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Gorzkiewicz M, Klajnert-Maculewicz B. Dendrimers as nanocarriers for nucleoside analogues. Eur J Pharm Biopharm 2017; 114:43-56. [DOI: 10.1016/j.ejpb.2016.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/02/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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2
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Cervetti G, Galimberti S, Cecconi N, Caracciolo F, Petrini M. Role of Low-Dose 2-CdA in Refractory or Resistant Lymphoplasmocytic Lymphoma. J Chemother 2013; 16:388-91. [PMID: 15332715 DOI: 10.1179/joc.2004.16.4.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cladribrine (2-CdA), a purine analogue active on both dividing and resting lymphocytes, plays an important role in the treatment of indolent lymphoproliferative malignancies such as Hairy Cell Leukemia (HCL), Chronic Lymphocytic Leukemia (CLL), Lymphoplasmocytic Lymphoma (LPL), Waldenström's Macroglobulinemia (WM). With the aim of evaluating the efficacy and toxicity of low dose 2-CdA, 15 lymphoplasmocytic lymphoma patients, not eligible for more aggressive or standard therapies, because of age or poor performance status, were treated with the drug at a dose of 5 mg/m2, once a week for six total courses. All patients showed disease progression. Fourteen patients were valuable for response. In eleven out of these 14 (85.7%) disease progression stopped, with 21% having good hematological responses (one CR and two PR). The treatment was generally well tolerated, without serious infectious events. This schedule may be appropriate for the management of patients where the aim of the treatment is control of disease progression.
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MESH Headings
- Aged
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Cladribine/administration & dosage
- Cladribine/adverse effects
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug Resistance, Neoplasm
- Female
- Humans
- Infusions, Intravenous
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/drug therapy
- Leukemia, Hairy Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Probability
- Prognosis
- Prospective Studies
- Risk Assessment
- Severity of Illness Index
- Survival Analysis
- Treatment Outcome
- Waldenstrom Macroglobulinemia/diagnosis
- Waldenstrom Macroglobulinemia/drug therapy
- Waldenstrom Macroglobulinemia/mortality
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Affiliation(s)
- G Cervetti
- Hematology Division, Department of Oncology, Transplants and Advanced Technologies, University of Pisa, Pisa, Italy.
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3
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Dighiero G. Perspectives in chronic lymphocytic leukemia biology and management. Hematol Oncol Clin North Am 2004; 18:927-43, x. [PMID: 15325707 DOI: 10.1016/j.hoc.2004.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Considerable progress has been achieved in the comprehension of the pathogenesis, prognosis, assessment, and treatment of chronic lymphocytic leukemia. However, this progress also has introduced new enigmas in the fields of biology, prognosis, and treatment. This article discusses some unanswered questions in these different topics.
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MESH Headings
- Genes, Immunoglobulin
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Prognosis
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Affiliation(s)
- Guillaume Dighiero
- Unité d'Immuno-Hématologie et d'Immunopathologie, Institut Pasteur, 28 rue du Dr Roux F-75724 Paris cedex 15, France.
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4
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Affiliation(s)
- G Dighiero
- Institut Pasteur, Unité Immuno-Hématologie et Immuno Pathologie, rue du Dr Roux, Paris, France
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5
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Abruzzo LV, Rosales CM, Medeiros LJ, Vega F, Luthra R, Manning JT, Keating MJ, Jones D. Epstein-Barr virus-positive B-cell lymphoproliferative disorders arising in immunodeficient patients previously treated with fludarabine for low-grade B-cell neoplasms. Am J Surg Pathol 2002; 26:630-6. [PMID: 11979093 DOI: 10.1097/00000478-200205000-00009] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe five patients with treated low-grade B-cell neoplasms who subsequently developed Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disorders (BLPDs). The low-grade B-cell neoplasms were B-cell chronic lymphocytic leukemia in four patients and splenic marginal zone lymphoma in one patient. All patients had received treatment with fludarabine for the low-grade B-cell neoplasm, and three had also received Campath-1H. The EBV-BLPDs arose 2-12 months after completion of fludarabine therapy and morphologically resembled the EBV-BLPDs that occur in the setting of iatrogenic immunodeficiency. Molecular genetic studies showed that these lesions were clonally distinct from the low-grade B-cell neoplasm in three of four cases assessed. Two patients did not receive therapy for the EBV-BLPD. The lesions regressed spontaneously in both patients but recurred in one. One patient underwent surgical excision and remains without evidence of the EBV-BLPD. One patient received aggressive multiagent chemotherapy with a complete response initially, but the EBV-BLPD recurred after 12 months. One patient received antiviral therapy and responded completely but died 2 months later of an opportunistic infection. We conclude that patients with low-grade B-cell neoplasms treated with fludarabine, possibly in combination with other immune suppressive agents, may subsequently develop EBV-BLPDs that morphologically resemble other iatrogenic immunodeficiency-associated BLPDs. Most are clonally distinct from the underlying low-grade B-cell neoplasm. A subset of these lesions may regress without systemic therapy.
