ROLE OF CHLORAMBUCIL IN COMBINATION OR NOT WITH ANTI‐CD20 AS FRONTLINE THERAPY IN CHRONIC LYMPHOCYTIC LEUKEMIA IN "REAL LIFE"

Abstract

Introduction: Recently, different studies have shown superiority of ibrutinib in progression-free survival (PFS) over chlorambucil or chlorambucil in combination anti-CD20 in the treatment of chronic lymphocytic leukemia (CLL) in first line. Some guidelines consider that the role of chlorambucil is obsolete. However, despite superiority in PFS, no benefit in overall survival (OS) has been observed. Moreover, anti-CD20 chlorambucil combination has been used in population with comorbidities in which life expectancy, either by age or comorbidities, is short. Therefore, the benefit of ibrutinib in this population is controversial, in addition to an exponential increase in drug cost. Aims: Analyze characteristics and the evolution of patients diagnosed of CLL treated with chlorambucil in monotherapy or in combination with antiCD20 in first line, in real life. Methods: A retrospective study of patients with CLL in University Hospital of Alava, between January 2012-2019, whose frontline therapy is chlorambucil in monotherapy or in combination with antiCD20. Comorbidities were assessed using the CIRS scale (Cumulative Illness Rating Scale for Geriatrics), and time to next treatment (TTNT), OS and disease status at the time of death were also recorded. Results: 16 men and 4 women were included, with a median age of 81 years (75-86) and a median CIRS score of 7 (2-15), additional characteristics are shown in table 1. With a median follow-up of 35 months, the PFS was 30 months, while the median TTNT was 40 months and OS was 59 months (figure 1). It should be noted that 7 of the 10 patients died without receiving a second line therapy, although 70% of them had active disease at the time of death. The cause of death were: infections (3), pulmonary thromboembolism (1), sudden death (1), progression to acute leukemia (1) and uncontrolled primary immune thrombocytopenia and hemolityc anemia. Conclusions: In our setting, CLL patients requiring treatment with Chlorambucil +/- antiCD20 are older and have more comorbidities than patients reported in the published clinical trials. 70% of patients died without requiring a second line therapy. Therefore, in terms of therapeutic efficiency and also regarding pharmaco-economy, chlorambucil-antiCD20 continues to be a valid alternative in unfit patients. (Figure Presented).