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High dose methyl prednisolone in refractory chronic lymphocytic leukaemia
P D Thornton1, M Hamblin, J G Treleaven
1Academic Department of Haematology and Cytogenetics, Royal Marsden Hospital, London, UK.
Insights
High-dose methylprednisolone (HDMP) showed partial response in some chronic lymphocytic leukemia (CLL) patients but was ineffective for CLL with prolymphocytes (CLL/PL). HDMP was generally well-tolerated in refractory CLL cases.
Area of Science:
- Hematology
- Oncology
- Clinical Pharmacology
Background:
- Chronic lymphocytic leukemia (CLL) is a common lymphoid malignancy.
- Advanced and refractory CLL poses significant treatment challenges.
- Limited treatment options exist for patients resistant to standard therapies.
Purpose of the Study:
- To evaluate the efficacy and tolerability of high-dose methylprednisolone (HDMP) in patients with advanced, resistant chronic lymphocytic leukemia (CLL).
- To assess the response in CLL patients with and without prolymphocytosis (CLL/PL).
Main Methods:
- A cohort of 14 patients with advanced, resistant CLL (including 3 with CLL/PL) received HDMP (1 g/m2 for five days) monthly.
- Response was assessed based on NCI guidelines.
- Concurrent supportive care included H2 antagonists, antimicrobial, and acyclovir prophylaxis as indicated.
Main Results:
- Six of eleven evaluable CLL patients achieved a partial response (PR), with a median PR duration of 8 months.
- No complete remissions were observed.
- None of the three patients with CLL/PL demonstrated a measurable response.
- HDMP was generally well-tolerated, with side effects including fluid retention and hyperglycemia.
Conclusions:
- HDMP may offer a potential treatment benefit for refractory CLL patients without prolymphocytosis.
- HDMP demonstrated no significant efficacy in patients with CLL/PL.
- Further investigation into HDMP for specific CLL subtypes is warranted.
Abstract:
We treated 14 patients with advanced, resistant chronic lymphocytic leukaemia (CLL) including three with >10% prolymphocytes (CLL/PL) with high dose methyl prednisolone (HDMP). All patients had stage C CLL or bulky stage B disease. There were 11 males and 3 females with a median age of 58.5 years (range: 49-69). Six out of eleven CLL patients had a partial response as defined by the NCI guidelines, no patient had a complete remission. The mean duration of PR was 19.6 months with a median of 8 months (range 6-78). Seven patients have died including the 5 non-responders. None of the 3 patients with CLL/PL had a measurable response. Previous treatments included chlorambucil, fludarabine, deoxycoformycin, anthracycline containing regimens such as CHOP and Campath-1H. HDMP was given at a dose of 1 g/m2 for five days, at monthly intervals for one to seven courses depending on the response. H2 antagonists and antimicrobial prophylaxis were given concurrently. Acyclovir prophylaxis was given if there was a recent history of herpes infection. HDMP was generally well tolerated. Side effects included fluid retention, hyperglycaemia, bradycardia (1 patient), herpes simplex (1), and pneumonia (1) in a patient with a previous history of recurrent chest infection and pneumonia. These results suggest that HDMP may be beneficial in the treatment of refractory CLL but is of no value in CLL/PL.