Display options
Cite
Šimkovič M, Motyčková M, Belada D, et al. Five years of experience with rituximab plus high-dose dexamethasone for relapsed/refractory chronic lymphocytic leukemia. Arch Med Sci. 2015;12(2):421-7doi: 10.5114/aoms.2016.55425.
Šimkovič, M., Motyčková, M., Belada, D., Vodárek, P., Kapoor, R., Jaffar, H., Vrbacký, F., Žák, P., & Smolej, L. (2016). Five years of experience with rituximab plus high-dose dexamethasone for relapsed/refractory chronic lymphocytic leukemia. Archives of medical science : AMS, 12(2), 421-7. https://doi.org/10.5114/aoms.2016.55425
Šimkovič, Martin, et al. "Five years of experience with rituximab plus high-dose dexamethasone for relapsed/refractory chronic lymphocytic leukemia." Archives of medical science : AMS vol. 12,2 (2016): 421-7. doi: https://doi.org/10.5114/aoms.2016.55425
Šimkovič M, Motyčková M, Belada D, Vodárek P, Kapoor R, Jaffar H, Vrbacký F, Žák P, Smolej L. Five years of experience with rituximab plus high-dose dexamethasone for relapsed/refractory chronic lymphocytic leukemia. Arch Med Sci. 2016 Apr 01;12(2):421-7. doi: 10.5114/aoms.2016.55425. Epub 2015 Dec 08. PMID: 27186190; PMCID: PMC4848354.
Copy Download .nbib Format: NLM
Share it on

Arch Med Sci. 2016 Apr 01;12(2):421-7. doi: 10.5114/aoms.2016.55425. Epub 2015 Dec 08.

Five years of experience with rituximab plus high-dose dexamethasone for relapsed/refractory chronic lymphocytic leukemia.

Archives of medical science : AMS

Martin Šimkovič, Monika Motyčková, David Belada, Pavel Vodárek, Rahul Kapoor, Hamna Jaffar, Filip Vrbacký, Pavel Žák, Lukáš Smolej

Affiliations

  1. 4 Department of Internal Medicine - Hematology, University Hospital and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic.

PMID: 27186190 PMCID: PMC4848354 DOI: 10.5114/aoms.2016.55425

Abstract

INTRODUCTION: High-dose methylprednisolone (HDMP) in combination with rituximab is active in the treatment of relapsed/refractory chronic lymphocytic leukemia (CLL), but serious infections are frequent. Recently published data suggested that high-dose dexamethasone might be equally effective as HDMP despite a lower cumulative dose.

MATERIAL AND METHODS: We performed retrospective analysis of 60 patients with relapsed/refractory CLL (median age: 66 years; range: 37-86) treated with rituximab plus dexamethasone (R-dex) at a single tertiary center between September 2008 and October 2012. The schedule of R-dex consisted of rituximab 500 mg/m(2) i.v. day 1 (375 mg/m(2) in cycle 1) and dexamethasone 40 mg orally on days 1-4 and 10-13 repeated every 3 weeks for a maximum of 8 cycles. Unfavorable prognostic features were frequent (Rai stages III/IV in 67%, unmutated IgVH 82%, del 11q 43%, TP53 mutation/deletion 23%, bulky lymphadenopathy 58% of patients).

RESULTS: Overall response (OR)/complete remission (CR) was achieved in 75/3%. At the median follow-up of 21 months, median progression-free survival (PFS) was 8 months, median time to next treatment 12.9 months and median overall survival 25.5 months. Refractoriness to fludarabine (p = 0.04) and age ≥ 65 years (p = 0.03) were significant predictors of shorter PFS. R-dex was successfully used for debulking before allogenic stem cell transplantation in 7 patients (12%). Serious (CTCAE grade III/IV) infections occurred in 27% of patients; 20% of patients developed steroid diabetes requiring temporary short-acting insulin.

CONCLUSIONS: Our results show that R-dex is an active and well-tolerated regimen for patients with relapsed/refractory CLL; however, major infections remain frequent despite combined antimicrobial prophylaxis.

Keywords: chemoimmunotherapy; chronic lymphocytic leukemia; dexamethasone; refractory disease; rituximab

References

  1. Leuk Lymphoma. 1999 Jun;34(1-2):167-70 - PubMed
  2. Leuk Lymphoma. 2007 Dec;48(12):2412-7 - PubMed
  3. Expert Opin Investig Drugs. 2012 Jul;21(7):1009-17 - PubMed
  4. Haematologica. 2008 Mar;93(3):475-6 - PubMed
  5. Leuk Lymphoma. 2011 Jun;52(6):1055-65 - PubMed
  6. Blood. 2012 May 3;119(18):4101-7 - PubMed
  7. Leukemia. 2008 Nov;22(11):2048-53 - PubMed
  8. Leuk Lymphoma. 2008 Oct;49(10):1995-8 - PubMed
  9. Leuk Res. 2012 Oct;36(10):1278-82 - PubMed
  10. Blood. 2008 Jun 15;111(12):5446-56 - PubMed
  11. Ann Hematol. 2003 Dec;82(12):759-65 - PubMed
  12. J Clin Oncol. 2010 Apr 1;28(10):1756-65 - PubMed
  13. J Clin Oncol. 2010 Apr 1;28(10 ):1749-55 - PubMed
  14. Leuk Lymphoma. 2008 Oct;49(10):1843-5 - PubMed
  15. J Clin Oncol. 2012 May 10;30(14 ):1647-55 - PubMed
  16. Leukemia. 2006 Aug;20(8):1441-5 - PubMed
  17. Lancet. 2010 Oct 2;376(9747):1164-74 - PubMed
  18. Blood. 2002 Sep 1;100(5):1765-73 - PubMed
  19. Leukemia. 2009 Oct;23(10):1779-89 - PubMed
  20. Cancer. 2009 Jul 1;115(13):2824-36 - PubMed
  21. Leuk Lymphoma. 2002 Sep;43(9):1755-62 - PubMed

Publication Types