لوسمي لنفوسيتيك مزمن و اثر فلودارابين در درمان آن

Chronic Lymphocytic leukemia and Treatment Effect of Fludarabin

Background and Objectives: CLL (Chronic Lymphocytic Leukemia) is the most common form of leukemia in the western world and because of prolonged survival of patients, the prevalence is high. Chemotherapy is usually not indicated in early and stable disease and using chlorambucil with or without steroids has been the drug of choicc in the treatment of CLL for many years .Clinical studies have shown that using fludarabin can cause a complete response in significant number of untreated and/or previously treated CLL patients. The aim of this study was evaluation of CLL patients and determining the effects of treatment with fludarabin. Materials and Methods: A retrospective (descriptive/cross sectional) study of CLL patients who were admitted to Hematology and Oncology Research Center of Tabriz University of Medical Sciences, between 1995-2005 was made and 126 patients enrolled. Collection of data was carried out according to special questionnaire and response to fludarabin was analyzed by SPSS-1 1 software. Results: The mean age of patients at diagnosis was 63.7±8.9 years, 69.8% were males. Illness and fatigue were the most common presenting symptoms in 54% and lymphadenopathy was the most common clinical sign in 88.9%. Most of the patients were in stage C in Binct system (52.4%) and/or stage IV in Rai system (44.4%). Chemotherapy with chlorambucil and prednisolone was the most common regimen used (60.3%) and 49.2% of patients were in partial remission with this treatment. Forty two patients treated with fludarabin and 50% were in partial remission, 35% in static disease, 10% in progressive disease and 5% in complete remission (P=0.053). Conclusion: The median survival with fludarabin was 43.9±27.2, months and in the case of chlorambucil + prednisolone and cyclophosphamide + vincristine + prednisone (CVP) or cyclophosphamide + vincristine + prednisone + doxorubicine (CHOP), it was 45±26.5, months and 50±32.2, months respectively (P>0.05). P value in relation with survival and response to fludarabin was 0.05. Above all, fludarabin is the treatment of choice as first and second line therapy and for patients who have failed therapy with standard regimens.