Fludarabine in resistant or relapsing B-cell chronic lymphocytic leukemia: the Spanish Group experience.
Fludarabine produces high response rates in patients with B-cell chronic lymphocytic leukemia (CLL). Nevertheless, response to fludarabine of patients with previously treated CLL varies from 17% to 74% (0% to 38% CR). In 68 patients with heavily pretreated and advanced CLL, an overall response rate to fludarabine of 28% (4% CR) was observed. Response correlated with sensitivity of the disease to previous treatments (relapsing vs. refractory disease) (62% vs. 20%; p = 0.005) and, albeit not significantly, with the number of cycles of fludarabine (>3 vs. < or = 3) that patients could receive (36% vs. 15%; p = NS). Responding patients had a longer survival (median, not reached) than those not responding (median, 11 months) (p = 0.03). Severe toxicity was observed in some cases. It is concluded that fludarabine is a highly useful agent in CLL. However, in order to improve its effectiveness and decrease its toxicity, fludarabine should be given as soon as a lack of response to front-line therapy is observed and before the disease becomes completely resistant to therapy.
Montserrat
E
E
Postgraduate School of Hematology "Farreras-Valenti", Department of Medicine, University of Barcelona, Spain.
Lopez-Lorenzo
J L
JL
Manso
F
F
Martin
A
A
Prieto
E
E
Arias-Sampedro
J
J
Fernandez
M N
MN
Oyarzabal
F J
FJ
Odriozola
J
J
Alcala
A
A
Garcia-Conde
J
J
Guardia
R
R
Bosch
F
F
D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced / Q000628:therapy; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D004341:Drug Evaluation; D005334:Fever / Q000209:etiology; D006086:Graft vs Host Disease / Q000209:etiology; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007239:Infections / Q000209:etiology; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality; D015993:Life Tables; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D014740:Vidarabine; C024352:fludarabine