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A randomized phase II trial of fludarabine, cyclophosphamide and mitoxantrone (FCM) with or without rituximab in previously treated chronic lymphocytic leukaemia.
Br J Haematol. 2011 Mar; 152(5):570-8.BJ

Abstract

Combination fludarabine (F), cyclophosphamide (C) and rituximab (R) is the standard front-line therapy in chronic lymphocytic leukaemia (CLL), but appropriate treatment of relapsed/refractory CLL is less clear. Combined FC and mitoxantrone (M) has been reported to be effective in a single arm study, and rituximab when added to chemotherapy in CLL is synergistic. A randomized, two-stage, Phase II trial of FCM and FCM-R was conducted in relapsed CLL. The primary endpoint was response rate 2 months after therapy, assessed according to the 2008 International Workshop CLL criteria. In addition, minimal residual disease (MRD) in the marrow was studied 2 months after therapy, with MRD negativity defined as <0·01% CLL cells. Fifty-two patients were entered, 26 in each arm. The overall response rates to FCM and FCM-R were 58% and 65% respectively. Combined complete response (CR) and CR with incomplete marrow recovery [CR(i)] was 15% (95% confidence interval [CI]:4-35%) for FCM and 42% (95%CI:23-63%) for FCM-R, with eight patients achieving MRD negativity (3 FCM; 5 FCM-R). The toxicity of both regimens was acceptable. In conclusion, the addition of rituximab to FCM improves the response rates in relapsed CLL, resulting in more complete remissions and without additional safety concerns. Efficacy and safety should be fully tested in a randomized Phase III trial.

Authors+Show Affiliations

Department of Haematology, Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street, Leeds, UK. peter.hillmen@nhs.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase II
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21231927

Citation

Hillmen, Peter, et al. "A Randomized Phase II Trial of Fludarabine, Cyclophosphamide and Mitoxantrone (FCM) With or Without Rituximab in Previously Treated Chronic Lymphocytic Leukaemia." British Journal of Haematology, vol. 152, no. 5, 2011, pp. 570-8.
Hillmen P, Cohen DR, Cocks K, et al. A randomized phase II trial of fludarabine, cyclophosphamide and mitoxantrone (FCM) with or without rituximab in previously treated chronic lymphocytic leukaemia. Br J Haematol. 2011;152(5):570-8.
Hillmen, P., Cohen, D. R., Cocks, K., Pettitt, A., Sayala, H. A., Rawstron, A. C., Kennedy, D. B., Fegan, C., Milligan, D. W., Radford, J., Mercieca, J., Dearden, C., Ezekwisili, R., Smith, A. F., Brown, J., Booth, G. A., Varghese, A. M., & Pocock, C. (2011). A randomized phase II trial of fludarabine, cyclophosphamide and mitoxantrone (FCM) with or without rituximab in previously treated chronic lymphocytic leukaemia. British Journal of Haematology, 152(5), 570-8. https://doi.org/10.1111/j.1365-2141.2010.08317.x
Hillmen P, et al. A Randomized Phase II Trial of Fludarabine, Cyclophosphamide and Mitoxantrone (FCM) With or Without Rituximab in Previously Treated Chronic Lymphocytic Leukaemia. Br J Haematol. 2011;152(5):570-8. PubMed PMID: 21231927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized phase II trial of fludarabine, cyclophosphamide and mitoxantrone (FCM) with or without rituximab in previously treated chronic lymphocytic leukaemia. AU - Hillmen,Peter, AU - Cohen,Dena R, AU - Cocks,Kim, AU - Pettitt,Andrew, AU - Sayala,Hazem A, AU - Rawstron,Andy C, AU - Kennedy,Daniel B, AU - Fegan,Christopher, AU - Milligan,Don W, AU - Radford,John, AU - Mercieca,Jane, AU - Dearden,Claire, AU - Ezekwisili,Raphael, AU - Smith,Alexandra F, AU - Brown,Julia, AU - Booth,Gillian A, AU - Varghese,Abraham M, AU - Pocock,Christopher, AU - ,, Y1 - 2011/01/14/ PY - 2011/1/15/entrez PY - 2011/1/15/pubmed PY - 2011/5/13/medline SP - 570 EP - 8 JF - British journal of haematology JO - Br. J. Haematol. VL - 152 IS - 5 N2 - Combination fludarabine (F), cyclophosphamide (C) and rituximab (R) is the standard front-line therapy in chronic lymphocytic leukaemia (CLL), but appropriate treatment of relapsed/refractory CLL is less clear. Combined FC and mitoxantrone (M) has been reported to be effective in a single arm study, and rituximab when added to chemotherapy in CLL is synergistic. A randomized, two-stage, Phase II trial of FCM and FCM-R was conducted in relapsed CLL. The primary endpoint was response rate 2 months after therapy, assessed according to the 2008 International Workshop CLL criteria. In addition, minimal residual disease (MRD) in the marrow was studied 2 months after therapy, with MRD negativity defined as <0·01% CLL cells. Fifty-two patients were entered, 26 in each arm. The overall response rates to FCM and FCM-R were 58% and 65% respectively. Combined complete response (CR) and CR with incomplete marrow recovery [CR(i)] was 15% (95% confidence interval [CI]:4-35%) for FCM and 42% (95%CI:23-63%) for FCM-R, with eight patients achieving MRD negativity (3 FCM; 5 FCM-R). The toxicity of both regimens was acceptable. In conclusion, the addition of rituximab to FCM improves the response rates in relapsed CLL, resulting in more complete remissions and without additional safety concerns. Efficacy and safety should be fully tested in a randomized Phase III trial. SN - 1365-2141 UR - https://www.unboundmedicine.com/medline/citation/21231927/A_randomized_phase_II_trial_of_fludarabine_cyclophosphamide_and_mitoxantrone__FCM__with_or_without_rituximab_in_previously_treated_chronic_lymphocytic_leukaemia_ L2 - https://doi.org/10.1111/j.1365-2141.2010.08317.x DB - PRIME DP - Unbound Medicine ER -