TOTAL-BODY IRRADIATION AND PREDNIMUSTINE IN CHRONIC LYMPHOCYTIC-LEUKEMIA AND LOW-GRADE NON-HODGKINS-LYMPHOMAS - A 9-YEAR EXPERIENCE AT A SINGLE INSTITUTION

Background. The efficacy and toxicity of total body irradiation (TBI) in patients with chronic lymphocytic leukemia (CLL) and low grade non- Hodgkin's lymphomas (NHL) were evaluated. Methods. Between January 198 4 and September 1992, 81 consecutive patients, 40 affected with CLL an d 41 with low grade NHL, with symptomatic Stage III and IV disease, we re treated with TBI followed by prednimustine. TBI was given with a 6 MV linear accelerator, applying two opposite alternating fields, inclu ding total body, with two fractions of 15 cGy given per week (3-day in terval). A total dose of 150 cGy was given over 5 weeks. Six to nine c ourses of prednimustine (100 mg/m(2) orally for 5 consecutive days eve ry 4 weeks) was administered 2 months after TBI treatment as consolida tion therapy. Results. Of 40 patients with CLL, 18 (Group I; median ag e 58.5 years) were younger than 65 years and 22 (Group II; median age 73 years) were older. The overall response rates were 78% in Group I a nd 91% in Group II, with a median response time of 16.5 and 16 months, respectively. Hematologic toxicity was 72% in Group I and 73% in Grou p II, It was reversible in all but one heavily pretreated patient who died of progressive anemia and thrombocytopenia after TBI alone. In th e 40 patients with CLL, the response rate was 85%; there were 5 comple te responses (CRs) (12.5%) and 29 partial responses (PRs) (72.5%). Of the 41 patients with NHL, 29 (Group I; median age 55 years) were young er than 65 years and 12 (Group II; median age 71.5) were older. The ov erall response rate in both groups was 83%, with median response times of 18.5+ and 14.5+ months for Groups I and II, respectively. Hematolo gic toxicity was 59% in Group I, whereas it was 50% in Group II. It wa s reversible in all patients. Overall, in the 41 patients with symptom atic Stage III and IV low grade NHL, the response fate was 82.8%; ther e were 10 CRs (24.3%) and 24 PRs (58.5%). The prednimustine regimen wa s generally well tolerated. Conclusions. In our experience, TBI given in a dose of 150 cGy in 10 fractions twice a week, followed by prednim ustine, is an effective treatment for patients with CLL and patients w ith low grade NHL, This treatment also is effective in patients older than 65 years. The toxicity is acceptable, particularly when TBI and p rednimustine are given as initial treatment. Pretreated patients shoul d be monitored strictly.