De Rossi G, Mauro F R, Caruso R, Monarca B, Mandelli F
Human Biopathology Department, University La Sapienza, Rome, Italy.
Haematologica. 1993 May-Jun;78(3):167-71.
The use of fludarabine, an analog of vidarabine with significant lymphocytolytic activity, has provided encouraging results in the treatment of patients with non Hodgkin's lymphoma (NHL) and sometimes in phase II studies of solid tumors and acute leukemias. Fludarabine has also been shown to be effective in B-CLL. Some studies referred results using fludarabine in high-risk untreated or pretreated CLL patients.
We report treatment results with fludarabine and prednisone in 22 pretreated B-CLL patients in progressive disease, refractory to CHL and other regimens.
One patient obtained a complete response (CR), 8 obtained a partial response (PR). Thirteen failed to respond to treatment. Among the partial responders, 1 patient had fatal pneumonia while neutropenic, another died of disease progression. Among the non responders, 7 died of progressive disease, and 3 evolved into high-grade NHL. Three are still alive in disease progression.
We confirm the effectiveness of fludarabine in pretreated and resistant B-CLL, but in the light of the considerable toxicity observed in this series, we believe that the drug would be better employed as a first-line approach to "younger" untreated B-CLL patients.
氟达拉滨是阿糖腺苷的类似物，具有显著的淋巴细胞溶解活性，在非霍奇金淋巴瘤（NHL）患者的治疗中取得了令人鼓舞的结果，在实体瘤和急性白血病的II期研究中有时也有成效。氟达拉滨在B细胞慢性淋巴细胞白血病（B-CLL）中也显示出有效性。一些研究报告了在未经治疗或经过预处理的高危CLL患者中使用氟达拉滨的结果。
我们报告了22例对CHL和其他方案难治的、处于疾病进展期的预处理B-CLL患者使用氟达拉滨和泼尼松的治疗结果。
1例患者获得完全缓解（CR），8例获得部分缓解（PR）。13例治疗无效。在部分缓解者中，1例在中性粒细胞减少时发生致命性肺炎，另1例死于疾病进展。在无反应者中，7例死于疾病进展，3例演变为高级别NHL。3例仍处于疾病进展期存活。
我们证实了氟达拉滨在预处理和耐药的B-CLL中的有效性，但鉴于本系列中观察到的相当大的毒性，我们认为该药物作为“年轻”未经治疗的B-CLL患者的一线治疗方法会更好。
