AUTHOR=Szász Róbert , Telek Béla , Illés Árpád 

TITLE=Fludarabine-Cyclophosphamide-Rituximab Treatment in Chronic Lymphocytic Leukemia, Focusing on Long Term Cytopenias Before and After the Era of Targeted Therapies

JOURNAL=Pathology and Oncology Research

VOLUME=Volume 27 - 2021

YEAR=2021

URL=https://www.por-journal.com/journals/pathology-and-oncology-research/articles/10.3389/pore.2021.1609742

DOI=10.3389/pore.2021.1609742

ISSN=1532-2807

ABSTRACT=The widespread application of fludarabine, cyclophosphamide and rituximab combination is limited due to its toxicity, the prolonged cytopenias in particular.
The aim of the study was to compare the prolonged cytopenias depending on fitness and also to report real-life data on dose reduction measures and on efficacy.
According to our database, 120 and 14 patients were treated with FCR between 2011-2015 and between 2016-2019. Out of the first cohort 34 patients were treated in subsequent lines.
The rate of complete and partial remission after first-line treatment was 79%, 16% in the first cohort and 86%, 14% in the second cohort, respectively; and 47%, 35% after non first-line treatment. Based on today's standards only 37.5% of the patients were fit for FCR.
The frequency of persistent cytopenia was 14% and it was significantly associated with fitness (c2(1)=6.001, p=0.014 for all patients).
The small number of FCR treated patients after 2016 shows how the availability of targeted therapies, mostly ibrutinib, in later lines changed the first-line choice.
Recently, it is recommended first-line for fit patients with mutated IGHV and no TP53 aberrations. With this narrow indication, decrease in the frequency of persistent cytopenias is predicted.