Fludarabine is an Effective Agent in Immunocytic Lymphoma

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Abstract
Background: Fludarabine monophosphate is a new adenine nucleoside analogue with promising efficacy in Waldenström’s macroglobulinemia with response rates of 31-45% in previously treated and up to 100% in previously untreated patients. Patients and Methods: In this paper we report on the clinical experience with fludarabine and its side effects in 9 patients with advanced or refractory immunocytic lymphoma including 5 patients with Waldenström’s macroglobulinemia. Fludarabine was administered at a dosage of 25 mg/m2 daily for 5 days as a 30-minute, intravenous infusion. This course was repeated every 5th week. Results: 1/9 patients achieved complete remission, and 6/9 achieved partial remission (PR); 1/9 had stable disease and 1/9 was progressive. The median remission duration until relapse or death was 7.4 months. Most responses to fludarabine occurred within 2 treatment courses. Major toxic effects included lethal infections in 2 patients. Both patients were in PR at time of developing infections, one Pneumocystis carinii pneumonia and one septicemia. The occurrence of even opportunistic infections may be due not only to hypogammaglobulinemia or fludarabine-induced granulocytopenia, but also to a remarkable decrease of CD4+ cells during fludarabine therapy. Conclusion: It is concluded that fludarabine is an effective agent in patients with advanced immunocytic lymphoma. However, fludarabine has a remarkable suppres-sive effect on T-lymphocytes, in particular on CD4+ lymphocytes, especially in pre-treated patients.

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