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The HOVON68 CLL trial revisited: performance status and comorbidity affect survival in elderly patients with chronic lymphocytic leukemia

FJ. Vojdeman, MB. Van't Veer, GE. Tjønnfjord, M. Itälä-Remes, E. Kimby, A. Polliack, KL. Wu, JK. Doorduijn, WG. Alemayehu, S. Wittebol, T. Kozak, J. Walewski, MC. Abrahamse-Testroote, MH. van Oers, CH. Geisler,

. 2017 ; 58 (3) : 594-600. [pub] 20160802

Language English Country Great Britain

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc18011090

In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.

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