Pentostatin, cyclophosphamide, and rituximab is an active, well-tolerated regimen for patients with previously treated chronic lymphocytic leukemia Journal Article


Authors: Lamanna, N.; Kalaycio, M.; Maslak, P.; Jurcic, J. G.; Heaney, M.; Brentjens, R.; Zelenetz, A. D.; Horgan, D.; Gencarelli, A.; Panageas, K. S.; Scheinberg, D. A.; Weiss, M. A.
Article Title: Pentostatin, cyclophosphamide, and rituximab is an active, well-tolerated regimen for patients with previously treated chronic lymphocytic leukemia
Abstract: Purpose: Purine analogs and alkylators are important agents for treating chronic lymphocytic leukemia (CLL). Early studies combining fludarabine and chlorambucil were abandoned owing to increased toxicity from overlapping myelosuppression and immunosuppression. Of the purine analogs active in CLL, pentostatin appears to be the least myelosuppressive. We previously reported that pentostatin and cyclophosphamide (PC) is active and well-tolerated in patients with relapsed or refractory CLL. Subsequently, we added rituximab, and now report on this three-drug combination. Patients and Methods: We treated 46 patients with either previously treated CLL (32 patients) or other low-grade B-cell neoplasms (14 patients). Patients received pentostatin 4 mg/m 2, cyclophosphamide 600 mg/m 2, and rituximab 375 mg/m 2 (PCR). All drugs were administered on the same day (rituximab omitted from cycle 1), and patients received six cycles at 3-week intervals. Filgrastim, sulfamethoxazole/ trimethoprim, and acyclovir were administered prophylactically. Results: The median age was 62 years (range, 30 to 80 years). The median number of prior regimens was two (range, one to seven). For CLL patients, there were 24 responses (75%), including eight complete responses (25%). In fludarabine-refractory patients, 75% responded. Toxicity was acceptable, with grade 3/4 infections (including fever of unknown origin) in 28%. The regimen was well tolerated, with 72% of patients receiving the planned treatment at full dose. Conclusion: PCR is safe and effective in previously treated patients with CLL. In comparison with our prior two-drug regimen, we find that rituximab did not seem to add significantly to the toxicity, but did appear to confer a survival advantage. Based on these results, we are currently studying PCR as initial therapy for patients with CLL. © 2006 by American Society of Clinical Oncology.
Keywords: adult; clinical article; controlled study; aged; fludarabine; drug tolerability; neutropenia; drug withdrawal; side effect; rituximab; infection; multiple cycle treatment; anemia; bone marrow suppression; nausea; thrombocytopenia; vomiting; aciclovir; cyclophosphamide; dexamethasone; herpes zoster; pneumocystis pneumonia; pneumonia; tumor lysis syndrome; prophylaxis; granisetron; ondansetron; leukocyte count; recombinant granulocyte colony stimulating factor; chronic lymphatic leukemia; cotrimoxazole; pentostatin; allopurinol; pyrexia idiopathica
Journal Title: Journal of Clinical Oncology
Volume: 24
Issue: 10
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2006-04-01
Start Page: 1575
End Page: 1581
Language: English
DOI: 10.1200/jco.2005.04.3836
PROVIDER: scopus
PUBMED: 16520464
DOI/URL:
Notes: --- - "Cited By (since 1996): 81" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Nicole Lamanna
    57 Lamanna
  2. Mark L Heaney
    90 Heaney
  3. Renier J Brentjens
    189 Brentjens
  4. Joseph G Jurcic
    127 Jurcic
  5. Andrew D Zelenetz
    551 Zelenetz
  6. Katherine S Panageas
    327 Panageas
  7. Peter Maslak
    166 Maslak
  8. Mark Weiss
    80 Weiss
  9. Denise E Horgan
    9 Horgan