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Affiliation(s)
- Lynne V Abruzzo
- Department of Hematopathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Chandra J, Mansson E, Gogvadze V, Kaufmann SH, Albertioni F, Orrenius S. Resistance of leukemic cells to 2-chlorodeoxyadenosine is due to a lack of calcium-dependent cytochrome c release. Blood 2002; 99:655-63. [PMID: 11781251 DOI: 10.1182/blood.v99.2.655] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purine nucleoside 2-chlorodeoxyadenosine (CdA) is often used in leukemia therapy. Its efficacy, however, is compromised by the emergence of resistant cells. In the present study, 3 CdA-resistant cell lines were generated and characterized. Their ability to accumulate 2-chloroadenosine triphosphate (CdATP) varied, reflecting differences in activities of deoxycytidine kinase (dCK) and deoxyguanosine kinase (dGK). Nonetheless, the selected lines were uniformly resistant to CdA-induced apoptosis, as assessed by caspase activation and DNA fragmentation. In contrast, cytosols from resistant cells were capable of robust caspase activation when incubated in the presence of cytochrome c and dATP. Moreover, replacement of dATP with CdATP also resulted in caspase activation in the parental and some of the resistant cell lines. Strikingly, CdA-induced decreases in mitochondrial transmembrane potential and release of cytochrome c from mitochondria were observed in the parental cells but not in any resistant lines. The lack of cytochrome c release correlated with an increased ability of mitochondria from resistant cells to sequester free Ca2+. Consistent with this enhanced Ca2+ buffering capacity, an early increase in cytosolic Ca2+ after CdA treatment of parental cells but not resistant cells was detected. Furthermore, CdA-resistant cells were selectively cross-resistant to thapsigargin but not to staurosporine- or Fas-induced apoptosis. In addition, CdA-induced caspase-3 activation and DNA fragmentation were inhibited by the Ca2+ chelator BAPTA-AM in sensitive cells. Taken together, the data indicate that the mechanism of resistance to CdA may be dictated by changes in Ca2+-sensitive mitochondrial events.
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Affiliation(s)
- Joya Chandra
- Institute for Environmental Medicine, Division of Toxicology, and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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7
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Morrison VA, Rai KR, Peterson BL, Kolitz JE, Elias L, Appelbaum FR, Hines JD, Shepherd L, Martell RE, Larson RA, Schiffer CA. Impact of therapy With chlorambucil, fludarabine, or fludarabine plus chlorambucil on infections in patients with chronic lymphocytic leukemia: Intergroup Study Cancer and Leukemia Group B 9011. J Clin Oncol 2001; 19:3611-21. [PMID: 11504743 DOI: 10.1200/jco.2001.19.16.3611] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We sought to determine whether therapy with single-agent fludarabine compared with chlorambucil alone or the combination of both agents had an impact on the incidence and spectrum of infections among a series of previously untreated patients with B-cell chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS Five hundred fifty-four previously untreated CLL patients with intermediate/high-risk Rai-stage disease were enrolled onto an intergroup protocol. Patients were randomized to therapy with chlorambucil, fludarabine, or fludarabine plus chlorambucil. Data pertaining to infection were available on 518 patients. Differences in infections among treatment arms were tested with the Kruskal-Wallis, Wilcoxon, and chi(2) tests. RESULTS A total of 1,107 infections (241 major infections) occurred in 518 patients over the infection follow-up period (interval from study entry until either reinstitution of initial therapy, therapy with a second agent, or death). Patients treated with fludarabine plus chlorambucil had more infections than those receiving either single agent (P <.0001). Comparing the two single-agent arms, there were more infections on the fludarabine arm (P =.055) per month of follow-up. Fludarabine therapy was associated with more major infections and more herpesvirus infections compared with chlorambucil (P =.008 and P =.004, respectively). Rai stage and best response to therapy were not associated with infection. A low serum immunoglobulin G was associated with number of infections (P =.02). Age was associated with incidence of major infection in the combination arm (P =.004). CONCLUSION Combination therapy with fludarabine plus chlorambucil resulted in significantly more infections than treatment with either single agent. Patients receiving single-agent fludarabine had more major infections and herpesvirus infections compared with chlorambucil-treated patients.