The most common type of leukaemia diagnosed in Australia is chronic lymphocytic leukaemia (CLL) and it mainly affects older people.

But the results of a new CLL trial – described as remarkable and exceptional – “point to a new standard of care” for leukemia more broadly.

The participants received a combination of cancer-blocking drugs – but these were administered at varied durations depending on how rapidly their disease responded.

This individualised or personalised treatment helped patients survive for longer and stay in remission.

Better than previous treatments

According to the study’s lead author:

“Most patients treated with the new combination have no detectable leukaemia in their blood or bone marrow by the end of treatment.”

He said this was better than with previous treatments “and is very encouraging”.

The FLAIR trial, from the University of Leeds’ School of Medicine, has been identified as groundbreaking research by the New England Journal of Medicine.

Chronic lymphocytic leukaemia is a type of cancer that affects the blood and bone marrow. It cannot usually be cured but can be managed with treatment. More than nine in 10 people are aged 55 and over when they are diagnosed.

The study

Treatments for CLL include chemotherapy, immunotherapy, or cancer growth blockers.

According to a statement from the University of Leeds, the FLAIR trial tested a combination of cancer growth blockers called Ibrutinib and Venetoclax (I+V).

As is often the case with cancer treatments, these “are usually administered either continuously or for the same fixed duration rather than tailored to each patient’s response”.

This means that many patients “may stop treatment too early”. In that cadre, they don’t get “the full potential benefit from their therapy”.

Or, it means they continue therapy for longer than necessary.

This could lead to a greater chance of relapse of their leukaemia and/or of treatment side effects.

The FLAIR research aimed to discover whether it was possible to personalise I+V treatment duration for patients based on regular blood and bone marrow sampling. And would this be as effective or better than standard treatment.

A more up-to-date picture

The e regular blood and bone marrow monitoring “gave researchers a more up-to-date picture of how patients were responding to I+V”.

This meant that the duration of I+V treatment could be tailored accordingly to each patient.

Even better, it was found that quicker blood samples were just as effective, and much less invasive, than bone marrows.

Results by the numbers

A total of 523 patients were randomly assigned to receiving I+V or the  chemoimmunotherapy treatment fludarabine–cyclophosphamide–rituximab (FCR).

At a median of 43.7 months, disease progression or death occurred in 12 patients in the I+V group and 75 patients in the FCR group.

Death occurred in 9 patients in the I+V group and 25 patients in the FCR group.

After three years, 58 per cent the patients in the I+V group had stopped therapy. This was no minimal residual disease (MRD) detected.

After five years of I+V therapy, 65.9 per cent of the patients had undetectable MRD in the bone marrow.

And 92.7 per cent had undetectable MRD in the peripheral blood.

What the researchers say

Lead author Peter Hillmen, Professor of Experimental Haematology in the University of Leeds’ School of Medicine, said:

“Our findings show that, for this group of patients, the treatment is very effective at tackling their disease.”

He said this means that patients had better outcomes while enjoying a better quality of life during treatment.

Dr Iain Foulkes, Executive Director of Research and Innovation at Cancer Research UK, said:

“We are delighted to see these results from the FLAIR trial which show the importance and effectiveness of tailoring cancer treatment to the individual patient.”