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High-dose chlorambucil for the treatment of chronic lymphocytic leukaemia and low-grade non-Hodgkin's lymphoma

Lookup NU author(s): Dr Penelope Taylor, Professor Stephen Proctor

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Abstract

Chlorambucil has been used for many years for the treatment of low-grade B-cell lymphoproliferative disorders, including chronic lymphocytic leukaemia and low-grade non-Hodgkin's lymphoma. There is evidence in the literature that increasing the dose of chlorambucil produces better results than 'standard' doses in terms of response rates and overall survival. There is also evidence that this approach may be at least as effective as the use of fludarabine, as well as being very much less expensive. We describe a high-dose chlorambucil (HDC) regimen, which involves a sustained but intermittent dose of chlorambucil, i.e. 30 mg/d for 4 d per week for 4 weeks, followed by a further four courses at fortnightly intervals for 8 weeks (a total of eight 4-d courses) given as a single drug over an initial 12-week period. The outcome of treatment in previously treated and untreated patients was excellent, with a median time to treatment failure of 33 months for the patient cohort overall and for previously treated and chemotherapy-naive patients of 13 and 104 months respectively. In patients previously treated with fludarabine, 78% had a response. Autoimmune haemolytic anaemia was reversed in one patient. Toxicity, both haematological and other, was minimal. We propose that escalated-dose chlorambucil regimens should be compared with fludarabine in randomized controlled trials, rather than 'standard' lower dose protocols.

Publication metadata

Author(s): Summerfield GP, Taylor PRA, Mounter PJ, Proctor SJ

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2002

Volume: 116

Issue: 4

Pages: 781-786

Print publication date: 01/03/2002

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

URL: http://dx.doi.org/10.1046/j.0007-1048.2002.03362.x

DOI: 10.1046/j.0007-1048.2002.03362.x

PubMed id: 11886381

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