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chlorambucil/administration & dosage
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Middle Aged
- Ontario
- Respiratory Tract Infections/complications
- Respiratory Tract Infections/mortality
- Skin Diseases, Infectious/complications
- Skin Diseases, Infectious/mortality
- Treatment Outcome
- United States
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- V A Morrison
- Section of Hematology/Oncology and Infectious Disease, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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8
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Ikpeazu EV, Kaplon MK. Cryptococcal meningitis occurring at 19 months after cladribine therapy for hairy cell leukemia. Eur J Haematol 1998; 61:286-7. [PMID: 9820640 DOI: 10.1111/j.1600-0609.1998.tb01719.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Costa P, Luzzati R, Nicolato A, Perboni G, Scalzini A, Lazzarini L, Forghieri ME, Aitini E, Zinzani PL. Cryptococcal meningitis and intracranial tuberculoma in a patient with Waldenstrom's macroglobulinemia treated with fludarabine. Leuk Lymphoma 1998; 28:617-20. [PMID: 9613995 DOI: 10.3109/10428199809058373] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a patient with Waldenstrom's Macroglobulinemia who presented with cryptococcal meningitis followed by an intracranial tuberculoma during the 18 months period after termination of cytotoxic therapy with Fludarabine. Opportunistic infections due to intracellular organisms are extremely rare in the course of this malignancy and we review the predisposing factors of these infectious entities.
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Affiliation(s)
- P Costa
- Department of Infectious Diseases, Ospedale C. Poma, Mantova, Italy
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10
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The Novel Cyclin-Dependent Kinase Inhibitor Flavopiridol Downregulates Bcl-2 and Induces Growth Arrest and Apoptosis in Chronic B-Cell Leukemia Lines. Blood 1997. [DOI: 10.1182/blood.v90.11.4307] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractFlavopiridol is a novel, potent inhibitor of cyclin-dependent kinases (CDK). This synthetic flavone has been reported to exhibit antitumor activity in murine and human tumor cell lines in vitro and in vivo and is currently undergoing clinical phase I evaluation. In the present study, 1 Epstein-Barr virus (EBV)-transformed B-prolymphocytic cell line (JVM-2), 1 EBV-transformed B-CLL cell line (I83CLL), and 1 non-EBV transformed B-CLL cell line (WSU-CLL) were used as targets. Treatment of the cells with flavopiridol (100 nmol/L to 400 nmol/L) led to a marked dose- and time-dependent inhibition of cell growth and survival as determined using trypan blue exclusion. Morphologic analysis showed characteristic apoptotic changes such as chromatin condensation and fragmentation, membrane blebbing, and formation of apoptotic bodies. Furthermore, quantitative assessment of apoptosis-associated DNA strand breaks by in situ TdT labeling showed that a significant number of flavopiridol-treated cells underwent apoptosis. These cellular effects were associated with a significant decrease in bcl-2 expression as observed by Northern and Western blotting. The results showed that flavopiridol downregulates bcl-2 mRNA and bcl-2 protein expression within 24 hours. Genistein and quercetin, two flavonoids that do not inhibit CDKs, did not affect bcl-2 expression. These data suggest an additional mechanism of action of this new flavone which might be useful as an agent in the treatment of chronic lymphoid malignancies.
