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Combination chemotherapy of advanced chronic lymphocytic leukemia: the M-2
protocol (vincristine, BCNU, cyclophosphamide, melphalan, and prednisone)
S Kempin, BJ Lee , HT Thaler, B Koziner, S Hecht, T Gee, Z Arlin, C Little, D Straus, L Reich, E Phillips, H Al-Mondhiry, M Dowling, K Mayer and B Clarkson
The M-2 protocol (vincristine, cyclophosphamide, BCNU, melphalan, and
prednisone) was administered monthly to 63 evaluable patients with advanced
chronic lymphocytic leukemia. Complete remission (absence of all clinical
and bone marrow evidence of leukemia) and partial response (greater than
50% decrease in organ enlargement and reduction of WBC count to below
15,000 x 10(6)/liter) were achieved in 17% and 44%, respectively, for a
total response rate of 61%. The median survivals from therapy of patients
achieving a CR, RR, or no response were 73+, 40, and 14 mo respectively.
The median survival time from onset of treatment for stages II, III, and IV
disease were 47, 20 and 19 mo, respectively, which was not statistically
different from historical controls. However, when untreated patients are
compared to this latter group, a significant survival advantage from
diagnosis was found (p = 0.01), stressing the importance of prior therapy
as the only unfavorable prognostic factor. Although complete remissions in
CLL, as reflected in apparently normal bone marrow B-lymphocyte markers,
can be induced wih acceptable morbidity, the majority of patients relapse
after cessation of therapy. An alternative approach to the M-2 protocol
will be needed to eradicate the disease.
Volume 60,
Issue 5,
pp. 1110-1121,
11/01/1982
Copyright © 1982 by The American Society of Hematology
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