ASH 2017 - Chronic Lymphocytic Leukemia

In patients with relapsed chronic lymphocytic leukemia (CLL), first salvage therapy with bendamustine and rituximab resulted in a 12-month progression-free survival (PFS) of 81% and overall survival (OS) of 92%, but PFS and OS were significantly lower in patients with del(17p) and/or unmutated IGHV and advanced stage disease (ie, Rai III-IV or Binet C).
At a median follow-up of 6 months, the triplet combination of umbralisib, ublituximab, and pembrolizumab was well-tolerated, with durable responses in patients with chronic lymphocytic leukemia (CLL) refractory to Bruton’s tyrosine kinase inhibitor therapy.
Treatment of patients with relapsed/refractory or symptomatic, treatment-naïve chronic lymphocytic leukemia (CLL) with the combination of acalabrutinib and obinutuzumab resulted in an acceptable safety profile and a >90% overall response rate, with 8% to 16% complete responses, and a median progression-free survival that was not reached at a median follow-up of 18 to 21 months.
In a retrospective cohort analysis of the largest series of patients with mantle-cell lymphoma (MCL) in which real-world economic burden data have been reported, the substantial economic burden of MCL was quantified, with inpatient admissions and office visits as the largest drivers of total costs for patients treated with rituximab, cyclophosphamide, doxorubicin, and vincristine; bendamustine and rituximab; and rituximab, and prescription drug costs as the largest component of total costs for patients receiving ibrutinib.
In a single-center, open-label, nonrandomized phase 2 study, the combination of pembrolizumab and rituximab was shown to be safe and effective (64% overall response rate, with a 48% complete response rate) in treating relapsed follicular lymphoma (FL); however, efficacy appeared to be unrelated to PD-L1 expression.
The addition of rituximab to ibrutinib in relapsed and high-risk treatment-naïve patients with chronic lymphocytic leukemia (CLL) did not improve progression-free survival, but patients treated with the combination reached their remissions significantly faster and achieved lower minimal residual disease levels, suggesting that single-agent ibrutinib should remain as the standard-of-care therapy in CLL, but the addition of rituximab can be considered in high-risk patients in whom a faster response is desirable.
The combination of ibrutinib and venetoclax is safe and effective in patients with chronic lymphocytic leukemia (CLL), with a 100% overall response rate and acceptable toxicities.
Ibrutinib, fludarabine, cyclophosphamide, and obinutuzumab used as first-line treatment in patients with chronic lymphocytic leukemia (CLL) with mutated IGHV achieves a high rate of undetectable minimal residual disease and complete remission after 3 courses, with an acceptable safety profile.
A multicenter phase 2 study of ibrutinib plus fludarabine, cyclophosphamide, and rituximab (FCR) as frontline therapy for younger patients with relatively high-risk chronic lymphocytic leukemia (CLL) showed that this combination resulted in superior rates of complete remission and bone marrow minimal residual disease negativity compared with FCR alone, with acceptable levels of toxicity.
The combination of obinutuzumab, ibrutinib, and venetoclax for 25 treatment-naïve patients with chronic lymphocytic leukemia (CLL) was safe and resulted in a 96% overall response rate, with a 52% rate of complete remission and a 58% rate of minimal residual disease negativity in blood and bone marrow after 8 cycles of therapy.
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