Outcomes of first-line treatment for chronic lymphocytic leukemia (CLL) with 17p deletion (del17p).

Abstract

7102 Background: Patients (pts) with relapsed CLL bearing del17p are very high-risk for poor clinical outcomes. We summarize outcomes for first-line treatment of del17p CLL. Methods: We identified pts with CLL and del17p by FISH who received first-line treatment at MDACC between 1/04 and 12/12. Log-rank test and Cox regression were used for univariable and multivariable analyses. Results: Baseline characteristics are shown (Table). Median time from diagnosis to first treatment (TTFT) was 15 (11-19) mos; no association between % del17p positive cells at diagnosis and TTFT was noted (p=.45). With first-line therapy (Table), 19 pts (30%) achieved complete remission (CR), 2 (3%) nodular partial remission (nPR), 18 (30%) PR, and 24 (37%) were non-responders. Fourteen CR pts (78%) were minimal residual disease negative by flow cytometry. The median time-to-treatment failure (TTF) was 14 (10-18) mos (43 events); the median follow-up was 33 (1-89) mos. Univariable analyses showed age >65 yrs (p=.04), complex karyotype (p=.02), lack of response to therapy (p<.001) and >50% cells positive for del17p by FISH (p=0.009) associated with shorter TTF. The multivariable model showed karyotype (p=.005) and quality of response (p<.001) independently associated with TTF. Median Overall Survival (OS) was 63 (43-83) mos (48 deaths). Fifteen pts (23%) developed Richter Syndrome (RS) after a median of 12 (1-27) mos; 8 deaths (29%) were related to RS. Univariable analysis showed that only lack of response was associated with a shorter OS (p=.001). Conclusions: Del17p CLL is high-risk for first-line therapy; better response to therapy was observed in young patients with low % del17p positive cells by FISH who received FCR. New strategies and agents must aim at both improving response and maintaining remission, particularly in pts with complex karyotype. [Table: see text]