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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. References 1 Tallman MS, Hakimian D. Purine nucleoside analogs: emerging roles in indolent lymphoproliferative disorders. Blood 1995; 86: 2463–2474. 2 Juliusson G, Liliemark J. Long-term survival following cladribine (2-chlorodeoxyadenosine) therapy in previously treated patients with chronic lymphocytic leukemia. Ann Oncol 1996; 7: 373– 379. 3 Robak T, Błoński JZ, Urbańska-Ryś H, Błasińska-Morawiec M, Skotnicki AB. 2-Chlorodeoxyadenosine (Cladribine) in the treatment of patients with chronic lymphocytic leukemia 55 years old and younger. Leukemia 1999; 13: 518–523. 4 KeatingMJ, O’Brien S, Lerner C, Koller C, Beran M, Robertson LE, Freireich EJ, Estey E, Kantarjian H. Long-term follow-up of patients with chronic lymphocytic leukemia (CLL) receivingfludarabine regimens as initial therapy. Blood 1998; 92: 1165–1171. 5 Rai KR, Peterson BL, Appelbaum FR, Kolitz J, Cheson BD, Schiffer CA. Fludarabine compared with chlorambucil as primary therapy for chronic lymphocytic leukemia. N Engl J Med 2000; 343: 1750–1757. 6 Delannoy A, Martiat P, Gala JL, Deneys V, Ferrant A, Bosly A, Scheiff JM Michaux JL. 2-chlorodeoxyadenosine (CdA) for patients with previously untreated chronic lymphocytic leukemia (CLL). Leukemia 1995; 9: 1130–1135. 7 Robak T, Błoński JZ, Kasznicki M, Konopka L, Ceglarek B, Dmoszyñska A, Soroka-Wojtaszko M, Skotnicki AB, Nowak W, Dwilewicz-Trojaczek J, Tomaszewska A, Hellmann A, Lewandowski K, Kuliczkowski K, Potoczek S, Zdziarska B, Hansz J, Kroll R, Komarnicki M, Hołowiecki J, Grieb P. Cladribine with or without prednisone in the treatment of previously treated and untreated B- cell chronic lymphocytic leukaemia – updated results of the multicentre study of 378 patients. Br J Haematol 2000; 108: 357–368. 8 Robak T, Błoński JZ, Kasznicki M, Błasińska-Morawiec M, Krykowski E, Dmoszyńska A, Mrugała-Śpiewak H, Skotnicki AB, Nowak W, Konopka L, Ceglarek B, Maj S, Dwilewicz-Trojaczek J, Hellmann A, Urasiński I, Zdziarska B, Kotlarek-Haus S, Potoczek S, Grieb P. Cladribine with prednisone versus chlorambucil with CMC in untreated CLL T Robak et al prednisone as first-line therapy in chronic lymphocytic leukemia: report of a prospective, randomized, multicenter trial. Blood 2000; 96: 2723–2729. 9 Robertson LE, Huh YO, Butler JJ, Pugh WC, Hirsch-Ginsberg C, Stass S, Kantarjian H, KeatingMJ. Response assessment in chronic lymphocytic leukemia after fludarabine plus prednisone: clinical, pathologic, immunophenotypic and molecular analysis. Blood 1992; 80: 29–36. 10 Van Den Neste E, Bontemps F, Delacauw A, Cardoen S, Louviaux I, Scheiff JM, Gillis E, Leveugle P, Deneys V, Ferrant A, Van den Berghe G. Potentiation of antitumor effects of cyclophosphamide derivatives in B-chronic lymphocytic leukemia cells by 2-chloro- 2deoxyadenosine. Leukemia 1999; 13: 918–925. 11 Góra-Tybor J, Robak T. Synergistic action of 2-chlorodeoxyadenosine and cyclophosphamide on murine leukemia L1210 and P388. Acta Haematol Pol 1993; 24: 177–182. 12 Hoffman M, Xu JC, Lesser M, Rai K. Cytotoxicity of 2-chlorodeoxyadenosine (cladribine 2-CdA) in combination with other chemotherapy drugs against two lymphoma cell lines. Leuk Lymphoma 1999; 33: 141–145. 13 Van Den Neste E, Louviaux I, Michaux JL, Dellannoy A, Michaux L, Sonet A, Bosly A, Doyen C, Mineur P, Andre M, Straetmans N, Coche E, Venet C, Duprez T, Ferrant A. Phase I/II study of 2- chloro-2-deoxyadenosine with cyclophosphamide in patients with pretreated B cell chronic lymphocytic leukemia and indolent non-Hodgkin’s lymphoma. Leukemia 2000; 14: 1136–1142. 