High Dose Methyl Prednisolone in Refractory Chronic Lymphocytic Leukaemia

Abstract

We treated 14 patients with advanced, resistant chronic lymphocytic leukaemia (CLL) including three with >10% prolymphocytes (CLL/PL) with high dose methyl prednisolone (HDMP). All patients had stage C CLL or bulky stage B disease. There were 11 males and 3 females with a median age of 58.5 years (range: 49-69). Six out of eleven CLL patients had a partial response as defined by the NCI guidelines, no patient had a complete remission. The mean duration of PR was 19.6 months with a median of 8 months (range 6-78). Seven patients have died including the 5 non-responders. None of the 3 patients with CLL/PL had a measurable response. Previous treatments included chlorambucil, fludarabine, deoxycoformycin, anthracycline containing regimens such as CHOP and Campath-1H. HDMP was given at a dose of 1 g/m2 for five days, at monthly intervals for one to seven courses depending on the response. H2 antagonists and antimicrobial prophylaxis were given concurrently. Acyclovir prophylaxis was given if there was a recent history of herpes infection. HDMP was generally well tolerated. Side effects included fluid retention, hyperglycaemia, bradycardia (1 patient), herpes simplex (1), and pneumonia (1) in a patient with a previous history of recurrent chest infection and pneumonia. These results suggest that HDMP may be beneficial in the treatment of refractory CLL but is of no value in CLL/PL.

The combination of rituximab, bendamustine, and cytarabine for heavily pretreated relapsed/refractory cytogenetically high‐risk patients with chronic lymphocytic leukemia

“…In CLL patients carrying 17p deletions no therapeutic approach has proved satisfactory, with the exception of alemtuzumab or HDMP [6,[9][10][11][12]. For this reason, such patients should be recruited, whenever possible, in clinical trials aiming at investigating not only new cytotoxic agents but also the possible role of cellular therapy and immunomodulatory drugs.…”

“…However, this antibody showed little benefit in fludarabine-refractory patients harboring the 17p deletion and bulky lymphadenopathy (OR 14%) [8]. Therapy with HDMP, with or without anti-CD20 antibody rituximab, was shown to be effective in refractory CLL [9][10][11], including cases with the TP53 mutation, with reported OR of 69% and median PFS of 12 months [12].…”

High dose methylprednisolone and rituximab is an effective therapy in advanced refractory chronic lymphocytic leukemia resistant to fludarabine therapy

“…The χ 2 test was used to compare response rates with HDMP-R and our previous cohort of patients treated with HDMP alone. 2 Responses were seen in 13/14 (93%). Two patients achieved a CR and another a nodular PR ( Table 2).…”

Treatment of B-cell chronic lymphocytic leukemia with nonchemotherapeutic agents: experience with single-agent and combination therapy

“…18 Among 11 treated patients, 6 achieved PR and none achieved CR. The median duration of response was 8 months.…”