Background: In the last years the treatment of patients with chronic lymphocytic leukemia (CLL) and low-grade lymphomas (NHL) has changed because of the introduction of new agents, mainly the purine analogs. We report our experience with fludarabine in patients with indolent lymphoid malignancies that were previously treated with conventional agents.
Patients and methods: Twenty patients were studied. Eleven had CLL and nine NHL. Among the patients with CLL and NHL, 72 and 100%, respectively, had advanced disease. All patients had previously been treated. Fludarabine was administered by intravenous infusion at a dose of 25 mg/m2, for 5 days every 4 weeks until a maximum of 6 cycles.
Results: Neither complete response (CR) nor partial response (PR) was recorded in patients with CLL; 4 (36%) achieved clinical improvement. Among the 9 patients with NHL, 3 (33%) had a CR and one a PR; two of the 3 patients with CR also achieved a molecular remission. In 3 patients with CLL their disease progressed from stage II to IV. Three patients (one with CLL and two with NHL) developed high-grade lymphoma during or immediately after the treatment with fludarabine. The major toxicities were infections: 3 patients had lobar pneumonia and one an interstitial pneumonia without microbiological identification.
Conclusions: Fludarabine is an active agent in patients with low-grade lymphoid malignancies refractory to the treatment or in relapse. The possibility of obtaining molecular remissions makes this agent specially interesting in those therapies including hemopoietic progenitors transplantation as intensification treatment.