Survival of young patients with chronic lymphocytic leukemia failing fludarabine therapy: a basis for the use of myeloablative therapies.
We examined the survival of 91 young patients (< or = 55 years) with chronic lymphocytic leukemia from the time of failure of fludarabine therapy, in an attempt to identify those with a poor outcome who may benefit from investigative dose-intensive therapies. The median survival of patients unresponsive to fludarabine (n = 42) was 48 weeks, and only 11% responded to subsequent therapies. The median survival of patients relapsing following a fludarabine-induced remission (n = 49) was 87 weeks, and 83% of those who had received fludarabine as their first therapy (n = 14) responded to further fludarabine-containing therapies, with 60% alive at four years. Only 7% of those relapsing patients who had received fludarabine as salvage therapy (n = 35) responded to subsequent therapies (median survival 72 weeks). The poor outlook for these patients justifies the consideration of innovative dose-intensive therapies, such as bone marrow transplantation, with their attendant risk of toxicity.
Department of Medical Oncology and Clinical Haematology, Royal Melbourne Hospital, Australia.
J F
JF
Seymour
L E
LE
Robertson
S
S
O'Brien
S
S
Lerner
M J
MJ
Keating
D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D017338:Cladribine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D016019:Survival Analysis; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D017338:Cladribine; D014740:Vidarabine; C024352:fludarabine