Fludarabine-based combined chemotherapy in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma

Objective:To evaluate the therapeutic effects and adverse reactions of fludarabine-based combined chemotherapy in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL/SLL).Methods:Eighteen patients with CLL/SLL,nine of whom were previously untreated and nine of whom were relapsed/refractory,were treated with regimens including fludarabine(FMD,fludarabine,mitoxantrone and dexamethasone;FMC,fludarabine,cyclophosphamide and mitoxantrone;FC,fludarabine and cyclophosphamide).Results:The average course of the eighteen patients was 4.2.The complete response(CR)rate,partial response(PR)rate and overall response(OR)rate were 61.1%,22.2% and 83.3% respectively.There were no significance difference of CR,PR and OR rates between previously untreated and relapsed/refractory group(66.7%,33.3%,100% vs.55.6%,11.1%,66.7% respectively,P0.05).There were no significance difference of CR and OR rates between FC and FMD(50%,75% vs 80%,100%,P0.05).The main adverse reactions included myelosuppression and immunosuppression.Grade Ⅲ-Ⅳ agranulocytosis was found in 27.8% patients,and grade Ⅲ-Ⅳ thrombocytopenia in 22.2% patients.Infection and fever occurred in 5 patients,including died of pulmonary infection.Other toxicities mainly included nausea,vomiting and mild liver,kidney function impairment and autoimmune haemolytic anemia.The median follow-up time was 24 months(range 1~40 months).2-year survival rate was 88.9%,and 2-year progression free survival rate was 81.8%.In the previously untreated group,2-year survival rate and progression free survival rate were 100%.While in the relapsed or refractory group,2-year survival rate was 83.3%,and 2-year progression free survival rate was 66.7%.There was no significant difference between the two groups(P0.05).Conclusion:The fludarabine-based chemotherapy regimens had good therapeutic effect on patients with CLL/SLL and could be well tolerated.