New treatment approach significantly improves survival for most common form of adult leukemia

Treating patients until there were no cancer cells detected in the blood before stopping treatment was more effective. Image credit – National Cancer Institute

Cancer Digest – Dec. 23, 2023 – Personalized treatment of the most common form of adult leukemia resulted in significantly longer progression-free and overall survival, a new study in the Dec. 10, 2023 New England Journal of Medicine shows.

The FLAIR trial began in 2014 involved 1,509 patients with chronic lymphocytic leukemia (CLL) at 100 hospitals in the United Kingdom. The patients were randomly assigned to one of four treatment regimens. 

Chronic lymphocytic leukemia is cancer of blood and bone marrow cells. There is no cure but it can be successfully managed with treatment. More than 90 percent of people diagnosed with it are over age 55.

This report, presented at the annual American Society of Hematology (ASH) meeting in San Diego, analyzed data from two of the four treatment groups involving 260 patients being given the cancer blocking drugs Ibrutinib and Ventoclax (I+V), and 269 patients given standard combination chemotherapy and immunotherapy regimen using fludarabine, cyclophosphamide and rituximab (FCR).

In addition, the I+V group were regularly monitored for measurable residual disease (MRD), meaning any cancer remaining in the circulating blood and bone marrow. Patients in the I+V group were treated until MRD reached zero, meaning no detectable cancer in the blood, then the treatment was stopped. In some patients that point was reached sooner than in others, so the treatment was personalized depending on how aggressive their cancer was.

After a median of 43.7 months 12 patients in the I+V group had their cancer resume growing or had died, compared to 75 patients in the standard treatment group. The researchers said the study shows that personalizing the treatment for each patient resulted in significant improvement in progression-free and overall survival.

Lead author Peter Hillmen, professor of experimental hematology at The University of Leeds says the findings could lead to a change in the way CLL is treated. 

“Our findings show that, for this group of patients, the treatment is very effective at tackling their disease and is well tolerated by them," Hillmen said in a press release. "This means that patients on our trial had better outcomes while also enjoying a better quality of life during their treatment. Most patients treated with the new combination have no detectable leukemia in their blood or bone marrow by the end of treatment which is better than with previous treatments and is very encouraging.” 

Sources: University of Leeds press release and New England Journal of Medicine