14 Laurencet FM, Zulian GB, Guetty-Alberto M, Iten PA, Betticher DC, Alberto P. Cladribine with cyclophosphamide and prednisone in the management of low-grade lymphoproliferative malignancies. Br J Cancer 1999; 79: 1215–1219. 15 Kano Y, Akutsu M, Tsunoda S, Suzuki K, Ichikawa A, Furukawa Y, Bai L, Kon K. In vitro cytotoxicity effects of fludarabine (2-Fara-A) in combination with commonly used antileukemic agents by isohologram analysis. Leukemia 2000; 14: 379–388. 16 Robertson LE, O’Brien S, Kantarjian H, Koller C, Beran M, Andreeff M, Lerner S KeatingMJ. Fludarabine plus doxorubicin in previously treated chronic lymphocytic leukemia. Leukemia 1995; 9: 943–945. 17 McLaughlin P, Hagemeister FB, Romagnera JE, Sarris AH, Pate O, Younes A, Swan F, KeatingM, Cabanillas F. Fludarabine, mitoxantrone and dexamethasone: an effective new regimen for indolent lymphoma. J Clin Oncol 1996; 14: 1262–1268. 18 Saven A, Lee T, Kosty M, Piro L. Cladribine and mitoxantrone dose escalation in indolent non-Hodgkin’s lymphoma. J Clin Oncol 1996; 14: 2139–2144. 19 Robak T, Góra-Tybor J, Urbañska-Ryś H, Krykowski E. Combination regimen of 2-chlorodeoxyadenosine (cladribine), mitoxantrone and dexamethasone (CMD) in the treatment of refractory and recurrent low grade non-Hodgkin’s lymphoma. Leuk Lymphoma 1999; 32: 359–363. 20 Robak T, Góra-Tybor J, Chojnowski K. Cladribine as monotherapy or combined with dexamethasone and idarubicin or mitoxantrone in previously treated patients with low-grade lymphoid malignancies. Haematologica 2000; 85: 215–216. 21 Robak T, Góra-Tybor J, Lech-Marańda E, Błoński JZ, Kasznicki M. Cladribine in combination with mitoxantrone and cyclophosphamide (CMC) in the treatment of heavily pretreated patients with advanced indolent lymphoid malignancies. Eur J Haematol 2000; 66: 188–194. 22 Cheson BD, Bennett JM, Grever M, Kay N, KeatingMJ, O’Brien S, Rai KR. National Cancer Institute-Sponsored WorkingGroup guidelines for chronic lymphocytic leukemia: revised guidelines for diagnosis and treatment. Blood 1996; 87: 4990–4997. 23 Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood 1975; 46: 219–234. 24 Kazimierczuk Z, Cottam HB, Ravanliar GR, Robins RK. Synthesis of 2-deoxytubercidin, 2-deoxyadenosin and related 2-dexynucleosides via a novel direct stereospecific serum salt glycosylation procedure. J Am Chem Soc 1984; 106: 6379–6382. 25 Cheson BD, Bennet MJ, Rai KR, Grever MR, Kay NE, Schiffer CA, Oken MM, KeatingMJ, Boldt DH, Kempin SJ, Foon KA. Guidelines for clinical protocols for chronic lymphocytic leukemia: recommendations of the National Cancer Institute-Sponsored WorkingGroup. Am J Hematol 1988; 29: 152–163. 1515 Leukemia
1516 CMC in untreated CLL T Robak et al 26 Brugiatelli M, Claisse JF, Lenormand B, Marabiro F, Callea V, Malloum K, Chevret S, Binet JL, Dighiero G, Travade P. Long term clinical outcome of B-cell chronic lymphocytic leukaemia patients in clinical remission phase evaluated at phenotypic level. BrJ Haematol 1997; 97: 113–118. 27 Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981; 47: 207–214. 28 Duffy DR, Santner TJ. Confidence intervals for binomial parameter based on multistage tests. Biometrics 1987; 43: 81–93. 29 Rummel MJ, Kafer G, Pfreundschuh M, Jager E, Reinhardt U, Mitrou PS, Hoelzer D, Bergmann L. Fludarabine and epirubicin in the treatment of chronic lymphocytic leukaemia: a German multicenter phase II study. Ann Oncol 1999; 10: 183–188. 30 Zinzani PL, Magagnoli M, Moretti L, De Renzo A, Battista R, Zaccaria A, Guardigni L, Mazza P, Marra R, Ronconi F, Lauta VM, Bendandi M, Gherlinzoni F, Gentilini P, Ciccone F, Cellini C, Stefoni V, Ricciuti F, Gobbi M, Tura S. Randomized trial of fludarabine versus fludarabine and idarubicin as front line treatment in patients with indolent or mantle-cell lymphoma. J Clin Oncol 2000; 18: 773–779. 