SURVIVAL OF YOUNG-PATIENTS WITH CHRONIC LYMPHOCYTIC-LEUKEMIA FAILING FLUDARABINE THERAPY - A BASIS FOR THE USE OF MYELOABLATIVE THERAPIES

We examined the survival of 98 young patients (less than or equal to 5 5 years) with chronic lymphocytic leukemia from the time of failure of fludarabine therapy, in an attempt to identify those with a poor outc ome who may benefit from investigative dose-intensive therapies. The m edian survival of patients unresponsive to fludarabine (n = 42) was 48 weeks, and only 11% responded to subsequent therapies. The median sur vival of patients relapsing following a fludarabine-induced remission (n = 49) was 87 weeks, and 83% of those who had received fludarabine a s their first therapy (n = 14) responded to further fludarabine-contai ning therapies, with 60% alive at four years. Only 7% of those relapsi ng patients who had received fludarabine as salvage therapy (n = 35) r esponded to subsequent therapies (median survival 72 weeks). The poor outlook for these patients justifies the consideration of innovative d ose-intensive therapies, such as bone marrow transplantation, with the ir attendant risk of toxicity.