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Randomized phase III trial of fludarabine plus cyclophosphamide with or without oblimersen sodium (Bcl-2 antisense) in patients with relapsed or refractory chronic lymphocytic leukemia.

Publication ,  Journal Article
O'Brien, S; Moore, JO; Boyd, TE; Larratt, LM; Skotnicki, A; Koziner, B; Chanan-Khan, AA; Seymour, JF; Bociek, RG; Pavletic, S; Rai, KR
Published in: J Clin Oncol
March 20, 2007

PURPOSE: Expression of Bcl-2 protein is associated with chemotherapy resistance and decreased survival in chronic lymphocytic leukemia (CLL). We evaluated whether oblimersen would improve response to chemotherapy in patients with relapsed or refractory CLL. PATIENTS AND METHODS: Patients had received at least one prior fludarabine-containing regimen and were stratified on the basis of prior fludarabine response, number of prior regimens, and duration of response to last prior therapy. Patients were randomly assigned to 28-day cycles of fludarabine 25 mg/m2/d plus cyclophosphamide 250 mg/m2/d administered intravenously for 3 days with or without oblimersen 3 mg/kg/d as a 7-day continuous intravenous infusion (beginning 4 days before chemotherapy) for up to six cycles. The primary end point was the proportion of patients who achieved complete response (CR) or nodular partial response (nPR). RESULTS: Of 241 patients randomly assigned, CR/nPR was achieved in 20 (17%) of 120 patients in the oblimersen group and eight (7%) of 121 patients in the chemotherapy-only group (P = .025). Achievement of CR/nPR was correlated with both an extended time to progression and survival (P < .0001). In patients who remained sensitive to fludarabine, oblimersen was associated with a four-fold increase in the CR/nPR rate and a significant survival benefit (P = .05). Oblimersen was frequently associated with thrombocytopenia and, rarely, tumor lysis syndrome and cytokine release reactions; the incidence of opportunistic infections and second malignancies was similar in both groups. CONCLUSION: The addition of oblimersen to fludarabine plus cyclophosphamide significantly increases the CR/nPR rate in patients with relapsed or refractory CLL (particularly fludarabine-sensitive patients), as well as response duration among patients who achieve CR/nPR.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

March 20, 2007

Volume

25

Issue

9

Start / End Page

1114 / 1120

Location

United States

Related Subject Headings

  • Vidarabine
  • Treatment Outcome
  • Treatment Failure
  • Time Factors
  • Thionucleotides
  • Recurrence
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Oligonucleotides, Antisense
  • Middle Aged
 

Citation

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ICMJE
MLA
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O’Brien, S., Moore, J. O., Boyd, T. E., Larratt, L. M., Skotnicki, A., Koziner, B., … Rai, K. R. (2007). Randomized phase III trial of fludarabine plus cyclophosphamide with or without oblimersen sodium (Bcl-2 antisense) in patients with relapsed or refractory chronic lymphocytic leukemia. J Clin Oncol, 25(9), 1114–1120. https://doi.org/10.1200/JCO.2006.07.1191
O’Brien, Susan, Joseph O. Moore, Thomas E. Boyd, Loree M. Larratt, Aleksander Skotnicki, Benjamin Koziner, Asher A. Chanan-Khan, et al. “Randomized phase III trial of fludarabine plus cyclophosphamide with or without oblimersen sodium (Bcl-2 antisense) in patients with relapsed or refractory chronic lymphocytic leukemia.J Clin Oncol 25, no. 9 (March 20, 2007): 1114–20. https://doi.org/10.1200/JCO.2006.07.1191.
O’Brien, Susan, et al. “Randomized phase III trial of fludarabine plus cyclophosphamide with or without oblimersen sodium (Bcl-2 antisense) in patients with relapsed or refractory chronic lymphocytic leukemia.J Clin Oncol, vol. 25, no. 9, Mar. 2007, pp. 1114–20. Pubmed, doi:10.1200/JCO.2006.07.1191.
O’Brien S, Moore JO, Boyd TE, Larratt LM, Skotnicki A, Koziner B, Chanan-Khan AA, Seymour JF, Bociek RG, Pavletic S, Rai KR. Randomized phase III trial of fludarabine plus cyclophosphamide with or without oblimersen sodium (Bcl-2 antisense) in patients with relapsed or refractory chronic lymphocytic leukemia. J Clin Oncol. 2007 Mar 20;25(9):1114–1120.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

March 20, 2007

Volume

25

Issue

9

Start / End Page

1114 / 1120

Location

United States

Related Subject Headings

  • Vidarabine
  • Treatment Outcome
  • Treatment Failure
  • Time Factors
  • Thionucleotides
  • Recurrence
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Oligonucleotides, Antisense
  • Middle Aged