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of treatment. As an alternative, some authors are in favor of
prophylaxis with antibacterial and antiviral agents in patients
treated with purine analogs. 44,45 This approach is intended to
reduce the incidence of opportunistic infections. We have not,
however, observed in our patients infections caused by Pneumocystis
carinii or other opportunistic infections. Such an
approach should also not be recommended because of the
broad spectrum of potential infections that may necessitate the
use of numerous potentially toxic drugs. 46
In conclusion, combined treatment with 2-CdA, mitoxantrone
and cyclophosphamide (CMC programme) shows significant
therapeutic activity in previously untreated patients
with CLL. However, the toxicity of the CMC programme is
significant although it is restricted mainly to myelosuppression
and infections. The reduction of total dose of 2-CdA per cycle
in the CMC programme does not seem to decrease its antileukemic
activity but significantly reduces the risk of infections.
At present, it is not clear whether the CMC programme is more
efficient in comparison to 2-CdA in monotherapy or the combination
of 2-CdA with cyclophosphamide in previously
untreated CLL patients. Nevertheless, in our opinion, the
CMC3, but not the CMC5 programme, deserves further
evaluation.
Acknowledgements
This work was supported in part by grant No. 4P05B06019,
from KBN, Warsaw, Poland. We thank Mr Shane Gollop for
the correction of the English version of the manuscript.
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