The Pharmaceutical Journal
Vol 269 No 7229 p879
21/28 December 2002

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American Society of Hematology (www.hematology.org)

Leukaemia treatment will be tailored to each individual's disease status

Successful treatment of leukaemia in the future will involve a combination of interventions tailored to individuals' disease status and prognostic markers, specialists heard at an American Society of Hematology meeting held in Philadelphia last week.

Two trials presented at the meeting showed that combining two active treatments, fludarabine (Fludara) and the monoclonal antibody alemtuzumab (MabCampath), was effective and safe in patients with chronic lymphocytic leukaemia (CLL). The first trial involved 56 patients with active disease who were previously untreated. They were given intravenous fludarabine 25mg/m² body area daily for five days every month for four months. Those who responded went on after two months to receive a six-week course of intravenous alemtuzumab 30mg three times a week.

Of the 56 patients, 27 per cent had a complete response and 43 per cent achieved a partial response. Ten months later, 87 per cent of patients were still alive. The authors say the results are extremely encouraging in a patient population that is often difficult to treat successfully.

Meanwhile, a smaller European study suggests that giving these two treatments at the same time may induce a synergistic response with acceptable toxicity profiles, at least in a group of patients who have failed to respond to other treatments.

The trial involved 14 patients with relapsed or refractory CLL. All were pre-treated with alemtuzumab up to 30mg a day then given both drugs together. Preliminary results show that, of the 11 patients analysed so far, eight are in complete remission and a further one has had a partial response.

The authors suggest the combination is extremely effective with generally mild transitory side effects. However, they stress that a larger trial in this heavily pre-treated group of patients is needed.

Professor Clare Dearden, lead clinician in haemato-oncology at St George's Medical School in London, said: "With combinations we are now starting to see complete remission rates that make us believe we are making real progress in CLL. Hopefully, with the development of useful prognostic markers, we can decide which patients are going to have the poorest outcome and be able to treat them effectively."