The treatment of chronic lymphocytic leukemia with COP chemotherapy

Abstract

Since single drug therapy of chronic lymphocytic leukemia (CLL) has not resulted in prolonged remissions of advanced disease, we initiated a program of combination chemotherapy, COP (cycloposphamide, vincristine sulfate, prednisone) for CLL patients with increasing adenopathy, spenomegaly, and/or signs of marrow failure defined as either anemia or thrombocytopenia. Thirty-six patients received COP either as initial therapy or following progression of disease on single agent therapy. The response rate was 72% with 26 patients responding (16 complete remissions, and 10 good partial remissions). The responses lasted from 8 to 50+ months. Sixteen of the responding patients remain in remission, 2 have active disease and 8 have died. Median survival has not yet been reached but the two-year survival from initiation of COP of the responding patients (complete and good partial response) is 90%. Ten patients had either poor partial or no response with median survival of 18 months. The median survival of the entire group of 36 patients is 35 months. COP is an effective and well tolerated therapy for advanced chronic lymphocytic leukemia.

An assessment of a short-term tumour chemosensitivity assay in chronic lymphocytic leukaemia

“…Typical dose-response curves are shown for Chl in from the dose-response curves which gave a scatter of results in accordance with clinical experience of response (Desai et al, 1970;Han et al, 1973;Liepman & Votaw, 1978;Oken & Kaplan, 1979;Sawitsky et al, 1977) success of the assay was 100%, and this included repeat assays of the previous 3 patients whose cells were non-viable after 4 days in culture. Assays were often performed on cells taken from the same patient on consecutive visits to the hospital.…”

“…First, an estimate of the possible range of drug concentrations was obtained from in vitro methods already published (Salmon et al, 1978;Von Hoff et al, 1981;Weisenthal et al, 1983a) or from pharmacological parameters such as concentration times time values (Nelson et al, 1980;Bosanquet & Gilby, 1982;Alberts & Chen, 1980). Up to 5 different concentrations based on these figures were then used in the assay when the drug was first investigated.…”

Treatment of early chronic lymphocytic leukemia: Intermittent chlorambucil versus observation

“…Therapy after disease progression in the observation group undoubtedly affected these survival results and may have masked the benefit of early treatment. A more aggressive approach to this disease has been urged (Knospe, 1978) and apparent 'complete remissions' may be achieved with regimens varying iri toxicity (Kempin et al, 1982;Liepman and Votaw, 1978). Nevertheless, disease eradication and cure in CLL would appear presently to be an elusive objective.…”

Salvage Therapy for CLL and the Role of Stem Cell Transplantation

“…[1][2][3][4][5] Response rates to purine analogs in these circumstances are higher and of longer duration. In the Intergroup study comparing primary treatment with chlorambucil and fludarabine, at crossover, those patients who failed chlorambucil had an overall response rate to fludarabine of 46%, whereas only 7% of patients who failed fludarabine responded to chlorambucil, suggesting there is little role for alkylator therapy in patients who have failed previous purine analogs.…”