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• W2148900175 abstract "The treatment of chronic lymphocytic leukemia (CLL) has undergone a revolution during the past two decades. CLL was considered an indolent, incurable disease, and therapy consisted primarily of alkylator-based regimens. The introduction of the purine analogs fludarabine, pentostatin, and cladribine into clinical trials in the 1980s invigoratedclinicalresearchinCLLanddramaticallychanged the treatment of this disease. Studies using fludarabine as salvage therapy demonstrated that a small fraction (10% or less) of patients attained complete remission (CR), 1,2 whereasuptoathirdofpatientsattainedaCRwithfludarabine as first-line therapy. 3 Three large phase III trials in symptomatic, untreated CLL patients have confirmed the superiority offludarabine, demonstrating advantages in response rate, CR rate, and progression-free survival (PFS) compared with alkylator-based regimens. 4-6 However, no overallsurvival(OS)improvementwasnotedinthesestudies. A small incremental increase may not have been identified because of trial sample size or cross-over designs that allowed patients to receivefludarabine after progression on alkylator therapy. Given that we treat CLL at time of symptomsandgiventheabilityoffludarabinetomoreeffectively palliate disease-related manifestations and time of remission, fludarabine is considered by many, but not all, physicians as a better initial treatment than alkyators for CLL. Because of the ability of fludarabine to result in complete responses, this end point might serve as a surrogate marker for improved survival. This notion was derived from clinical experience in acute leukemia and nonHodgkin’s lymphoma (NHL), where CR correlates with long-term survival. In CLL, the relationship of CR to longtermsurvivalislessclear.Long-termfollow-upbytheM.D. Anderson group with fludarabine monotherapy did not confirm this, 7 and the randomized phase III studies of flu" @default.
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• W2148900175 date "2005-06-20" @default.
• W2148900175 modified "2023-09-24" @default.
• W2148900175 title "Changing the Way We Think About Chronic Lymphocytic Leukemia" @default.
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• W2148900175 doi "https://doi.org/10.1200/jco.2005.08.964" @default.
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