Two major hematology/oncology meetings were held during the month of June with significant presentations on aspects of CLL treatment. The American Society of Clinical Oncology (ASCO) meeting was held in Chicago with only two CLL presentations being chosen for oral presentation. Dr. Con Tam, an Australian CLL Fellow working at MD Anderson Cancer Center, presented on the long-term follow-up of the FCR protocol. In CLL patients requiring treatment of their disease, the addition of rituximab to the chemotherapy combination of fludarabine and cyclophosphamide (FC) suggests a 30% increase in the five year survival of CLL patients.
The study illustrates a low risk (3% over 5 years) of long-term complication such as acute leukemia or myelodysplastic syndrome, with Richter’s syndrome showing a similar risk level. Results of the study show a 10% risk of infection in the first year following FCR, but this decreases rapidly to normally anticipated levels after the first year. Thus, FCR appears to be safe in the long-term.
The early promise of FCR’s efficacy has stood the test of time. The second presentation at the ASCO meeting was a discussion I led on the treatment results of CLL patients once they relapse after FCR. Overall, fifty percent of relapsed patients previously treated with FCR will get a second remission. The most effective combination for achieving a second remission uses alemtuzumab (Campath) combined with either rituximab or the FCR regimen. These regimens appear to have a 45% – 50% complete remission rate and an overall response of 80%. A key finding of this analysis is that non-ablative stem cell transplant (NST, mini-transplant) from either related donors or unrelated donors is very effective in eradicating disease (as observed in two-thirds of study participants). Treatment of recurrence is now a top priority for future research.
At the European Hematology Association (EHA meeting held recently in Vienna, Dr. Alessandra Ferrajoli presented an update of her studies with lenalidomide (Revlimid) in advanced CLL patients. Indications are that 35% to 40% of patients are responding, suggesting that Revlimid is a major new agent in the management of CLL. Subsequent studies are being implemented with Revlimid as a single agent, in management for minimal residual disease and in combination with rituximab.
Dr. Apostolia Tsimberidou presented the results of her study on the management of Richter’s transformation with a novel combination including oxaliplatin (a less toxic form of cisplatinum). This combination was a well tolerated, effective regimen in very advanced CLL patients and those with Richter’s transformation. It enabled patients to receive an allogeneic transplant which would have previously not been possible.
Prof. Mauricette Michallet from Lyon presented an update of the European Bone Marrow Transplant Registry data for full transplant and NST transplants. The European data demonstrated up to 15 years of freedom of disease for full and mini-transplants. Post-transplant, the new immune cells are killing off the CLL cells.
A wide range of new opportunities exists for continued research in CLL with new chemicals as well as new antibodies. High on the priority list is the development of safer, more effective modalities of treatment using the transplant model. The International Workshop on CLL meeting in September will provide an opportunity for additional updates on ongoing research. I look forward to sharing the progress from that meeting with you.