Mariapia Lenoci

Low-dose oral fludarabine plus cyclophosphamide in elderly patients with untreated and relapsed or refractory chronic lymphocytic Leukaemia†

Fludarabine plus cyclophosphamide (FC) at conventional doses is an effective treatment for chronic lymphocytic leukaemia (CLL). However, FC at standard doses may give hematological and non‐hematological toxicity, predominantly in the elderly. Intravenous or oral low‐dose FC regimens remain highly effective in elderly patients with Low‐Grade Lymphomas other than CLL and are well tolerated. We tested efficacy and toxicity of oral FC at reduced doses in 26 elderly patients (median 71 years) with previously untreated (UT‐CLL, n = 14) or relapsed/refractory CLL (R‐CLL, n = 12), unfit for conventional treatments. Twentyfour‐of‐26 (92%) patients (14/14, 100% UT‐CLL; 10/12, 83.5% R‐CLL) obtained a response, with 12/26 (46%) complete responses (9/14, 64.2% in UT‐CLL; 3/12, 25% in R‐CLL). Non‐hematological toxicity was mild and myelosuppression was documented in 8/26 (31%) patients (4/14, 28% UT‐CLL; 4/12, 33% R‐CLL). With a median follow‐up of 24 months, median event‐free survival was 48 months with no differences between UT‐CLL and R‐CLL and all responders were alive. Low‐dose oral FC treatment showed good efficacy in both untreated and refractory/relapsed CLL. The treatment is useful in elderly patients who cannot benefit of more aggressive schedules and is easy to administer on an outpatient basis. Copyright

Low-dose oral fludarabine plus cyclophosphamide as first-line treatment in elderly patients with indolent non-hodgkin lymphoma

Twenty‐five elderly patients with untreated indolent non‐Hodgkin lymphoma were treated with oral fludarabine 25 mg/m2/d (40 mg total dose) and cyclophosphamide 150 mg/m2/d, both for four consecutive days, repeated every 28 d for four cycles. In all, 21 (84%) patients were responsive: 10 patients achieved complete remission while partial response was obtained in 11. During an observation period of 37 months, there was an overall survival rate of 70% and a median event‐free survival of 20 months. Haematological and extra‐haematological toxicity were mild. This reduced‐dose Flu‐based oral regimen showed good efficacy and was simple to administer on an outpatient basis.

Role of interferon‐alpha administration after 2‐deoxycoformycin in the treatment of hairy cell leukemia patients

Abstract:  Background and objective: Hairy cell leukemia (HCL) is a rare chronic B‐cell lymphoproliferative disorder which is treated effectively by interferon‐alpha (IFN‐α), deoxycoformycin (DCF) and 2‐clorodeoxyadenosine (2‐CdA). As a third of patients treated with DCF do not achieve a complete remission (CR) and many of them tend to relapse, we evaluated the potential role of IFN‐α, randomly administered after DCF, in increasing the number of patients attaining CR and/or duration of CR. Methods: From March 1997 to December 2000, 167 previously untreated HCL patients, from 37 Italian institutions, were enrolled in the study. A total of 138 males and 29 females, with a median age of 55 yr were included in the study. All patients received six courses of DCF 4 mg/m2 i.v. every other week and then two additional courses once a month. Complete and partial responders were randomly assigned to receive or not receive IFN‐α at a dose of 3 MU s.c. three times a week for 6 months. Results: Of the 167 patients enrolled in the study, 145 (86.8%) obtained a CR or a partial remission (PR) and were therefore suitable for randomization. One hundred and thirty‐five patients were successively randomized to receive IFN‐α (63 cases; arm A) or not (72 cases; arm B). Progression of disease was observed in eight (arm A) and 12 (arm B) patients with a median time of 27.8 and 26.9 months, respectively. As far as the improvement in response was concerned, no significant difference in the two subgroups was observed. In fact, five patients in arm A and six patients in arm B showing a good PR at the end of DCF therapy, subsequently attained a late CR. Conclusions: From our data there does not appear to be any significant role for IFN‐α in improving the proportion and the duration of CR in HCL patients previously treated with DCF.

Trisomy 12 and t(14;22)(q32;q11) in a patient with B-cell chronic lymphocytic leukemia.

Abstract Recurrent cytogenetic abnormalities are typically found in about one third of B-cell chronic lymphocytic leukemia patients (B-CLL) by standard cytogenetic analysis and their prognostic relevance is well known. We report a case of a B-CLL patient showing both trisomy 12 and a t(14;22)(q32;q11). Trisomy 12 is often associated with aggressive disease and resistance to chemotherapy, however, our patient is in good health and currently untreated after 7 years, suggesting in this case a relatively good prognosis and a questionable role for translocations involving the 14q32 locus.

Disseminated Mucormycosis in a Patient with Acute Myeloblastic Leukemia Misdiagnosed as Infection by Enterococcus faecium

ABSTRACT Mucormycosis is a rare complication in cancer patients. This report presents the case of a acute myeloblastic leukemia patient who developed an ascending paralysis due to disseminated mucormycosis. The presentation was unusual because the early symptoms were fever and pain, and the disease was misdiagnosed because of a concomitant infection by Enterococcus faecium.

An unusual presentation of chronic B-cell lymphocytic leukaemia.

We report a 63-year-old man who was admitted with severe neck pain and tetraparesis. A peripheral blood count showed mild anaemia and lymphocytosis (WBC 43AE5 · 10/l with 78% lymphocytes, Hb concentration 10AE8 g/dl and platelet count 196 · 10/l). Physical examination showed multiple small cervical and inguinal lymph nodes with mild liver and spleen enlargement. Cytological and immunophenotypic studies were typical for B-cell chronic lymphocytic leukaemia (B-CLL) (CD5/CD19, CD23, surface membrane Ig±). Trephine bone marrow biopsy with immunostaining confirmed this diagnosis, showing an interstitial infiltration by small lymphocytes. Chest X-ray examination was normal and abdominal ultrasound tomography showed splenomegaly (17 cm length). Postcontrast sagittal TSET1 512 weighted magnetic resonance imaging scan showed diffusely thickened enhancing meninges of the cervical spine. Leptomeningeal layer involvement is shown (arrow). The cervical spinal cord was compressed and narrowed. Prevertebral soft tissue was involved by an infiltrative neoplastic process. C1 (atlas) and C2 (odontoid) showed irregular enhancing (top). An axial computed tomography scan showed lytic bone destruction that involved the odontoid process of C2 (lower right) and the anterior arc of C1 (left pedicle erosion; lower left). A needle biopsy of the paravertebral neoplastic tissue showed a small-lymphocyte infiltration, consistent with B-CLL localization, while the lumbar puncture showed a normal spinal fluid cell count. The patient was treated with local radiotherapy (30 cGy) and chemotherapy (fludarabine, cyclophosphamide and dexamethasone) with a good haematological response, but persistent neurological impairment. Infiltration or compression of the central nervous system and osteolytic bone lesions are both uncommon in B-CLL, particularly in untreated early stage patients.