氟达拉滨和环磷酰胺联合利妥昔单抗（FCR方案）一线治疗慢性淋巴细胞白血病43例临床分析

OBJECTIVE: To investigate the efficacy of fludarabine and cyclophosphamide combined with rituximab（FCR）in previously untreated patients with chronic lymphocytic leukemia（CLL）. METHODS: The clinical data of 43 enrolled patients from May 2004 to December 2017 were analyzed the efficacy and survival results. RESULTS: A total of 43 patients with 31 males and 12 females, and the median age was 58 years old（range 36 to72）before treatment. There were 8 patients with symptom B. The median number of peripheral blood lymphocyte was 26（3–550）×10(9)/L. IGHV unmutated was detected in 62.1％（18/29）patients, P53 deletion in 14％（6/43）patients, RB1 deletion in 18.6％（8/43）patients, Trisomy 12 in 25.6％（11/33）patients, ATM deletion in 16.7％（7/42）patients, respectively. The median number of treatment courses administered was 4（range 2–6）. Twenty patients obtained CR（46.5％）, 18 patients obtained PR, 4 patients were SD, 1 patient was PD. The overall response rate（ORR）was 88.37％. Seven patients obtained MRD negative. After the median follow-up time of 51（6–167）months, median PFS was 67（29–105）months, median OS was not reach, 5-year PFS was（62.1±8.6）％, 10-year PFS was（31±14.3）％, 5-year OS was（70.5±8.3）％, and 10-year OS was（51.3±13.8）％. Less than 4 courses predicted adverse OS（P<0.05）. P53 deletion and less than 4 courses were associated with poor PFS（P<0.001），and the prognostic value still remained after multivariate analysis［HR＝7.65（95％CI 1.74–33.60）, P＝0.007; HR＝3.75（95％ CI 1.19–11.80）, P＝0.025］. Eighteen patients（41.9％）appeared grade 2–3 infection after chemotherapy, and 19 patients（44.2％）appeared grade 3–4 hematological adverse reactions. One patient（2.3％）was developed tumor lysis syndrome. All adverse reactions were controlled or recovered spontaneously. CONCLUSION: Previously untreated CLL patients treated with FCR had a high response rate and good survival rate, which is an important treatment choice for fit patients.