Dose Intensive Rituximab and High-Dose Methylprednisolone in Elderly or Unfit Patients with Relapsed Chronic Lymphocytic Leukemia

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2019-10, Vol.55 (11), p.719
• Main Authors: Pileckyte, Regina, Valceckiene, Vilma, Stoskus, Mindaugas, Matuzeviciene, Reda, Sejoniene, Jurgita, Zvirblis, Tadas, Griskevicius, Laimonas
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - standards; Antineoplastic Agents - therapeutic use; chronic lymphocytic leukemia; elderly; Female; high-dose methylprednisolone; Humans; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy; Male; Methylprednisolone - standards; Methylprednisolone - therapeutic use; Prospective Studies; rituximab; Rituximab - therapeutic use
• ISSN: 1648-9144; 1010-660X; 1648-9144; 1010-660X
• DOI: 10.3390/medicina55110719

: BTK and BCL2 inhibitors have changed the treatment paradigms of high-risk and elderly patients with chronic lymphocytic leukemia (CLL), but their long-term efficacy and toxicity are still unknown and the costs are considerable. Our previous data showed that Rituximab (Rtx) and high-dose methylprednisolone (HDMP) can be an effective and safe treatment option for relapsed high-risk CLL patients. : We explored the efficacy and safety of a higher Rtx dose in combination with a shorter (3-day) schedule of HDMP in relapsed elderly or unfit CLL patients. : Twenty-five patients were included in the phase-two, single-arm trial. The median progression free survival (PFS) was 11 months (range 10-12). Median OS was 68 (range 47-89) months. Adverse events (AE) were mainly grade I-II° (77%) and no deaths occurred during the treatment period. : 3-day HDMP and Rtx was associated with clinically meaningful improvement in most patients. The median PFS in 3-day and 5-day HDMP studies was similar and the toxicity of the 3-day HDMP schedule proved to be lower. The HDMP and Rtx combination can still be applied in some relapsed high-risk and elderly or unfit CLL patients if new targeted therapies are contraindicated or unavailable. (ClinicalTrials.gov identifier: NCT01576588).