Long Island Jewish Medical Center, Hofstra University School of Medicine, New York, NY 11042, USA.
Clin Lymphoma Myeloma Leuk. 2011 Jun;11 Suppl 1:S7-9. doi: 10.1016/j.clml.2011.04.007. Epub 2011 May 7.
Historically, chlorambucil had been considered to be the treatment of choice for previously untreated patients with chronic lymphocytic leukemia (CLL) from the 1950's until 1990's. Ever since the 1990's, when the nucleoside analogue, fludarabine, became available as a therapeutic agent, this drug has replaced chlorambucil in the treatment of CLL. In the initial treatment of CLL. Although, prospectively conducted, randomized clinical trials comparing these two drugs in the front-line therapy of CLL, initially, showed a significant increase in the complete remission rates, overall remission rates, and progression-free-survival in patients treated with fludarabine, as compared to the patients treated with chlorambucil, the overall survival duration did not show a significant improvement improvement. A recent report, of a long-term follow-up of that study now reveals that a significant increase in the overall survival time of the patients who, originally, were randomized to fludarabine arm started to become manifest only after about 6 years had passed from the time of first treatment on this study. Thus, fludarabine has now been proven to be superior to chlorambucil for the initial treatment of CLL.
从 20 世纪 50 年代到 90 年代，苯丁酸氮芥一直被认为是治疗慢性淋巴细胞白血病（CLL）初治患者的首选药物。自 90 年代核昔类似物氟达拉滨作为治疗药物问世以来，氟达拉滨已取代苯丁酸氮芥用于 CLL 的治疗。在 CLL 的初始治疗中，虽然前瞻性随机临床试验比较了这两种药物在 CLL 一线治疗中的疗效，但最初显示氟达拉滨治疗组的完全缓解率、总缓解率和无进展生存期显著提高，而苯丁酸氮芥治疗组则无显著改善。最近的一份报告显示，对该研究的长期随访显示，最初随机分配到氟达拉滨组的患者的总生存时间显著增加，仅在该研究首次治疗后约 6 年才开始显现。因此，氟达拉滨现已被证明优于苯丁酸氮芥用于 CLL 的初始治疗。
