Patients (aged ?8 years) with CLL Binet stage A, B, or C or Rai stages I¨CIV were randomly assigned in a 1:1 ratio according to a computer-generated allocation schedule to open-label combination treatment (fludarabine 30 mg/m2 per day and alemtuzumab 30 mg per day on days 1?) or monotherapy (fludarabine 25 mg/m2 on days 1?) by use of an interactive voice response system. Both regimens were given intravenously for a maximum of six 28-day cycles. The primary endpoint was progression-free survival (PFS). Analysis was by intention to treat. This trial is registered with , number .
Fludarabine plus alemtuzumab (n=168) resulted in better PFS than did fludarabine monotherapy (n=167; median 23¡¤7 months [95 % CI 19¡¤2?8¡¤4] vs 16¡¤5 months [12¡¤5?1¡¤2]; hazard ratio 0¡¤61 [95 % CI 0¡¤47?¡¤80]; p=0¡¤0003) and overall survival (median not reached vs 52¡¤9 months [40¡¤9¨Cnot reached]; 0¡¤65 [0¡¤45?¡¤94]; p=0¡¤021) compared with fludarabine alone. All-cause adverse events occurred in 161 (98 % ) of 164 patients in the combination treatment group and 149 (90 % ) of 165 in the fludarabine alone group. Patients in the fludarabine plus alemtuzumab group had more cytomegalovirus events (23 [14 % ] vs one [<1 % ]) and grade 1 or 2 potentially alemtuzumab infusion-related adverse reactions (102 [62 % ] vs 22 [13 % ]). Grade 3 or 4 toxicities in the combination treatment and monotherapy groups were leucopenia (121 [74 % ] of 164 vs 55 [34 % ] of 164), lymphopenia (149 [94 % ] of 158 vs 53 [33 % ] of 161), neutropenia (93 [59 % ] of 157 vs 110 [68 % ] of 161), thrombocytopenia (18 [11 % ] of 164 vs 27 [17 % ] of 163), and anaemia (14 [9 % ] of 163 vs 28 [17 % ] of 164). The incidence of serious adverse events was higher in the combination treatment group (54 [33 % ] of 164 vs 41 [25 % ] of 165); deaths due to adverse events were similar between the two groups (ten [6 % ] vs 12 [7 % ]).
The combination of fludarabine and alemtuzumab is another treatment option for patients with previously treated CLL.
Genzyme.