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
Digital Object Identifier (DOI)
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 progression-free, 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.
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Citation / Publisher Attribution
Blood, v. 118, issue 13, p. 3525-3527
Scholar Commons Citation
Smith, Mitchell R.; Neuberg, Donna; Flinn, Ian W.; Grever, Michael R.; Lazarus, Hillard M.; Rowe, Jacob M.; Dewald, Gordon; Bennett, John M.; Paietta, Elisabeth M.; Byrd, John C.; Hussein, Mohamad A.; Appelbaum, Frederick R.; Larson, Richard A.; Litzow, Mark R.; and Tallman, Martin S., "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" (2011). Internal Medicine Faculty Publications. 180.