According to an early online article published in the Journal of Clinical Oncology, the treatment combination consisting of the chemotherapy agents pentostatin (Nipent®), cyclohpsophamide (Cytoxan®), and the biologic agent Rituxan® (rituximab) appears promising for patients with recurrent or progressive chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia. The American Cancer Society estimates that approximately 8,000 people will be diagnosed with CLL this year. Currently, there are approximately 60,000 people in the US living with CLL.

CLL is characterized by the production of atypical lymphocytes. Lymphocytes are specialized immune cells that exist in two forms: B- and T-cells. These cells are produced in the bone marrow and each serves a specific function in aiding the body fight infection.

The large majority of CLL cases involve mature B-lymphocytes that tend to live much longer than normal. B-lymphocytes accumulate in the blood, bone marrow, lymph nodes, and spleen. This results in overcrowding of these areas and suppression of the formation and function of blood and immune cells. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further decrease in the body’s ability to fight infection.

Relapsed or refractory CLL refers to CLL that has stopped responding to prior therapies. Although there are several treatment options for patients with relapsed or refractory CLL, researchers continue to evaluate new therapeutic combinations and agents in order to provide optimal outcomes.

Researchers from Memorial Sloan Kettering Cancer Center and the Cleveland Clinic recently conducted a clinical trial evaluating the treatment combination consisting of chemotherapy agents pentostatin and cyclophosphamide and the biologic agent Rituxan. This trial included 32 patients with relapsed or refractory CLL; patients had received a median of two prior therapeutic regimens.

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The combination of pentostatin, cyclohpsophamide, and Rituxan® was active and well tolerated:

  • 75% of patients achieved anticancer responses.
  • Among patients who had stopped responding to the standard chemotherapy agent Fludara® (fludarabine), 75% of patients achieved anticancer responses to the trial treatment.
  • Median survival was 44 months.
  • At 3 years, 100% of patients who achieved a complete disappearance of detectable cancer were alive, while only 28% of patients who did not achieve large anticancer responses were still living.
  • Infections, occurring in 28% of patients, were the most common serious side effect.

The researchers concluded that the treatment combination consisting of pentostatin, cyclophosphamide, and Rituxan appears promising for patients with relapsed or refractory CLL, including those who have stopped responding to Fludara. Based on these favorable results, researchers are evaluating this treatment combination as initial therapy for CLL.

Reference: Lamanna N, Kalaycio M, Maslak P, et al. Pentostatin, Cyclophosphamide, and Rituximab Is an Active, Well-Tolerated Regimen for Patients With Previously Treated Chronic Lymphocytic Leukemia. Journal of Clinical Oncology. 2006. Early on-line publication. DOI: 10.1200/JCO.2005.04.3836.

Related News:Pentostatin/Cytoxan®/Rituxan® Shows High Activity in High-Risk CLL (11/17/05)

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