Fink et al identified factors associated with a poor outcome for a patent with CLL following therapy with fludarabine, cyclophosphamide and rituximab (FCR). These can help to identify a patient who may require more aggressive therapy. The authors are from multiple institutions in Germany, Austria, Switzerland and the Czech Republic.
Patient selection: CLL with any tumor cells following therapy with fludarabine, cyclophosphamide and rituximab (FCR)
Outcome: progression-free survival (PFS)
Parameters:
(1) minimal residual disease (MRD): any residual CLL cells
(2) mutation status for IGHV gene
MRD is quantified based on the number of CLL cells per 10,000 leukocytes on 4-color flow cytometry or quantitative PCR.
MRD
Number CLL Cells per 10,000 Leukocytes
Ratio
low
< 1
< 10^(-4)
intermediate
1 to 99
>= 10^(-4) to < 10^(-2)
high
>= 100
>= 10^(-2)
Criteria for poor progression-free survival following FCR:
(1) high MRD
(2) intermediate MRD and unmutated IGHV gene
(3) presence of TP53 aberrations (loss or mutation indicates an ultra-high-risk patient).
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