903Article on Fludaribine and 2CDA
- Sep 26, 1998For your information. --Matt--
1998 Jul;4 Suppl 2:S27-S36
New prospects in the treatment of indolent lymphomas with purine analogues.
Division of Cancer Treatment and Diagnosis, National Cancer Institute,
Bethesda, Maryland 20892-7436, USA.
PURPOSE: To review the activity of the purine analogues fludarabine,
cladribine (2-chlorodeoxyadenosine [2-CdA]), and pentostatin
(2'-deoxycoformycin) in the treatment of indolent lymphoid malignancies,
including chronic lymphocytic leukemia, hairy cell leukemia, and indolent non-
Hodgkin's lymphomas (NHLs). PATIENTS AND METHODS: Patients with previously
untreated, relapsed, or refractory indolent NHL and other indolent lymphoid
malignancies who have been treated with purine analogues. RESULTS: Purine
analogues have revolutionized the treatment of indolent lymphomas. Fludarabine
induces responses in almost 50% of patients with relapsed or refractory
indolent NHL and produces complete remissions (CRs) in 10% to 15% of patients.
In patients receiving fludarabine as initial treatment, CRs are achieved in
almost 40%, with an overall response rate of 70% and a median time to
progression > 1 year. Response rates with 2-CdA in previously treated patients
appear similar to those with fludarabine, although less durable. Fludarabine
and 2-CdA achieve a higher number of durable responses in Waldenstrom's
macroglobulinemia than are generally achieved with alkylating agents in this
disease. Pentostatin appears to be less active in NHL. Newer purine analogues
currently in clinical trials in lymphomas include gemcitabine and compound
506U. Promising activity has been reported with the combination of
fludarabine, mitoxantrone, dexamethasone, and fludarabine plus
cyclophosphamide. Combinations of 2-CdA with other agents are also in
development. Toxicities associated with these purine analogues primarily
include moderate myelosuppression, profound immunosuppression, neurotoxicity
at higher than recommended doses, and a possible increase in secondary
malignancies. CONCLUSION: The purine analogues should provide the basis for
new treatment strategies with the goal of curing patients with indolent NHL.
For progress to continue, patients must be referred to important and
innovative clinical research trials.
PMID: 9672772, UI: 98336643
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