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11
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The Novel Cyclin-Dependent Kinase Inhibitor Flavopiridol Downregulates Bcl-2 and Induces Growth Arrest and Apoptosis in Chronic B-Cell Leukemia Lines. Blood 1997. [DOI: 10.1182/blood.v90.11.4307.4307_4307_4312] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Flavopiridol is a novel, potent inhibitor of cyclin-dependent kinases (CDK). This synthetic flavone has been reported to exhibit antitumor activity in murine and human tumor cell lines in vitro and in vivo and is currently undergoing clinical phase I evaluation. In the present study, 1 Epstein-Barr virus (EBV)-transformed B-prolymphocytic cell line (JVM-2), 1 EBV-transformed B-CLL cell line (I83CLL), and 1 non-EBV transformed B-CLL cell line (WSU-CLL) were used as targets. Treatment of the cells with flavopiridol (100 nmol/L to 400 nmol/L) led to a marked dose- and time-dependent inhibition of cell growth and survival as determined using trypan blue exclusion. Morphologic analysis showed characteristic apoptotic changes such as chromatin condensation and fragmentation, membrane blebbing, and formation of apoptotic bodies. Furthermore, quantitative assessment of apoptosis-associated DNA strand breaks by in situ TdT labeling showed that a significant number of flavopiridol-treated cells underwent apoptosis. These cellular effects were associated with a significant decrease in bcl-2 expression as observed by Northern and Western blotting. The results showed that flavopiridol downregulates bcl-2 mRNA and bcl-2 protein expression within 24 hours. Genistein and quercetin, two flavonoids that do not inhibit CDKs, did not affect bcl-2 expression. These data suggest an additional mechanism of action of this new flavone which might be useful as an agent in the treatment of chronic lymphoid malignancies.
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12
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Montserrat E, Lopez-Lorenzo JL, Manso F, Martin A, Prieto E, Arias-Sampedro J, Fernandez MN, Oyarzabal FJ, Odriozola J, Alcala A, Garcia-Conde J, Guardia R, Bosch F. Fludarabine in resistant or relapsing B-cell chronic lymphocytic leukemia: the Spanish Group experience. Leuk Lymphoma 1996; 21:467-72. [PMID: 9172812 DOI: 10.3109/10428199609093445] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fludarabine produces high response rates in patients with B-cell chronic lymphocytic leukemia (CLL). Nevertheless, response to fludarabine of patients with previously treated CLL varies from 17% to 74% (0% to 38% CR). In 68 patients with heavily pretreated and advanced CLL, an overall response rate to fludarabine of 28% (4% CR) was observed. Response correlated with sensitivity of the disease to previous treatments (relapsing vs. refractory disease) (62% vs. 20%; p = 0.005) and, albeit not significantly, with the number of cycles of fludarabine (>3 vs. < or = 3) that patients could receive (36% vs. 15%; p = NS). Responding patients had a longer survival (median, not reached) than those not responding (median, 11 months) (p = 0.03). Severe toxicity was observed in some cases. It is concluded that fludarabine is a highly useful agent in CLL. However, in order to improve its effectiveness and decrease its toxicity, fludarabine should be given as soon as a lack of response to front-line therapy is observed and before the disease becomes completely resistant to therapy.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/chemically induced
- Anemia, Hemolytic, Autoimmune/therapy
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Cause of Death
- Drug Evaluation
- Fever/etiology
- Graft vs Host Disease/etiology
- Hematologic Diseases/chemically induced
- Humans
- Infections/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Life Tables
- Remission Induction
- Retrospective Studies
- Salvage Therapy
- Spain/epidemiology
- Survival Analysis
- Transfusion Reaction
- Treatment Outcome
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- E Montserrat
- Postgraduate School of Hematology "Farreras-Valenti", Department of Medicine, University of Barcelona, Spain
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Petersen AJ, Brown RD, Gibson J, Pope B, Luo XF, Schutz L, Wiley JS, Joshua DE. Nucleoside transporters, bcl-2 and apoptosis in CLL cells exposed to nucleoside analogues in vitro. Eur J Haematol Suppl 1996; 56:213-20. [PMID: 8641389 DOI: 10.1111/j.1600-0609.1996.tb01932.