ASH: Aspirin Might Improve Survival in Refractory and Relapsed CLL

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ATLANTA — Adding aspirin therapy to FCR (fludarabine, cyclophosphamide and rituximab) improves outcomes for patients with relapsed or refractory chronic lymphocytic leukemia (CLL), according to a single-institution study presented during the 54th American Society of Hematology Annual Meeting and Exposition.

“The concurrent use of aspirin with FCR regimen improved PFS (progression free survival) and OS (overall survival) in relapsed and refractory CLL patients,” reported lead author Young Kwang Chae, MD, MPH, of The University of Texas MD Anderson Cancer Center in Houston, TX, and coauthors. “This finding provides the first clinical evidence to support the suggested pro-apoptotic effect of aspirin in CLL cells.”

Aspirin activates caspase pathways and PARP cleavage, and DNA fragmentation, and preclinical studies have found aspirin to induce apoptosis in B-CLL cells, Dr. Chae noted.

Dr. Chae's team studied data for 280 patients with relapsed or refractory CLL who underwent salvage chemoimmunotherapy with FCR during 1999-2012 at the MD Anderson Cancer Center. Of these, 41 patients (15%) were on aspirin therapy before and during treatment.

At 12 years follow-up, aspirin use was associated with prolonged PFS and OS.

“Thirty out of 41 aspirin users (61.2%) experienced disease progression compared to 198 out of 239 non-users (82.8%),” Dr. Chae reported. “Twenty-eight out of 41 aspirin users (68.3%) died compared to 175 out of 239 non-users (73.2%).”

However, use of other nonsteroid anti-inflammatory drugs did not correlate with survival (HR 0.59; P=0.18).

Both before and after statistically adjusting for survival-related variables including age, Rai stage, treatment history, and unfavorable cytogenetics, the researchers found PFS and OS to be significantly associated with aspirin use, Dr. Chae reported. After controlling for those factors, aspirin use was associated with a PFS HR of 0.55 (95% CI 0.35-0.87;P=0.01) and an OS HR of 0.57 (95% CI 0.33-0.98;P=0.04).

“Prospective randomized studies are warranted to validate this finding and to explore the use of aspirin as a novel adjuvant therapy in the setting of salvage chemoimmunotherapy,” Dr. Chae concluded.  

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