Limited information is available on the efficacy of front-line bendamustine and rituximab (BR) in chronic lymphocytic leukemia (CLL) with reduced renal function or coexisting conditions. We therefore analyzed a cohort of real-world patients and performed a matched adjusted indirect comparison with a cohort of patients treated with ibrutinib. One hundred and fifty-seven patients with creatinine clearance (CrCl) <70 mL/min and/or CIRS score >6 were treated with BR. The median age was 72 years; 69% of patients had ≥2 comorbidities and the median CrCl was 59.8 mL/min. 17.6% of patients carried TP53 disruption. The median progression-free survival (PFS) was 45 months; TP53 disruption was associated with a shorter PFS (P = 0.05). The overall survival (OS) at 12, 24, and 36 months was 96.2%, 90.1%, and 79.5%, respectively. TP53 disruption was associated with an increased risk of death (P = 0.01). Data on 162 patients ≥65 years treated with ibrutinib were analyzed and compared with 165 patients ≥65 years treated with BR. Factors predicting for a longer PFS at multivariable analysis in the total patient population treated with BR and ibrutinib were age (HR 1.06, 95% CI 1.02-1.10, P < 0.01) and treatment with ibrutinib (HR 0.55, 95% CI 0.33-0.93, P = 0.03). In a post hoc analysis of patients in advanced stage, a significant PFS advantage was observed in patient who had received ibrutinib (P = 0.03), who showed a trend for OS advantage (P = 0.08). We arrived at the following conclusions: (a) BR is a relatively effective first-line regimen in a real-world population of unfit patients without TP53 disruption, (b) ibrutinib provided longer disease control than BR in patients with advanced disease stage.
- Klíčová slova
- bendamustine, chronic lymphocytic leukemia, ibrutinib, real-world analysis, unfit patients,
- MeSH
- adenin škodlivé účinky analogy a deriváty terapeutické užití MeSH
- alkylační protinádorové látky škodlivé účinky terapeutické užití MeSH
- bendamustin hydrochlorid škodlivé účinky terapeutické užití MeSH
- časové faktory MeSH
- chronická lymfatická leukemie diagnóza farmakoterapie mortalita MeSH
- doba přežití bez progrese choroby MeSH
- inhibitory proteinkinas škodlivé účinky terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- piperidiny škodlivé účinky terapeutické užití MeSH
- progrese nemoci MeSH
- protinádorové látky imunologicky aktivní škodlivé účinky terapeutické užití MeSH
- protokoly protinádorové kombinované chemoterapie škodlivé účinky terapeutické užití MeSH
- retrospektivní studie MeSH
- rituximab škodlivé účinky terapeutické užití MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Evropa MeSH
- Spojené státy americké MeSH
- Názvy látek
- adenin MeSH
- alkylační protinádorové látky MeSH
- bendamustin hydrochlorid MeSH
- ibrutinib MeSH Prohlížeč
- inhibitory proteinkinas MeSH
- piperidiny MeSH
- protinádorové látky imunologicky aktivní MeSH
- rituximab MeSH
