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903Article on Fludaribine and 2CDA

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  • Matt960@aol.com
    Sep 26, 1998
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      For your information. --Matt--

      1998 Jul;4 Suppl 2:S27-S36

      New prospects in the treatment of indolent lymphomas with purine analogues.

      Cheson BD

      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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