Lenalidomide as initial therapy of elderly patients with chronic lymphocytic leukemia
Mené sur 60 patients de plus de 65 ans, cette étude évalue le lénalidomide en traitement de première ligne d'une leucémie lymphocytaire chronique (durée médiane de suivi : 29 mois)
The best initial therapy for elderly patients with chronic lymphocytic leukemia (CLL) has not yet been defined. We investigated the activity of lenalidomide as initial therapy for elderly patients with CLL. Sixty patients with CLL age 65 years and older received treatment with lenalidomide orally 5 mg daily for 56 days, then titrated up to 25 mg per day as tolerated. Treatment was continued until disease progression. At a median follow-up of 29 months, 53 patients (88%) are alive and 32 patients (53%) remain on therapy. Estimated 2-year progression-free survival is 60%. The overall response rate to lenalidomide therapy is 65% including 10% complete response, 5% complete response with residual cytopenia, 7% nodular partial response, and 43% partial response. Neutropenia is the most common grade 3-4 treatment-related toxicity observed in 34% of treatment cycles. Major infections or neutropenic fever occurred in 12% of patients. When compared with baseline levels we noted an increase in serum Immunoglobulin levels across all classes and a reduction in CCL3 and CCL4 plasma levels were noted in responding patients. Lenalidomide therapy was well tolerated and induced durable remissions in this population of elderly, symptomatic patients with CLL. This study was registered in www.ClinicalTrials.gov (ID# NCT00535873).