31 O’Brien S, Kantarjian H, Beran M, Freireich E, Kornblau S, Koller C, Lerner S, Gilbreath J, KeatingM. Fludarabine (FAMP) and cyclophosphamide (CTX) therapy in chronic lymphocytic leukemia (CLL). Blood 1996; 88 (Suppl. 1): 480a (Abstr. 1910.) 32 Flinn IW, Byrd JC, Morrison C, Janison J, Diehl LF, Murphy T, Piantadosi S, Seifter C, Ambinder RF, Vogelsang G, Grever MR. Fludarabine and cyclophosphamide with filgrastim support in patients with previously untreated indolent lymphoid malignancies. Blood 2000; 96: 71–75. 33 Cazin B, Binet JL, Divine M, Lepretre S, Lederlin P, Travade P, Lemaire G, Guibon O. Oral fludarabine and cyclophosphamide in previously untreated chronic lymphocytic leukemia. Blood 2000; 96 (Suppl. 1): 515a (Abstr. 2218). 34 O’Brien S, Kantarjian H, Beran M, Robertson LE, Freilich E, Kornblau S, Koller C, Estey E, Lerner S, KeatingM. Fludarabine and mitoxantrone therapy in chronic lymphocytic leukemia. Blood 1996; 88 (Suppl. 1): 588a (Abstr. 2341). 35 Rummel MJ, Stilgenbauer S, Gamm H, Karakas T, Mitrou PS, Doelmer H, Hoelzer D, Bergmann L. Fludarabine versus fludarabine plus epirubicin in the treatment of chronic lymphocytic leukemia – preliminary results of a randomized phase III multicenter study. Blood 2000; 96 (Suppl. 1): 2946 (Abstr. 5013). 36 Bocchia M, Bigazzi C, Marconcini S, Forconi F, Marotta G, Algeri R, Lauria F, Favorable impact of low-dose fludarabine plus epirubicin and cyclophosphamide regimen (FLEC) as treatment for lowgrade non-Hodgkin’s lymphomas. Hematologica 1999; 84: 716– 720. 37 Perales M, Bosch F, Esteve J, Fludarabine, cyclophosphamide and mitoxantrone (FCM) in resistant or relapsed chronic lymphocytic leukemia and follicular lymphoma. Ann Oncol 1999; 10 (Suppl. 3): 128 (Abstr. 462). 38 Weiss M, Spiess T, Berman E, Kempin S. Concomitant administration of chlorambucil limits dose intensity of fludarabine in previously treated patients with chronic lymphocytic leukemia. Leukemia 1994; 8: 1290–1293. 39 Cheson BD. Infectious and immunosuppressive complications of purine analogtherapy. J Clin Oncol 1995; 13: 2431–2448. 40 Anaissie EJ, Kontoyiannis DP, O’Brien S, Kantarjian H, Robertson L, Lerner S, KeatingMG. Infections in patients with chronic lymphocytic leukemia treated with fludarabine. Ann Intern Med 1998; 129: 559–566. 41 Betticher DC, von Rohr A, Ratschiller D, Schmitz SF, Egger T, Sonderegger T, Herrmann R, Kroner T, Zulian GB, Cavalli F, Fey MF, Cerny T. Fewer infections, but maintained antitumor activity with lower-dose versus standard-dose cladribine in pretreated lowgrade non-Hodgkin’s lymphoma. J Clin Oncol 1998; 16: 850–858. 42 O’Brien S, Kantarjian H, Beran M, Koller C, Talpaz M, Lerner S, KeatingMJ. Fludarabine and granulocyte colony-stimulatingfactor (G-CSF) in patients with chronic lymphocytic leukemia. Leukemia 1997; 11: 1631–1635. 43 Flinn IW, Byrd JC, Morrison C, Jamison J, Diehl LF, Murphy T, Piantadosi S, Seifter E, Ambinder RF, Vogelsang G, Grever MR. Fludarabine and cyclophosphamide with filgrastim support in patients with previously untreated indolent lymphoid malignancies. Blood 2000; 96: 71–75. 44 Sudhoff T, ArningM, Schneider W. Prophylactic strategies to meet infectious complications in fludarabine treated CLL. Leukemia 1997; 11: S38–41. 45 Byrd JC, Hargis JB, Kester KE, Hospenthal DR, Knutson SW, Diehl LF. Opportunistic pulmonary infections with fludarabine in previously treated patients with low-grade lymphoid malignancies: a role for Pneumocystis carinii pneumonia prophylaxis. Am J Hematol 1995; 49: 135–142. 46 Kalil N, Cheson BD. Management of chronic lymphocytic leukaemia. Drugs Aging 2000; 16: 9–27. Leukemia
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