title: Fludarabine plus cyclophosphamide is an efficient treatment for advanced chronic lymphocytic leukaemia (CLL): results of a phase II study of the German CLL Study Group.
abstract: The efficacy and toxicity of a combination of fludarabine and cyclophosphamide (FC) was evaluated in patients with B-cell chronic lymphocytic leukaemia (CLL). Between April 1997 and July 1998, 36 patients with CLL (median age 59 years) received a regimen that consisted of fludarabine 30 mg/m(2) in a 30-min IV infusion, d 1-3, and cyclophosphamide 250 mg/m(2) in a 30-min IV infusion on d 1-3. Cycles were repeated every 28 d. Twenty-one patients had received between one and three different treatment regimens prior to the study, while 15 patients had received no prior therapy. The median Eastern Cooperative Oncology Group performance score was 1. One patient was at Binet stage A, 18 were stage B and 17 patients were stage C. Objective responses, assessed according to the revised guidelines of the National Cancer Institute-sponsored Working Group, were recorded in 29 out of 32 assessable patients (90.6%). Twenty-four partial remissions and five complete remissions were observed. Two patients showed no change and one patient showed disease progression. At February 2000, three of the responders had relapsed. Severe neutropenia, anaemia and thrombocytopenia (Common Toxicity Criteria grade 3 and 4) were observed in 25, six and six patients (69.4%, 16.7% and 16.7%) respectively. Other side-effects were uncommon. No treatment-related deaths and no grade 3 or 4 infections occurred. We conclude that the combination of fludarabine and cyclophosphamide showed significant activity in patients with CLL. Myelosuppression was the major side-effect. These results warrant further study on the FC combination in randomized trials.
authors.affiliation: Klinikum der Universität München, Grosshadern, München, Germany. mhallek@med3.med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Hallek
authors.forename: B
authors.initials: B
authors.lastname: Schmitt
authors.forename: M
authors.initials: M
authors.lastname: Wilhelm
authors.forename: R
authors.initials: R
authors.lastname: Busch
authors.forename: A
authors.initials: A
authors.lastname: Kröber
authors.forename: H P
authors.initials: HP
authors.lastname: Fostitsch
authors.forename: O
authors.initials: O
authors.lastname: Sezer
authors.forename: M
authors.initials: M
authors.lastname: Herold
authors.forename: W
authors.initials: W
authors.lastname: Knauf
authors.forename: C M
authors.initials: CM
authors.lastname: Wendtner
authors.forename: R
authors.initials: R
authors.lastname: Kuse
authors.forename: M
authors.initials: M
authors.lastname: Freund
authors.forename: A
authors.initials: A
authors.lastname: Franke
authors.forename: F
authors.initials: F
authors.lastname: Schriever
authors.forename: C
authors.initials: C
authors.lastname: Nerl
authors.forename: H
authors.initials: H
authors.lastname: Döhner
authors.forename: E
authors.initials: E
authors.lastname: Thiel
authors.forename: W
authors.initials: W
authors.lastname: Hiddemann
authors.forename: G
authors.initials: G
authors.lastname: Brittinger
authors.forename: B
authors.initials: B
authors.lastname: Emmerich
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine