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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn chronic lymphocytic leukemia, progression-free survival in minimal residual disease\u2013negative patients can be best predicted using a combination of minimal residual disease and the clinical response. The combination is more accurate than clinical response alone. Assessment using only splenomegaly has no influence on progression-free survival prediction.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eprogression-free survival\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eperipheral blood\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprediction\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group drug\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Efludarabine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecyclophosphamide\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erituximab\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebendamustine\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EBarbara Eichhorst, MD, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany, presented on behalf of the German CLL Study Group on the value of minimal residual disease (MRD) in combination with clinical response as a predictor of progression-free survival (PFS) in chronic lymphocytic leukemia (CLL).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe study was based on previous observations that correlated PFS and overall survival (OS) with MRD level in patients with partial response (PR) and complete response (CR), with increasing MRD levels associated with increasingly worse outcomes in PFS and OS [Strati P et al. \u003Cem\u003EBlood.\u003C\/em\u003E 2014; Boettcher S et al. \u003Cem\u003EJ Clin Oncol.\u003C\/em\u003E 2012]. To evaluate the relevance of MRD testing from peripheral blood with clinical response, 1378 patients treated with fludarabine\/cyclophosphamide vs fludarabine\/cyclophosphamide\/rituximab (FCR) in 1 German CLL Study Group trial and with FCR vs bendamustine\/rituximab in another trial were analyzed to identify the target population, composed of 555 patients who achieved CR or PR for whom MRD measurements from peripheral blood were available at the end of the trial. The target and nontarget populations were comparable at baseline (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11569\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11569\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11569\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EBaseline Characteristics and Prognostic Factors\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EMRD negativity was associated with significantly improved CR (median PFS, 68.9 vs 44.4 months; \u003Cem\u003EP\u2009\u003C\/em\u003E=\u2009.004) and PR (median, 61.7 vs 28.1 months; \u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.001). The improved MRD negativity\u2013associated PR was significantly longer than the CR (\u003Cem\u003EP\u2009\u003C\/em\u003E=\u2009.047). For OS, MRD positivity was associated with significantly worse PR. Multivariate analysis revealed significance between positive vs negative MRD status (HR, 3.487; 95% CI, 2.678 to 4.541; \u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.001), PR vs CR (HR, 1.420; 95% CI, 1.075 to 1.876; \u003Cem\u003EP\u2009\u003C\/em\u003E=\u2009.014), presence of del(17p) (HR, 9.082; 95% CI, 4.325 to 19.072; \u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.001), and unmutated vs mutated immunoglobulin heavy chain variable (HR, 2.582; 95% CI, 1.930 to 3.455; \u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.001).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe second portion of the study evaluated the MRD-negative target population for the clinical relevance of splenomegaly, lymph node enlargement, and bone marrow involvement at response assessment in MRD-negative patients. The analysis centered on patients with only lymphadenopathy (n\u2009=\u200925), only bone marrow involvement (n\u2009=\u200918), only splenomegaly (n\u2009=\u200978), and \u0026gt;\u20091 involvement (n\u2009=\u200940). The respective median PFSs were 38.7, 56.8, 72.0, and 51.8 months. The median PFS was significantly lower in patients with lymph node enlargement (\u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.001; \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). No improvement in OS was evident.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11572\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11572\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11572\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EPFS Grouped by MRD\u2009\u2013\u2009PR Subgroups\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EFinally, PFS in MRD-negative patients displaying a PR was assessed using different cutoffs for normal spleen size on radiologic examination in the patients with only lymphadenopathy. PFS was not appreciably affected by use of a splenomegaly cutoff exceeding 12 cm in patients with only bone marrow involvement, only splenomegaly, lymph node enlargement, and \u0026gt;\u20091 involvement.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EThe data indicate that MRD and clinical response are strong predictors of PFS, with the 2 together providing a more accurate prediction of PFS than clinical response alone. Finally, splenomegaly as the only anomaly at the end of the trial had no influence on PFS in the MRD-negative patients who displayed PR.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/55\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm2le\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm2le\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}