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The frequency, manifestations, and duration of prolonged cytopenias after first-line fludarabine combination chemotherapy
Annals of Oncology, 07/24/09

Gill S et al. - In a trial to assess the presence and significance of prolonged cytopenias after completion of fludarabine-based chemoimmunotherapy in treatment of lymphoid malignancies, it was determined that cytopenias often persist >3 mos after first-line fludarabine combination therapy and can lead to important clinical sequelae. Although cytopenias generally resolve over time, treating physicians should be aware of these factors when considering fludarabine combination chemotherapy and when documenting treatment response status in chronic lymphocytic leukaemia (CLL).

Methods

61 pts receiving initial therapy with fludarabine-based regimens were categorised according to the presence of post-treatment cytopenias (haemoglobin <110–130 g/l depending on sex and age, neutrophils <2.0 x 109/l, or platelets <140 x 109/l) lasting >3 mos.

Results

Persistent cytopenias unrelated to persistent disease were found in 43% of pts.
Cytopenias were associated with clinically important rates of infection and transfusion requirement and predicted for worse overall survival (61% vs 96% at 60 mos).
Increasing age predicted for persistent cytopenias, but the presence of pretreatment cytopenias and delivered dose intensity were not predictive.
Median times to resolution of anaemia, neutropenia, and thrombocytopenia were 7, 9, and 10 mos, respectively.

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