RITUXIMABIBENDAMUSTINE:'STILL'AN'OPTION'FOR'ELDERLY'PATIENTS'WITH'
POSTER'35'
CHRONIC'LYMPHOCYTIC'LEUKEMIA?'
'
Francisca!Miranda,!Ana!Jorge!and!Celina!Afonso!
!
Hospital!de!São!Francisco!Xavier,!Centro!Hospitalar!de!Lisboa!Ocidental,!Lisbon,!Portugal!
!
INTRODUCTION:! Elderly! patients! represent! the! majority! of! CLL! patients.! This! population! is!
extremely! heterogenous,! requiring! a! careful! evaluation,! incorporating! comorbidities,!
cognitive!capacity,!life!expectancy!as!well!as!performance!status,!when!choosing!adequate!
therapy.!Despite!the!emergence!of!new!treatment!options,!the!optimal!therapy!for!elderly!
CLL! patients! remains! uncertain.! RituximabJBendamustine! protocol! proved! efficacy! and!
safety!in!this!group!of!patients.!This!is!still!a!widely!used!option!for!CLL!treatment!in!unfit!
patients,! though! not! devoid! of! toxicity! that! may! lead! to! therapy! discontinuation! in! severe!
cases.!
OBJECTIVES:!Characterization!of!CLL!patients!ineligible!for!intensive!therapy!who!underwent!
treatment! with! RituximabJBendamustine! (RB)! at! first! line! or! relapse! setting.! Evaluation! of!
response,!adverse!events!(AE),!discontinuation!of!therapy!and!mortality.!
METHODS:!Retrospective,!unicentric!analysis!of!CLL!patients!ineligible!for!intensive!therapy,!
treated!with!RB.!
RESULTS:!A!total!of!12!patients!included,!17%!female,!median!age!of!70,5!years!at!beginning!
of! therapy.! Median!Cummulative! Illness! Rating! Score!(CIRS)! of! 12! points.! In! 58,3%! of!
patients,! RB! was! used! as! first! line! treatment,! and! in! 41,7%! in! the! relapse! setting.! Overall!
response!rate!documented!in!75%.!AE!recognized!in!75%!of!patients,!of!which!66%!related!
to! hematological! toxicity! (neutropenia! and! anemia! grade! ≥! 3)! and! 25%! to! infectious!
complications.!33%!of!patients!required!dose!reduction!of!bendamustine!due!to!AE,!and!25%!
suspended! treatment! with! RB! due! to! unacceptable! toxicity! or! intolerance.! In! 41,6%! there!
was!at!least!one!episode!of!treatment!delay!due!to!AE.!Mortality!rate!of!41,6%!(40%!due!to!
disease! progression,! 40%! infectious! complications,! 20%! cause! unrelated! to! CLL! or!
treatment).!50%!remain!under!observation!and!without!treatment!indication,!after!a!median!
followJup!time!of!39!months!postJtreatment!completion.!
CONCLUSION:! Analysis! of! presented! data! shows! that! an! important! percentage! of! elderly!
patients! respond! to! RB! protocol,! although! inferior! when! compared! to! available! studies.!
Regarding!AE,!results!were!similar!to!study!reports,!however!causing!treatment!interruption!
or!delays,!which!could!contribute!to!the!inferior!results!in!response.!
In!the!era!of!chemoJfree!options,!with!acceptable!toxicity!in!the!elderly,!should!targeted!and!
novel! drugs! be! an! optimal! approach! for! this! population?! Comparison! data! of! RB! regimen!
with! new! therapies! in! the! elderly! is! warranted,! supporting! the! choice! of! adequate!
treatment,! specially! concerning! toxicity,! which! has! a! major! relevance! in! this! population.!
Additionally,!score!validation!for!accurate!fitness!evaluation,!allowing!a!correct!stratification!
within!this!vast!population,!is!essential.!
! !