Florida Center for Cellular Therapy, Florida Hospital Cancer Institute, Orlando, FL 32804, USA. melhem.solh.MD@fl hosp.org
Leuk Lymphoma. 2013 Feb;54(2):252-4. doi: 10.3109/10428194.2012.710327. Epub 2012 Sep 8.
The impact of initial fludarabine therapy on transformation to Richter syndrome (RS) or prolymphocytic leukemia (PLL) in patients with chronic lymphocytic leukemia (CLL) is uncertain. We studied the outcomes of 521 patients with CLL who were randomized to initial fludarabine (F), chlorambucil (C) or F + C therapy on an intergroup trial (CALGB 9011). RS developed in 34 (7%) patients and PLL in 10 (2%). RS and PLL occurred in 14 (7%) and three (2%) of 188 patients randomized to F; nine (5%) and four (2%) of 191 patients treated with C; and 11 (8%) and three (2%) of 142 receiving F + C, respectively. Four percent of the 206 patients with Rai stage III/IV developed PLL, compared to only 1% of the 315 patients with Rai stage I/II (p = 0.02). Initial fludarabine therapy in patients with CLL did not impact transformation to RS or PLL, nor were any other baseline characteristics predictive for such transformation in this series.
初始氟达拉滨治疗对慢性淋巴细胞白血病（CLL）患者向 Richter 综合征（RS）或前淋巴细胞白血病（PLL）转化的影响尚不确定。我们研究了 521 例 CLL 患者的结局，这些患者在一项分组试验（CALGB 9011）中被随机分配接受初始氟达拉滨（F）、苯丁酸氮芥（C）或 F + C 治疗。34 例（7%）患者发生 RS，10 例（2%）患者发生 PLL。188 例接受 F 治疗的患者中，7%（14 例）和 2%（3 例）发生 RS 和 PLL；191 例接受 C 治疗的患者中，5%（9 例）和 2%（4 例）发生 RS 和 PLL；142 例接受 F + C 治疗的患者中，8%（11 例）和 2%（3 例）发生 RS 和 PLL。4%的 Rai 分期 III/IV 期患者发生 PLL，而仅 1%的 Rai 分期 I/II 期患者发生 PLL（p = 0.02）。在本系列中，初始氟达拉滨治疗并未影响 CLL 患者向 RS 或 PLL 的转化，也没有任何其他基线特征可预测这种转化。
