Incidence of therapy-related myeloid neoplasia after initial therapy for chronic lymphocytic leukemia with fludarabine-cyclophosphamide versus fludarabine: Long-term follow-up of US intergroup study E2997 Academic Article uri icon


MeSH Major

  • Antineoplastic Combined Chemotherapy Protocols
  • Bone Marrow Neoplasms
  • Cyclophosphamide
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • Neoplasms, Second Primary
  • Vidarabine


  • Chemotherapy-related myeloid neoplasia (t-MN) is a significant late toxicity concern after cancer therapy. In the randomized intergroup phase 3 E2997 trial, initial therapy of chronic lymphocytic leukemia with fludarabine plus cyclophosphamide (FC) compared with fludarabine alone yielded higher complete and overall response rates and longer progression-free, but not overall, survival. Here, we report t-MN incidence in 278 patients enrolled in E2997 with a median 6.4-year follow-up. Thirteen cases (4.7%) of t-MN occurred at a median of 5 years from initial therapy for chronic lymphocytic leukemia, 9 after FC and 4 after fludarabine alone. By cumulative incidence methodology, rates of t-MN at 7 years were 8.2% after FC and 4.6% after fludarabine alone (P = .09). Seven of the 9 cases of t-MN after FC occurred without additional therapy. Abnormalities involving chromosomes 5 or 7 were found in 10 cases, which suggests alkylator involvement. These data suggest that FC may induce more t-MN than fludarabine alone.

publication date

  • September 29, 2011



  • Academic Article



  • eng

PubMed Central ID

  • PMC3186330

Digital Object Identifier (DOI)

  • 10.1182/blood-2011-03-342485

PubMed ID

  • 21803850

Additional Document Info

start page

  • 3525

end page

  • 7


  • 118


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