Response to 2-chlorodeoxyadenosine in patients with B-cell chronic lymphocytic leukemia resistant to fludarabine.

Abstract

BACKGROUND:

Patients with untreated B-cell chronic lymphocytic leukemia have a high rate of complete remission when given the halogenated nucleoside analogue fludarabine. However, patients in whom the disease has proved refractory to primary treatment have a reduced life expectancy and a dismal outcome.

METHODS:

We treated four consecutive patients who had unsatisfactory responses to second-line or subsequent treatment with fludarabine with another halogenated nucleoside analogue, 2-chlorodeoxyadenosine.

RESULTS:

One patient with progressing lymphocytosis, anemia, and thrombocytopenia despite 10 courses of fludarabine entered a complete remission when treated with 2-chlorodeoxyadenosine. Two patients who had less-than-partial remissions after six courses of fludarabine had good partial remissions when treated with 2-chlorodeoxyadenosine. One patient with Coombs-positive hemolytic anemia who had no response to three courses of fludarabine had a partial remission, with resolution of hypogammaglobulinemia, when treated with 2-chlorodeoxyadenosine.

CONCLUSIONS:

There was no evidence of cross-resistance between fludarabine and 2-chlorodeoxyadenosine despite their similar structures. 2-Chlorodeoxyadenosine may induce a complete remission in chronic lymphocytic leukemia that is highly resistant to chemotherapy, and it deserves wider clinical evaluation in patients with this condition.

• Authors: G Juliusson, A Elmhorn-Rosenborg, J Liliemark
• Journal: The New England journal of medicine (N Engl J Med) Vol. 327 Issue 15 Pg. 1056-61 (Oct 08 1992) ISSN: 0028-4793 [Print] United States
• PMID: 1355853 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Deoxyadenosines
• Haptoglobins
• Immunoglobulins
• 2-Chloroadenosine
• Cladribine
• Vidarabine
• fludarabine

Topics

• 2-Chloroadenosine (analogs & derivatives, therapeutic use)
• Adult
• Antineoplastic Agents (therapeutic use)
• Cladribine
• Deoxyadenosines (therapeutic use)
• Drug Resistance
• Female
• Haptoglobins (analysis)
• Humans
• Immunoglobulins (analysis)
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy)
• Leukocyte Count
• Lymphocytes
• Male
• Middle Aged
• Remission Induction
• Vidarabine (analogs & derivatives, therapeutic use)