Authors: Neste, E.¹; Michaux, L.²; Layios, N.²; Costantini, S.²; Francart, J.³; Lambert, C.²; Sonet, A.⁴; André, M.⁵; Robert, A.³; Ferrant, A.²

Source: Annals of Hematology, Volume 83, Number 6, June 2004 , pp. 356-363(8)

Publisher: Springer

Abstract:

The combination of purine analogs with alkylating agents is able to produce a synergistic antitumoral effect. However, the addition of immunosuppressive and DNA-targeting agents might increase purine analog-related complications. The risk for serious complications was evaluated in 38 patients treated with 2-chloro-2'-deoxyadenosine (CDA) and cyclophosphamide (CP). The diagnoses were chronic lymphocytic leukemia (CLL) in 15, Waldenström's macroglobulinemia in 4, mantle cell lymphoma in 6, follicular non-Hodgkin's lymphoma (NHL) in 10, and other low-grade NHL in 3 patients. All patients were pretreated (median: 2 lines, range: 1–5) and 23 (61%) were refractory. The patients received a median of two courses (range: 1–5) of 5.6 mg/m² CDA, followed by a median of 200 mg/m² CP, for 3 days. The response rate was 51% [complete remission (CR): 14%, partial remission (PR): 38%]. Grade 3/4 infections occurred in 16 (42%) patients. Dose-limiting cytopenias were seen in 22 (58%) patients. In 12 (32%) patients, autoimmune manifestations developed requiring treatment in most of them. Second cancers arose in five (13%) patients (myelodysplastic syndrome/acute myelocytic leukemia in three, lung cancer in two). Multivariate analysis showed that cytopenias, gender (F), prior radiotherapy, and age (>65 years) predicted for the complications seen after CDA-CP. To conclude, because of the high incidence of complications, caution is warranted in selecting patients with advanced lymphoid malignancies for the CDA-CP protocol.

Keywords: Chronic lymphocytic leukemia; Cladribine; Non-Hodgkin's lymphoma; Myeloid leukemia; Nucleoside analog

Document Type: Research article

DOI: http://dx.doi.org/10.1007/s00277-004-0858-7

Affiliations: 1: Department of Hematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, 1200, Brussels, Belgium, Email: vandenneste@sang.ucl.ac.be 2: Department of Hematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, 1200, Brussels, Belgium, 3: Department of Epidemiology, School of Public Health, Faculty of Medicine, Université catholique de Louvain, Brussels, Belgium, 4: Department of Hematology, Cliniques universitaires UCL de Mont-Godinne, Yvoir, Belgium, 5: Department of Hematology, Centre d'Hémato-Oncologie de Charleroi, Charleroi, Belgium,

Publication date: 2004-06-01

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