Older and Younger Chronic Leukemia Patients May Need Different Therapy
Doctors should use different therapies when treating older and younger patients with chronic lymphocytic leukemia (CLL), a new study at the OSUCCC – James suggests.
Age is usually not considered when determining treatment for people with CLL, but this study indicates that older people with the disease may not respond as well to the therapy used for most patients.
“Our analysis shows that optimal therapy for younger and older patients with chronic lymphocytic leukemia is likely to be different, at least when using current treatments,” says first author Jennifer Woyach, MD, assistant professor in the Division of Hematology at Ohio State. “We hope this study will shape future research by highlighting the importance of enrolling older patients on clinical trials and of developing trials that specifically target older patients.”
CLL most often occurs in people older than 65; the average age at diagnosis is 72. But most CLL clinical trial participants are in their early 60s.
“Our findings apply to both routine care of CLL patients 70 years and older and to future CLL trials,” says principal investigator John C. Byrd, MD, who directs the Division of Hematology at Ohio State and is a member of the OSUCCC – James.
“The study suggests that chlorambucil is superior to fludarabine in older patients, and that CD20 antibody therapies such as rituximab are beneficial as frontline therapy for all CLL patients, regardless of age,” Byrd says. “These data also show that future treatment trials for older adults with CLL should build on CD20 antibody therapies such as rituximab and ofatumumab, but not on fludarabine or alemtuzumab.”
Byrd, Woyach and colleagues reviewed 663 CLL patients who were enrolled in four sequential CLL clinical trials evaluating frontline therapies. The researchers looked for differences in treatment outcomes between older and younger patients to identify the most effective therapy for older adults.
Published in the Journal of Clinical Oncology.
NIH/National Cancer Institute grants CA31946, CA33601 and CA140158, and funds from the Leukemia and Lymphoma Society, the Harry Mangurian Foundation and the D. Warren Brown Family Foundation supported this research.