Outcomes of CLL patients treated with sequential kinase inhibitor therapy: A real world experience

Anthony R. Mato, Chadi Nabhan, Paul M. Barr, Chaitra S. Ujjani, Brian T. Hill, Nicole Lamanna, Alan P. Skarbnik, Christina Howlett, Jeffrey J. Pu, Alison R. Sehgal, Lauren E. Strelec, Alexandra Vandegrift, Danielle M. Fitzpatrick, Clive S. Zent, Tatyana Feldman, Andre Goy, David F. Claxton, Spencer Henick Bachow, Gurbakhash Kaur, Jakub SvobodaSunita Dwivedy Nasta, David Porter, Daniel J. Landsburg, Stephen J. Schuster, Bruce D. Cheson, Pavel Kiselev, Andrew M. Evens

Research output: Contribution to journalArticle

92 Scopus citations

Abstract

B-cell receptor kinase inhibitor (KI) therapy represents a paradigm shift in chronic lymphocytic leukemia (CLL) management, but data on practice patterns after KI discontinuation and optimal sequencing are limited. We conducted a multicenter, retrospective, comprehensive analysis on 178 patients with CLL (ibrutinib 5 143; idelalisib 5 35) who discontinued KI therapy. We examined responses, toxicity, post-KI therapies, and overall survival (OS). Patients had a median of 3 prior therapies (range 0-11); del17p (34%), p53 mutation (27%), del11q (33%), and complex karyotype (29%). Overall response rate (ORR) to first KI was 62% (complete response 14%). The most common reasons for KI discontinuation were toxicity (51%), CLL progression (29%), and Richter transformation (RT) (8%). Median progression-free survival (PFS) and OS from KI initiation were 10.5 and 29 months, respectively. Notably, initial KI choice did not impact PFS or OS; however, RT portended significantly inferior OS (P 5 .0007). One hundred fourteen patients received subsequent salvage therapy following KI discontinuation with an ORR to subsequent KI at 50% and a median PFS of 11.9 months. Median PFS in KIintolerant patients treated with an alternate KI was not reached vs 7 months for patients with CLL progression. In summary, these data demonstrate that toxicity was the most common reason for KI discontinuation, that patients who discontinue KI due to toxicity can respond to an alternate KI, and that these responses may be durable.

Original languageEnglish (US)
Pages (from-to)2199-2205
Number of pages7
JournalBlood
Volume128
Issue number18
DOIs
StatePublished - Nov 3 2016

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Mato, A. R., Nabhan, C., Barr, P. M., Ujjani, C. S., Hill, B. T., Lamanna, N., Skarbnik, A. P., Howlett, C., Pu, J. J., Sehgal, A. R., Strelec, L. E., Vandegrift, A., Fitzpatrick, D. M., Zent, C. S., Feldman, T., Goy, A., Claxton, D. F., Bachow, S. H., Kaur, G., ... Evens, A. M. (2016). Outcomes of CLL patients treated with sequential kinase inhibitor therapy: A real world experience. Blood, 128(18), 2199-2205. https://doi.org/10.1182/blood-2016-05-716977