THERAPY PROGRAM FOR PATIENTS WITH ADVANCED STAGES OF CHRONIC LYMPHOCYTIC-LEUKEMIA - CHLORAMBUCIL, SPLENECTOMY, AND TOTAL LYMPH-NODE IRRADIATION

Background. The clinical course of chronic lymphocytic leukemia (CLL) is variable. Staging systems define high risk groups, such as patients with Rai's Stage III and IV and Binet's stage C disease, as having a poor overall median survival. Most combination therapy programs have r esulted in similar results. Chlorambucil remains the most commonly use d drug, and new drugs, such as fludarabine, are promising. Methods. Fi fty-three patients with poor prognosis CLL (Stage III and IV) underwen t chlorambucil treatment at a high intermittent dose. When Stage 0 was obtained, patients were considered responders and kept under surveill ance. When the patients stopped responding after one or several course s of chlorambucil, further therapy was performed, including splenectom y (29 patients) and total lymph node irradiation (9 of the 29 splenect omized patients). Results. The overall median survival was 60 months. Thrombocytopenia and anemia were resolved in 55% and 82% of the patien ts, respectively, after chlorambucil therapy and in 85% and 100%, resp ectively, after splenectomy. Complications occurred in 34% of the sple nectomized population Total lymph node irradiation was poorly tolerate d in 66% of the patients. When this analysis was performed, 24 patient s were classified as having Stage 0 disease with no disease progressio n for a mean of 21 months. Conclusions. Therapy programs allowing the selection of responders by the successive use of high intermittent dos e chlorambucil and splenectomy may be beneficial in treating patients with advanced stage CLL. Because of its toxicity, total lymph node irr adiation has no significant therapeutic effect.