A Clinical Update on Chronic Lymphocytic Leukemia. II. Critical Analysis of Current Chemotherapeutic Modalities

AYALEW TEFFERI, ROBERT L. PHYLIKY

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Not all patients with B-cell chronic lymphocytic leukemia require therapy. Patients with stable early stage disease do not need treatment, whereas those with progressive early stage disease or advanced stage disease do. The standard initial therapeutic regimen is orally administered chlorambucil and prednisone. The overall response rate to initial chemotherapy is approximately 80%; the median duration of response is 2 years. Conventional chemotherapy, however, does not provide long-term remission for patients in whom the disease becomes refractory to chlorambucil. For such patients, alternative treatment approaches including the use of purine nucleoside analogues or bone marrow transplantation may be considered. Fludarabine, 2-chlorodeoxyadenosine, and pentostatin are three analogues of the naturally occurring deoxypurine nucleoside, deoxyadenosine, and all have shown activity in chronic lymphocytic leukemia. Overall response rates of 57 to 79% have been reported with use of fludarabine. A dose-related toxic effect is myelosuppression. Experience with bone marrow transplantation is limited. The number of eligible patients with histocompatible sibling donors is low. The future role of allogeneic bone marrow transplantation in patients with B-cell chronic lymphocytic leukemia will depend on the ability to identify poor-risk groups and the long-term therapeutic efficacy of the purine nucleoside analogues or other new agents

Original languageEnglish (US)
Pages (from-to)457-461
Number of pages5
JournalMayo Clinic proceedings
Volume67
Issue number5
DOIs
StatePublished - Jan 1 1992

ASJC Scopus subject areas

  • Medicine(all)

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