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purine nucleoside analogues fludarabine (F1) and chlorodeoxyadenosine (2-CdA) are considered to be cell cycle specific agents which require DNA synthesis for cytotoxicity. However, their efficacy in the treatment of CLL, an indolent lymphoid malignancy suggests additional mechanisms of action. Like cytosine arabinoside (AraC), F1 and 2-CdA gain access to the cell via a specific nucleoside transporter (NST) protein. To investigate the mode of action of these drugs in CLL, we used a fluorescent ligand for the NST (5'-(SAENTA- x8)-fluorescein) and 3-colour flow cytometry to determine NST expression on CD5+/CD19+ B-cells from the peripheral blood (PB) of patients with CLL. NST levels on these cells was found to be not significantly different from normal control lymphocytes (mean = 485 +/- 425) vs. (mean = 553 +/- 178). Exposure to varying concentrations (0, 3 microM and 30 microM) of F1 and 2-CdA, however, resulted in an upregulation of NST (mean = 1552 +/- 775 with 30 microM FL; mean = 3392 +/- 2197 with 30 microM 2-CdA) after 48. "Large" lymphoid cells (not present in normal PB) were found to express significantly more NST (mean = 2540 +/- 2861) and have a higher proliferative capacity than "small" cells (mean = 357 +/- 517 NST/cell). Incubation of CLL cells with F1 (n = 6) and 2-CdA (n = 8) in vitro over 48 h also resulted in an increase in the proportion of cells in S-phase (0 microM = 0.2 + 2 - 0.1; 30 microM FL = 2.4 +/- 2.0; 30 microM 2-CdA = 3.3 +/- 1.3) and a significant increase in morphologically identifiable apoptosis. Apoptosis was confirmed by flow cytometric DNA analysis (0 microM = 13 +/- 8%; 30 microM FL = 40 +/- 20%; 30 microM 2-CdA = 48 +/- 11%). In situ hybridization using a biotinylated cDNA bcl-2 probe demonstrated that bcl-2 mRNA expression was markedly decreased in treated cells after 24 h. These studies have demonstrated that: (1) NST expression on CLL lymphocytes is low; (2) in vitro exposure to the analogues increases both the level of NST expression and the % cells in S-phase; (3) exposure to the analogues downregulates bcl-2 expression and increases apoptosis.
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Affiliation(s)
- A J Petersen
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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14
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McLaughlin P, Robertson LE, Keating MJ. Fludarabine phosphate in lymphoma: an important new therapeutic agent. Cancer Treat Res 1996; 85:3-14. [PMID: 9043771 DOI: 10.1007/978-1-4615-4129-5_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P McLaughlin
- Department of Hematology, U.T.M.D. Anderson Cancer Center, Houston 77030, USA
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15
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Fenchel K, Bergmann L, Wijermans P, Engert A, Pralle H, Mitrou PS, Diehl V, Hoelzer D. Clinical experience with fludarabine and its immunosuppressive effects in pretreated chronic lymphocytic leukemias and low-grade lymphomas. Leuk Lymphoma 1995; 18:485-92. [PMID: 8528057 DOI: 10.3109/10428199509059649] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fludarabine monophosphate (FAMP) is a new adenine nucleoside analogue with a promising efficacy in B-cell chronic lymphocytic leukemia (B-CLL) and low-grade non-Hodgkin lymphomas (NHLs). Here, the clinical experience and side effects with FAMP are reported in 77 patients with pretreated CLL (59 B-CLL, 2 T-CLL) and low-grade NHLs (9 immunocytic lymphomas including 5 Waldenström's macroglobulinaemia, 2 centrocytic (cc) and 5 centroblastic-centrocytic (cb-cc) NHLs). 70/77 patients are evaluable for response. All except 8 patients were pretreated with one to four different regimens and had progressive disease. FAMP was administered at a dosage of 25 mg/m2 daily for 5 days as 30 minute infusion every fifth week. Partial (PR) or complete remission (CR) was achieved in 38/56 (68%) and 3/56 (5%) of evaluable patients with CLL, respectively. In 7/8 (1 x CR, 6 x PR) evaluable patients with immunocytic lymphoma and in 3/6 (3 x PR) patients with cc or cb-cc lymphoma remissions were obtained. The probability of progression-free survival was 66% and the event-free survival was 25% and 22% at 12 and 18 months. The median progression-free survival until relapse or death, however, was only 7 months (2-20+). Major toxic effects included infections in 22 patients (grade 3 and 4 WHO), granulocytopenia (mainly grade 3) and nausea in 8 patients (mainly grade 1). 19/22 patients were in PR at the time of occurrence of infectious complications. Meanwhile, 14 patients died due to septicaemia, pneumonia or other infections. Nine patients developed severe septicaemia, 4 patients had pneumocystis carinii or aspergillus pneumonias. The high infection rate may not only be due to hypogammaglobulinaemia and granulocytopenia induced by FAMP but also to a remarkable decrease of CD4+ cells from a median of 2479 to 241 CD4+ cells/microliters after 6 cycles of FAMP. In one case a tumor lysis syndrome was observed. No CNS toxicity was noted. It is concluded that FAMP is effective even in patients with advanced CLL and low-grade NHLs refractory to multiple chemotherapy regimens. However, FAMP has a marked suppressive effect on granulocytes and T-lymphocytes, predominantly CD4+ lymphocytes.
