Results of a fludarabine induction and alpha-interferon maintenance protocol in pretreated patients with chronic lymphocytic leukemia and low-grade non-Hodgkin's lymphoma.
The activity of fludarabine monophosphate (FLU) and alpha-interferon (alpha-IFN) in low-grade non-Hodgkin's lymphoma (LG-NHL) and B-cell chronic lymphocytic leukemia (B-CLL) has been demonstrated in several clinical trials. In a study of 137 previously treated patients, of whom 77 had B-CLL and 60 with LG-NHL, we used FLU as salvage chemotherapy. Dosages of 25 mg/m2 were given in 30-min infusions for 5 consecutive d. Treatment was repeated every 28 d depending on the patient's clinical status for a maximum of 6 cycles. Entrance to the alpha-IFN maintenance portion of the study depended on patient response to initial FLU. All patients who had obtained a complete or partial response after the FLU therapy were randomized to receive alpha-IFN or no further therapy. The alpha-IFN dose was 3x10(6) units 3 times per wk until disease progression. At 4 yr with a median follow-up of 22 months the percentage of patients with persistent response ranged between 20% and 30% among all the responders. Thirty-five (45%) B-CLL patients achieved major responses (complete/partial response), as did 29 (48%) of those with LG-NHL. Among the 64 patients who achieved a good response to initial therapy and who have entered the second part of the trial, there has been a rate of prolongation of remission in favour of maintenance alpha-IFN (p=0.02). FLU therapy is an effective drug inducing remission in pretreated B-CLL and LH-NHL patients. However, as with other therapeutic modalities, remission is rarely maintained beyond 2 yr. So far, maintenance alpha-IFN has not been shown to produce significantly longer remission after treatment with FLU in LG-NHL, and there is no trend towards prolonged remission in B-CLL patients. The role of FLU needs to be further evaluated in the management of lymphoproliferative disorders by introducing it in combination with other drugs (alpha-IFN) in the induction phase and in maintenance treatment.
Zinzani
P L
PL
Institute of Hematology and Oncology Seràgnoli, University of Bologna,Italy.
Bendandi
M
M
Magagnoli
M
M
Rondelli
D
D
de Vivo
A
A
Benni
M
M
Zamagni
E
E
Cavo
M
M
Tura
S
S
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D016898:Interferon-alpha; D014740:Vidarabine; C024352:fludarabine