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Blood, Vol. 92 No. 4 (August 15), 1998:
pp. 1165-1171
Long-Term Follow-Up of Patients With Chronic Lymphocytic Leukemia
(CLL) Receiving Fludarabine Regimens as Initial Therapy
M.J. Keating,
S. O'Brien,
S. Lerner,
C. Koller,
M. Beran,
L.E. Robertson,
E. J Freireich,
E. Estey, and
H. Kantarjian
From the Department of Hematology, The University of Texas, M.D.
Anderson Cancer Center, Houston, TX.
One hundred seventy-four patients with progressive or advanced
chronic lymphocytic leukemia (CLL) have received initial therapy with
fludarabine as a single agent or fludarabine combined with prednisone.
The overall response rate was 78% and the median survival was 63 months. No difference in response rate or survival was noted in the 71 patients receiving fludarabine as a single agent compared with the 103 patients who received prednisone in addition. The median time to
progression of responders was 31 months and the overall median survival
was 74 months. Patients over the age of 70 years had shorter survivals.
Patients with advanced stage disease (Rai III and IV) had a somewhat
shorter survival than earlier stage patients. More than half the
patients who relapsed after fludarabine therapy responded to salvage
treatment, usually with fludarabine-based regimens. Second remissions
were more common in patients who had achieved a complete remission on
their initial treatment. The CD4 and CD8 T-lymphocyte subpopulations
decreased to levels in the range of 150 to 200/µL after the first 3 courses of treatment. Although recovery towards normal levels was slow, the incidence of infections was low in patients in remission (1 episode
of infection for every 3.33 patient years at risk) and decreased with
time off treatment. There was no association of infections or febrile
episodes with the use of corticosteroids or the CD4 count at the end of
treatment and a poor correlation with the increase in CD4 counts during
remission. Infectious episodes were less common in patients who had a
complete response compared with partial responders. Richter's
transformation occurred in 9 patients and Hodgkin's disease occurred
in 4 patients. Five other patients died from other second malignancies.
Fludarabine appears to be an effective initial induction therapy with a
reasonable safety profile for patients with CLL.
© 1998 by The American Society of Hematology.
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