outcome efficacy. Materials and Methods: We retrospectively identified 143 patients aged >65 years, who received fludarabine, cyclophosphamide, and rituximab (FCR) (n=49), fludarabine and rituximab (FR) (n=74), or rituximab with chlorambucil (R–CLB) (n=20) as first initial immunochemotherapy. Results: At current follow-up (median: 24 months), the proportion of patients with a clinical response was higher with FCR (75%) than FR (57%) and R–CLB (28%). For FCR, FR, and R–CLB patients, 2-year overall survival (OS) was 94%, 76%, and 73%, respectively, (p=0.14), while 2-year progression-free survival (PFS) was 90%, 58%, and 30% (p<0.001). In the fludarabine based regimen (FR and FCR) population, higher rituximab doses (500mg/m² vs. 375mg/m²) correlated with prolonged PFS. Conclusion: Despite the retrospective nature of this study, we demonstrate that elderly patients with CLL benefit from frontline immunochemotherapy, and emphasize the importance of maintaining rituximab dose intensity. [Copyright &y& Elsevier]

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المؤلفون: Michallet, Anne-Sophie¹ (AUTHOR) anne-sophie.michallet@chu-lyon.fr, Rossignol, Julien² (AUTHOR), Cazin, Bruno² (AUTHOR), Ysebaert, Loic³ (AUTHOR)

المصدر: Leukemia & Lymphoma. Jul2011, Vol. 52 Issue 7, p1401-1403. 3p. 1 Chart, 1 Graph.

مصطلحات موضوعية: *CHRONIC lymphocytic leukemia treatment, *RITUXIMAB, *CYCLOPHOSPHAMIDE, *DEXAMETHASONE, *AUTOIMMUNE hemolytic anemia, *ANEMIA, *PATIENTS, *AUTOIMMUNE disease treatment

مستخلص: We report our experience on rituximab--cyclophosphamide--dexamethasone (RCD) combination therapy for the treatment of autoimmune disorders in 48 patients with chronic lymphocytic leukemia (CLL). The diagnosis of autoimmune disease (AID) was autoimmune hemolytic anemia (AIHA) in 26 (54%%), autoimmune thrombocytopenic purpura (AITP) in nine (18.8%%), Evans syndrome in eight (16.7%%), and pure red cell anemia (PRCA) in five patients (10.5%%). CLL was considered progressive in 40%% of subjects upon AID diagnosis. Overall, an 89.5%% response rate was obtained with this combination, irrespective of the AID type. Relapse occurred in 19 patients (39.6%%). The median duration of autoimmunity was 24 months, but the duration of response of autoimmunity (DR-AI) was higher for patients presenting with: (1) AID early during the CLL course (<3 years), or (2) both and pure red cell aplasia (PRCA) in five patients (10.5%) and AIHA. [ABSTRACT FROM AUTHOR]