Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia
<b>Background/Objectives</b>: Anti-CD20 monoclonal antibodies combined with alkylator-based chemotherapy enhance survival in chronic lymphocytic leukemia (CLL). However, the risks of infection and bone marrow suppression may mean that new, targeted therapies are more appropriate for some...
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2025-01-01
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| author | Tong-Yoon Kim Gi-June Min Young-Woo Jeon Seung-Ah Yahng Seok-Goo Cho Jong-Mi Lee Myungshin Kim Ki-Seong Eom |
| author_facet | Tong-Yoon Kim Gi-June Min Young-Woo Jeon Seung-Ah Yahng Seok-Goo Cho Jong-Mi Lee Myungshin Kim Ki-Seong Eom |
| author_sort | Tong-Yoon Kim |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Anti-CD20 monoclonal antibodies combined with alkylator-based chemotherapy enhance survival in chronic lymphocytic leukemia (CLL). However, the risks of infection and bone marrow suppression may mean that new, targeted therapies are more appropriate for some patients than fludarabine–cyclophosphamide–rituximab (FCR). In the Republic of Korea, where insurance limits coverage to novel agents, FCR therapy should be carefully considered for patients with CLL. <b>Methods</b>: Using clinical data from 144 FCR-treated patients with CLL, we retrospectively analyzed clinical characteristics impacting survival outcomes, the impact of cytopenia after FCR, and the durable remission status in terms of measurable residual disease (MRD). We compared the impact of bicytopenia with those of other hematologic conditions. <b>Results</b>: The 5-year overall survival (OS) and 5-year progression-free survival (PFS) for all patients were 84.4% and 68.3%, respectively. FCR-treated patients in the bicytopenia and <i>TP53</i>-positive groups exhibited poor OS and PFS; in particular, the bicytopenia group often experienced prolonged anemia and thrombocytopenia (6–12 months). The responder group achieved sustained remission for a median of 5 years for MRD negativity. <b>Conclusions</b>: In bicytopenia, FCR can induce prolonged cytopenia, making it difficult to switch to second-line therapy or complete cycles of chemoimmunotherapy, directly affecting poor survival outcomes. The cautious application of FCR therapy in CLL without bicytopenia or <i>TP53</i> positivity can achieve long-term remission. |
| format | Article |
| id | doaj-art-3de98b4a01034277bce94dfc1cf87217 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Biomedicines |
| spelling | doaj-art-3de98b4a01034277bce94dfc1cf872172025-01-24T13:24:21ZengMDPI AGBiomedicines2227-90592025-01-0113119410.3390/biomedicines13010194Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and AnemiaTong-Yoon Kim0Gi-June Min1Young-Woo Jeon2Seung-Ah Yahng3Seok-Goo Cho4Jong-Mi Lee5Myungshin Kim6Ki-Seong Eom7Department of Hematology, Catholic Hematology Hospital, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of KoreaDepartment of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Hematology, Catholic Hematology Hospital, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of KoreaDepartment of Hematology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Republic of KoreaDepartment of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of KoreaDepartment of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea<b>Background/Objectives</b>: Anti-CD20 monoclonal antibodies combined with alkylator-based chemotherapy enhance survival in chronic lymphocytic leukemia (CLL). However, the risks of infection and bone marrow suppression may mean that new, targeted therapies are more appropriate for some patients than fludarabine–cyclophosphamide–rituximab (FCR). In the Republic of Korea, where insurance limits coverage to novel agents, FCR therapy should be carefully considered for patients with CLL. <b>Methods</b>: Using clinical data from 144 FCR-treated patients with CLL, we retrospectively analyzed clinical characteristics impacting survival outcomes, the impact of cytopenia after FCR, and the durable remission status in terms of measurable residual disease (MRD). We compared the impact of bicytopenia with those of other hematologic conditions. <b>Results</b>: The 5-year overall survival (OS) and 5-year progression-free survival (PFS) for all patients were 84.4% and 68.3%, respectively. FCR-treated patients in the bicytopenia and <i>TP53</i>-positive groups exhibited poor OS and PFS; in particular, the bicytopenia group often experienced prolonged anemia and thrombocytopenia (6–12 months). The responder group achieved sustained remission for a median of 5 years for MRD negativity. <b>Conclusions</b>: In bicytopenia, FCR can induce prolonged cytopenia, making it difficult to switch to second-line therapy or complete cycles of chemoimmunotherapy, directly affecting poor survival outcomes. The cautious application of FCR therapy in CLL without bicytopenia or <i>TP53</i> positivity can achieve long-term remission.https://www.mdpi.com/2227-9059/13/1/194chronic lymphocytic leukemiabicytopenia B-cellchemotherapyfludarabinecyclophosphamiderituximab |
| spellingShingle | Tong-Yoon Kim Gi-June Min Young-Woo Jeon Seung-Ah Yahng Seok-Goo Cho Jong-Mi Lee Myungshin Kim Ki-Seong Eom Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia Biomedicines chronic lymphocytic leukemia bicytopenia B-cell chemotherapy fludarabine cyclophosphamide rituximab |
| title | Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia |
| title_full | Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia |
| title_fullStr | Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia |
| title_full_unstemmed | Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia |
| title_short | Inferior Outcomes of Fludarabine–Cyclophosphamide–Rituximab Chemotherapy in Korean Chronic Lymphocytic Leukemia Patients with Concurrent Thrombocytopenia and Anemia |
| title_sort | inferior outcomes of fludarabine cyclophosphamide rituximab chemotherapy in korean chronic lymphocytic leukemia patients with concurrent thrombocytopenia and anemia |
| topic | chronic lymphocytic leukemia bicytopenia B-cell chemotherapy fludarabine cyclophosphamide rituximab |
| url | https://www.mdpi.com/2227-9059/13/1/194 |
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