Treatment of cutaneous T-cell lymphomas with purine analogues (fludarabine and 2-chlorodeoxyadenosine)

The aim of this study was to evaluate the efficacy and toxicity of the purine analogues 2-chlorodeoxyadenosine (2-CdA) and fludarabine (FAMP) combined with cyclophosphamide (CY) in the treatment of stage III and IV cutaneous T-cell lymphoma (CTCL).

From January 1998 to December 2002, 10 heavily pretreated patients with CTCL, hospitalized at the Department of Dermatology in Wroclaw, were administered monotherapy with 2-CdA (6 patients) or FAMP plus CY combination chemotherapy (4 patients). 2-CdA was administered at a dose of 0.12 mg/kg daily for 7 days every 28 days. FAMP was administered at a dose of 25 mg/m(2) daily, days 1-3, and cyclophosphamide 400 mg/m(2), day 1. The combination was repeated every 28 days.

Five out of 6 patients treated with 2-CdA showed a transient partial remission of the skin lesions lasting for a median of 2 months, and 1 patient showed disease progression with dissemination of the skin lesions. Of the 4 patients who received FAMP plus CY 1 achieved complete remission lasting for 6 months, and 2 attained a partial response lasting for a median of 3 months.

Purine analogues such as 2-CdA and FAMP may be used in the treatment of advanced stages of CTCL. The combination of FAMP plus CY, based on the restrictive effect of FAMP on the repair mechanisms of DNA damaged by CY, seems to be a promising therapeutic modality. Decreased immunity, leucopenia, thrombocytopenia and anaemia are common side effects of 2-CdA and FAMP.