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Affiliation(s)
- K Fenchel
- Medical Clinic III, J. W. Goethe University, Frankfurt/M., Federal Republic of Germany
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16
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17
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Guchelaar HJ, Richel DJ, Schaafsma MR. Clinical and toxicological aspects of the antineoplastic drug cladribine: a review. Ann Hematol 1994; 69:223-30. [PMID: 7948311 DOI: 10.1007/bf01700276] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cladribine (2-chlorodeoxyadenosine, 2-CdA) is a new antineoplastic drug which exerts its antilymphoproliferative activity by its resistance to the enzyme adenosine deaminase. Cladribine is mostly administered as a 7-day continuous infusion and in a dose of 0.1 mg/kg/day. However, preliminary data show that the subcutaneous and oral routes of administration might be feasible. The drug is well tolerated, and myelosuppression was found to be the dose-limiting toxicity. Nonhematological toxicity, such as alopecia, nausea, vomiting, stomatitis, diarrhea, and organ toxicity is mild or absent. Cladribine has shown efficacy in phase-II studies in hairy cell leukemia [response rate (RR) = 75-100% and complete response rate (CR) = 46-92%], chronic lymphocytic leukemia (RR = 37-67% and CR = 4-39%), and lymphocytic lymphoma (RR = 43-52% and CR = 14-20%). Furthermore, there is preliminary evidence that cladribine might be effective in the treatment of cutaneous T cell lymphoma (RR = 47% and CR = 20%), acute myeloid leukemia in children (RR = 59% and CR = 47%), acute lymphoid leukemia in children (RR = 14% and CR = 14%) and Waldenström macroglobulinemia (RR = 58% and CR = 3.5%). In multiple myeloma cladribine was not effective. Comparative randomized studies with established first-line and second-line therapeutic regimens are warranted and will define the ultimate place of cladribine in the therapy of malignant hematological disorders.
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Affiliation(s)
- H J Guchelaar
- Department of Clinical Pharmacy, Medical Spectrum Twente, Enschede, The Netherlands
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18
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Gillis S, Dann EJ, Cass Y, Rochlemer RR, Polliack A. Activity of fludarabine in refractory chronic lymphocytic leukemia and low grade non-Hodgkin's lymphoma--the Jerusalem experience. Leuk Lymphoma 1994; 15:173-5. [PMID: 7858497 DOI: 10.3109/10428199409051694] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Twenty four patients with refractory chronic lymphocytic leukemia (CLL) and advanced low grade lymphoma (LGL) were treated with Fludarabine given at a dose of 25 mg/m2, intravenously daily for 5 days, every 28 days. Ten of the patients with LGL were in terminal leukemic phase. All patients had received previous chemotherapy, most with multiple regimens. Patients received a mean of 5.1 cycles (range 1-9). 4 patients--one with CLL and 3 with LGL--achieved a complete remission, while 7 LGL and 3 CLL patients had a partial response. Two patients remain in complete remission 23 and 25 months after completion of therapy. One patient underwent successful autologous bone marrow transplantation after achieving a complete remission, while two others had marrow cryopreserved during complete remission. The drug was well tolerated and toxicity was mild. In 9 of the 122 given cycles patients required hospitalization. In conclusion, Fludarabine is active in refractory patients with CLL and LGL and induces complete and partial remissions in some. It seems that Fludarabine could be used as primary therapy in these disorders in the future.
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MESH Headings
- Adult
- Aged
- Bone Marrow Transplantation
- Combined Modality Therapy
- Female
- Humans
- Israel/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Male
- Middle Aged
- Remission Induction
- Salvage Therapy
- Treatment Outcome
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- S Gillis
- Department of Hematology, Hadassah University Medical Center, Hebrew University, Hadassah Medical School, Jerusalem, Israel
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